Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis

Neuropsychology Review volume 27, pages 124–133 (2017)Cite this article

Abstract

The long-term neurocognitive prognosis of childhood onset acute disseminated encephalomyelitis (ADEM) is unclear. This review and quantitative synthesis of the available literature examined whether there are long-term impacts of childhood ADEM on neurocognitive functioning. A search of online databases (MEDLINE, EMBASE, EBSCO CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews) from their inception to October 2015 and reference lists identified 13 papers eligible for inclusion in the systematic review; seven of these were eligible for inclusion in meta-analyses. The systematic review indicated that, at a group level there is a positive long-term neuropsychological outcome from childhood onset ADEM. However, despite the apparent absence of long-term negative impacts of ADEM at a group level, at an individual level impairments in the areas of IQ, attention, executive functioning, processing speed, learning and memory, visuospatial skills and internalising symptoms were found in up to 43% of patients when aggregated across the studies. No significant negative effect of ADEM for any of the neuropsychological domains examined was found in meta-analyses. However, the effects for Processing Speed (r mean = −0.296 (CI 95% = −0.605-0.013)) and Internalising symptoms (r mean = 0.242 (CI 95% = −0.014-0.564)) approached significance (p = 0.06), suggesting a trend towards ADEM leading to long-term reduced processing speed and elevated internalising symptoms. Together, our findings suggest that despite a generally positive neurocognitive outcome post childhood ADEM there are a subset of individuals who can suffer from ongoing specific cognitive impairments. Clinical implications and research priorities are discussed.

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Fig. 1
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Notes

  1. 1.

    The threshold for impairment varied across studies; some authors used ≥1 SD below the mean, while others used ≥1.5 SD below the mean.

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Affiliations

  1. Kids Rehab, The Children’s Hospital at Westmead, Cnr Hawkesbury Road and Hainsworth Street, Westmead, NSW, 2145, Australia

    Karen L. O. Burton, Tracey A. Williams & Ruth K. Brunsdon

  2. Sydney Medical School, University of Sydney, Sydney, Australia

    Sarah E. Catchpoole

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Appendix 1

Appendix 1

Example list of search terms: Search conducted in Cochrane Database of Systematic Reviews.

ADEM or acute disseminated encephalomyelit* or acute demyelinating encephalomyelit* AND psych* test* or neurocog* test* or neuropsych* test* or cog* disorder* or psychol* or anxiety disorder* or mood disorder* or psychiatr* or cogn* or neurocog* or neuropsych* or intell* or IQ or attent* or behav* or learning or memory or executive function* or language* or percept* or visuospatial or speed or information process* or visual or verbal* or adapt* or speech or academic or motor or abstract reason* or fluency or spatial or construction* or retriev* or recall* or reason* or read* or arithmetic or math* or write or writing or comprehen* or inhibit* AND infant* or infancy or newborn or baby or babies or neonat* or child* or boy* or girl* or kid or kids or toddler* or pediatric* or paediatric* or adoles* or teen* or minor* or puberty* or prepubescen* or pubescen* or school* or school age or preschool* or nursery school* or primary school* or secondary school* or elementary school* or high school* or highschool* or school child* or schoolchild* or college or universit* or student*

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Burton, K.L.O., Williams, T.A., Catchpoole, S.E. et al. Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis. Neuropsychol Rev 27, 124–133 (2017). https://doi.org/10.1007/s11065-017-9343-7

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Keywords

  • Acute disseminated encephalomyelitis
  • ADEM
  • Paediatric
  • Neuropsychology
  • Meta-analysis