Acute Disseminated Encephalomyelitis and Multiple Sclerosis in Children [Article in Bosnian]

Osman Sinanović, Adnan Burina

Abstract

Acute disseminated encephalomyelitis (ADEM) is a monophasic, immuno-mediated disease with multifocal demyelinated lesions in the central nervous system (CNS). However, the course of disease could be with multiple sclerosis (MS)-like relapses. ADEM is a childhood disease (children 10 years of age and younger) and could be the first phase of MS in 25% or more children. Onset of the disease is acute. The clinical picture depends on the intensity of the process itself, and the parts of the CNS affected. It correlates with an infectious syndrome affecting the menings and different parts of the brain and spinal cord. Prognosis is very uncertain, and the disease is lethal in 1/3 of cases. MS is a chronic inflammatory, non-contagious, progressive multifocal demyelinated, autoimmune disease of the CNS (white matter of the brain and spinal cord) with many and various neurological symptoms. In 85-90% of cases the symptoms come and go in "attacks" (exacerbations and remissions), or slowly progress over time. The cause and pathogenesis of MS still is not well known. Inheritance could have an important possible precipitating role. The pathogenesis of MS includes inflammation, demyelinisation and axonloss. Although demyelinisation could generate relapse, long-term disability is primarily due to irreversible loss of axons and cell death. MS is most frequent in patients 30 to 40 years of age, although it can be seen prior and after this age range. Childhood onset is reported in 3-5% of cases. It is estimated that 2.5% to 5% of all MS patients experience the first MS "attack" before 16 years of age. Onset before the age of 10 occurs in only 0.2% cases. Diagnosis of ADEM and/or MS is based on cerebrospinal liquor analysis, brain evoked potentials (EP's), and magnetic resonance imaging (MRI) of the brain and spinal cord. Computed tomography (CT) of the brain could be useful, not to diagnose MS but to exclude some other brain disorders (tumors, stroke etc.). Recently, for secure diagnose of MS revised McDonald's criteria for MS are used. Patients with ADEM are treated with anti-inflammatory medications (corticosteroids) and immunosuppressive therapy administered in the same manner as in MS. Interferon β (1a, 1b), as well as glatiramer acetate are used to slow the progress of MS.

Keywords

Acute disseminated encephalomyelitis; Multiple sclerosis; Childhood

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