The influence of age at onset of acute disseminated encephalomyelitis (ADEM) on cognitive, educational, and social functioning was evaluated in 19 children (10 < 5 years of age) admitted to the Royal Children’s Hospital, Melbourne, Australia. Compared to controls, stratified for age and socioeconomic status, patients who developed ADEM before 5 years of age had a lower mean intelligence quotient (p<0.01), significantly lower scores on reading and spelling (p<0.001), and a higher incidence of severe behavioral and emotional problems. The young onset group also obtained a significantly lower standard score on spelling in comparison with the old onset group (p<0.05). No significant differences were found on cognitive measures in children treated or not treated with steroids; the number not treated was too small for a meaningful conclusion. The frequency of MRI abnormalities was similar in the young and old onset groups, and the proportion of children experiencing one or more relapses was also similar. [1]

COMMENT. Long-term neuropsychological dysfunction may occur in children who develop ADEM in early childhood, despite the absence of persisting neurologic deficits. Children under 5 years of age recovering from ADEM should be tested for possible cognitive, behavioral, and emotional problems that require educational and psychological intervention.