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Lakshmi Narasimhan M, Wilson DB, Schuettpelz LG. Acute disseminated encephalomyelitis as paraneoplastic syndrome preceding pediatric B acute lymphoblastic leukemia. Pediatr Blood Cancer 2024; 71:e30967. [PMID: 38520675 DOI: 10.1002/pbc.30967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/25/2024]
Affiliation(s)
| | - David B Wilson
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
| | - Laura G Schuettpelz
- Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri, USA
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Torty C, Eyong KI, Nwachukwu K, Asindi AA. Clinical Profile and Outcome of Pediatric Demyelinating Disorders in Calabar, Nigeria: A Case Series. Niger J Clin Pract 2024; 27:696-701. [PMID: 38943292 DOI: 10.4103/njcp.njcp_155_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 04/19/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Demyelinating disorders of the central nervous system (CNS) are rare disorders characterized by inflammation and the selective destruction of CNS myelin. The incidence of this disorder is increasing in developed countries. Nigerian studies on the pediatric population on the subject are very scarce. AIMS The aim of the study was to document the epidemiology, clinical profile, and impact of late presentation on the treatment outcome of demyelinating diseases of the CNS in pediatric patients. METHODS The retrospective review of patients aged 1-15 years admitted in a tertiary hospital from January 2018 to December 2022 with various symptoms suggestive of demyelinating CNS disorders. The diagnosis was clinically and radiologically confirmed. Information retrieved from the case notes included patients' demographics, clinical symptoms and signs, number of days with symptoms to presentation in the hospital, results of the magnetic resonance imaging (MRI), treatment, and treatment outcomes. Data were entered in Excel sheet and results were presented in tables and percentages. RESULTS The incidence of demyelinating disorders over the period was 0.013% (10 out of 769 patients admitted over the period). Acute demyelinating encephalomyelitis (ADEM) was the most common disorder seen in the study population (60%, n = 6), followed by transverse myelitis and two (20%) had optic neuritis (ON). Most of the patients with ADEM were in the 1-5-year age group. The female-to-male ratio was 2.3:1. Paraplegia, visual impairment, and ataxia were the most common clinical presentations in the study population. One of the patients met the criteria for the diagnosis of multiple sclerosis during follow-up. Human immunodeficiency virus (HIV) was identified as the cause of demyelination in one case. Most of the patients improved with steroids. CONCLUSION ADEM was the most common clinical phenotype seen in this study. Patients with ADEM and ON had a better prognosis than transverse myelitis. Late presentation was also identified as a poor prognostic factor. Follow-up of cases is very important to monitor disease progression to multiple sclerosis.
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Affiliation(s)
- C Torty
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - K I Eyong
- Department of Paediatrics, University of Calabar, Calabar, Nigeria
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - K Nwachukwu
- Department of Ophthalmology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - A A Asindi
- Department of Paediatrics, University of Calabar Teaching Hospital, Calabar, Nigeria
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Kundapur D, Badeeb N, Mollanji E, Karanjia R, Lelli D, Albreiki D. Detecting seasonal trends in optic neuritis within the Ottawa region. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024; 59:e142-e148. [PMID: 36731536 DOI: 10.1016/j.jcjo.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In this study we aim to determine seasonal patterns underlying optic neuritis (ON) onset that may provide valuable epidemiologic information and help delineate causative or protective factors. DESIGN Single-centre retrospective chart review. METHODS A database search of centralized electronic health records was completed using diagnostic codes employed at the Ottawa Eye Institute for data collection. Charts were reviewed for documentation supporting a diagnosis of ON falling into the following categories: multiple sclerosis ON and clinically isolated syndrome ON, myelin oligodendrocyte glycoprotein ON, neuromyelitis optica ON, and idiopathic ON. Date of onset, biological sex, and age were extracted from each chart. Data were analyzed for calculation of frequency by season and overall pooled seasonal trends of all cases of ON. RESULTS From the 218 included patients with ON, there was no statistically significant seasonal correlation. The overall trend of ON was lowest in winter and spring (22% and 23%, respectively) and highest in summer and fall (28% and 27% respective). Divided further, multiple sclerosis ON or clinically isolated syndrome ON rates (n = 144) were lowest in the spring (21%) and highest in fall (29%); myelin oligodendrocyte glycoprotein ON rates (n = 25) were lowest in winter (16%) and highest in summer and fall (both at 32%); neuromyelitis optica ON rates (n = 16) were lowest in fall (12.5%) and highest in winter and summer (both at 31.25%); and idiopathic ON rates (n = 33) were lowest in fall (18%) and highest in spring (33%). CONCLUSIONS The overall ON seasonal trend appears to have a predilection for the summer and fall months, which may be explained by warmer weather and viral infections as risk factors for multiple sclerosis relapse during those seasons.
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Affiliation(s)
| | - Nooran Badeeb
- Department of Ophthalmology, School of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Department of Ophthalmology, University of Ottawa, Ottawa, ON
| | - Eisi Mollanji
- University of Ottawa, Faculty of Medicine, Ottawa, ON
| | - Rustum Karanjia
- Department of Ophthalmology, University of Ottawa, Ottawa, ON
| | - Daniel Lelli
- Division of Neurology, University of Ottawa, Ottawa, ON
| | - Danah Albreiki
- Department of Ophthalmology, University of Ottawa, Ottawa, ON.
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Hwang J, Chae SA, Lim BC, Choi SA. Incidence of Pediatric Acute Disseminated Encephalomyelitis During the Coronavirus Disease 2019 Pandemic in South Korea. Pediatr Neurol 2023; 146:44-49. [PMID: 37429226 DOI: 10.1016/j.pediatrneurol.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/03/2023] [Accepted: 06/12/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is an immune-mediated demyelinating disorder of the central nervous system that is usually triggered by infections. We aimed to determine the temporal trends in the incidence of ADEM before and during the pandemic and their correlation with viral epidemiology. METHODS We conducted a nationwide, population-based, retrospective, ADEM cohort study by using the Health Insurance Review and Assessment Service database. New-onset ADEM was defined as a patient (age <19 years) who was hospitalized with a diagnostic code of G04.0, G36.8, and G36.9 and a prescription of intravenous methylprednisolone. The National Infectious Disease Surveillance System was used to collect the nationwide viral epidemics. RESULTS A total of 185 new-onset pediatric ADEM cases were included. The mean patient age was 7.0 ± 4.9 years. The incidence of ADEM was 0.34 to 0.48 of 100,000 persons per year before the pandemic, which dropped to 0.22 of 100,000 persons per year during the first pandemic year. The risk of ADEM occurrence was approximately 1.74% higher during the prepandemic years compared with the first pandemic year (odds ratio = 1.017, P = 0.009). There was a weak positive correlation between acute respiratory viral infection and ADEM incidence (r = 0.28, P = 0.03). CONCLUSION This study demonstrates how infection control during the early coronavirus disease 2019 (COVID-19) pandemic influenced the incidence of ADEM. The low incidence of ADEM in the early COVID-19 pandemic may be related to the decline in acute respiratory viral infections, which are potential triggers of ADEM.
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Affiliation(s)
- Junho Hwang
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Soo Ahn Chae
- Department of Pediatrics, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun Ah Choi
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea.
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Li K, Li M, Wen L, Wang Q, Ding X, Wang J. Clinical Presentation and Outcomes of Acute Disseminated Encephalomyelitis in Adults Worldwide: Systematic Review and Meta-Analysis. Front Immunol 2022; 13:870867. [PMID: 35757742 PMCID: PMC9218070 DOI: 10.3389/fimmu.2022.870867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/03/2022] [Indexed: 02/05/2023] Open
Abstract
Background Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disorder that is often misdiagnosed. To improve early diagnosis, we performed a systematic review and meta-analysis of clinical features, outcomes for ADEM in adults. Methods The PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies reporting the clinical features of adults with ADEM between January 1990 and May 2021. A random-effects meta-analysis model was used to pool data on clinical features and functional outcomes. Results Twelve studies examining 437 adults with ADEM met the inclusion criteria. Overall, the clinical features and diagnostic findings observed in more than two-thirds of the patients were white matter lesions [87.1%, 95% confidence interval (CI)=75-95.6], polyfocal onset (80.5%, 95% CI=50.5-98.9) and pyramidal signs (68.7%, 95% CI =40.0-91.9). The mortality rate was 7.8% (95% CI = 3.3–13.5), and the risk of residual deficits was 47.5% (95% CI = 31.8–63.4). Conclusions Adults with ADEM had worse outcomes than children. Clinicians should maintain high clinical suspicion for patients presenting with certain clinical features and diagnostic findings.
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Affiliation(s)
- Kunyi Li
- Department of Neurology, the Second People's Hospital of Chengdu, Chengdu, China
| | - Maolin Li
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Lan Wen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
| | - Qiancheng Wang
- Department of Neurology, Chongqing North-Kuanren General Hospital, ChongQing, China
| | - Xin Ding
- Department of Neurology, the Second People's Hospital of Chengdu, Chengdu, China
| | - Jian Wang
- Department of Neurology, the Second People's Hospital of Chengdu, Chengdu, China
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URINE NEOPTERIN IN CHILDHOOD ACUTE DEMYELINATING DISEASES: POTENTIAL FOR DIFFERENTIAL DIAGNOSIS. Mult Scler Relat Disord 2022; 59:103662. [DOI: 10.1016/j.msard.2022.103662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/23/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022]
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Isaac Maximo LM, March A, Lam SK. Weakness, Numbness and Urinary Incontinence in an 11-Year-Old Female. Glob Pediatr Health 2022; 9:2333794X221106165. [PMID: 35747895 PMCID: PMC9210078 DOI: 10.1177/2333794x221106165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/23/2022] [Indexed: 11/26/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) affects the central nervous system (CNS) via a rapid and auto-immune process. It has been associated to viral and bacterial infections, as well as after immunization. Since the beginning of the SARS-CoV-2 (COVID-19) pandemic, reports of COVID 19 infection have been linked to ADEM. We present a case of an 11-year-old female with neurological symptoms during the acute phase of her COVID-19 illness, with MRI changes and positive Myelin Oligodendrocyte Glycoprotein (MOG) antibodies, with clinical presentation consistent of ADEM.
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Affiliation(s)
| | - Amanda March
- Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
| | - Suet Kam Lam
- Cleveland Clinic Children’s Hospital, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
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Robinson A, Chapman L, Watts W. Acute Disseminated Encephalomyelitis in a 2-Year-Old Patient Following COVID-19. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1736602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractThis report presents the case of acute disseminated encephalomyelitis in a 2-year-old patient following a positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) test. She presented with ataxic gait, truncal ataxia, and reduced coordination following 10 days of intermittent fever and lethargy. She did not have any respiratory symptoms. Magnetic resonance imaging of the brain and spine showed widespread T2 high signal within the gray and white matters and within the spinal cord. She was treated with intravenous methylprednisolone followed by tapering oral prednisolone; this led to resolution of her neurological symptoms. This case highlights that neurological complications can occur secondary to SARS-CoV-2 infection.
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Affiliation(s)
- Amy Robinson
- Department of Pediatrics, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, North Yorkshire, United Kingdom
| | - Louise Chapman
- Department of Pediatrics, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, North Yorkshire, United Kingdom
| | - Wendy Watts
- Department of Pediatrics, York and Scarborough Teaching Hospitals NHS Foundation Trust, York, North Yorkshire, United Kingdom
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Manzano GS, McEntire CRS, Martinez-Lage M, Mateen FJ, Hutto SK. Acute Disseminated Encephalomyelitis and Acute Hemorrhagic Leukoencephalitis Following COVID-19: Systematic Review and Meta-synthesis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:e1080. [PMID: 34452974 PMCID: PMC8404207 DOI: 10.1212/nxi.0000000000001080] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 07/06/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Since the onset of the COVID-19 pandemic, a growing number of reports have described cases of acute disseminated encephalomyelitis (ADEM) and acute hemorrhagic leukoencephalitis (AHLE) following infection with COVID-19. Given their relatively rare occurrence, the primary objective of this systematic review was to synthesize their clinical features, response to treatments, and clinical outcomes to better understand the nature of this neurologic consequence of COVID-19 infection. METHODS Patients with a history of COVID-19 infection were included if their reports provided adequate detail to confirm a diagnosis of ADEM or AHLE by virtue of clinical features, radiographic abnormalities, and histopathologic findings. Cases purported to be secondary to vaccination against COVID-19 or occurring in the context of a preexisting relapsing CNS demyelinating disease were excluded. Case reports and series were identified via PubMed on May 17, 2021, and 4 additional cases from the authors' hospital files supplemented the systematic review of the literature. Summary statistics were used to describe variables using a complete case analysis approach. RESULTS Forty-six patients (28 men, median age 49.5 years, 1/3 >50 years old) were analyzed, derived from 26 case reports or series originating from 8 countries alongside 4 patient cases from the authors' hospital files. COVID-19 infection was laboratory confirmed in 91% of cases, and infection severity necessitated intensive care in 67%. ADEM occurred in 31 cases, whereas AHLE occurred in 15, with a median presenting nadir modified Rankin Scale score of 5 (bedridden). Anti-MOG seropositivity was rare (1/15 patients tested). Noninflammatory CSF was present in 30%. Hemorrhage on brain MRI was identified in 42%. Seventy percent received immunomodulatory treatments, most commonly steroids, IV immunoglobulins, or plasmapheresis. The final mRS score was ≥4 in 64% of patients with adequate follow-up information, including 32% who died. DISCUSSION In contrast to ADEM cases from the prepandemic era, reported post-COVID-19 ADEM and AHLE cases were often advanced in age at onset, experienced severe antecedent infection, displayed an unusually high rate of hemorrhage on neuroimaging, and routinely had poor neurologic outcomes, including a high mortality rate. Findings are limited by nonstandardized reporting of cases, truncated follow-up information, and presumed publication bias.
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Affiliation(s)
- Giovanna S Manzano
- From the Division of Neuroimmunology and Neuroinfectious Diseases (G.S.M., C.R.S.M., F.J.M., S.K.H.), Department of Neurology, Massachusetts General Hospital, Boston, MA; and Department of Pathology (M.M.-L.), Massachusetts General Hospital, Boston, MA
| | - Caleb R S McEntire
- From the Division of Neuroimmunology and Neuroinfectious Diseases (G.S.M., C.R.S.M., F.J.M., S.K.H.), Department of Neurology, Massachusetts General Hospital, Boston, MA; and Department of Pathology (M.M.-L.), Massachusetts General Hospital, Boston, MA
| | - Maria Martinez-Lage
- From the Division of Neuroimmunology and Neuroinfectious Diseases (G.S.M., C.R.S.M., F.J.M., S.K.H.), Department of Neurology, Massachusetts General Hospital, Boston, MA; and Department of Pathology (M.M.-L.), Massachusetts General Hospital, Boston, MA
| | - Farrah J Mateen
- From the Division of Neuroimmunology and Neuroinfectious Diseases (G.S.M., C.R.S.M., F.J.M., S.K.H.), Department of Neurology, Massachusetts General Hospital, Boston, MA; and Department of Pathology (M.M.-L.), Massachusetts General Hospital, Boston, MA
| | - Spencer K Hutto
- From the Division of Neuroimmunology and Neuroinfectious Diseases (G.S.M., C.R.S.M., F.J.M., S.K.H.), Department of Neurology, Massachusetts General Hospital, Boston, MA; and Department of Pathology (M.M.-L.), Massachusetts General Hospital, Boston, MA.
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Kaseka ML, Ly M, Yea C, Longoni G, Yeh EA. Impact of COVID-19 public health measures on myelin oligodendrocyte glycoprotein IgG-associated disorders in children. Mult Scler Relat Disord 2021; 56:103286. [PMID: 34627003 DOI: 10.1016/j.msard.2021.103286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 09/02/2021] [Accepted: 09/26/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Despite better characterization of the spectrum of MOG-IgG-associated disorders (MOGAD) in children, the role of infection in its pathophysiology remains unclear. The goal of this study was to evaluate if public health measures put in place to prevent the spread of SARS-CoV-2 in March 2020 in Ontario (Canada) have been associated with a change in the incidence of MOGAD and other neuroinflammatory disorders in children. METHODOLOGY We reviewed a single-centre cohort of children referred for a suspicion of neuroinflammatory disorder between January 2015 and March 2021. Age, date, sex, diagnosis, MOG-IgG antibodies status and detected pathogens at presentation were identified. Comparative statistical analysis was performed based on diagnosis between years and seasons using Pearson's Chi-squared test or Fisher's exact test for categorical variables and using ANOVA or Kruskal-Wallis test for continuous variables, as appropriate. We compared the post-lockdown period (March 17th, 2020, to March 31st, 2021) to previous calendar years (2015 to 2019) alone and to previous calendar years and the pre-lockdown 2020 period (January 1st, 2020, to March 16th, 2020). A p-value of < 0.05 was considered significant. Post-hoc pairwise comparisons between the post-lockdown period and previous years were performed on significant results. A false discovery rate adjustment with an adjusted p-value (q-value) < 0.05 was computed. We hypothesized that the number of new MOGAD would be significantly lower in the post-lockdown period compared to previous years due to decreased regional pathogen transmission. RESULTS Among 491 referred cases, we identified 415 new cases of neuroinflammatory disorder between January 2015 and March 2021. The number of new neuroinflammatory disorder diagnoses did not change between years. We noted significantly fewer new MOGAD diagnoses in 2020 compared to previous years, with no MOGAD patients presenting in 2020 after the spring lockdown (q=0.0009). In addition, there were significantly fewer parainfectious neuroinflammatory cases (q=0.04) and pathogen detected (q=0.04) in the post-lockdown period. The number of new multiple sclerosis (MS) and aquaporin-4 neuromyelitis optica spectrum disorders (AQP4-NMOSD) cases remained stable despite the lockdown (q=0.185 and 0.693 respectively). INTERPRETATION Enhanced population-based infection control strategies may have a role in modulating the incidence of MOGAD and parainfectious neuroinflammatory disorders, but not MS or AQP4-NMOSD.
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Affiliation(s)
- Matsanga Leyila Kaseka
- Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada
| | - Mina Ly
- Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada
| | - Carmen Yea
- Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada
| | - Giulia Longoni
- Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada
| | - E Ann Yeh
- Divisions of Neurology and Neuroscience and Mental Health, Hospital for Sick Children and Hospital for Sick Children Research Institute, University of Toronto, Canada.
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Sánchez P, Chan F, Hardy TA. Tumefactive demyelination: updated perspectives on diagnosis and management. Expert Rev Neurother 2021; 21:1005-1017. [PMID: 34424129 DOI: 10.1080/14737175.2021.1971077] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tumefactive demyelination (TD) can be a challenging scenario for clinicians due to difficulties distinguishing it from other conditions, such as neoplasm or infection; or with managing the consequences of acute lesions, and then deciding upon the most appropriate longer term treatment strategy. AREAS COVERED The authors review the literature regarding TD covering its clinic-radiological features, association with multiple sclerosis (MS), and its differential diagnosis with other neuroinflammatory and non-inflammatory mimicking disorders with an emphasis on atypical forms of demyelination including acute disseminated encephalomyelitis (ADEM), MOG antibody-associated demyelination (MOGAD) and neuromyelitis spectrum disorders (NMOSD). We also review the latest in the acute and long-term treatment of TD. EXPERT OPINION It is important that the underlying cause of TD be determined whenever possible to guide the management approach which differs between different demyelinating and other inflammatory conditions. Improved neuroimaging and advances in serum and CSF biomarkers should one day allow early and accurate diagnosis of TD leading to better outcomes for patients.
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Affiliation(s)
- Pedro Sánchez
- Department of Neurology, Alexianer St. Josefs-Krankenhaus, Potsdam, Germany
| | - Fiona Chan
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.,Brain & Mind Centre, University of Sydney, Nsw, Australia
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McLendon LA, Rao CK, Da Hora CC, Islamovic F, Galan FN. Post-COVID-19 Acute Disseminated Encephalomyelitis in a 17-Month-Old. Pediatrics 2021; 147:peds.2020-049678. [PMID: 33762311 DOI: 10.1542/peds.2020-049678] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/18/2021] [Indexed: 11/24/2022] Open
Abstract
Neurologic manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pediatric patients have been reported in the acute and postinfectious stages of coronavirus disease 2019. Acute disseminated encephalomyelitis (ADEM) typically presents in children after a viral illness at a mean age of 3 to 7 years. A total of 60% to 90% of literature-reported pediatric patients with ADEM have minimal to no neurologic deficits at long-term follow-up. We present a 17-month-old developmentally typical girl with parental complaints of irritability, upper extremity weakness, and gait disturbance. She presented to the hospital afebrile and irritable with right-sided nasolabial fold flattening, neck stiffness, left upper extremity rigidity, right upper extremity paresis, bilateral lower extremity hyperreflexia, and truncal ataxia. During her hospital course, she became somnolent with autonomic instability and was transferred to intensive care. Contrasted brain MRI revealed diffuse patchy T2 hyperintensities without contrast enhancement. Nasopharyngeal SARS-CoV-2 polymerase chain reaction and serum antibody testing results were positive. Cerebral spinal fluid analysis was unremarkable. Respiratory viral panel and autoimmune encephalitis and demyelinating disorders panel results were negative. She was started on high-dose methylprednisolone and intravenous immunoglobulin, with improvement in mental status, focal deficits, and ambulation. After hospital discharge, she received inpatient rehabilitation for 2 weeks and at 2 month follow-up had a full neurologic recovery. We report the youngest case of postinfectious ADEM due to SARS-CoV-2 in a toddler. Early recognition of autoimmune and inflammatory complications of SARS-CoV-2 is vital for early aggressive immunomodulatory treatment and, consequently, improved morbidity in these patients.
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Affiliation(s)
- Loren A McLendon
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.,Division of Pediatric Neurology, Nemours Children Specialty Clinic, Jacksonville, Florida; and
| | - Chethan K Rao
- Division of Child and Adolescent Neurology, Mayo Clinic College of Medicine and Science, Jacksonville, Florida.,Division of Pediatric Neurology, Nemours Children Specialty Clinic, Jacksonville, Florida; and
| | - Cintia Carla Da Hora
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, Florida
| | - Florinda Islamovic
- Department of Pediatrics, College of Medicine - Jacksonville, University of Florida, Jacksonville, Florida
| | - Fernando N Galan
- Division of Pediatric Neurology, Nemours Children Specialty Clinic, Jacksonville, Florida; and
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Monge Galindo L, Martínez de Morentín A, Pueyo Royo V, García Iñiguez J, Sánchez Marco S, López-Pisón J, Peña-Segura J. Optic neuritis in paediatric patients: experience over 27 years and a management protocol. NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Yoon HH, Park JY, Kim SY, Lee NM, Yi DY, Yun SW, Lim IS, Chae SA. Epidemiology of Demyelinating Diseases in Korean Pediatric Patients. J Child Neurol 2021; 36:141-147. [PMID: 32988277 DOI: 10.1177/0883073820959543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The epidemiology of demyelinating diseases in the Korean pediatric population has not been reported to date. This study aimed to identify the epidemiology of demyelinating diseases in Korean children by using big data. The subjects were children (0-17 years old) diagnosed with acute-disseminated encephalomyelitis, multiple sclerosis, neuromyelitis optica, and Guillain-Barré syndrome enrolled in the Korean Health Insurance Review and Assessment Service (HIRA) from January 2010 to December 2017.Of 1722 enrolled children, 553 (32.1%) had acute-disseminated encephalomyelitis, 170 (9.9%) had multiple sclerosis, 68 (3.9%) had neuromyelitis optica, and 931 (54.1%) had Guillain-Barré syndrome. The male-female ratios were 1.47:1 in acute-disseminated encephalomyelitis, 1.43:1 in Guillain-Barré syndrome, 1:1.66 in multiple sclerosis, and 1:1.62 in neuromyelitis optica. Demyelinating diseases were most prevalent in summer. The prevalence differed by region, with 545 (31.6%) in Seoul and 298 (17.3%) in Gyeonggi. This study is the first to identify the incidence of demyelinating diseases in South Korea.
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Affiliation(s)
- Hye Hyun Yoon
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Ji Young Park
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Su Yeong Kim
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Na Mi Lee
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Dae Yong Yi
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Sin Weon Yun
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - In Seok Lim
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
| | - Soo Ahn Chae
- Department of Pediatrics, 65542Chung-Ang University Hospital, Seoul, Korea
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15
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Bozzola E, Spina G, Valeriani M, Papetti L, Ursitti F, Agostiniani R, Mascolo C, Ruggiero M, Di Camillo C, Quondamcarlo A, Matera L, Vecchio D, Memo L, Villani A. Management of pediatric post-infectious neurological syndromes. Ital J Pediatr 2021; 47:17. [PMID: 33494818 PMCID: PMC7836589 DOI: 10.1186/s13052-021-00968-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 01/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-Infectious Neurological Syndromes (PINS) are heterogeneous neurological disorders with post or para-infectious onset. PINS diagnosis is complex, mainly related to the absence of any recognized guidelines and a univocal definition. AIM OF THE STUDY To elaborate a diagnostic guide for PINS. MATERIALS AND METHODS We retrospectively analysed patients younger than 14 years old admitted to Bambino Gesù Children's Hospital in Rome for PINS from December 2005 to March 2018. Scientific literature using PubMed as research platform was analysed: the key words "Post-Infectious Neurological Syndromes" were used. RESULTS A polysymptomatic presentation occurred in a percentage of 88% of the children. Motor signs and visual disturbances the most observed symptoms/signs were the most detached, followed by fever, speech disturbances, sleepiness, headache and bradipsychism. Blood investigations are compatible with inflammation, as a prodromal illnesses was documented in most cases. Normal cerebral spinal fluid (CSF) characteristics has been found in the majority of the study population. Magnetic resonance imaging (MRI) was positive for demyelinating lesions. Antibiotics, acyclovir and steroids have been given as treatment. DISCUSSION We suggest diagnostic criteria for diagnosis of PINS, considering the following parameters: neurological symptoms, timing of disease onset, blood and CSF laboratory tests, MRI imaging. CONCLUSIONS We propose criteria to guide clinician to diagnose PINS as definitive, probable or possible. Further studies are required to validate diagnostic criteria.
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Affiliation(s)
| | | | - Massimiliano Valeriani
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Laura Papetti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | - Fabiana Ursitti
- Department of Neuroscience, Headache Center, Bambino Gesù Children Hospital, Rome, Italy
| | | | | | | | | | | | | | | | - Luigi Memo
- Italian Pediatric Society, Florence, Italy
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16
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Guimarães MPM, Nascimento ACB, Alvarenga RMP. CLINICAL course of acute disseminated encephalomyelitis in adults from Rio de Janeiro: Retrospective study of 23 cases and literature review. Mult Scler Relat Disord 2020; 46:102424. [DOI: 10.1016/j.msard.2020.102424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 07/03/2020] [Accepted: 07/24/2020] [Indexed: 01/07/2023]
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17
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Meirson H, Shiran SI, Raz M, Roth J, Fattal-Valevski A. Fulminant Acute Disseminated Encephalomyelitis: A Remarkable Outcome with Cyclophosphamide. JOURNAL OF PEDIATRIC NEUROLOGY 2020. [DOI: 10.1055/s-0040-1716824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractAcute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system which occurs predominantly in the pediatric population. Acute treatment is high-dose intravenous glucocorticoids. Alternative treatment is usually intravenous immune globulin and/or plasma exchange. Fulminant ADEM is rare in children. Only a few cases of cyclophosphamide use in refractory ADEM have been reported. Here, we report a case of a 12-year-old girl with fulminant ADEM who was comatose and improved dramatically after cyclophosphamide administration. Cyclophosphamide treatment should be considered as a therapy in children with fulminant ADEM nonresponsive to standard therapies.
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Affiliation(s)
- Hadas Meirson
- Pediatric Neurology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly I. Shiran
- Pediatric Radiology Unit, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Raz
- Department of Pathology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Jonathan Roth
- Department of Pediatric Neurosurgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- Pediatric Neurology Institute, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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18
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Dos Passos GR, Elsone L, Luppe S, Kitley J, Messina S, Rodríguez Cruz PM, Harding K, Mutch K, Leite MI, Robertson N, Jacob A, Palace J. Seasonal distribution of attacks in aquaporin-4 antibody disease and myelin-oligodendrocyte antibody disease. J Neurol Sci 2020; 415:116881. [PMID: 32428758 DOI: 10.1016/j.jns.2020.116881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 05/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Seasonal variation in incidence and exacerbations has been reported for neuroinflammatory conditions such as multiple sclerosis and acute disseminated encephalomyelitis (ADEM). It is unknown whether seasonality also influences aquaporin-4 antibody (AQP4-Ab) disease and myelin-oligodendrocyte antibody (MOG-Ab) disease. OBJECTIVE We examined the seasonal distribution of attacks in AQP4-Ab disease and MOG-Ab disease. METHODS Observational study using data prospectively recorded from three cohorts in the United Kingdom. RESULTS There was no clear seasonal variation in AQP4-Ab or MOG-Ab attacks for either the onset attack nor subsequent relapses. In both groups, the proportion of attacks manifesting with each of the main phenotypes (optic neuritis, transverse myelitis, ADEM/ADEM-like) appeared stable across the year. This study is the first to examine seasonal distribution of MOG-Ab attacks and the largest in AQP4-Ab disease so far. CONCLUSION Lack of seasonal distribution in AQP4-Ab and MOG-Ab disease may argue against environment factors playing a role in the aetiopathogenesis of these conditions.
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Affiliation(s)
- Giordani Rodrigues Dos Passos
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Liene Elsone
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sebastian Luppe
- Department of Neurology, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom
| | - Joanna Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Pedro María Rodríguez Cruz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Katharine Harding
- Department of Neurology, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom
| | - Kerry Mutch
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Neil Robertson
- Department of Neurology, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
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Noto T, Ohshima M, Seto H, Aoki R, Noguchi T, Fukuhara J, Fujimoto H, Murabayashi M, Morioka I. Low bone marrow signal on T1-weighted magnetic resonance imaging in a 2-year-old patient with acute disseminated encephalomyelitis. Pediatr Int 2019; 61:626-627. [PMID: 31242538 DOI: 10.1111/ped.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 03/01/2019] [Accepted: 04/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Takanori Noto
- Department of Pediatrics, Numazu City Hospital, Numazu, Shizuoka, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Masanari Ohshima
- Department of Pediatrics, Numazu City Hospital, Numazu, Shizuoka, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroki Seto
- Department of Pediatrics, Numazu City Hospital, Numazu, Shizuoka, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ryoji Aoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Teppei Noguchi
- Department of Pediatrics, Numazu City Hospital, Numazu, Shizuoka, Japan
| | - Junji Fukuhara
- Department of Pediatrics, Numazu City Hospital, Numazu, Shizuoka, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Hajime Fujimoto
- Department of Radiology, Numazu City Hospital, Numazu, Shizuoka, Japan
| | - Masao Murabayashi
- Department of Pediatrics, Numazu City Hospital, Numazu, Shizuoka, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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20
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Balamurugesan K, Ponprabha R, Davis P. An interesting case of acute disseminated encephalomyelitis following E. coli infection. J Family Med Prim Care 2019; 8:292-295. [PMID: 30911524 PMCID: PMC6396596 DOI: 10.4103/jfmpc.jfmpc_402_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is a rare inflammatory demyelinating disease of central nervous system (CNS), characterized by multifocal white matter involvement with neurological deficits and accompanied by encephalopathy. ADEM is thought to be caused by autoimmune etiology. CNS autoantigens are produced by molecular mimicry triggered by an environmental stimulus, mostly infection (viral/bacterial) or post vaccination, in genetically susceptible individuals. ADEM is sometimes referred to as post/para-infectious or post-immunization ADEM. ADEM is characterized by multifocal neurological signs and occasionally it rapidly progresses to coma. Magnetic resonance imaging (MRI) is used to confirm the diagnosis. The treatment is based on intravenous high-dose methylprednisolone, which usually leads to a rapid improvement. Recently, the use of intravenous immunoglobulins and plasma exchange (PLEX) has also been suggested. We report a case of a 6-year-old girl who was admitted for urinary tract infection but developed neurological complications which was treated successfully.
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Affiliation(s)
- Kandan Balamurugesan
- Department of Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, Tamil Nadu, India
| | - Rajangam Ponprabha
- Department of Paediatrics, Government Villupuram Medical College, Villupuram, Tamil Nadu, India
| | - Prem Davis
- Health Centre, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
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21
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Bhatt P, Bray L, Raju S, Dapaah-Siakwan F, Patel A, Chaudhari R, Donda K, Bhatt NS, Dave M, Linga VG, Lekshminarayanan A, Patel SV, Billimoria ZC, Zuckerman S, Yagnik P, Singh D. Temporal Trends of Pediatric Hospitalizations with Acute Disseminated Encephalomyelitis in the United States: An Analysis from 2006 to 2014 using National Inpatient Sample. J Pediatr 2019; 206:26-32.e1. [PMID: 30528761 DOI: 10.1016/j.jpeds.2018.10.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/14/2018] [Accepted: 10/23/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the temporal trends in the epidemiology of acute disseminated encephalomyelitis (ADEM) and hospitalization outcomes in the US from 2006 through 2014. STUDY DESIGN Pediatric (≤18 years of age) hospitalizations with ADEM discharge diagnosis were identified from the National (Nationwide) Inpatient Sample (NIS) for years 2006 through 2014. Trends in the incidence of ADEM with respect to age, sex, race, and region were examined. Outcomes of ADEM in terms of mortality, length of stay (LOS), cost of hospitalization, and seasonal variation were analyzed. NIS includes sampling weight. These weights were used to generate national estimates. P value of < .05 was considered significant. RESULTS Overall incidence of ADEM associated pediatric hospitalizations from 2006 through 2014 was 0.5 per 100 000 population. Between 2006 through 2008 and 2012 through 2014, the incidence of ADEM increased from 0.4 to 0.6 per 100 000 (P-trend <.001). Black and Hispanic children had a significantly increased incidence of ADEM during the study period (0.2-0.5 per 100 000 population). There was no sex preponderance and 67% of ADEM hospitalizations were in patients <9 years old. From 2006 through 2008 to 2012 through 2014 (1.1%-1.5%; P-trend 0.07) and median LOS (4.8-5.5 days; Ptrend = .3) remained stable. However, median inflation adjusted cost increased from $11 594 in 2006 through 2008 to $16 193 in 2012 through 2014 (Ptrend = .002). CONCLUSION In this large nationwide cohort of ADEM hospitalizations, the incidence of ADEM increased during the study period. Mortality and LOS have remained stable over time, but inflation adjusted cost of hospitalizations increased.
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Affiliation(s)
- Parth Bhatt
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX.
| | - Leonita Bray
- Department of Pediatrics, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Sneha Raju
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX
| | | | - Achint Patel
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Riddhi Chaudhari
- Department of Pediatrics, University of Connecticut, Farmington, CT
| | - Keyur Donda
- Department of Pediatrics, University of Miami, Coral Gables, FL
| | - Neel S Bhatt
- Department of Pediatrics, Division of Hematology/ Oncology/ BMT, Medical College of Wisconsin, Milwaukee, WI
| | - Mihir Dave
- Department of Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Vijay Gandhi Linga
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX
| | | | - Samir V Patel
- Department of Internal Medicine, Sparks Health Systems, Fort Smith, AR
| | | | - Samuel Zuckerman
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX
| | - Priyank Yagnik
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, KS
| | - Dinesh Singh
- Department of Pediatrics, Tulane University, New Orleans, LA; Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, TX
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22
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Repić-Buličić A, Filipović-Grčić P, Jadrijević E, Jurinović P, Titlić M. SUCCESSFUL TREATMENT OF ACUTE DISSEMINATED ENCEPHALOMYELITIS (ADEM) BY PROMPT USAGE OF IMMUNOGLOBULINS - CASE REPORT AND REVIEW OF THE LITERATURE. Acta Clin Croat 2019; 58:173-179. [PMID: 31363340 PMCID: PMC6629195 DOI: 10.20471/acc.2019.58.01.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that usually affects children and young adults. It most commonly has a monophasic course, although relapses are reported. Clinical presentation of the disease includes encephalopathy and multifocal neurological deficits. There are no established reliable criteria for diagnosis of ADEM and sometimes it is difficult to distinguish it from first attack of multiple sclerosis, especially in adults. The diagnosis of ADEM is based on clinical, radiological and laboratory findings. In the treatment of ADEM, high doses of corticosteroids, plasmapheresis and immunoglobulins are used. We report a case of a young adult female patient with ADEM who fully recovered after prompt administration of high dose methylprednisolone and immunoglobulins.
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Affiliation(s)
| | | | - Eni Jadrijević
- Department of Neurology, Split University Hospital Centre, Split, Croatia
| | - Pavao Jurinović
- Department of Neurology, Split University Hospital Centre, Split, Croatia
| | - Marina Titlić
- Department of Neurology, Split University Hospital Centre, Split, Croatia
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23
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Orbach R, Schneebaum Sender N, Lubetzky R, Fattal-Valevski A. Increased Intracranial Pressure in Acute Disseminated Encephalomyelitis. J Child Neurol 2019; 34:99-103. [PMID: 30477374 DOI: 10.1177/0883073818811541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess the intracranial pressure in pediatric acute disseminated encephalomyelitis using spinal tap opening pressure on lumbar puncture, which is routinely performed as part of suspected acute disseminated encephalomyelitis workup. Compared to other cerebrospinal fluid parameters such as cell count, protein concentration, and presence of oligoclonal bands, cerebrospinal fluid opening pressure is infrequently recorded. METHODS A retrospective chart review of demographic, clinical, and laboratory data of children diagnosed with acute disseminated encephalomyelitis admitted to a tertiary referral hospital between 2005 and 2016. RESULTS Of the 36 children diagnosed with acute disseminated encephalomyelitis, 24 had the cerebrospinal fluid opening pressure documented in their records. The mean cerebrospinal fluid opening pressure was 27.6±12.6 cmH2O, range 9-55 cmH2O (95% confidence interval 21.9-33.6). Cerebrospinal fluid opening pressure in the acute disseminated encephalomyelitis group was statistically significantly higher ( P = .0013, 95% confidence interval 4.2-15.0) than the accepted upper limit in this age group (18 cmH2O). In 10 of 24 patients (42%), the opening pressure was above 28 cmH2O. CONCLUSIONS Increased opening pressure was the most frequent cerebrospinal fluid abnormal finding in our cohort, which suggests a potential role of increased intracranial pressure in the acute disseminated encephalomyelitis pathophysiological disease mechanism. In certain cases, the opening pressure value could have monitoring and therapeutic implications, and therefore its measurement is highlighted by this study.
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Affiliation(s)
- Rotem Orbach
- 1 Pediatrics Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Nira Schneebaum Sender
- 3 Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ronit Lubetzky
- 1 Pediatrics Department, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.,2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Aviva Fattal-Valevski
- 2 Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.,3 Pediatric Neurology Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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24
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Acute Disseminated Encephalomyelitis in an Incarcerated Adolescent Presents as Acute Psychosis: Case Report and Literature Review. Pediatr Emerg Care 2019; 35:e22-e25. [PMID: 27749808 DOI: 10.1097/pec.0000000000000919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to describe a case of an incarcerated adolescent with acute disseminated encephalomyelitis (ADEM) presenting as acute psychosis. METHODS This was a retrospective case report followed with chart and literature review. MAIN FINDINGS An adolescent with ADEM presented with drastic behavior and personality changes that led to her incarceration for serious charges. Acute disseminated encephalomyelitis leads to neuropsychiatric effects and can be seen with magnetic resonance imaging as a large mass effect that may result in a poor prognosis. This adolescent made a full recovery from her left facial droop, slurred speech, and left-sided hemiplegia, and her personality changes were reverted. CONCLUSIONS Acute disseminated encephalomyelitis can present as acute psychosis; therefore, clinical suspicion is important when treating patients who have a history of past infectious brain diseases, especially encephalitis. Given the rapid onset of disease, physicians must be knowledgeable of the diagnosis and treatment of ADEM and be vigilant in finding organic causes of acute psychosis.
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25
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Delayed appearance of transient hyperintensity foci on T1-weighted magnetic resonance imaging in acute disseminated encephalomyelitis. Jpn J Radiol 2019; 37:277-282. [PMID: 30671706 DOI: 10.1007/s11604-018-00808-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 12/26/2018] [Indexed: 01/23/2023]
Abstract
PURPOSE To evaluate the frequency, characteristics, and clinical significance of transient hyperintensity foci on T1-weighted images (T1WI) in acute disseminated encephalomyelitis (ADEM). MATERIALS AND METHODS Patients diagnosed with ADEM underwent MR studies at the time of disease onset and every 3 months or more often thereafter. The frequency and appearance timing of abnormal signals including T1WI and their morphological characteristics were evaluated. Relations between patient symptoms and abnormal signals on MRI were also evaluated. RESULTS Five ADEM patients were included in this study. Linear (n = 2) or nodular (n = 1) T1-hyperintensity foci appeared in 3 patients (60%, 3/5). Locations of T1-hyperintensity foci were both cortical/subcortical region and basal ganglia (n = 1), subcortical region alone (n = 1), and internal capsule (n = 1). Those T1-hyperintensity foci were located within the T2-weighted image (T2WI) and fluid-attenuated inversion recovery (FLAIR) hyperintensity foci on initial MRI. Some T1-hyperintensity foci also showed hyperintensity on diffusion-weighted image (DWI) and contrast enhancement. T1-hyperintensity appeared at 14-43 days (median, 28 days), and disappeared in 2 patients at 91 days and 627 days after disease onset. There were no neurological sequelae remained in any patients. CONCLUSION T1-hyperintensity foci is not a rare finding (60%) and it can be observed after improvement in symptoms in ADEM.
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Abstract
Brain has been considered as an immune-privileged site for centuries owing to the presence of blood-brain barrier, absent lymphatic drainage, and antigen-presenting cells. However, the present prevailing concept is of immune surveillance where brain is continuously surveyed by immune cells. However, the presence of immune cells in central nervous system (CNS) brings the risk of inflammation and autoimmunity involving both T and B cell mediated pathways. These mechanisms form the underlying pathology in a wide spectrum of pediatric CNS diseases manifesting as acquired neurological deficits. Overlapping, heterogenous, and ambiguous clinical features often delays the diagnosis. Although not always pathognomonic, magnetic resonance imaging can be an important biomarker leading to early diagnosis, prognostication, and systematic follow-up pf these diseases. This review describes the spectrum of different pediatric inflammatory disorders and their pertinent imaging features illustrated with clinical examples.
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Affiliation(s)
| | - Karthik Muthusamy
- Department of Neurology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Manohar Shroff
- Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
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27
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Iype M, Ts A, Kunju PM, Saradakutty G, Sreedharan M, Ahamed SM. Factors Related to Long Term Motor, Behavioral, and Scholastic Outcome in Children with Acute Disseminated Encephalomyelitis. Pediatr Neurol 2018; 89:49-57. [PMID: 30409457 DOI: 10.1016/j.pediatrneurol.2018.08.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 08/05/2018] [Accepted: 08/11/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE We studied the long-term outcome of Acute disseminated encephalomyelitis (ADEM). METHODS We performed a retrospective cohort study among children diagnosed with ADEM (fulfilling IPMSSG criteria). Major outcome variables were motor deficit, scholastic underperformance, and behavioral abnormality. RESULTS The inclusion criteria were fulfilled by 102 children. Three died in hospital. The follow-up ranged from one to 10 years (median 4 years). Motor deficit was seen in 17(17.2%), attention deficit in 25 (25.3%), behavioral abnormality in 13(13.1%), persistent seizures in seven (7%) invididuals and poor learning skills in 22 (22.2%). Recurrence of demyelination occurred in seven (7.1%). Two individuals had a recurrent demyelinating disorder (a chronic relapsing demyelinating disorder) that could not be classified as multiple sclerosis (MS), two had ADEM with sequential optic neuritis and three had multiphasic ADEM. At follow-up, the mean (SD) modified Rankin Scale (mRS) score was 0.556 (1.36) and Expanded Disability Status Scale score was 1.71(2.22). On multivariate analysis, the mRS score at discharge (p<0.01) and thalamic lesions on magnetic resonance imaging (MRI) (p<0.01) were associated with motor sequelae; poor learning skills with ADEM with concomitant polyneuropathy (p<0.02); and behavioral abnormality with tumefactive demyelination (p<0.02). CONCLUSIONS Children who had ADEM may have motor or cognitive sequelae, seizures or recurrent demyelinating events on follow-up. We identified a few risk factors for these sequelae. Factors that affected outcome on discharge from hospital did not affect chances of having long-term sequelae. On follow-up, none of the children fulfilled the diagnostic criteria for MS, suggesting that the chance of conversion of ADEM to MS is less likely.
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Affiliation(s)
- Mary Iype
- Government Medical College Trivandrum, Kerala, India.
| | - Anish Ts
- Government Medical College Trivandrum, Kerala, India
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Monge Galindo L, Martínez de Morentín AL, Pueyo Royo V, García Iñiguez JP, Sánchez Marco S, López-Pisón J, Peña-Segura JL. Optic neuritis in paediatric patients: Experience over 27 years and a management protocol. Neurologia 2018. [PMID: 29526320 DOI: 10.1016/j.nrl.2018.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE In this article, we present our experience on optic neuritis (ON) and provide a diagnostic/therapeutic protocol, intended to rule out other aetiologies (particularly infection), and a fact sheet for parents. MATERIAL AND METHODS We conducted a descriptive, retrospective study of patients with ON over a 27-year period (1990-2017). A review of the available scientific evidence was performed in order to draft the protocol and fact sheet. RESULTS Our neuropaediatrics department has assessed 20,744 patients in the last 27 years, of whom 14 were diagnosed with ON: 8 had isolated ON, 1 had multiple sclerosis (MS), 1 had clinically isolated syndrome (CIS), 3 had acute disseminated encephalomyelitis, and 1 had isolated ON and a history of acute disseminated encephalomyelitis one year previously. Patients' age range was 4-13 years; 50% were boys. Eight patients were aged over 10: 7 had isolated ON and 1 had MS. Nine patients had bilateral ON, and 3 had retrobulbar ON. MRI results were normal in 7 patients and showed involvement of the optic nerve only in 2 patients and optic nerve involvement + central nervous system demyelination in 5. Thirteen patients received corticosteroids. One patient had been vaccinated against meningococcus-C the previous month. Progression was favourable, except in the patient with MS. A management protocol and fact sheet are provided. CONCLUSIONS ON usually has a favourable clinical course. In children aged older than 10 years with risk factors for MS or optic neuromyelitis (hyperintensity on brain MRI, oligoclonal bands, anti-NMO antibody positivity, ON recurrence), the initiation of immunomodulatory treatment should be agreed with the neurology department. The protocol is useful for diagnostic decision-making, follow-up, and treatment of this rare disease with potentially major repercussions. The use of protocols and fact sheets is important.
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Affiliation(s)
- L Monge Galindo
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España.
| | | | - V Pueyo Royo
- Servicio de Oftalmología, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J P García Iñiguez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - S Sánchez Marco
- Unidad de Cuidados Intensivos Pediátricos, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J López-Pisón
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
| | - J L Peña-Segura
- Sección de Neuropediatría, Hospital Infantil Universitario Miguel Servet, Zaragoza, España
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Chaudhry LA, Babur W, Chaudhry GA, Al-Atawi FE, Robert AA. Acute disseminated encephalomyelitis: a call to the clinicians for keeping this rare condition on clinical radar. Pan Afr Med J 2018; 29:138. [PMID: 30050602 PMCID: PMC6057575 DOI: 10.11604/pamj.2018.29.138.13942] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/29/2018] [Indexed: 12/02/2022] Open
Abstract
Acute disseminated encephalomyelitis is a rare disease of central nervous system, which can present with a variety of clinical manifestations. That is why first attack of ADEM, in particular remains a diagnostic puzzle. Early anticipation and diagnosis is important for better outcomes. We present a case of acute disseminated encephalomyelitis which initially had atypical clinical features with cough, expectoration, fever and later manifested strange neurological features, diagnosed to be a case of acute disseminated encephalomyelitis based on radio-imaging.
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Affiliation(s)
- Liaqat Ali Chaudhry
- Department of Internal Medicine, King Salman Military Hospital (NWAFH), Tabuk, Saudi Arabia
| | - Waseem Babur
- Department of Internal Medicine, King Salman Military Hospital (NWAFH), Tabuk, Saudi Arabia
| | - Ghazala Aslam Chaudhry
- Department of Family Medicine, King Salman Armed Forces Hospital (NWAFH), Tabuk, Saudi Arabia
| | - Feddah Eid Al-Atawi
- Department of Internal Medicine, King Salman Military Hospital (NWAFH), Tabuk, Saudi Arabia
| | - Asirvatham Alwin Robert
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Abstract
Encephalitis is an uncommon but severe disease characterized by neurologic dysfunction with central nervous system inflammation. Children with encephalitis should receive supportive care and empiric therapies for common and treatable causes while prioritizing diagnostic evaluation for common, treatable, and high-risk conditions. Even with an extensive diagnostic workup, an infectious cause is identified in less than half of cases, suggesting a role for postinfectious or noninfectious processes.
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Affiliation(s)
- Kevin Messacar
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, B055, 13123 East 16th Avenue, Aurora, CO 80045, USA.
| | - Marc Fischer
- Surveillance and Epidemiology Activity, Arboviral Diseases Branch, Centers for Disease Control and Prevention, 3156 Rampart Road, Fort Collins, CO 80521, USA
| | - Samuel R Dominguez
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, B055, 13123 East 16th Avenue, Aurora, CO 80045, USA
| | - Kenneth L Tyler
- Department of Neurology, University of Colorado, 12700 East 19th Avenue, B182, Aurora, CO 80045, USA
| | - Mark J Abzug
- Department of Pediatrics, University of Colorado, Children's Hospital Colorado, B055, 13123 East 16th Avenue, Aurora, CO 80045, USA
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Iype M, Kunju PM, Saradakutty G, Anish T, Sreedharan M, Ahamed SM. Short term outcome of ADEM: Results from a retrospective cohort study from South India. Mult Scler Relat Disord 2017; 18:128-134. [DOI: 10.1016/j.msard.2017.09.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/10/2017] [Accepted: 09/18/2017] [Indexed: 10/18/2022]
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Kushwaha S, Gupta A, Agarwal N, Chaturvedi S, Jha D. Hyper Acute Demyelinating Encephalomyelitis of Childhood: A Rare Entity. Ann Indian Acad Neurol 2017; 20:316-318. [PMID: 28904469 PMCID: PMC5586132 DOI: 10.4103/aian.aian_52_17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A young child with catastrophic neurological illness diagnosed as a rare variant of acute demyelinating encephalomyelitis (ADEM). She succumbed to her illness despite of aggressive and appropriate management. Malignant demyelinating encephalomyelitis should be considered in children who are refractory to the treatment of ADEM.
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Affiliation(s)
- Suman Kushwaha
- Department of Neurology, Pathology, Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Ashutosh Gupta
- Department of Neurology, Pathology, Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Neha Agarwal
- Department of Neurology, Pathology, Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Sujata Chaturvedi
- Department of Neurology, Pathology, Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
| | - Deepak Jha
- Department of Neurology, Pathology, Neurosurgery, Institute of Human Behaviour and Allied Sciences, New Delhi, India
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Gordon-Lipkin E, Banwell B. An update on multiple sclerosis in children: diagnosis, therapies, and prospects for the future. Expert Rev Clin Immunol 2017; 13:975-989. [PMID: 28738749 DOI: 10.1080/1744666x.2017.1360135] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Multiple sclerosis (MS), a chronic demyelinating disease of the central nervous system, is increasingly being recognized in children and adolescents. Pediatric MS follows a relapsing-remitting course at onset, with a risk for early cognitive impairment. Areas covered: In this review, we discuss the clinical features of acute demyelinating syndromes in children and risk factors that increase the likelihood of a diagnosis of MS. We also address the application of diagnostic criteria for MS in children, immunological features, therapeutic options and psychosocial considerations for children and adolescents with MS. Expert commentary: Collaborative multicenter clinical trials and research efforts are key to the advancement in understanding the pathophysiology and therapeutic strategies for multiple sclerosis across the lifespan.
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Affiliation(s)
- Eliza Gordon-Lipkin
- a Department of Neurology and Developmental Medicine , Kennedy Krieger Institute and Johns Hopkins School of Medicine , Baltimore , MD , USA
| | - Brenda Banwell
- b Children's Hospital of Philadelphia , Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
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Kisseih E, Mamilla D, Kaddurah A. A Rare Presentation of Encephalopathy in a 3-Year-Old Child. Glob Pediatr Health 2017; 4:2333794X17696682. [PMID: 28491921 PMCID: PMC5406187 DOI: 10.1177/2333794x17696682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 12/27/2016] [Indexed: 11/17/2022] Open
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Kaunzner UW, Salamon E, Pentsova E, Rosenblum M, Karimi S, Nealon N, Lavi E, Jamieson DG. An Acute Disseminated Encephalomyelitis-Like Illness in the Elderly: Neuroimaging and Neuropathology Findings. J Neuroimaging 2016; 27:306-311. [PMID: 27896893 DOI: 10.1111/jon.12409] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Revised: 09/24/2016] [Accepted: 10/18/2016] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Acute disseminated encephalomyelitis (ADEM) is a rare demyelinating disease of the central nervous system (CNS) that classically occurs in children and adolescents. It characteristically presents with acute inflammation, resulting in demyelination, often following an infectious disease. ADEM has been described in adult patients, but the incidence in the adult and especially elderly population is low. CASES We describe five older adults (age 57 to 85) who presented with acute neurological symptoms. Three patients presented with an infectious illness preceding the event, 4 patients were encephalopathic, and oligoclonal bands (OCBs) were negative in all tested cases. The clinical scenario and imaging studies suggested alternative diagnoses, such as metastasis, primary CNS tumor, or stroke. Two patients had contrast enhancing lesions, two other patients had lesions with restricted diffusion on diffusion-weighted imaging. Neuropathologic diagnostic from biopsy or autopsy was eventually conclusive, showing perivascular zones of myelin loss with relative axonal sparing in all five cases. CONCLUSION Each of these patients was found to have pathological findings of acute demyelination on tissue diagnosis, suggesting ADEM or ADEM-like disease. The initial presentation and imaging was pointing toward other diagnoses. Broad differential diagnosis is important, especially for older patients, and pathological proof might be warranted for a conclusive diagnosis.
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Affiliation(s)
- Ulrike W Kaunzner
- Department of Neurology, NewYork Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065
| | - Elliott Salamon
- Department of Neurology, NewYork Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065
| | - Elena Pentsova
- Department of Neurology, NewYork Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065.,Department of Neurology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Marc Rosenblum
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Sasan Karimi
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065
| | - Nancy Nealon
- Department of Neurology, NewYork Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065
| | - Ehud Lavi
- Department of Pathology, NewYork Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065
| | - Dara G Jamieson
- Department of Neurology, NewYork Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, New York, NY, 10065
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Dorsett M, Liang SY. Diagnosis and Treatment of Central Nervous System Infections in the Emergency Department. Emerg Med Clin North Am 2016; 34:917-942. [PMID: 27741995 PMCID: PMC5082707 DOI: 10.1016/j.emc.2016.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Central nervous system (CNS) infections, including meningitis, encephalitis, and brain abscess, are rare but time-sensitive emergency department (ED) diagnoses. Patients with CNS infection can present to the ED with nonspecific signs and symptoms, including headache, fever, altered mental status, and behavioral changes. Neuroimaging and CSF fluid analysis can appear benign early in the course of disease. Delaying therapy negatively impacts outcomes, particularly with bacterial meningitis and herpes simplex virus encephalitis. Therefore, diagnosis of CNS infection requires vigilance and a high index of suspicion based on the history and physical examination, which must be confirmed with appropriate imaging and laboratory evaluation.
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Affiliation(s)
- Maia Dorsett
- Division of Emergency Medicine, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8072, St. Louis, Missouri 64110, USA
| | - Stephen Y. Liang
- Division of Emergency Medicine, Division of Infectious Diseases, Washington University School of Medicine, 660 S. Euclid Avenue, Campus Box 8051, St. Louis, Missouri 63110, USA
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Yamada A, Miyachi N, Miura T, Suzuki M, Watanabe N, Akechi T. Long-term poor rapport, lack of spontaneity and passive social withdrawal related to acute post-infectious encephalitis: a case report. SPRINGERPLUS 2016; 5:345. [PMID: 27652003 PMCID: PMC4798482 DOI: 10.1186/s40064-016-1994-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 03/11/2016] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Post-infectious encephalitis/encephalopathy is a neurological syndrome that sometimes develops following common viral or bacterial infections. The most common form is acute disseminated encephalomyelitis (ADEM). ADEM is a demyelinating disease of the central nervous system that typically presents as a monophasic disorder associated with multifocal neurologic symptoms and encephalitis. Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis is another type of severe autoimmune disorder, characterized by seizures, movement disorders and psychiatric symptoms. In general, the prognosis and long-term outcomes of both ADEM and anti-NMDAR encephalitis are favorable. Most patients show complete, albeit slow recovery over a period of one to 2 years. There are few reports of patients with these disorders showing long-term residual psychiatric symptoms. CASE PRESENTATION We report the case of a 16-year-old Japanese male who suffered from acute post-infectious encephalitis. The patient followed an atypical recovery course, in that he showed poor rapport, lack of spontaneity and passive social withdrawal for more than 2 years after the initial symptoms. While treatment with small doses of antipsychotic drugs at the hospital had no effect on the symptoms, the patient recovered gradually over a prolonged period of five or so years. CONCLUSIONS This case report suggests that a type of acute post-infectious encephalitis with demyelinating features, possibly ADEM or anti-NMDAR encephalitis, or an overlap between the two, can cause a prodrome of behavioral changes and long-term residual psychiatric symptoms for many months, although it is eventually associated with a good prognosis.
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Affiliation(s)
- Atsurou Yamada
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Nobuhiro Miyachi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Koseikan Hospital, Ama, Aichi Japan
| | - Toshiyasu Miura
- Department of Neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masako Suzuki
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Norio Watanabe
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/School of Public Health, Kyoto, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Sudhakar SV, Muthusamy K, Mani S, Gibikote S, Shroff M. Imaging in Pediatric Demyelinating and Inflammatory Diseases of the Brain- Part 1. Indian J Pediatr 2016; 83:952-64. [PMID: 26634264 DOI: 10.1007/s12098-015-1916-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2015] [Accepted: 09/14/2015] [Indexed: 10/22/2022]
Abstract
Imaging plays an important role in the diagnosis, management, prognostication and follow up of pediatric demyelinating and inflammatory diseases of the brain and forms an integral part of the diagnostic criteria. Conventional and advanced MR imaging is the first and only reliable imaging modality. This article reviews the typical and atypical imaging features of common and some uncommon demyelinating and inflammatory diseases with emphasis on the criteria for categorization. Imaging protocols and the role of advanced imaging techniques are also covered appropriately.
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Affiliation(s)
- Sniya Valsa Sudhakar
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India.
| | - Karthik Muthusamy
- Department of Neurology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Sunithi Mani
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Sridhar Gibikote
- Department of Radiodiagnosis, Christian Medical College and Hospital, Vellore, Tamil Nadu, 632004, India
| | - Manohar Shroff
- Department of Pediatric Neuroimaging, Hospital for Sick Children, Toronto, Canada
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Yang HQ, Zhao WC, Yang WM, Li YL, Sun ZK, Chen S, Li W, Ma JJ. Clinical Profiles and Short-Term Outcomes of Acute Disseminated Encephalomyelitis in Adult Chinese Patients. J Clin Neurol 2016; 12:282-8. [PMID: 27449911 PMCID: PMC4960211 DOI: 10.3988/jcn.2016.12.3.282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 03/01/2015] [Accepted: 03/01/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND PURPOSE Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder that predominantly affects children. Previous studies have mostly involved children in Western developed countries. METHODS This study retrospectively reviewed the clinical profiles of ADEM in adult Chinese patients. RESULTS ADEM occurred during summer and autumn in about two-thirds of the 42 included patients. Prior infection was found in five patients and no preimmunization was recorded. The most frequent clinical presentations were alterations in consciousness (79%) and behavior changes (69%), followed by motor deficits (64%) and fever (50%). About one-quarter (26%) of the patients showed positive results for oligoclonal bands, and about half of them exhibited increases in the IgG index and 24-hour IgG synthesis rate. Magnetic resonance imaging showed white- and gray-matter lesions in 83% and 23% of the patients, respectively. Steroids were the main treatment, and full recovery occurred in 62% of the patients, with residual focal neurological deficits recorded in a few patients. After a mean follow-up period of 3.4 years, two patients exhibited recurrence and one patient exhibited a multiphasic course. One patient was diagnosed with multiple sclerosis (MS). CONCLUSIONS With the exception of the seasonal distribution pattern and prior vaccine rate, the clinical profiles of ADEM in adult Chinese patients are similar to those in pediatric populations. No specific markers are available for distinguishing ADEM from MS at the initial presentation. Careful clinical evaluations, cerebrospinal fluid measurements, and neuroradiological examinations with long-term follow-up will aid the correct diagnosis of ADEM.
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Affiliation(s)
- Hong Qi Yang
- Department of Neurology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wen Cong Zhao
- Department of Pharmacology, Zhengzhou Maternal and Child Health Hospital, Zhengzhou, China
| | - Wei Min Yang
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yong Li Li
- Department of Radiology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Zhi Kun Sun
- Department of Neurology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Chen
- Department of Neurology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Wei Li
- Department of Neurology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China.
| | - Jian Jun Ma
- Department of Neurology, Henan Provincial People's Hospital of Zhengzhou University, Zhengzhou, China.
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Abstract
Acute disseminated encephalomyelitis is a primarily pediatric, immune-mediated disease characterized by demyelination and polyfocal neurologic symptoms that typically occur after a preceding viral infection or recent immunization. This article presents the pathophysiology, diagnostic criteria, and magnetic resonance imaging characteristics of acute disseminated encephalomyelitis. We also present evaluation and management strategies.
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Long-term motor, cognitive and behavioral outcome of acute disseminated encephalomyelitis. Eur J Paediatr Neurol 2016; 20:361-7. [PMID: 26876769 DOI: 10.1016/j.ejpn.2016.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 01/06/2016] [Accepted: 01/23/2016] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the long-term motor and neurocognitive outcome of children with acute disseminated encephalomyelitis and to identify prognostic risk factors. METHODS The study included 43 children who were hospitalized due to acute disseminated encephalomyelitis during the years 2002-2012. The children underwent full neurological examinations, along with comprehensive neurocognitive and behavioral assessments. RESULTS Twenty-six (61%) children had different degrees of neurological sequelae after a mean follow-up of 5.5 ± 3.5 years. The most common residual impairment included attention-deficit hyperactivity disorder (44%), behavioral problems (32%), and learning disabilities (21%). Five (12%) children had a full-scale IQ of 70 or less, compared to 2.2% in the general population. CONCLUSIONS Neurocognitive sequelae were found even in children who were considered as fully recovered at the time of discharge. Risk factors for severe neurological sequelae were older age at diagnosis and male gender. We suggest neuropsychological testing and long-term follow-up for all children with acute disseminated encephalomyelitis, even in the absence of neurological deficits at discharge.
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Beatty C, Bowler RA, Farooq O, Dudeck L, Ramasamy D, Yeh EA, Zivadinov R, Weinstock-Guttman B, Parrish JB. Long-Term Neurocognitive, Psychosocial, and Magnetic Resonance Imaging Outcomes in Pediatric-Onset Acute Disseminated Encephalomyelitis. Pediatr Neurol 2016; 57:64-73. [PMID: 26996404 DOI: 10.1016/j.pediatrneurol.2016.01.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 12/12/2015] [Accepted: 01/01/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a demyelinating disorder that is usually self-limited. Recent studies have suggested ongoing neurological deficits and neurocognitive impairment in these patients. Little information on the correlation of clinical and neuroimaging markers in ADEM is available. We examined potential clinical factors (e.g., age of onset, acute symptom duration, magnetic resonance imaging [MRI] lesions) and their relation to neurocognitive and psychosocial outcomes. METHODS This is a retrospective chart review of consecutive pediatric patients diagnosed with ADEM between 2006 and 2012. Patients were evaluated with standard neurological assessment, MRI of the brain, and neuropsychological evaluation. RESULTS Twenty-three patients with ADEM with average age at neuropsychological assessment of 10.1 years (±3.50) were included. Five (22.7%) patients were impaired on three or more neurocognitive measures. Psychosocial problems were reported in 20%-40% of patients. Earlier age of onset was correlated with poorer sustained attention and psychosocial problems, whereas acute symptom duration and Expanded Disability Status Scale were not. MRI outcomes were correlated with psychosocial outcomes but not neuropsychological findings. CONCLUSIONS Our findings suggest lingering cognitive and psychosocial deficits in children with a history of ADEM. Clinical features and MRI findings correlated more strongly with psychosocial outcomes than cognitive functioning. Further studies are needed to confirm relationships and other possible contributing factors to lingering deficits.
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Affiliation(s)
- Cynthia Beatty
- Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York
| | - Rachael A Bowler
- Department of Neurology, University at Buffalo, Buffalo, New York
| | - Osman Farooq
- Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York
| | - Lindsay Dudeck
- Division of Pediatric Neurology, Department of Neurology, University at Buffalo, Women & Children's Hospital of Buffalo, Buffalo, New York
| | - Deepa Ramasamy
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Buffalo, New York
| | - E Ann Yeh
- Department of Neurology, Sick Kids Hospital, Toronto, Canada
| | - Robert Zivadinov
- Department of Neurology, Buffalo Neuroimaging Analysis Center, Buffalo, New York
| | | | - Joy B Parrish
- Department of Neurology, University at Buffalo, Buffalo, New York.
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Barahona Afonso AF, João CMP. The Production Processes and Biological Effects of Intravenous Immunoglobulin. Biomolecules 2016; 6:15. [PMID: 27005671 PMCID: PMC4808809 DOI: 10.3390/biom6010015] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 03/01/2016] [Accepted: 03/01/2016] [Indexed: 12/17/2022] Open
Abstract
Immunoglobulin is a highly diverse autologous molecule able to influence immunity in different physiological and diseased situations. Its effect may be visible both in terms of development and function of B and T lymphocytes. Polyclonal immunoglobulin may be used as therapy in many diseases in different circumstances such as primary and secondary hypogammaglobulinemia, recurrent infections, polyneuropathies, cancer, after allogeneic transplantation in the presence of infections and/or GVHD. However, recent studies have broadened the possible uses of polyclonal immunoglobulin showing that it can stimulate certain sub-populations of T cells with effects on T cell proliferation, survival and function in situations of lymphopenia. These results present a novel and considerable impact of intravenous immunoglobulin (IVIg) treatment in situations of severe lymphopenia, a situation that can occur in cancer patients after chemo and radiotherapy treatments. In this review paper the established and experimental role of polyclonal immunoglobulin will be presented and discussed as well as the manufacturing processes involved in their production.
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Affiliation(s)
- Ana Filipa Barahona Afonso
- Department of Chemistry, Universidade de Évora, Colégio Luís António Verney, Rua Romão Ramalho 59, 7000-671 Évora, Portugal.
| | - Cristina Maria Pires João
- Hematology Department, Champalimaud Center for the Unknown, Av. Brasília, 1400-038 Lisboa, Portugal.
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Hassanein SM, Ibrahim YA. Posttraumatic Acute Disseminated Encephalomyelitis in a Child Resolved by Steroid Therapy: Case Report. J Clin Neurol 2016; 12:245-7. [PMID: 26833988 PMCID: PMC4828576 DOI: 10.3988/jcn.2016.12.2.245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 10/11/2015] [Accepted: 10/13/2015] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sahar M.A. Hassanein
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Berzero G, Cortese A, Ravaglia S, Marchioni E. Diagnosis and therapy of acute disseminated encephalomyelitis and its variants. Expert Rev Neurother 2015; 16:83-101. [DOI: 10.1586/14737175.2015.1126510] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Nationwide Incidence of Acquired Central Nervous System Demyelination in Icelandic Children. Pediatr Neurol 2015; 53:503-7. [PMID: 26463471 DOI: 10.1016/j.pediatrneurol.2015.08.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 08/27/2015] [Accepted: 08/28/2015] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Recognizing acquired demyelinating syndromes and multiple sclerosis is important to commence early treatment. The objective of this study was to describe the incidence of acquired demyelinating syndromes and multiple sclerosis among the entire Icelandic pediatric population according to recently promoted criteria. PATIENTS AND METHODS The study included all children in Iceland (<18 years) with acquired demyelinating syndromes and multiple sclerosis from 1990 to 2009 with a minimum of 5-year follow-up. Clinical data were gathered and radiological images reviewed. The cohort included all patients with acquired demyelinating syndromes and multiple sclerosis in the Icelandic pediatric population. RESULTS Eighteen patients with acquired demyelinating syndromes and multiple sclerosis were included, the total annual incidence being 1.15/100,000 (acquired demyelinating syndromes 1.02 and multiple sclerosis 0.45/100,000). The median age at diagnosis was 14.25 years (range 1.25-17.5 years). Thirteen patients were initially diagnosed with clinically isolated syndrome, two had acute disseminated encephalomyelitis, two had multiple sclerosis, and one had neuromyelitis optica. Seven children were diagnosed with multiple sclerosis; three patients with clinically isolated syndrome developed multiple sclerosis after the age of 18 and were not included in the multiple sclerosis group. The gender ratio was equal. Of the nine girls, seven were diagnosed with clinically isolated syndrome. Most patients (11 of 18) were diagnosed during the period January through March. Oligoclonal bands in cerebrospinal fluid were exclusively found in patients with multiple sclerosis and clinically isolated syndrome and 13 of 14 available magnetic resonance images revealed clear abnormalities. CONCLUSION The annual incidence of acquired demyelinating syndromes and multiple sclerosis in Iceland was 1.15/100,000 children. The risk of progression from clinically isolated syndrome to multiple sclerosis was high. There was no female preponderance.
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Tadmori I, Chaouki S, Abourazzak S, Zahra SF, Benmiloud S, Idrissi ML, Atmani S, Hida M. [Acute disseminated encephalomyelitis in children]. Pan Afr Med J 2015; 19:280. [PMID: 25870735 PMCID: PMC4391900 DOI: 10.11604/pamj.2014.19.280.4720] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022] Open
Abstract
L'encéphalomyélite aiguë disséminée (ADEM) est une maladie inflammatoire, démyélinisante, multifocale intéressant principalement la substance blanche du système nerveux central. Elle est rare mais non exceptionnelle chez l'enfant. Les auteurs rapportent une étude colligeant 9 cas d'ADEM pris en charge au service de Pédiatrie du CHU Hassan II à Fès, sur une période de 4 ans. Il s'agit de cinq garçons et quatre filles; âgés entre 2 ans et 13 ans. Les antécédents (ATCD) d'infection virale sont notés chez quatre patients. La fièvre est constante. Les convulsions sont présentes dans cinq cas et les troubles de conscience dans cinq cas. L'examen neurologique était anormal. L’étude de liquide céphalo-rachidien a révélé une réaction méningée. On ne notait pas de syndrome inflammatoire biologique. L'imagerie par résonance magnétique (IRM) cérébrale a objectivé des lésions en hyper-signal en T2 et T2 FLAIR chez tous les patients. Pour le traitement, des bolus de corticoïdes intraveineux ont été administrés, relayés par une corticothérapie orale et associés à une kinésithérapie motrice et un traitement antiépileptique pour certains patients. L’évolution de nos malades était favorable globalement et on a déploré le décès d'une patiente. L'ADEM est une affection rare du système nerveux central. Les critères diagnostiques sont fondés sur des éléments cliniques et des données d'imagerie. La prise en charge doit être précoce et multidisciplinaire.
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Affiliation(s)
- Ilham Tadmori
- Service Pédiatrie, Département mère-enfant, CHU Hassan II, Fès, Maroc
| | - Sana Chaouki
- Service Pédiatrie, Département mère-enfant, CHU Hassan II, Fès, Maroc
| | - Sana Abourazzak
- Service Pédiatrie, Département mère-enfant, CHU Hassan II, Fès, Maroc
| | | | - Sarra Benmiloud
- Service Pédiatrie, Département mère-enfant, CHU Hassan II, Fès, Maroc
| | | | - Samir Atmani
- Service Pédiatrie, Département mère-enfant, CHU Hassan II, Fès, Maroc
| | - Moustapha Hida
- Service Pédiatrie, Département mère-enfant, CHU Hassan II, Fès, Maroc
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Burla MJ, Benjamin J. Pediatric Urinary Retention in the Emergency Department: A Concerning Symptom with Etiology Outside the Bladder. J Emerg Med 2015; 50:e53-6. [PMID: 26482829 DOI: 10.1016/j.jemermed.2015.09.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Revised: 08/21/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Urinary retention in an otherwise healthy adolescent is a concerning symptom, in which etiology can range from an extracystic mass to central nervous system involvement (CNS). One possibility is acute disseminated encephalomyelitis (ADEM), a rare inflammatory autoimmune disease that affects the CNS via demyelination. The disease usually is preceded by an acute viral infection, and commonly presents with multifocal neurological deficits. The diagnosis for ADEM is made based on clinical presentation, correlating with findings characterized on magnetic resonance imaging (MRI) in the CNS. CASE REPORT Our case involves a 16-year-old boy who presented to the Emergency Department (ED) with urinary retention. The patient was an otherwise healthy adolescent who was experiencing intermittent fevers for 1 week, and was found to be monospot positive when seen by his pediatrician. When presenting to the ED, the patient's primary complaint was urinary retention, which he experienced acutely in the middle of the night. Due to the suspicious nature of the patient's symptoms and history of present illness, the patient received a thorough workup including magnetic resonance imaging (MRI) of the patient's brain and spinal cord, which demonstrated findings consistent with ADEM. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: There is very little literature describing a case of ADEM in the ED where the primary manifesting symptom was urinary retention. In addition, it is important that clinicians address acute urinary retention in an otherwise healthy adolescent as a red flag, with the need to rule out concerning etiology.
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Affiliation(s)
- Michael J Burla
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
| | - Joseph Benjamin
- Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan; Oakland University William Beaumont School of Medicine, Rochester, Michigan
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Chamarthi VS, Chamarthi S, Johansson BE. Case 3: Acute Onset of Headache, Fever, and Right Arm Weakness in 12-year-old Boy. Pediatr Rev 2015; 36:465-7. [PMID: 26430208 DOI: 10.1542/pir.36-10-465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Venkata Sushma Chamarthi
- Department of Pediatrics, Texas Tech Health Sciences Center El Paso; El Paso Children's Hospital, El Paso, TX
| | - Sastry Chamarthi
- Department of Pediatrics, Texas Tech Health Sciences Center El Paso; El Paso Children's Hospital, El Paso, TX
| | - Bert E Johansson
- Department of Pediatrics, Texas Tech Health Sciences Center El Paso; El Paso Children's Hospital, El Paso, TX
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