Editing Acute disseminated encephalomyelitis (section)

==Prognosis==
Full recovery is seen in 50 to 70% of cases, ranging to 70 to 90% recovery with some minor residual disability (typically assessed using measures such as [[Modified Rankin Scale|mRS]] or [[Expanded Disability Status Scale|EDSS]]), average time to recover is one to six months.<ref name="Menge_2007" /> The mortality rate may be as high as 5–10%.<ref name="Menge_2007" /><ref>{{cite journal | vauthors = Kamel MG, Nam NT, Han NH, El-Shabouny AE, Makram AM, Abd-Elhay FA, Dang TN, Hieu NL, Huong VT, Tung TH, Hirayama K, Huy NT | display-authors = 6 | title = Post-dengue acute disseminated encephalomyelitis: A case report and meta-analysis | journal = PLOS Neglected Tropical Diseases | volume = 11 | issue = 6 | pages = e0005715 | date = June 2017 | pmid = 28665957 | pmc = 5509372 | doi = 10.1371/journal.pntd.0005715 | doi-access = free }}</ref> Poorer outcomes are associated with unresponsiveness to steroid therapy, unusually severe neurological symptoms, or sudden onset. Children tend to have more favorable outcomes than adults, and cases presenting without fevers tend to have poorer outcomes. The latter effect may be due to either protective effects of fever, or that diagnosis and treatment is sought more rapidly when fever is present. <ref>{{cite journal | vauthors = Lin CH, Jeng JS, Hsieh ST, Yip PK, Wu RM | title = Acute disseminated encephalomyelitis: a follow-up study in Taiwan | journal = Journal of Neurology, Neurosurgery, and Psychiatry | volume = 78 | issue = 2 | pages = 162–67 | date = February 2007 | pmid = 17028121 | pmc = 2077670 | doi = 10.1136/jnnp.2005.084194 }}</ref>

ADEM can progress to MS. It will be considered MS if some lesions appear in different times and brain areas<ref>{{cite journal | vauthors = Malo-Pion C, Lambert R, Décarie JC, Turpin S | title = Imaging of Acquired Demyelinating Syndrome With 18F-FDG PET/CT | journal = Clinical Nuclear Medicine | volume = 43 | issue = 2 | pages = 103–05 | date = February 2018 | pmid = 29215409 | doi = 10.1097/RLU.0000000000001916 }}</ref>

===Motor deficits===
Residual motor deficits are estimated to remain in about 8 to 30% of cases, the range in severity from mild clumsiness to [[ataxia]] and [[hemiparesis]].<ref name="Tenembaum_2007" />

===Neurocognitive===
Patients with demyelinating illnesses, such as MS, have shown cognitive deficits even when there is minimal physical disability.<ref>{{cite journal | vauthors = Foong J, Rozewicz L, Quaghebeur G, Davie CA, Kartsounis LD, Thompson AJ, Miller DH, Ron MA | display-authors = 6 | title = Executive function in multiple sclerosis. The role of frontal lobe pathology | journal = Brain | volume = 120 | issue = 1 | pages = 15–26 | date = January 1997 | pmid = 9055794 | doi = 10.1093/brain/120.1.15 | doi-access = free }}</ref> Research suggests that similar effects are seen after ADEM, but that the deficits are less severe than those seen in MS. A study of six children with ADEM (mean age at presentation 7.7 years) were tested for a range of neurocognitive tests after an average of 3.5 years of recovery.<ref>{{cite journal | vauthors = Hahn CD, Miles BS, MacGregor DL, Blaser SI, Banwell BL, Hetherington CR | title = Neurocognitive outcome after acute disseminated encephalomyelitis | journal = Pediatric Neurology | volume = 29 | issue = 2 | pages = 117–23 | date = August 2003 | pmid = 14580654 | doi = 10.1016/S0887-8994(03)00143-7 }}</ref> All six children performed in the normal range on most tests, including [[Wechsler Adult Intelligence Scale#Verbal Subtests|verbal IQ]] and [[Wechsler Adult Intelligence Scale#Performance Subtests|performance IQ]], but performed at least one [[standard deviation]] below age norms in at least one cognitive domain, such as complex attention (one child), [[Wechsler Adult Intelligence Scale#Working memory|short-term memory]] (one child) and internalizing behaviour/[[Affect (psychology)|affect]] (two children). Group means for each cognitive domain were all within one standard deviation of age norms, demonstrating that, as a group, they were normal. These deficits were less severe than those seen in similar aged children with a diagnosis of MS.<ref>{{cite journal | vauthors = Banwell BL, Anderson PE | title = The cognitive burden of multiple sclerosis in children | journal = Neurology | volume = 64 | issue = 5 | pages = 891–94 | date = March 2005 | pmid = 15753431 | doi = 10.1212/01.WNL.0000152896.35341.51 | s2cid = 6532050 }}</ref>

Another study compared nineteen children with a history of ADEM, of which 10 were five years of age or younger at the time (average age 3.8 years old, tested an average of 3.9 years later) and nine were older (mean age 7.7y at time of ADEM, tested an average of 2.2 years later) to nineteen matched controls.<ref>{{cite journal | vauthors = Jacobs RK, Anderson VA, Neale JL, Shield LK, Kornberg AJ | title = Neuropsychological outcome after acute disseminated encephalomyelitis: impact of age at illness onset | journal = Pediatric Neurology | volume = 31 | issue = 3 | pages = 191–97 | date = September 2004 | pmid = 15351018 | doi = 10.1016/j.pediatrneurol.2004.03.008 }}</ref> Scores on IQ tests and educational achievement were lower for the young onset ADEM group (average IQ 90) compared to the late onset (average IQ 100) and control groups (average IQ 106), while the late onset ADEM children scored lower on verbal processing speed. Again, all groups means were within one standard deviation of the controls, meaning that while effects were statistically reliable, the children were as a whole, still within the normal range. There were also more behavioural problems in the early onset group, although there is some suggestion that this may be due, at least in part, to the stress of hospitalization at a young age.<ref>{{cite journal | vauthors = Douglas JW | title = Early hospital admissions and later disturbances of behaviour and learning | journal = Developmental Medicine and Child Neurology | volume = 17 | issue = 4 | pages = 456–80 | date = August 1975 | pmid = 1158052 | doi = 10.1111/j.1469-8749.1975.tb03497.x | s2cid = 19270009 }}</ref><ref>{{cite journal | vauthors = Daviss WB, Racusin R, Fleischer A, Mooney D, Ford JD, McHugo GJ | title = Acute stress disorder symptomatology during hospitalization for pediatric injury | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 39 | issue = 5 | pages = 569–75 | date = May 2000 | pmid = 10802974 | doi = 10.1097/00004583-200005000-00010 }}</ref>