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J Neurol. 2017 Aug;264(8):1754-1762. doi: 10.1007/s00415-017-8563-3. Epub 2017 Jul 10.

Acute disseminated encephalomyelitis: prognostic value of early follow-up brain MRI.

Author information

1
Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA.
2
Academic Medical Center - University of Amsterdam, Amsterdam, The Netherlands.
3
Group in Biostatistics, University of California, Berkeley, Berkeley, CA, USA.
4
Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
5
Department of Radiology, Brigham and Women's Hospital, Boston, MA, USA.
6
Harvard Medical School, Boston, MA, USA.
7
Department of Neurology, Massachusetts General Hospital, 165 Cambridge Street, #627, Boston, MA, 02114, USA. fmateen@partners.org.
8
Harvard Medical School, Boston, MA, USA. fmateen@partners.org.

Abstract

Patients with acute disseminated encephalomyelitis (ADEM) are presumed to have radiological monophasic disease, but this is uncertain since follow-up brain MRI is not routinely performed. We aimed to ascertain combined radiological and clinical monophasic disease in ADEM patients and to assess whether performing early (<6 months) follow-up brain MRI has prognostic value for subsequent multiphasic disease. We retrospectively studied the medical records of patients initially diagnosed with ADEM (years 2000-2014) at the Massachusetts General Hospital, USA. A neuroimaging specialist, masked to clinical events, reviewed all available brain MRIs. We included 62 patients (25 male; 30 pediatric; median clinical follow-up 3 years) and classified them into two subgroups: (1) clinically monophasic (no new, recurrent or worsening neurological symptoms >3 months after onset) (n = 45), and (2) clinically multiphasic (clinical relapse >3 months after onset) (n = 17). All clinically monophasic patients with brain MRI follow-up (n = 30) also had radiological monophasic disease a median of 2 years after ADEM onset. New lesions (58 vs. 14%) and persistent lesions (100 vs. 18%) on early brain MRI [available in 40 patients (65%)], as well as clinical flares (53 vs. 20%), were more common in clinically multiphasic versus monophasic patients. These early follow-up data allowed us to predict multiphasic disease with reasonable accuracy in a multivariable model (AUC = 0.73). We conclude that performing early follow-up brain MRI routinely in ADEM patients would aid clinicians in predicting multiphasic disease and may stratify patients who would benefit from initiation of disease-modifying therapy for multiple sclerosis.

KEYWORDS:

Acute disseminated encephalomyelitis; MRI; Multiple sclerosis; No evidence of disease activity (NEDA); Prognostic factors

PMID:
28695361
DOI:
10.1007/s00415-017-8563-3
[Indexed for MEDLINE]

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