[Acute disseminated encephalomyelitis in children].

OBJECTIVE

Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory-demyelinating disease, which usually follows an infection or vaccination. It is more frequent in children. In this paper, I will review clinical, diagnosis, treatment, and prognosis data, based on last 10 years papers, including our experience with 42 patients studied at Calvo Mackenna Hospital and German Clinic of Santiago de Chile, Chile.

METHODS

ADEM symptoms present 2 to 30 days after viral or bacterial infection. There is a slight male predominance (1,3:1). The clinical picture is characterized by multiple symptoms. Prominent findings are altered level of consciousness in 50-60% of patients, and motor system dysfunction in 80-90%. Spinal cord dysfunction occurs in 20-25% of children. Optic neuritis (10-20%) is usually bilateral. Magnetic resonance imaging is the gold standard to detect typical white matter lesions, which suggest ADEM diagnosis, but a clinico-neuroimaging gap may occurs. Steroids are the first choice for treatment. In practice, they seem to be useful in up to 90% of patients. Recurrences occur in 10-30% of cases, and raise a differential diagnosis with multiple sclerosis. Mortality is as low as 0-7%. Sequelae are seen in 10-20% of patients.

CONCLUSIONS

ADEM is a demyelinating condition, usually with a monophasic course and good outcome. The only way to confirm a definite diagnosis is long-term follow-up.