Русский журнал детской неврологии (Apr 2018)
Multimodal evoked potentials and transcranial magnetic stimulation in diagnostics of children with encephalitis, acute disseminated encephalomyelitis and multiple sclerosis
Abstract
Background. The growing incidence of such central nervous system disorders as encephalitis (EP), acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) in pediatric population, similarity of their clinical manifestations at the onset, lack of universal diagnostic criteria and the risk of ADEM transformation into MS in the case of late diagnosis and inadequate treatment suggest the importance of this problem.Objective: to evaluate diagnostic and prognostic value of multimodal evoked potentials and transcranial magnetic stimulation (TCMS) in children with EP, ADEM and MS.Materials and methods. The study included 200 participants: 50 children with MS (mean age 14.0 ± 3.7 years), 50 children with ADEM (mean age 14.0 ± 3.5 years), 50 children with EP (mean age 12.0 ± 2.2 years) and 50 controls (mean age 14.0 ± 3.1 years). All patients underwent neurological examination, magnetic resonance imaging of the brain, diagnostic TCMS and assessment of visual evoked potentials, brainstem auditory evoked potentials, cognitive evoked potentials P300 to an auditory stimulus and somatosensory evoked potentials.Results. We found that the P37–N45 amplitude 124 msec) is a risk factor for ADEM transformation into MS. The P100 latency >132 msec and lack of cortical evoked motor response from the m. abductor hallucis at MS onset indicate a high risk of disease progression and further development of disabilityConclusion. TCMS and assessment of multimodal evoked potentials (with estimating response amplitudes) allow determining the nature and severity of brain lesions, detecting subclinical dysfunction of the central nervous system, monitoring of the recovery processes and predicting outcomes in children with EP, ADEM and MS.
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