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

Thomas Rossor, Christina Benetou, Sukhvir Wright, Sophie Duignan, Karine Lascelles, Robert Robinson, Krishna Das, Olga Ciccarelli, Evangeline Wassmer, Cheryl Hemingway, Ming Lim, Yael Hacohen

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish
JournalMultiple Sclerosis Journal
Early online date7 Feb 2019
DOIs
Publication statusE-pub ahead of print - 7 Feb 2019

Bibliographical note

© Sage 2019. The final publication is available via Sage at http://dx.doi.org/10.1177/1352458518823486

Keywords

  • Acute disseminated encephalomyelitis
  • autoimmune epilepsy
  • myelin oligodendrocyte glycoprotein antibodies
  • neuromyelitis optica

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