Neurology
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Acute disseminated encephalomyelitis (ADEM) is an immune-mediated inflammatory disorder of the CNS characterized by a widespread demyelination that predominantly involves the white matter of the brain and spinal cord. The condition is usually precipitated by a viral infection or vaccination. The presenting features include an acute encephalopathy with multifocal neurologic signs and deficits. ⋯ In addition, this review summarizes current knowledge of the main aspects of ADEM, including its clinical and radiologic diagnostic features, epidemiology, pathogenesis, and outcome. An overview of ADEM treatment in children is provided. Finally, the controversies surrounding pediatric MS and ADEM are addressed.
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Historical Article
Pediatric multiple sclerosis: a short history of a long story.
Shortly after multiple sclerosis (MS) was described by Charcot in 1872-1873, symptoms of MS were noted in children. At the time of these observations (late 19th century), the many inherited demyelinating diseases that manifest during childhood had not yet been recognized. ⋯ Only a half century later, with increased understanding of both inherited leukodystrophies as well as MS, was it acknowledged that children can develop MS. Our present challenges in the differential diagnoses of demyelinating disorders presenting in childhood are reflected in the history of pediatric MS.
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Review Meta Analysis
The impact of neuropathic pain on health-related quality of life: review and implications.
A number of high-quality studies have recently been published that examine the association between neuropathic pain and health-related quality of life (HRQoL). The current review identified 52 such studies in patients with six neuropathic pain conditions associated with lesions of either the peripheral (postsurgical neuropathic pain associated with breast and amputation surgery, postherpetic neuralgia, and painful diabetic neuropathy) or central (poststroke pain, spinal cord injury pain, multiple sclerosis pain) nervous system. ⋯ However, the evidence also indicates that this impact varies somewhat as a function of the HRQoL domain being considered and that different measures of HRQoL are differentially sensitive to the effects of neuropathic pain. The findings have important implications for the selection of HRQoL domains and measures to use in clinical trials and in clinical research on HRQoL in persons with neuropathic pain and suggest that a biopsychosocial (as opposed to a primarily biomedical) approach would be appropriate for understanding and treating neuropathic pain.