Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibres. ADEM often follows viral or bacterial infections, or less often, vaccination for measles, mumps, or rubella.
Treatment for ADEM is targeted at suppressing inflammation in the brain using anti-inflammatory drugs. Acute disseminated encephalomyelitis (ADEM) is often treated with high-dose intravenous corticosteroids, to which it appears to be responsive. Improvement may be observed within hours but usually requires several days.
One common protocol is 20 mg/kg/d of methylprednisolone (maximum dose of 1 g/d) for 3-5 days. When corticosteroids fail to work, plasmapheresis or intravenous immunoglobulin therapy are possible secondary treatment options that are reported to help in some severe cases. Additional treatment is symptomatic and supportive.
After initial evaluation and initiation of therapy, further inpatient care is dictated by the evolution of disease and rate of recovery exhibited by the patient.
Physical and occupational therapy may be indicated in patients with paresis, ataxia, low vision, and other focal neurologic abnormalities that impair function.
Provision for feeding and for the treatment of abnormalities of bowel or bladder function may be indicated.
When seizures occur, they usually do so transiently at the onset of disease. In rare instances, additional management issues for seizures arise during the subsequent course of treatment.
Most patients who experience a bout of ADEM can look forward to complete recovery or the persistence of only mild deficits, such as modestly diminished visual acuity. This excellent outlook even applies to patients who experienced a global low state of function during the acute illness.
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