(From the March 2014 Issue of PediatricsOnline)
Treating certain neurological conditions such as acute disseminated encephalomyelitis, transverse myelitis, optic neuritis and autoimmune encephalitis in children and adolescents is often challenging. Though diagnostic criteria and testing exist for some disorders, identifying these conditions and determining the appropriate therapy can be difficult — especially in children.
“It is cliché, but true, that kids are not little adults,” says Bethanie Morgan-Followell, MD, an attending pediatric neurologist and director of the new Neuroimmunology Clinic at Nationwide Children’s Hospital. The clinic combines clinical expertise in disorders of the nervous and immune system, a multidisciplinary approach that reflects the complexity inherent in neuroimmunological diseases.
“Children’s clinical pictures are often different with regard to symptoms and diagnostic tests results,” Dr. Morgan-Followell says. “Children may not be able to characterize symptoms or may describe them in vague terms.”
The clinic allows for coordinated services among Neurology, Infectious Diseases, Rheumatology, Neuroradiology, Ophthalmology, Neuropsychology and Social Work. Neuroimmunological disorders often affect each patient differently, Dr. Morgan-Followell says, and can lead to myriad problems affecting quality of life.
“A multidisciplinary approach is helpful in narrowing the differential diagnosis and pointing us toward or away from a neuroimmunological condition,” Dr. Morgan-Followell says. “In addition, we know that many neuroimmunological disorders affect not just neurological functioning, but may also affect psychological health, cognition and behavior, so addressing these areas is essential to restoring the health of the child.”
The pathophysiology of many neuroimmunological disorders is poorly understood and what is known comes largely from studies of adult patients. Faculty involved in the clinic are conducting studies designed to better characterize a number of these disorders, work that could lead to more defined diagnostic criteria and improved patient outcomes.
“We hope to develop diagnostic algorithms that lead us to accurate diagnoses and that are cost effective,” says Dr. Morgan-Followell, who also is an assistant professor of clinical pediatrics and neurology at The Ohio State University College of Medicine. “We will also construct treatment algorithms that provide the best possible neurological outcome for our patients.”
Plans also include an analysis of the prevalence of autoimmune encephalitis in children, which may be more common than previously thought. Already underway is a retrospective review of patients with autoimmune encephalitis, which will include an analysis of patients’ neuroradiographic and clinical characteristics to gain a better understanding of clinical presentation, imaging and laboratory findings, optimal treatment and clinical outcomes.