Childhood acute disseminated encephalomyelitis: An Egyptian pilot study
| Autor: | Hamed A. El-Khayat, Omnia Fathy El-Rashidy, Iman A. Elagouza, Yasser A. Abbas, Raghda Zaitoun |
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| Rok vydání: | 2017 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent Prednisolone Untreated group Anti-Inflammatory Agents Pilot Projects Methylprednisolone Lesion 03 medical and health sciences 0302 clinical medicine Post vaccination Humans Medicine 030212 general & internal medicine Child Retrospective review business.industry Encephalomyelitis Acute Disseminated Immunoglobulins Intravenous Infant Mean age General Medicine medicine.disease Radiological weapon Child Preschool Poliovirus Vaccine Oral Pediatrics Perinatology and Child Health Acute disseminated encephalomyelitis Disease Progression Egypt Female Neurology (clinical) medicine.symptom Hyponatremia business 030217 neurology & neurosurgery |
| Zdroj: | European Journal of Paediatric Neurology. 21:e109 |
| ISSN: | 1090-3798 |
| DOI: | 10.1016/j.ejpn.2017.04.940 |
| Popis: | Describing the variable clinical features, laboratory findings, neuroimaging findings, and treatments given to children who presented with ADEM and following them up both clinically and radiologically. 21 patients were recruited: 14 new cases, and 7 old ones presenting over the preceding 5 years (retrospective review of existing data). 11 males and 10 females, with a mean age of 4.4 years ± 2.7 SD, were included. All new patients were subject to full history, examination and a panel of investigations including MRI of the brain. Treatment was given in the form of pulsed methyl prednisolone or intravenous immunoglobulin (IVIG), followed by clinical and radiological follow-up every 3 months as needed. 11 cases occurred in spring, 8 post vaccine, of which 5 were after oral polio vaccine (OPV). MRI was done for all 21 patients and was abnormal in all of them, CT was done in only 10 patients as was normal in 9. Hyponatremia was seen in 11 patients. All patients who received corticosteroids showed prompt improvement. 6 out of 10 patients who received IVIG first failed treatment. Of the 17 treated patients, 10 had no sequelae and 10 had total lesion resolution on MRI at 3 months, versus 1 and 0 patients, respectively, in the untreated group. We found a disproportionately large number of post vaccination cases, especially after OPV. The association of ADEM with hyponatremia needs further study. MRI is central to diagnosis. Outcome is much better with treatment with steroids being far superior to IVIG. Excess use of IVIG should be discouraged. |
| Databáze: | OpenAIRE |
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