Combination regimen of methylprednisolone, IV immunoglobulin, and plasmapheresis early in the treatment of acute disseminated encephalomyelitis

Lu, Rommel P.; Keilson, Gary

doi:10.1002/jca.20103

Cited by 10 publications

(8 citation statements)

References 26 publications

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“…IVIG may have beneficial effects also as secondline therapy (class IV evidence) [149][150][151][152] especially in patients who could not receive or failed to respond to steroids (class IV evidence) [153][154][155] or in patients with peripheral nervous system involvement and steroid failure (class IV evidence). Alternatively combination therapy by steroids and IVIG (class IV evidence) [156][157][158][159][160][161] or steroids, IVIG and PE were suggested to have favourable effects especially if given early in the course of disease (class IV evidence) [162,163].…”

Section: Other Demyelinating Diseases Of Central Nervous Systemmentioning

confidence: 99%

EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases

Elovaara

Apostolski

Doorn

et al. 2008

Euro J of Neurology

259

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Despite high-dose intravenous immunoglobulin (IVIG) is widely used in treatment of a number of immune-mediated neurological diseases, the consensus on its optimal use is insufficient. To define the evidence-based optimal use of IVIG in neurology, the recent papers of high relevance were reviewed and consensus recommendations are given according to EFNS guidance regulations. The efficacy of IVIG has been proven in Guillain-Barre´syndrome (level A), chronic inflammatory demyelinating polyradiculoneuropathy (level A), multifocal mononeuropathy (level A), acute exacerbations of myasthenia gravis (MG) and short-term treatment of severe MG (level A recommendation), and some paraneoplastic neuropathies (level B). IVIG is recommended as a second-line treatment in combination with prednisone in dermatomyositis (level B) and treatment option in polymyositis (level C). IVIG should be considered as a second or third-line therapy in relapsing-remitting multiple sclerosis, if conventional immunomodulatory therapies are not tolerated (level B), and in relapses during pregnancy or post-partum period (good clinical practice point). IVIG seems to have a favourable effect also in paraneoplastic neurological diseases (level A), stiff-person syndrome (level A), some acute-demyelinating diseases and childhood refractory epilepsy (good practice point).

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Section: Other Demyelinating Diseases Of Central Nervous Systemmentioning

confidence: 99%

EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases

Elovaara

Apostolski

Doorn

et al. 2008

Euro J of Neurology

259

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“…We examined 18 previously reported cases of treatment with plasmapheresis for ADEM cited in the English literature (10,12–21). These cases, including our own, were divided into two groups: a non‐steroid use group and a steroid‐failure group.…”

Section: Discussionmentioning

confidence: 99%

A Case Report of Plasmapheresis in the Treatment of Acute Disseminated Encephalomyelitis

et al. 2008

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Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system associated with significant morbidity and mortality. High-dose corticosteroid administration has been considered the mainstay of treatment for ADEM; however, some patients with ADEM are refractory to steroid therapy. We report a case of a 17-year-old man suffering from ADEM who did not respond to corticosteroid therapy, but who exhibited a dramatic recovery with plasmapheresis. He became comatose, requiring ventilatory support, and exhibited abnormalities of some brainstem reflexes prior to treatment. He underwent sequential courses of plasma exchange therapy for three days. Plasma exchanges were carried out with concomitant continuous hemodiafiltration (CHDF) to control intracranial pressure by stabilizing pH, plasma Na+ concentration, and colloid osmotic pressure. After plasma exchanges, his reflexes and level of consciousness gradually improved. Eleven months after this treatment, he had only minimal neurological deficit that did not interfere with any of his activities of daily living. The efficacy of plasmapheresis for ADEM has not yet been established. Plasmapheresis may be indicated for ADEM, not only for patients with severe disease in whom high-dose corticosteroid treatment has failed, but also as first-line treatment for ADEM. Early initiation of plasmapheresis appears to be associated with moderate to marked improvement. Early recognition and early treatment of ADEM are thus of paramount importance.

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“…IVIG therapy has shown promising results in uncontrolled investigations in ADEM but does not appear to be effective in MS [82][83][84][85][86][87][88][89][90][91]. A prospective non-randomized study in a cohort with ADEM found that involvement of both the central and peripheral nervous system (particularly in severe cases) predicted corticosteroid failure and benefit from IVIG [92].…”

Section: Acute Demyelinating Encephalomyelitis (Adem)/ Hyperacute Mulmentioning

confidence: 99%

“…IVIG as an adjunct to methylprednisolone has been evaluated in two randomized placebo-controlled trials for acute MS exacerbations enrolling a total of 95 patients with negative results [71,94]. Thus, IVIG may be considered in the treatment of ADEM, especially with peripheral nerve involvement, but does not appear to have a role in treatment of MS. A typical treatment regimen for ADEM consists of 0.4 g/kg/day daily or every other day for 3-5 doses, though single infusions of 2 g/kg have also been reported [82][83][84][85][86][87][88][89][90][91]95].…”

Section: Acute Demyelinating Encephalomyelitis (Adem)/ Hyperacute Mulmentioning

confidence: 99%

Immunomodulatory Therapies in Neurologic Critical Care

et al. 2009

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Combination regimen of methylprednisolone, IV immunoglobulin, and plasmapheresis early in the treatment of acute disseminated encephalomyelitis

Cited by 10 publications

References 26 publications

EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases

EFNS guidelines for the use of intravenous immunoglobulin in treatment of neurological diseases

A Case Report of Plasmapheresis in the Treatment of Acute Disseminated Encephalomyelitis

Immunomodulatory Therapies in Neurologic Critical Care

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