Vitamin D Level in Childrenwith Acute and Relapsing Demyelinating Disorders of the Nervous system

Abstract

itamin D performs various immunomodulatory, anti-inflammatory, antioxidant and anti-fibrotic actions. Autoimmune diseases result from an aberrant activation of the immune system, whereby the immune response is directed against harmless self-antigens. Over the past years, researchers’ interest in vitamin D and its correlations with autoimmune diseases has considerably increased. The aim of this study was to measure the level of 25(OH) vitamin D3 in the serum of patients diagnosed with acute nervous system demyelination, comparing it to levels found in healthy controls, and to correlate the patient’ vitamin D levels with their clinical, laboratory and radiological profiles. This observational case-control study was conducted in the period from June 2018 till December 2020 at Pediatric Out Patient Clinic, Pediatric Neurology Clinic, the Emergency department and In-Patient wards at the Children Hospital, Ain Shams University. On 20 patients diagnosed with acute acquired demyelinating disease (patient group), and 40 healthy age and gender matched children (control group) were enrolled in the study. Cases were subjected to full history taking, examination, MRI of the brain and spinal cord as needed, EEG in case of encephalopathy and/or seizures, Lumbar puncture for CSF cytology, chemistry and culture if indicated, NCV in patients with peripheral nervous system demyelination and Serum level of vitamin D (25(OH)2 D3). The mean age of cases was 7.08 ± 3.8 years (range 0.83 to 14 years). 50% of the patients were males. Subjects in the control group were age and gender matched. Acute disseminated encephalomyelitis was the most common diagnosis among cases in 35%, followed by Guillain-Barré syndrome (GBS) (20%). Acute necrotizing encephalopathy of childhood (ANEC), autoimmune encephalitis (AE) and transverse myelitis (TM) were each observed in 15% of the cases. Collectively, motor weakness was the most common clinical feature, seen in 90% of the cases, followed by altered mental status seen in 60% of the cases and Bladder and/or bowel incontinence seen in 30% of the cases. The least commonly observed clinical feature was movement disorder seen in ten percent of the cases.