Acute disseminated encephalomyelitis followed by recurrent or monophasic optic neuritis in pediatric patients

Mult Scler. 2013 Jun;19(7):941-6. doi: 10.1177/1352458512466317. Epub 2012 Nov 5.


Background: Some pediatric patients with inflammatory demyelinating central nervous system disorders cannot be classified under any of the established disease entities, making their treatment and prognosis difficult.

Objective: The objective of this study is to characterize a subgroup of pediatric patients with recurrent demyelinating central nervous system disorders.

Methods: This study includes a case series of pediatric patients with monophasic or recurrent acute disseminated encephalomyelitis (ADEM) who later presented with either monophasic or recurrent optic neuritis (ON).

Results: We describe seven patients with a median follow-up of six years (five females, two males) who presented at a median age of 6 years (range 4-8 years) with monophasic (n = 4) or recurrent ADEM (two to four attacks) followed by monophasic (n = 3) or recurrent ON (two to nine attacks). Cranial magnetic resonance imaging (MRI) was typical for ADEM (n = 6) with complete or almost complete resolution of lesions on follow-up. Cerebrospinal (CSF) studies at the time of ADEM showed a pleocytosis in six patients and were negative for oligoclonal bands (OCBs) in all. In all patients high titers for serum anti-MOG antibodies were detected.

Conclusion: ADEM followed by ON is a rare but distinct clinical phenotype among pediatric patients. Further studies are needed to allow recommendations on treatment or prognosis.

Keywords: ADEM; NMO; optic neuritis; pediatric.

MeSH terms

  • Child
  • Child, Preschool
  • Encephalomyelitis, Acute Disseminated / complications*
  • Encephalomyelitis, Acute Disseminated / pathology*
  • Encephalomyelitis, Acute Disseminated / physiopathology
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Optic Neuritis / complications*
  • Optic Neuritis / pathology*
  • Optic Neuritis / physiopathology