Neurocognitive outcome after acute disseminated encephalomyelitis

Hahn, Cecil D; Miles, Brenda S; MacGregor, Daune L; Blaser, Susan I; Banwell, Brenda L; Hetherington, C.Ross

doi:10.1016/S0887-8994(03)00143-7

« Previous Next »Pediatric Neurology
Volume 29, Issue 2 , Pages 117-123, August 2003

Neurocognitive outcome after acute disseminated encephalomyelitis

Cecil D Hahn, MD
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
- Communications should be addressed to: Dr. Hahn; Division of Neurology; The Hospital for Sick Children; 555 University Avenue; Toronto, Ontario, M5G 1X8, Canada.
Brenda S Miles, PhD
- Department of Psychology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
Daune L MacGregor, MD
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
Susan I Blaser, MD
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
Brenda L Banwell, MD
- Division of Neurology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
C.Ross Hetherington, PhD
- Research Institute, The Hospital for Sick Children and University of Toronto, and Department of Psychology, University of Toronto, Toronto, Ontario, Canada.

Received 27 August 2002; accepted 23 January 2003.

Abstract

Cognitive dysfunction has been demonstrated in multiple sclerosis but has not been extensively studied after acute disseminated encephalomyelitis (ADEM). Because ADEM often presents with widespread demyelination, which may not completely resolve, these patients may be at risk for persistent cognitive dysfunction. The study objective was to explore the profile and severity of neurocognitive sequelae in pediatric ADEM. Children aged 6-15 years diagnosed with ADEM were invited to participate in a structured neurologic assessment, neuropsychological evaluation, and a follow-up magnetic resonance imaging. Nine of 15 children diagnosed with ADEM met the age criteria and six participated in the study. The mean age at presentation was 7.7 years; the mean duration of follow-up was 3.5 years. As a group, these children with prior ADEM performed within the average range on cognitive testing. However, a variety of mild cognitive deficits were demonstrated in each of the children, even in those whose magnetic resonance imaging studies had completely normalized. Four children demonstrated a cognitive profile of relatively poorer visuospatial/visuomotor function. The cognitive deficits observed in these children are similar but less severe than those previously reported in adults and children with multiple sclerosis, which may reflect the monophasic nature of ADEM, compared with the chronic, recurrent demyelination characteristic of multiple sclerosis.