The clinical and predictive factors for relapse after an initial event of acute disseminated encephalomyelitis in children.

Acute disseminated encephalomyelitis (ADEM) is an inflammatory monophasic condition of the central nervous system. We aimed to recognize the clinical, neuroradiologic, and cerebral spinal fluid features present during the initial event of ADEM in children, and the possible predictive relapse factors that may lead to recurrent or multiphasic ADEM using the proposed definitions of the International Pediatric Multiple Sclerosis Study Group published in 2007. A retrospective observational study was conducted at the University Pediatric Hospital. Thirteen subjects were included in the study. Seven children had mild encephalopathy as first event. Eleven patients had supratentorial and infratentorial involvement, and in six of the patients the lesions were greater than one cm. In our study seven of the thirteen patients with ADEM went on to relapse. Six of these patients developed multiphasic ADEM while one patient developed recurrent ADEM. Our results found no clear association between the grades of encephalopathy, brain MRI findings, particularly their location and size, and detection of oligoclonal bands in CSF, as possible predictive factors for relapses in ADEM. More studies are needed to characterize the possible risk factors that could lead to relapse in ADEM.