Monophasic demyelination reduces brain growth in children
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Abstract
Objective: To investigate how monophasic acquired demyelinating syndromes (ADS) affect age-expected brain growth over time.
Methods: We analyzed 83 pediatric patients imaged serially from initial demyelinating attack: 18 with acute disseminated encephalomyelitis (ADEM) and 65 with other monophasic ADS presentations (monoADS). We further subdivided the monoADS group by the presence (n = 33; monoADSlesion) or absence (n = 32; monoADSnolesion) of T2 lesions involving the brain at onset. We used normative data to compare brain volumes and calculate age- and sex-specific z scores, and used mixed-effect models to investigate their relationship with time from demyelinating illness.
Results: Children with monophasic demyelination (ADEM, non-ADEM with brain lesions, and those without brain involvement) demonstrated reduced age-expected brain growth on serial images, driven by reduced age-expected white matter growth. Cortical gray matter volumes were not reduced at onset but demonstrated reduced age-expected growth afterwards in all groups. Brain volumes differed from age- and sex-expected values to the greatest extent in children with ADEM. All patient groups failed to recover age-expected brain growth trajectories.
Conclusions: Brain volume, and more importantly age-expected brain growth, is negatively affected by acquired demyelination, even in the absence of chronicity, implicating factors other than active inflammation as operative in this process.
GLOSSARY
- ADEM=
- acute disseminated encephalomyelitis;
- ADS=
- acquired demyelinating syndrome;
- GM=
- gray matter;
- monoADS=
- monophasic acquired demyelinating syndrome;
- MS=
- multiple sclerosis;
- NC=
- normally developing control;
- NIHPD=
- NIH pediatric database;
- NMO=
- neuromyelitis optica;
- WM=
- white matter
Footnotes
Coinvestigators are listed at Neurology.org.
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Supplemental data at Neurology.org
Editorial, page 1691
- Received June 10, 2016.
- Accepted in final form January 23, 2017.
- © 2017 American Academy of Neurology
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