Acute disseminated encephalomyelitis medical therapy: Difference between revisions

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*A course of 4-6 PEs has been associated with moderate to marked and sustained improvement, with large volumes of [[plasma]] removable per exchange if there are no signs of [[autonomic]] [[dysfunction]]. Predictors include male sex, preserved [[reflexes]], and early initiation of [[treatment]]<ref name="pmid8912271">{{cite journal| author=Sakakibara R, Hattori T, Yasuda K, Yamanishi T| title=Micturitional disturbance in acute disseminated encephalomyelitis (ADEM). | journal=J Auton Nerv Syst | year= 1996 | volume= 60 | issue= 3 | pages= 200-5 | pmid=8912271 | doi=10.1016/0165-1838(96)00054-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8912271  }} </ref><ref name="pmid10589540">{{cite journal| author=Weinshenker BG, O'Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW | display-authors=etal| title=A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. | journal=Ann Neurol | year= 1999 | volume= 46 | issue= 6 | pages= 878-86 | pmid=10589540 | doi=10.1002/1531-8249(199912)46:6<878::aid-ana10>3.0.co;2-q | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10589540  }} </ref>.
*A course of 4-6 PEs has been associated with moderate to marked and sustained improvement, with large volumes of [[plasma]] removable per exchange if there are no signs of [[autonomic]] [[dysfunction]]. Predictors include male sex, preserved [[reflexes]], and early initiation of [[treatment]]<ref name="pmid8912271">{{cite journal| author=Sakakibara R, Hattori T, Yasuda K, Yamanishi T| title=Micturitional disturbance in acute disseminated encephalomyelitis (ADEM). | journal=J Auton Nerv Syst | year= 1996 | volume= 60 | issue= 3 | pages= 200-5 | pmid=8912271 | doi=10.1016/0165-1838(96)00054-9 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8912271  }} </ref><ref name="pmid10589540">{{cite journal| author=Weinshenker BG, O'Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW | display-authors=etal| title=A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease. | journal=Ann Neurol | year= 1999 | volume= 46 | issue= 6 | pages= 878-86 | pmid=10589540 | doi=10.1002/1531-8249(199912)46:6<878::aid-ana10>3.0.co;2-q | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10589540  }} </ref>.
* If conventional PE is unavailable, a small volume [[manual]] [[plasma exchange]] can be performed. A [[phlebotomy]] is done, the [[blood]] is centrifuged, 250-300ml of [[plasma]] is removed and the [[cells]] are returned.It can be done twice daily for 7-10 days<ref name="pmid28970675">{{cite journal| author=Batra A, Periyavan S| title=Role of low plasma volume treatment on clinical efficacy of plasmapheresis in neuromyelitis optica. | journal=Asian J Transfus Sci | year= 2017 | volume= 11 | issue= 2 | pages= 102-107 | pmid=28970675 | doi=10.4103/ajts.AJTS_111_16 | pmc=5613414 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28970675  }} </ref>.
* If conventional PE is unavailable, a small volume [[manual]] [[plasma exchange]] can be performed. A [[phlebotomy]] is done, the [[blood]] is centrifuged, 250-300ml of [[plasma]] is removed and the [[cells]] are returned.It can be done twice daily for 7-10 days<ref name="pmid28970675">{{cite journal| author=Batra A, Periyavan S| title=Role of low plasma volume treatment on clinical efficacy of plasmapheresis in neuromyelitis optica. | journal=Asian J Transfus Sci | year= 2017 | volume= 11 | issue= 2 | pages= 102-107 | pmid=28970675 | doi=10.4103/ajts.AJTS_111_16 | pmc=5613414 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28970675  }} </ref>.
====[[Intravenous]] [[immunoglobulin]]====
====[[Intravenous]] [[immunoglobulin]] (IVIg)====
* [[IVIg]] (0.4g/kg/day for five days) is another option, yet its administration is limited by high costs and Class IV level evidence for use as a [[therapeutic]] option in [[ADEM]]<ref name="pmid12509759">{{cite journal| author=Brekke OH, Sandlie I| title=Therapeutic antibodies for human diseases at the dawn of the twenty-first century. | journal=Nat Rev Drug Discov | year= 2003 | volume= 2 | issue= 1 | pages= 52-62 | pmid=12509759 | doi=10.1038/nrd984 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12509759  }} </ref>.
*[[Clinical]] improvement is apparent within 2-3 days<ref name="pmid10746613">{{cite journal| author=Sahlas DJ, Miller SP, Guerin M, Veilleux M, Francis G| title=Treatment of acute disseminated encephalomyelitis with intravenous immunoglobulin. | journal=Neurology | year= 2000 | volume= 54 | issue= 6 | pages= 1370-2 | pmid=10746613 | doi=10.1212/wnl.54.6.1370 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10746613  }} </ref><ref name="pmid8576561">{{cite journal| author=Kleiman M, Brunquell P| title=Acute disseminated encephalomyelitis: response to intravenous immunoglobulin. | journal=J Child Neurol | year= 1995 | volume= 10 | issue= 6 | pages= 481-3 | pmid=8576561 | doi=10.1177/088307389501000612 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8576561  }} </ref><ref name="pmid11784362">{{cite journal| author=Pittock SJ, Keir G, Alexander M, Brennan P, Hardiman O| title=Rapid clinical and CSF response to intravenous gamma globulin in acute disseminated encephalomyelitis. | journal=Eur J Neurol | year= 2001 | volume= 8 | issue= 6 | pages= 725 | pmid=11784362 | doi=10.1046/j.1468-1331.2001.00195.x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11784362  }} </ref>.
*[[Methylprednisolone]] along with [[IVIg]] has been successfully used in [[patients]] with [[atypical]] features and could be beneficial for [[fulminant]] and aggressive cases as well<ref name="pmid11275464">{{cite journal| author=Straussberg R, Schonfeld T, Weitz R, Karmazyn B, Harel L| title=Improvement of atypical acute disseminated encephalomyelitis with steroids and intravenous immunoglobulins. | journal=Pediatr Neurol | year= 2001 | volume= 24 | issue= 2 | pages= 139-43 | pmid=11275464 | doi=10.1016/s0887-8994(00)00229-0 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11275464  }} </ref>.


==References==
==References==

Revision as of 07:49, 21 November 2022

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

The analogy between the pathogenesis of ADEM and MS forms the basis of the use of high-dose steroids, plasma exchange and intravenous immunoglobulin for the treatment of ADEM.

Medical Therapy

Supportive Care[1]

Immunomodulation

Steroids[1]

Plasma exchange (PE)

Intravenous immunoglobulin (IVIg)

References

  1. 1.0 1.1 Alexander M, Murthy JM (2011). "Acute disseminated encephalomyelitis: Treatment guidelines". Ann Indian Acad Neurol. 14 (Suppl 1): S60–4. doi:10.4103/0972-2327.83095. PMC 3152158. PMID 21847331.
  2. 2.0 2.1 Sakakibara R, Hattori T, Yasuda K, Yamanishi T (1996). "Micturitional disturbance in acute disseminated encephalomyelitis (ADEM)". J Auton Nerv Syst. 60 (3): 200–5. doi:10.1016/0165-1838(96)00054-9. PMID 8912271.
  3. Straub J, Chofflon M, Delavelle J (1997). "Early high-dose intravenous methylprednisolone in acute disseminated encephalomyelitis: a successful recovery". Neurology. 49 (4): 1145–7. doi:10.1212/wnl.49.4.1145. PMID 9339706.
  4. 4.0 4.1 Weinshenker BG, O'Brien PC, Petterson TM, Noseworthy JH, Lucchinetti CF, Dodick DW; et al. (1999). "A randomized trial of plasma exchange in acute central nervous system inflammatory demyelinating disease". Ann Neurol. 46 (6): 878–86. doi:10.1002/1531-8249(199912)46:6<878::aid-ana10>3.0.co;2-q. PMID 10589540.
  5. Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG (2002). "Plasma exchange for severe attacks of CNS demyelination: predictors of response". Neurology. 58 (1): 143–6. doi:10.1212/wnl.58.1.143. PMID 11781423.
  6. Miyazawa R, Hikima A, Takano Y, Arakawa H, Tomomasa T, Morikawa A (2001). "Plasmapheresis in fulminant acute disseminated encephalomyelitis". Brain Dev. 23 (6): 424–6. doi:10.1016/s0387-7604(01)00256-x. PMID 11578855.
  7. Batra A, Periyavan S (2017). "Role of low plasma volume treatment on clinical efficacy of plasmapheresis in neuromyelitis optica". Asian J Transfus Sci. 11 (2): 102–107. doi:10.4103/ajts.AJTS_111_16. PMC 5613414. PMID 28970675.
  8. Brekke OH, Sandlie I (2003). "Therapeutic antibodies for human diseases at the dawn of the twenty-first century". Nat Rev Drug Discov. 2 (1): 52–62. doi:10.1038/nrd984. PMID 12509759.
  9. Sahlas DJ, Miller SP, Guerin M, Veilleux M, Francis G (2000). "Treatment of acute disseminated encephalomyelitis with intravenous immunoglobulin". Neurology. 54 (6): 1370–2. doi:10.1212/wnl.54.6.1370. PMID 10746613.
  10. Kleiman M, Brunquell P (1995). "Acute disseminated encephalomyelitis: response to intravenous immunoglobulin". J Child Neurol. 10 (6): 481–3. doi:10.1177/088307389501000612. PMID 8576561.
  11. Pittock SJ, Keir G, Alexander M, Brennan P, Hardiman O (2001). "Rapid clinical and CSF response to intravenous gamma globulin in acute disseminated encephalomyelitis". Eur J Neurol. 8 (6): 725. doi:10.1046/j.1468-1331.2001.00195.x. PMID 11784362.
  12. Straussberg R, Schonfeld T, Weitz R, Karmazyn B, Harel L (2001). "Improvement of atypical acute disseminated encephalomyelitis with steroids and intravenous immunoglobulins". Pediatr Neurol. 24 (2): 139–43. doi:10.1016/s0887-8994(00)00229-0. PMID 11275464.

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