Document Detail

Acute fulminant demyelinating disease: a descriptive study of 60 patients.
MedLine Citation:
PMID:  17923626     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Acute demyelinating encephalomyelitis (ADEM) is characterized by a severe inflammatory attack, frequently secondary to infectious events or vaccinations. To date, no clear criteria exist for ADEM, and the risk of subsequent evolution to multiple sclerosis (MS) remains unknown. OBJECTIVE: To evaluate the risk of evolution to MS after a first episode of ADEM. DESIGN: Observational, retrospective case study. SETTING: Thirteen French MS centers. Patients We retrospectively studied 60 patients with ADEM who were older than 15 years with no history suggestive of an inflammatory event who presented to MS centers from January 1, 1995, through December 31, 2005. We excluded 6 patients with multiphasic ADEM because this is a rare condition and somewhat difficult to classify. After a mean follow-up of 3.1 years (range, 1-10 years), the remaining 54 patients were then classified into 2 groups: monophasic ADEM (ADEM group) (n = 35) and clinically definite MS (MS group) (n = 19). MAIN OUTCOME MEASURES: Clinical, laboratory, magnetic resonance imaging, and follow-up data were evaluated for each group. RESULTS: Patients in the ADEM group more frequently had atypical symptoms of MS (26 of 35 [74%]) than patients with MS (8 of 19 [42%]) (P = .02). Oligoclonal bands were more frequently observed in the MS group (16 of 19 [84%]) than in the ADEM group (7 of 35 [20%]) (P <.001). Patients in the ADEM group more frequently had gray matter involvement (21 of 35 [60%]) than those in the MS group (2 of 19 [11%]) (P <.001). On the basis of these results, we consider that the presence of any 2 of the following 3 criteria could be used to differentiate patients with ADEM from those with MS in our cohort: atypical clinical symptoms for MS, absence of oligoclonal bands, and gray matter involvement. On this basis, 29 of the 35 patients in the ADEM group (83%) and 18 of the 19 patients in the MS group (95%) were classified in the appropriate category. CONCLUSIONS: Our study found some differences concerning the risk of evolution to clinically definite MS after a first demyelinating episode suggestive of ADEM. These findings led us to propose criteria that should now be tested in a larger, prospective cohort study.
Jérôme de Seze; Marc Debouverie; Hélène Zephir; Christine Lebrun; Frédéric Blanc; Véronique Bourg; Sandrine Wiertlewski; Sophie Pittion; David Laplaud; Emmanuelle Le Page; Romain Deschamps; Philippe Cabre; Jean Pelletier; Irina Malikova; Pierre Clavelou; Valérie Jaillon; Gilles Defer; Pierre Labauge; Olivier Gout; Clotilde Boulay; Gilles Edan; Patrick Vermersch
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Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Archives of neurology     Volume:  64     ISSN:  0003-9942     ISO Abbreviation:  Arch. Neurol.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-09     Completed Date:  2007-11-20     Revised Date:  2008-07-15    
Medline Journal Info:
Nlm Unique ID:  0372436     Medline TA:  Arch Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1426-32     Citation Subset:  AIM; IM    
Departement de Neurologie, Hôpital Civil, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg CEDEX, France.
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MeSH Terms
Brain / pathology
Cohort Studies
Databases, Factual
Demyelinating Diseases / cerebrospinal fluid,  classification,  pathology*
Disease Progression
Magnetic Resonance Imaging
Middle Aged
Multiple Sclerosis / pathology
Retrospective Studies
Spinal Cord / pathology
Comment In:
Arch Neurol. 2008 May;65(5):675-6; author reply 676   [PMID:  18474750 ]
Arch Neurol. 2008 May;65(5):674; author reply 674-5   [PMID:  18474749 ]
Arch Neurol. 2008 May;65(5):676-7; author reply 677   [PMID:  18474751 ]

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