Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis

Abstract

The long-term neurocognitive prognosis of childhood onset acute disseminated encephalomyelitis (ADEM) is unclear. This review and quantitative synthesis of the available literature examined whether there are long-term impacts of childhood ADEM on neurocognitive functioning. A search of online databases (MEDLINE, EMBASE, EBSCO CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews) from their inception to October 2015 and reference lists identified 13 papers eligible for inclusion in the systematic review; seven of these were eligible for inclusion in meta-analyses. The systematic review indicated that, at a group level there is a positive long-term neuropsychological outcome from childhood onset ADEM. However, despite the apparent absence of long-term negative impacts of ADEM at a group level, at an individual level impairments in the areas of IQ, attention, executive functioning, processing speed, learning and memory, visuospatial skills and internalising symptoms were found in up to 43% of patients when aggregated across the studies. No significant negative effect of ADEM for any of the neuropsychological domains examined was found in meta-analyses. However, the effects for Processing Speed (r = -0.296 (CI 95% = -0.605-0.013)) and Internalising symptoms (r = 0.242 (CI 95% = -0.014-0.564)) approached significance (p = 0.06), suggesting a trend towards ADEM leading to long-term reduced processing speed and elevated internalising symptoms. Together, our findings suggest that despite a generally positive neurocognitive outcome post childhood ADEM there are a subset of individuals who can suffer from ongoing specific cognitive impairments. Clinical implications and research priorities are discussed.

Clinical time course of pediatric acute disseminated encephalomyelitis

“…Our results are consistent with those of previous studies and support findings that the outcome of pediatric ADEM was more favorable than that of pediatric multifocal CIS [3,11,22,23]. On the other hand, other recent studies showed that there are lasting neurocognitive and psychosocial deficits including ADHD and epilepsy in pediatric ADEM, and even children who were considered to have fully recovered at discharge may be affected [17,24,25]. Our study also included two patients with ADHD or epilepsy, despite them achieving full recovery in the acute phase.…”

“…3) abnormal lesions may not be identified on initial MRI, and 4) more than half of the patients have a rapid response to high-dose mPSL, will be useful for clinical management of pediatric ADEM. Sequelae at discharge (25) Motor paralysis (13) Cognitive dysfunction…”

Acute Disseminated Encephalomyelitis with Seizures and Myocarditis: A Fatal Triad

“…A recent metaanalysis described an overall good long-term outcome after ADEM [6]. Nevertheless, fever on admission, ventilator-associated pneumonia, and meningism, as seen in our patient, seem to be associated with a poor outcome [7].…”

Autoimmune Neurologic Diseases in Children

“…It appears that though most children appear to lack long-term sequela, some children suffer from ongoing neurocognitive deficits. 43 A subset of children who present with clinical demyelinating attacks has been found to have antibodies which bind myelin oligodendrocyte glycoprotein (MOG). In a cohort of 19 children with ADEM and 28 with clinically isolated syndrome, 19 (40%) were found to have anti-MOG antibodies.…”