Predicting relapse in demyelinating diseases in children

Abstract

Introduction. Predicting relapse in acute demyelinating episode (ADE) in children is an urgent problem, since progressive demyelinating diseases are associated with the risk of disability and cognitive impairment.Methods. Descriptive cohort study. The results of long-term follow-up of 75 children after the first episode of demyelination are presented. Based on the clinical and radiological parameters of the first demyelinating event, the prognostic factors for the relapse in children were determined using the logistic regression method.Results. When comparing the clinical and instrumental signs of the first demyelinating event, we identified those that were significantly associated with relapse. These included age ≥ 11 years (p <0.001), brain stem symptoms (p = 0.002), multiple demyelinating lesions on brain magnetic resonance imaging (p = 0.001) periventricular (p = 0.002), subcortical (p = 0.001), brainstem lesions (p = 0.006), well-defined lesions (p = 0.03) and perpendicular to the corpus callosum lesions (p = 0.002), cervical spinal cord lesions (p = 0, 02) and lateralized spinal cord lesions (p = 0.02). Regression analysis showed independent risk factors for relapse in children with demyelinating diseases: age ≥ 11 years (OR = 1.34, 95% CI (1.11: 1.61), p = 0.003), brain stem symptoms (OR = 7.00, 95% CI (0.73: 67.25, p = 0.09), multiple CNS lesions, corresponding to the criteria for dissemination by McDonald (2010) (OR = 8.60, 95% CI (2, 24: 33.07), p = 0.002).Discussion. Existing descriptions of pediatric populations with demyelinating diseases often have short follow-up and focus on outcomes in multiple sclerosis and neuromyelitis optica. The article presents data on previously unexplored risk factors for exacerbation after the first episode of demyelination. Conclusion. The identified predictors of relapse in ADE in children are a simple and generally available tool for predicting the course of demyelinating diseases.