J Pediatr. 2004 Feb;144(2):246-52
Mikaeloff Y, Suissa S, Vallee L, Lubetzki C, Ponsot G, Confavreux C,
Tardieu M, Kidmus Study Group.
Service de Neurologie Pediatrique, Hopital Roger Salengro, Lille, France.
OBJECTIVES:
To evaluate prognostic factors for second attack and for disability in children presenting with an initial episode of central nervous system (CNS) demyelination.
STUDY DESIGN:
A cohort of 296 children having a first episode of acute CNS inflammatory demyelination was studied by survival analysis.
RESULTS:
The average follow-up was 2.9+/-3 years.
At the end of the follow-up, 57% of patients had a diagnosis of multiple sclerosis (MS), 29% had a monophasic acute disseminated encephalomyelitis, and 14% had a single focal episode.
The rate of a second attack was (1) higher in patients with age at onset >/=10 years (hazard ratio, 1.67; 95% CI, 1.04-2.67), MS-suggestive initial MRI (1.54; 1.02-2.33), or optic nerve lesion (2.59; 1.27-5.29); and (2) lower in patients with myelitis (0.23; 0.10-0.56) or mental status change (0.59; 0.33-1.07).
Of patients with a second attack, 29% had an initial diagnosis of acute disseminated encephalomyelitis.
At the end of the follow-up period, 90% of patients had no or minor disability.
Occurrence of severe disability was associated with a polysymptomatic onset (3.25; 1.16-11.01), sequelae after the first attack (26.65; 9.42-75.35), further relapses (1.49; 1.16-1.92), and progressive MS (3.57; 1.21-8.72).
CONCLUSIONS:
Risk of second attack of CNS demyelination is higher in older patients and lower in patients with mental status change.
Risk of disability is higher in polysymptomatic and relapsing patients.