Treatment of acute disseminated encephalomyelitis with intravenous immunoglobulin

Abstract

Acute disseminated encephalomyelitis (ADEM) is a presumed immune-mediated, demyelinating disease of the CNS for which the standard treatment is high-dose steroids. We describe two patients with ADEM in whom treatment with IV methylprednisolone coincided with deterioration in their clinical status. They were subsequently treated with IV immunoglobulin and exhibited dramatic clinical improvement, with return to their previous level of functioning.

Therapeutic Approach to the Management of Pediatric Demyelinating Disease: Multiple Sclerosis and Acute Disseminated Encephalomyelitis

“…The benefit of IVIg in acute demyelinating attacks is limited to case reports and small case series [49][50][51][52][53], and is thought to provide benefit by directly affecting cytokine production and T-cell proliferation and by binding potential autoantibodies targeted against myelin [54,55]. IVIg is given at a dose of 2 g/kg divided over 2-5 days.…”

Positive PCR for enterovirus in the cerebrospinal fluid of a child with acute disseminated encephalomyelitis

“…There are some reports about the efficacy of IvIg in ADEM, mainly after the failure of corticosteroid treatment [11][12][13][14]. In the present case of ADEM, IvIg therapy was safe and effective both in the first episode and in the relapse.…”

Immune Mediated Diseases and Immune Modulation in the Neurocritical Care Unit

“…Results from randomized trials comparing the efficacy of IVIG and plasmapheresis in myasthenia exacerbations are equivocal [288]. In addition to the treatment of chronic inflammatory demyelinating polyneuropathy, AIDP/GBS, and MG, IVIG is often considered for the treatment of acute exacerbations of demyelinating CNS disease, such as MS, NMO, and ADEM, although no RCTs have confirmed the benefit of IVIG in any of these conditions [45,[370][371][372][373][374][375].…”