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Introduction: Acute disseminatedencephalomyelitis (ADEM) is an immune-mediated inflammatory and demyelinating conditionof the central nervous system (CNS) that occurs mainly in the pediatric population. The diagnostic criteria for the disorder include multifocal clinical and neuroimaging findings associated with encephalopathy.  The disorder usually has a monophasic course, but multiphasic and recurrent cases have been reported in the literature, following the International Pediatric Multiple Sclerosis Study Group Consensus definitions published in 2007.  In this study, we aimed to recognize clinical,neuroradiological, and cerebrospinal fluid findings present at the initial event of ADEM, which may represent possible predictive factors of relapses that may predispose these children to develop recurrent or multiphasic ADEM forms.  Methods: A retrospective observational study was performed which was based on the definitions proposedby the International Pediatric Multiple Sclerosis Study Group in 2007.  Thirteen subjects were included in the study. Results: Seven children had a mild encephalopathy at the first event. Eleven patients had supratentorial and infratentorial lesions, and in six of the patients, the lesions were greater than 1 cm.  In our study, seven of the thirteen patients with ADEM went on to relapse. Six of these patients developed multiphasic ADEM, and one patient developed the recurrent form of ADEM. Discussion: In the study sample, no clear predictive factors forADEM relapse were found among the clinical, neuroradiological and cerebrospinal fluid findings.  Therefore, more studies are needed to characterize the possible underlying risk factors that may predispose patients with ADEM to develop relapses of the condition.

Acute disseminated encephalomyelitis