What is the risk for multiple sclerosis (MS) following a bout of acute disseminated encephalomyelitis (ADEM)?

Updated: Nov 08, 2018
  • Author: J Nicholas Brenton, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

In the authors' experience, the risk for MS for children who have had a single prepubertal bout of ADEM is less than 6%.

  • A single study looking at prognostic factors associated with relapse after ADEM included the presence of optic neuritis, family history of CNS inflammatory demyelination, meeting Barkhof MS criteria on MRI, and the absence of neurologic sequelae after the initial attack of ADEM. [71]

  • Consensus guidelines consider relapsing disease following ADEM occurring beyond a second encephalopathic event more suggestive of a chronic disorder, and entities such as MS and NMO need to be considered. [59]

  • Rare vasculitic or inflammatory processes that must be diagnosed by biopsy of brain tissue or other organs (eg, CNS vasculitis, hypersensitivity vasculitides, sarcoidosis, histiocytic lymphogranulomatosis) should also be considered.


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