A General Assessment of the Functional Impact of Acute Disseminated Encephalomyelitis

Abstract

Introduction: Long-term disability in patients with acute disseminated encephalomyelitis (ADEM) is caused not only by neurological deficiency, but also by the difficulties with social and psychological adaptation. Together with neurological condition, a very important role in clinical characteristics of the disease belongs to psychosocial disorders, as well as to patients’ subjective perception of the disease symptoms that has the impact on their quality of life. Methods: We have examined 45 patients diagnosed with acute disseminated encephalomyelitis, 10 men and 35 women, aged 15- 53 (average age 32±0.4). All the patients were being treated at the Kiev city centre of multiple sclerosis (Kiev city hospital number 4, Alexandrovskaya City Clinical Hospital, Kiev city, Ukraine) during 3 years. The diagnosis of ADEM was based on neurological examination, MRI of the brain and CSF analysis. The neurological status was assessed by Kurtzke an Expanded Disability Status Scale (EDSS) and Functional Systems Points (FSS). In order to assess the impact of the disease on the daily life of patients to the most full extent a survey was conducted with the use of tests: “Functional Limitation Profile” and “Sickness Impact Profile – 68”. Results: According to the "Functional Limitation Profile" test, patients diagnosed with acute disseminated encephalomyelitis demonstrated  functional condition impairment most often in 3 categories: "work" (86% of cases), "leisure and entertainments" (84% of cases), "social interaction" (82 % of cases), the least impaired were the categories "communication" (22% of cases), "emotions" (32% of cases), "food" (32% of cases). According to the "Sickness Impact Profile - 68" test, patients diagnosed with acute disseminated encephalomyelitis showed functional condition impairment most often in the category "social behavior" (84%), "somatic autonomy" (70% of cases), "mental autonomy and communication" (60% of cases). Categories "mobility control" (50%), "emotional stability" (44% of cases), "degree of mobility" (44% of cases) suffered the least. The highest percent in relation to the maximum possible point was noted in the category "social behavior", and the lowest – in the category “somatic autonomy”. Severity of neurologic deficit and increase in the number of demyelination foci on MRI have a negative impact on patients’ self-assessment of their quality of life. Gender of patients and the presence of disseminated encephalomyelitis relapses have the impact on the degree of functional limitation. Conclusion: We can conclude from the assessments that the emergence of ADEM results in significant changes in the patient’s functional condition. Of the factors observed, the disease has the greatest impact on the patient’s social sphere and associated activities and the smallest impact on their emotional condition. The disease has a significant impact on the emotional state of women and patients with multiphasic course of disseminated encephalomyelitis. It is also reflected in the disorders of their sleep and rest. Social sphere of life is suffering more in men and patients with a first episode of disseminated encephalomyelitis.