Highlights
- •Data on pediatric acquired demyelinating syndromes (PADS) in the Philippines is lacking.
- •A total of 77 patients with PADS were identified at our institution.
- •The most common PADS subtypes were TM, ADEM and MS.
- •IVMP is the most utilized treatment during an acute demyelinating attack.
- •The majority of patients with PADS experienced partial recovery.
Abstract
Background
Epidemiological data on the pediatric acquired demyelinating syndromes (PADS) in the
Philippines has not been described previously in the literature. There may be geographic
differences in frequencies of PADS where true disease burden is not known or underestimated
in resource-limited settings due to lack of case recognition and/or diagnostic facilities.
The purpose of this study was to determine the frequencies and clinical characteristics
of the different subtypes of PADS at our institution and compare these with those
in published literature.
Methods
We conducted a retrospective cross-sectional study of children diagnosed with PADS
who were admitted at the Philippine General Hospital from January 2009 to December
2018. Charts of these patients were reviewed to determine frequencies, clinical profile,
diagnostic findings and outcomes.
Results
A total of 77 patients were identified with PADS using the appropriate diagnostic
criteria. The frequencies of the PADS subtypes were the following: transverse myelitis
(n = 21; 27.3 %); acute disseminated encephalomyelitis (n = 20, 26.0 %); multiple
sclerosis (n = 17, 22.1 %); optic neuritis (n = 13, 16.9 %); clinically isolated syndrome
(n = 4, 5.2 %); and neuromyelitis optica spectrum disorder (n = 2, 2.6 %). Overall,
the mean age at initial event and at diagnosis were 10.6 ± 4.6 years. Female:male
ratio was 1.02:1. On admission, the majority of patients had motor paralysis (n = 49,
63.6 %) while several patients manifested with sensory deficits (n = 31, 40.3 %),
visual changes (n = 26, 33.8 %) and brainstem involvement (n = 20, 26.0 %). Nearly
all patients had evidence of lesions in magnetic resonance imaging (n = 72, 93.5 %)
located in spinal cord (n = 25; 32.5 %), cerebral white matter (n = 24; 31.2 %), and
optic nerve (n = 12, 15.6 %). Among patients who underwent cerebrospinal fluid analysis
(n = 34), 7 patients had abnormal findings (20.6 %). The most utilized treatment regimens
during admission were intravenous methylprednisolone (n = 53, 68.8 %) and oral prednisone
(n = 43, 55.8 %). The majority had partial recovery (n = 56, 72.7 %) and 16 experienced
full recovery (20.8 %) at discharge. Five patients died (6.5 %).
Conclusions
Our study provided the first comprehensive summary on the clinical features of children
with PADS admitted in a Philippine tertiary hospital with limited resources. Our study
highlights the value of using clinical diagnostic criteria in improving case recognition
especially in low-and middle-income countries. Regional disparities in disease burden
warrant international registries with wider geographic representation in order to
come up with diagnostic and management guidelines suitable for various levels of care.
Abbreviations:
ADEM (Acute disseminated encephalomyelitis), CIS (Clinically isolated syndrome), DMD (Disease-modifying drug), EEG (Electroencephalography/ electroencephalogram), IVMP (Intravenous methylprednisolone), MRI (Magnetic resonance imaging), MS (Multiple sclerosis), NMOSD (Neuromyelitis optica spectrum disorders), ON (Optic neuritis), PADS (Pediatric acquired demyelinating syndrome), TM (Transverse myelitis), VEP (Visual evoked potential)Keywords
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Article info
Publication history
Accepted:
August 7,
2022
Received:
November 13,
2021
Identification
Copyright
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