Contributions
Abstract: 62
Type: Scientific Session
Abstract Category: Clinical aspects of MS - Paediatric MS
Objective: To explore clinical features and investigations at first presentation with acute disseminated encephalomyelitis (ADEM) that may predict future relapse, or the development of post-ADEM epilepsy (PAE).
Methods: Children presenting with ADEM were identified from three tertiary paediatric neurology centres between 2005-017 and case notes reviewed. Myelin Oligodendrocyte Glycoprotein antibody (MOG-Ab) were tested as part of the clinical evaluation. Patients were followed-up for a median of 5 years (range 2-16 years).
A relapse was defined as an acute or subacute episode of new or increasing neurological dysfunction followed by a full or partial recovery, in the absence of fever or infection. PAE was defined as seizures requiring treatment with an anti-epileptic drug two years after first presentation, excluding those with a recognizable epilepsy syndrome.
Comparisons of groups were made using χ2 test for binomial variables, and Mann-Whitney U-test for continuous variables. Potential clinical predictors of subsequent neurological events that achieved significance at the 0.1 level were entered into a multivariable logistic regression model.
Results: 74 children were identified. 16/74 (22%) children had seizures during the acute presentation. MOG-Ab was positive in 50 (67.6%) of cases. 31(41.8%) children went on to have a further neurological relapse.
MOG-Ab was more frequently positive in the relapsing group (27/31 vs 23/43; odds ratio 5.9 (95% CI 1.8-19.7); p=0.002). There was a trend towards seizures at onset being more frequent in the relapsing group than those with monophasic disease (10/31 vs 6/43; odds ratio 2.9 (95% CI: 0.9-9.2); p=0.06).
A diagnosis of PAE was reported in 12/73(15.1%). Children with seizures at first presentation were more likely to develop PAE (odds ratio 5.2 (95% CI 1.4-19.4; p=0.01)). PAE was more frequently observed in in those with relapsing disease (10/31 vs 2/43; odds ratio 9.8 (95% CI: 2.0-48.7); p=0.001), intrathecal oligoclonal bands (OCB) (odds ratio 8.7 (95% CI: 1.4-54.0); p=0.01) and MOG-Ab (11/12 vs 39/62; odds ratio 6.5 (95% CI:0.8-53.6); p=0.05).
Multivariable logistic regression identified MOG-Ab as predictor of subsequent neurological relapse and seizures at onset, and positive OCB as predictors of PAA
Conclusion: Patients with ADEM who were MOG antibody positive and/or had OCB were more likely to develop relapsing disease and/or epilepsy. These findings have both diagnostic and treatment implications.
Disclosure: Thomas Rossor: Nothing to disclose; Christina Benetou: Nothing to disclose; Sukhvir Wright: Nothing to disclose; Sophie Duignan: Nothing to disclose; Karine Lascelles: Nothing to disclose; Robert Robinson: Nothing to disclose; Krishna Das: Nothing to disclose; Olga Ciccarelli: Nothing to disclose; Evangeline Wassmer: Nothing to disclose; Cheryl Hemingway: Nothing to disclose; Ming Lim: Nothing to disclose; Yael Hacohen: Nothing to disclose
Abstract: 62
Type: Scientific Session
Abstract Category: Clinical aspects of MS - Paediatric MS
Objective: To explore clinical features and investigations at first presentation with acute disseminated encephalomyelitis (ADEM) that may predict future relapse, or the development of post-ADEM epilepsy (PAE).
Methods: Children presenting with ADEM were identified from three tertiary paediatric neurology centres between 2005-017 and case notes reviewed. Myelin Oligodendrocyte Glycoprotein antibody (MOG-Ab) were tested as part of the clinical evaluation. Patients were followed-up for a median of 5 years (range 2-16 years).
A relapse was defined as an acute or subacute episode of new or increasing neurological dysfunction followed by a full or partial recovery, in the absence of fever or infection. PAE was defined as seizures requiring treatment with an anti-epileptic drug two years after first presentation, excluding those with a recognizable epilepsy syndrome.
Comparisons of groups were made using χ2 test for binomial variables, and Mann-Whitney U-test for continuous variables. Potential clinical predictors of subsequent neurological events that achieved significance at the 0.1 level were entered into a multivariable logistic regression model.
Results: 74 children were identified. 16/74 (22%) children had seizures during the acute presentation. MOG-Ab was positive in 50 (67.6%) of cases. 31(41.8%) children went on to have a further neurological relapse.
MOG-Ab was more frequently positive in the relapsing group (27/31 vs 23/43; odds ratio 5.9 (95% CI 1.8-19.7); p=0.002). There was a trend towards seizures at onset being more frequent in the relapsing group than those with monophasic disease (10/31 vs 6/43; odds ratio 2.9 (95% CI: 0.9-9.2); p=0.06).
A diagnosis of PAE was reported in 12/73(15.1%). Children with seizures at first presentation were more likely to develop PAE (odds ratio 5.2 (95% CI 1.4-19.4; p=0.01)). PAE was more frequently observed in in those with relapsing disease (10/31 vs 2/43; odds ratio 9.8 (95% CI: 2.0-48.7); p=0.001), intrathecal oligoclonal bands (OCB) (odds ratio 8.7 (95% CI: 1.4-54.0); p=0.01) and MOG-Ab (11/12 vs 39/62; odds ratio 6.5 (95% CI:0.8-53.6); p=0.05).
Multivariable logistic regression identified MOG-Ab as predictor of subsequent neurological relapse and seizures at onset, and positive OCB as predictors of PAA
Conclusion: Patients with ADEM who were MOG antibody positive and/or had OCB were more likely to develop relapsing disease and/or epilepsy. These findings have both diagnostic and treatment implications.
Disclosure: Thomas Rossor: Nothing to disclose; Christina Benetou: Nothing to disclose; Sukhvir Wright: Nothing to disclose; Sophie Duignan: Nothing to disclose; Karine Lascelles: Nothing to disclose; Robert Robinson: Nothing to disclose; Krishna Das: Nothing to disclose; Olga Ciccarelli: Nothing to disclose; Evangeline Wassmer: Nothing to disclose; Cheryl Hemingway: Nothing to disclose; Ming Lim: Nothing to disclose; Yael Hacohen: Nothing to disclose