Clinical comparative analysis of monophasic and multiphasic acute disseminated encephalomyelitis in adults
Wei-Zhou Zang 1,   Hong Yang 1, 2,   Dan Li 1,   Zheng-Da Zhao 1,   Ya-Jing Sun 1,   Ming-Rong Xia 1,   Shan Jiang 1,   Jie-Wen Zhang 1
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Department of Neurology, Henan Provincial People’s Hospital, Zhengzhou, China
Department of Neurology, Institute of Graduate School, Xinxiang Medical College, Xinxiang, China
Submission date: 2019-04-03
Final revision date: 2019-09-03
Acceptance date: 2019-09-06
Online publication date: 2020-10-13
This study aims to explore the clinical features and prognostic factors for relapse of acute disseminated encephalomyelitis (ADEM) in adults.

Material and methods:
56 patients with ADEM were retrospectively analyzed. The epidemiological characteristics, clinical manifestations, laboratory features, magnetic resonance imaging (MRI), treatment and prognosis data of these patients were analyzed using the χ2 test for categorical variables and Mann-Whitney U-test for continuous variables. Then, the clinical characteristics and recurrence factors were summarized.

56 patients with ADEM, based on the criteria of the International Pediatric Multiple Sclerosis Study Group, were recruited to the study. Among these patients, 31 were male and 25 were female. Furthermore, 13 patients had multiphasic ADEM, and 29 patients (52%) had definite incentive factors before onset. The commonest presenting symptoms and signs were fever (36%), disturbance of consciousness (52%), mental disorder (38%), seizure (14%), headache and dizziness (43%), optic neuritis (34%), autonomic nervous system symptoms (43%), limb paralysis or abnormal sensation (73%), and unilateral or bilateral pyramidal tract signs (48%). Inflammatory changes in the cerebrospinal fluid were prominent. MRI T2-weighted and fluid-attenuated inversion recovery images displayed multiple or large flaky high signals, and the lesions were usually different in the number and distribution of these lesions. Intravenous corticosteroids and/or immunoglobulin were still important treatments in the acute phase. After treatment, 38 patients completely recovered, 9 patients had neurologic deficits, and 9 patients died.

ADEM in adults is not uncommon, its clinical features are complex and varied, and some of these are multiphasic. There may be some potential clinical predictors at first onset.