Early predictors of epilepsy and subsequent relapse in children with acute disseminated encephalomyelitis


OBJECTIVE:: To identify predictors of epilepsy and clinical relapses in children presenting with acute disseminated encephalomyelitis (ADEM). METHODS:: Children presenting with ADEM between 2005 and 2017 and tested clinically for MOG-Ab were identified from three tertiary paediatric neurology centres in the United Kingdom. Patients were followed up for a median of 6 years (range, 1-16 years). RESULTS:: A total of 74 children were studied (38 females; median age at first presentation: 4.5 years (range, 1.4-16 years)). MOG-Ab was positive in 50/74 (67.6%) of cases, and 27 (54%) of MOG-Ab positive children presented with a neurological relapse over time. MOG-Ab was more frequently positive in the relapsing group than in the monophasic group (27/31 vs 23/43; odds ratio 5.9 (95% CI: 1.8-19.7); p = 0.002). 16/74 (22%) children had seizures during the acute presentation with ADEM and 12/74 (16.2%) patients were diagnosed with post-ADEM epilepsy. The diagnosis of post-ADEM epilepsy was more frequently observed in children with relapsing disease than monophasic disease (10/31 vs 2/43; odds ratio 9.8 (95% confidence interval (CI): 2.0-48.7); p = 0.003), in children who had positive intrathecal oligoclonal bands than those with negative bands (4/7 vs 4/30; odds ratio 8.7 (95% CI: 1.4-54.0); p = 0.027) and in children who had positive MOG-Ab than negative MOG-Ab cases (11/12 vs 39/62; odds ratio 6.5 (95% CI:0.8-53.6); p = 0.051). CONCLUSION:: A higher relapse rate and a greater risk of post-ADEM epilepsy in children with MOG-Ab-associated disease may indicate a chronic disease with immune-mediated seizures in these children.

Publication DOI: https://doi.org/10.1177/1352458518823486
Divisions: College of Health & Life Sciences
College of Engineering & Physical Sciences > School of Infrastructure and Sustainable Engineering > Engineering Systems and Supply Chain Management
Additional Information: © Sage 2019. The final publication is available via Sage at http://dx.doi.org/10.1177/1352458518823486
Uncontrolled Keywords: Acute disseminated encephalomyelitis,autoimmune epilepsy,myelin oligodendrocyte glycoprotein antibodies,neuromyelitis optica,Neurology,Clinical Neurology
Publication ISSN: 1477-0970
Last Modified: 19 Feb 2024 08:22
Date Deposited: 11 Mar 2019 12:54
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Related URLs: https://journal ... 352458518823486 (Publisher URL)
PURE Output Type: Article
Published Date: 2020-03-01
Published Online Date: 2019-02-07
Accepted Date: 2018-12-13
Authors: Rossor, Thomas
Benetou, Christina
Wright, Sukhvir (ORCID Profile 0000-0002-5464-3779)
Duignan, Sophie
Lascelles, Karine
Robinson, Robert
Das, Krishna
Ciccarelli, Olga
Wassmer, Evangeline
Hemingway, Cheryl
Lim, Ming
Hacohen, Yael



Version: Accepted Version

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