Children recover well from acute central nervous system demyelination

By Lucy Piper, Senior medwireNews Reporter

Most children can expect a good and quick physical recovery following acute central nervous system demyelination, study findings suggest.

Although a serious illness, which resulted in 86% of the 283 children studied being hospitalised for 3 to 10 days, 254 (90%) of 281 children available for 5-year follow-up examination had recovered fully; 209 within 3 months and a further 39 by 12 months.

Among the 27 (10%) patients who did not experience full neurological recovery from their incident acquired demyelination syndrome, 12 had severe residual visual, motor, bowel and bladder deficits. All of these children had moderate or severe deficits at presentation and those with transverse myelitis and optic neuritis were most affected.

Multiple sclerosis (MS) was diagnosed in 59 (21%) of the participants within 12 months of the incident attack and more than half of these experienced a second attack in the first year. Nevertheless, all of them recovered full mobility, normal vision and bowel and bladder control within 12 months of their incident attack and the majority within 3 months. Six of the MS patients, despite recovering fully from their incident attack, had subsequent relapses and developed deficits a median of 5.9 years later that persisted for at least a year.

Researcher Julia O’Mahony (University of Toronto, Ontario, Canada) and co-workers note in Pediatrics that MS was not associated with a poor outcome. All affected children recovered and were more likely to have milder deficits at acute demyelination onset than the 224 patients with monophasic disease even when the 69 with acute disseminated encephalomyelitis were excluded.

Moderate or severe deficits in vision, motor, bladder and bowel function or cognition during the incident attack were seen in 184 children, with 41 profoundly encephalopathic, 129 unable to ambulate independently and 59 with optic neuritis.

The 102 children with transverse myelitis and those with the acute disseminated encephalomyelitis phenotype were the most likely to have moderate or severe deficits at onset, as were children younger than 12 years of age. However, the researchers observe that age did not predict residual physical impairment from the acute attack, which they say suggests “a strong capacity for neurologic repair of acute lesions in the youngest patients”.

The team concludes that their findings indicate a recovery of gait, vision and bladder and bowel function in most patients following acquired demyelination syndrome, but they do not account for the cognitive effects of the condition, future deficits in which remain a possibility.

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