Department of Neurology, Erasmus University Medical Centre, The Netherlands.
Mult Scler. 2011 Apr;17(4):441-8. doi: 10.1177/1352458510390068. Epub 2010 Dec 8.
Acute disseminated encephalomyelitis (ADEM) affects children more frequently than adults. Current studies investigating ADEM in different age groups are difficult to compare.
To investigate whether the clinical presentation, outcome and disease course of ADEM differ between adults and children.
Disease characteristics of 25 adults and 92 children suffering from ADEM between 1988 and 2008 were compared.
The most common presenting symptoms of ADEM in both groups were pyramidal signs and encephalopathy. Ataxia occurred more frequently in children (p = 0.002). In general, MRI showed ill-defined and large white matter lesions in both groups, whereas periventricular lesions were more prevalent in adults (p = 0.001). In adults, duration of hospitalization was longer (p = 0.002) and intensive care unit (ICU) admission was more frequently required (p = 0.043). Three adults (12%) and one child (1%) died (p = 0.030). Fewer adults had complete motor recovery after their first clinical event (p < 0.001). In 73 patients follow-up time was ≥ 2 years and most of these patients remained monophasic. Although relapses after ADEM can occur, only one adult (5%) and five children (6%) converted to MS.
The clinical presentations in children and adults share similarities, but the disease course and outcome of ADEM is more severe in adults with respect to hospitalization, ICU admission, recovery and mortality.
急性播散性脑脊髓炎（ADEM）更常影响儿童而非成人。目前研究不同年龄组 ADEM 的难度在于难以比较。
研究 ADEM 在成人和儿童中的临床表现、结局和病程是否存在差异。
比较 1988 年至 2008 年间 25 例成人和 92 例儿童 ADEM 的疾病特征。
两组 ADEM 的最常见首发症状均为锥体束征和脑病。共济失调在儿童中更为常见（p = 0.002）。总体而言，两组 MRI 均显示边界不清和大面积白质病变，而成人中脑室周围病变更为常见（p = 0.001）。成人住院时间更长（p = 0.002），需要入住重症监护病房（ICU）的比例更高（p = 0.043）。3 名成人（12%）和 1 名儿童（1%）死亡（p = 0.030）。首次临床事件后，较少的成人完全恢复运动功能（p < 0.001）。73 例患者的随访时间≥2 年，这些患者大多呈单相病程。尽管 ADEM 后可能会复发，但仅有 1 名成人（5%）和 5 名儿童（6%）转化为多发性硬化症。
儿童和成人的临床表现相似，但成人的住院时间、入住 ICU、恢复和死亡率等预后较差。
