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Acute disseminated encephalomyelitis: a follow-up study in Taiwan

Department of Neurology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

Correspondence to:
Correspondence to:
Dr J-S Jeng
Department of Neurology, National Taiwan University Hospital, No 7 Chung-Shan South Road, Taipei 100, Taiwan; jsjeng{at}ha.mc.ntu.edu.tw

Background: Acute-disseminated encephalomyelitis (ADEM) is a demyelinating disorder of the central nervous system, whose epidemiology, clinical presentations and functional outcome are incompletely understood in Asian populations.

Objective: To assess the clinical presentations, predisposing factors and functional outcome of ADEM in Taiwan.

Methods: 50 patients initially diagnosed with ADEM (male, 19; female, 31) were enrolled from 1991 to 2005. Diagnosis of ADEM or multiple sclerosis was established during a follow-up period of 2–120 months. 8 adult patients were noted to have taken the immunomodulatory drug, levamisole, within 3 months before onset of symptoms. The remaining 42 patients (male, 17; female, 25) were categorised by age as children (<16 years, n = 12), young adults (16–49 years, n = 21) and elderly adults (50 years, n = 9). The clinical manifestations, predisposing factors and radiological findings were compared between different age groups and adult patients with or without levamisole use. Functional outcome was compared by a log-rank test.

Results: Preceding upper respiratory tract infection was evident in 21 (50%) patients and only one young-adult patient had received Rubella vaccine immunisation. The frequency of fever was higher in children (p = 0.04) and psychiatric symptoms were more prevalent in elderly patients (p = 0.03). Functional recovery was faster in children than in adults (p = 0.002). Initial Expanded Disability Status Scale score (odds ratio (OR) 1.9, p = 0.03) and no fever (OR 0.04, p = 0.06) were associated with poor outcome (modified Rankin scale 2). After a mean (SD) follow-up of 31.8 (9.9) months, 4 (9.5%) patients developed multiple sclerosis (3 (25%) children, 1 (4.7%) young adult, p = 0.03). The neurological disability, radiological and cerebrospinal fluid findings did not differ between patients with and without levamisole use. One elderly adult patient previously receiving levamisole developed multiple sclerosis of relapse-remitting type after a mean follow-up period of 36.9 months.

Conclusion: The clinical presentations, functional outcome and risk of developing multiple sclerosis differed between different age groups. Functional recovery was faster in children than in adults. Poor functional outcome was related to initial high Expanded Disability Status Scale score and absence of fever.

Abbreviations: ADEM, acute disseminated encephalomyelitis; CNS, central nervous system; CSF, cerebrospinal fluid; DTPA, diethylenetriamine penta-acetic acid; EAE, experimental allergic encephalomyelitis; EDSS, Expanded Disability Status Scale; GCS, Glasgow Coma Scale; IVIg, intravenous immunoglobulin; MRI, magnetic resonance imaging; mRS, modified Rankin’s scale