Acute fulminant demyelinating disease - A descriptive study of 60 patients
Acute fulminant demyelinating disease - A descriptive study of 60 patients
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DOI：
10.1001/archneur.64.10.1426
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发表时间：
2007-10-01
影响因子：
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通讯作者：
Vermersch, Patrick
中科院分区：
文献类型：
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作者：
de Seze, Jerome;Debouverie, Marc;Vermersch, Patrick
背景：急性脱髓鞘性脑脊髓炎（ADEM）的特点是严重的炎症发作，通常继发于感染事件或疫苗接种。迄今为止，对于ADEM没有明确的标准，并且随后演变为多发性硬化症（MS）的风险仍然未知。目的：评价首发ADEM发展为多发性硬化症的风险。设计：观察性、回顾性案例研究。设置：13个法国MS中心。患者：我们回顾性研究了从1995年1月1日至2005年12月31日在MS中心就诊的60例年龄大于15岁且无炎症病史的ADEM患者。我们排除了6例多相ADEM患者，因为这是一种罕见的情况，有些难以分类。平均随访3.1年（1 ~ 10年）后，将54例患者分为单相ADEM组（ADEM组）35例和临床明确型MS组（MS组）19例。主要观察指标：评估各组临床、实验室、磁共振成像和随访资料。结果：ADEM组患者出现MS非典型症状的频率（35例中26例[74%]）高于MS患者（19例中8例[42%]）（P= 0.02）。MS组（19例中有16例[84%]）比ADEM组（35例中有7例[20%]）更频繁地观察到寡克隆带(P
Background: Acute demyelinating encephalomyelitis (ADEM) is characterized by a severe inflammatory attack, frequently secondary to infectious events or vaccinations. To date, no clear criteria exist for ADEM, and the risk of subsequent evolution to multiple sclerosis (MS) remains unknown.Objective: To evaluate the risk of evolution to MS after a first episode of ADEM.Design: Observational, retrospective case study.Setting: Thirteen French MS centers.Patients: We retrospectively studied 60 patients with ADEM who were older than 15 years with no history suggestive of an inflammatory event who presented to MS centers from January 1, 1995, through December 31, 2005. We excluded 6 patients with multiphasic ADEM because this is a rare condition and somewhat difficult to classify. After a mean follow-up of 3.1 years (range, 1-10 years), the remaining 54 patients were then classified into 2 groups: monophasic ADEM(ADEM group) (n= 35) and clinically definite MS (MS group) (n= 19).Main Outcome Measures: Clinical, laboratory, magnetic resonance imaging, and follow-up data were evaluated for each group.Results: Patients in the ADEM group more frequently had atypical symptoms of MS ( 26 of 35 [74%]) than patients with MS ( 8 of 19 [42%]) ( P=.02). Oligoclonal bands were more frequently observed in the MS group ( 16 of 19 [84%]) than in the ADEM group ( 7 of 35 [20%]) (P