Affiliations: Department of Neurology, Malabar Institute of Medical
Sciences, Calicut, Kerala, India | Department of Pediatric Neurology, Michael G. De
Groote School of Medicine, Mcmaster University, Hamilton, Canada | Department of Neurology, MES Medical College,
Malappuram, Kerala, India | Department of Neurology, Gokulam Medical College,
Thiruvananthapuram, Kerala, India
Note: [] Correspondence: Dr. A. Girija, M.D, MIMS, Calicut, 673016,
India. Tel.: +91 495 2744000; Fax: +91 495 2741329; E-mail: [email protected]
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.
