Abstract
The chief treatment options for acute disseminated encephalomyelitis (ADEM) include
methylprednisolone (MP), plasma exchange (PE), intravenous immunoglobulin (IVIG).
However, there is no evidence-based recommendations for management of ADEM. To identify
the prognosis in ADEM after use of different modalities of treatment, a 3-year prospective
study of cases presenting with neurological features with a temporal relation to an
infection or vaccination or with a presumed etiology as demyelination was undertaken.
Investigations to identify the causative agent, magnetic resonance imaging of brain
and spinal cord, cerebrospinal fluid studies, electrophysiological studies, blood
tests to exclude metabolic and collagen vascular disorders were done. A standard protocol
of steroids, failing which (Modified Rankin scale score of four or 5 at end of 3 weeks)
IVIG or PE was given. One patient underwent hemicraniectomy. Cases were followed up
for 1 year. Telephonic interview was done at 3rd and 5th year. Of the 32 cases (<
18 years), 84% had early complete recovery with MP. One who was on dexamethasone recovered
by 1 year. With subsequent PE or IVIG, four cases (13%) had complete recovery. Relapses
were restricted to a maximum of three between 6 and 18 months. Prognosis in ADEM can
be improved remarkably by early diagnosis and treatment with intravenous MP followed
at times by plasmapheresis or IVIG. Hemicraniectomy may be life saving.
Keywords
Plasma exchange - methylprednisolone - immunoglobulin - acute disseminated encephalomyelitis
- hemicraniectomy
