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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Recovery From Central Nervous System Acute Demyelination in Children

Julia O’Mahony, Ruth Ann Marrie, Audrey Laporte, E. Ann Yeh, Amit Bar-Or, Cathy Phan, David Buckley, David Callen, Mary B. Connolly, Daniela Pohl, Marie-Emmanuelle Dilenge, Geneviève Bernard, Anne Lortie, Noel Lowry, E. Athen MacDonald, David Meek, Guillaume Sébire, Sunita Venkateswaran, Ellen Wood, Jerome Yager and Brenda Banwell
Pediatrics July 2015, 136 (1) e115-e123; DOI: https://doi.org/10.1542/peds.2015-0028
Julia O’Mahony
aInstitute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
bThe Hospital for Sick Children, Toronto, Ontario, Canada;
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Ruth Ann Marrie
cDepartment of Internal Medicine, Winnipeg Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada;
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Audrey Laporte
aInstitute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada;
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E. Ann Yeh
dDivision of Neurology, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada;
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Amit Bar-Or
eNeuroimmunology Unit, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada;
fExperimental Therapeutics Program, Montreal Neurologic Institute and Hospital, McGill University, Montreal, Quebec, Canada;
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Cathy Phan
bThe Hospital for Sick Children, Toronto, Ontario, Canada;
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David Buckley
gJaneway Children’s Health and Rehabilitation Centre, St John’s, Newfoundland, Canada;
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David Callen
hDepartment of Pediatrics, McMaster University, Hamilton, Ontario, Canada;
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Mary B. Connolly
iDepartment of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada;
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Daniela Pohl
jDepartment of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada;
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Marie-Emmanuelle Dilenge
kDepartment of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada;
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Geneviève Bernard
kDepartment of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada;
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Anne Lortie
lDepartment of Pediatrics, Université de Montreal, Montreal, Quebec, Canada;
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Noel Lowry
mDepartment of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada;
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E. Athen MacDonald
nDepartment of Pediatrics, Queen’s University, Kingston, Ontario, Canada;
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David Meek
oDepartment of Pediatrics, Saint John Regional Hospital, Saint John, New Brunswick, Canada;
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Guillaume Sébire
kDepartment of Pediatrics, Montreal Children’s Hospital, Montreal, Quebec, Canada;
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Sunita Venkateswaran
jDepartment of Pediatrics, Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada;
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Ellen Wood
pDepartment of Pediatrics, IWK Health Centre, Halifax, Nova Scotia, Canada;
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Jerome Yager
qDepartment of Pediatrics, Stollery Children’s Hospital, Edmonton, Alberta, Canada; and
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Brenda Banwell
bThe Hospital for Sick Children, Toronto, Ontario, Canada;
rThe Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Abstract

BACKGROUND: Few prospective studies have systematically evaluated the extent of recovery from incident acquired demyelinating syndromes (ADS) of the central nervous system in children.

METHODS: In a national cohort study of pediatric ADS, severity of the incident attack and extent of recovery by 12 months were evaluated. Annual evaluations were used to determine current diagnoses (monophasic ADS or multiple sclerosis [MS]) and new deficits.

RESULTS: Of 283 children, 244 (86%) required hospitalization for a median (interquartile range [IQR]) of 6 (3–10) days, and 184 had moderate or severe deficits; 41 children were profoundly encephalopathic, 129 were unable to ambulate independently, and 59 with optic neuritis (ON) had moderately or severely impaired vision. Those with transverse myelitis (TM) and patients with monophasic disease were more likely to have moderate or severe deficits at onset. Twenty-seven children (10%) did not experience full neurologic recovery from their incident attack; 12 have severe residual deficits. Monophasic illness, TM, and moderate or severe deficits at onset were associated with poor recovery. After a median (IQR) follow-up of 5.06 (3.41–6.97) years, 59 children (21%) were diagnosed with MS; all recovered fully from their incident ADS attacks, although 6 subsequently acquired irreversible deficits after a median (IQR) observation period of 5.93 (4.01–7.02) years.

CONCLUSIONS: ADS is a serious illness, with 86% of affected Canadian children requiring hospitalization. More than 90% of children recovered physically from their ADS event, including those children experiencing onset of MS. However, permanent visual or spinal cord impairment occurred in some children with ON or TM.

  • Accepted March 31, 2015.
  • Copyright © 2015 by the American Academy of Pediatrics

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1 Jul 2015
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Recovery From Central Nervous System Acute Demyelination in Children
Julia O’Mahony, Ruth Ann Marrie, Audrey Laporte, E. Ann Yeh, Amit Bar-Or, Cathy Phan, David Buckley, David Callen, Mary B. Connolly, Daniela Pohl, Marie-Emmanuelle Dilenge, Geneviève Bernard, Anne Lortie, Noel Lowry, E. Athen MacDonald, David Meek, Guillaume Sébire, Sunita Venkateswaran, Ellen Wood, Jerome Yager, Brenda Banwell
Pediatrics Jul 2015, 136 (1) e115-e123; DOI: 10.1542/peds.2015-0028

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Recovery From Central Nervous System Acute Demyelination in Children
Julia O’Mahony, Ruth Ann Marrie, Audrey Laporte, E. Ann Yeh, Amit Bar-Or, Cathy Phan, David Buckley, David Callen, Mary B. Connolly, Daniela Pohl, Marie-Emmanuelle Dilenge, Geneviève Bernard, Anne Lortie, Noel Lowry, E. Athen MacDonald, David Meek, Guillaume Sébire, Sunita Venkateswaran, Ellen Wood, Jerome Yager, Brenda Banwell
Pediatrics Jul 2015, 136 (1) e115-e123; DOI: 10.1542/peds.2015-0028
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