Acute disseminated encephalomyelitis in children and adolescents - 20-year single-center experience in Serbia

Introduction/Objective. Acute disseminated encephalomyelitis (ADEM) is the most common demyelinating disease CNS in pediatric patients. We aimed to evaluate the clinical profile of children with ADEM and to discern prognostic factors for disease outcome. Methods. A 20-year retrospective-prospective study was conducted in a cohort with diagnosis of ADEM. Results. The study included 36 patients, with range of follow-up period of 6-120 months (median of 26 months). Prior infection was reported in 72.2% patients. In the clinical presentation of the disease, motor deficit was the most common (81.1%), followed by ataxia (77.8%). More than a third of patients had back and limb pain or abdominal visceral pain, which highly correlated with MRI findings of myelitis. Abnormal brain CT findings were evident in 22.2% of patients, and this was associated with higher EDSS and quicker progression of the disease. Median EDSS was 0 at the most recent follow-up visit, in all patients. EDSS 0 to 2.5 was verified in 29 (80.6%) of patients, while 3 (8.3%) patients scored from 7 to 9.5 at the last visit. Two patients had a lethal outcome. Conclusions: ADEM is a serious disease in pediatric patients, but with a good prognosis, which is illustrated by the fact that 80.6% of our patients had a complete or almost complete recovery.