First episode of acute CNS inflammatory demyelination in childhood: prognostic factors for multiple sclerosis and disability - 24/08/11
, Samy Suissa, PhD, Louis Vallée, MD, Catherine Lubetzki, MD, Gérard Ponsot, MD, Christian Confavreux, MD, Marc Tardieu, MD, KIDMUS Study Group 
Reprint requests: Dr Yann Mikaeloff, Service de Neurologie Pédiatrique, Centre Hospitalier Universitaire d'Angers, 4, rue Larrey, 49033 Angers Cedex 01, France.Abstract |
Objectives |
To evaluate prognostic factors for second attack and for disability in children presenting with an initial episode of central nervous system (CNS) demyelination.
Study design |
A cohort of 296 children having a first episode of acute CNS inflammatory demyelination was studied by survival analysis.
Results |
The average follow-up was 2.9±3 years. At the end of the follow-up, 57% of patients had a diagnosis of multiple sclerosis (MS), 29% had a monophasic acute disseminated encephalomyelitis, and 14% had a single focal episode. The rate of a second attack was (1) higher in patients with age at onset ≥10 years (hazard ratio, 1.67; 95% CI, 1.04-2.67), MS-suggestive initial MRI (1.54; 1.02-2.33), or optic nerve lesion (2.59; 1.27-5.29); and (2) lower in patients with myelitis (0.23; 0.10-0.56) or mental status change (0.59; 0.33-1.07). Of patients with a second attack, 29% had an initial diagnosis of acute disseminated encephalomyelitis. At the end of the follow-up period, 90% of patients had no or minor disability. Occurrence of severe disability was associated with a polysymptomatic onset (3.25; 1.16-11.01), sequelae after the first attack (26.65; 9.42-75.35), further relapses (1.49; 1.16-1.92), and progressive MS (3.57; 1.21-8.72).
Conclusions |
Risk of second attack of CNS demyelination is higher in older patients and lower in patients with mental status change. Risk of disability is higher in polysymptomatic and relapsing patients.
Le texte complet de cet article est disponible en PDF.Abbreviations : ADEM, CNS, DSS, MRI, MS
Plan
 | Supported by grants from the Association pour la Recherche sur la Sclérose En Plaques (ARSEP, France). S. Suissa is the recipient of a Distinguished Senior Scientist award from the Canadian Institute of Health Research (CIHR). |
Vol 144 - N° 2
P. 246-252 - février 2004 Retour au numéro
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