Acute disseminated encephalomyelitis in children: Treatment and prognosis
- Timothy E Lotze, MD
Timothy E Lotze, MD
- Associate Professor of Pediatrics and Neurology
- Baylor College of Medicine
- Donald J Chadwick, MD
Donald J Chadwick, MD
- Adjunct Instructor
- Minneapolis Clinic of Neurology
Acute disseminated encephalomyelitis (ADEM), also known as postinfectious encephalomyelitis, is a demyelinating disease of the central nervous system that typically presents as a monophasic disorder associated with multifocal neurologic symptoms and disability.
This topic will review the prognosis and treatment of ADEM in children. Other aspects of ADEM are discussed separately. (See "Acute disseminated encephalomyelitis in children: Pathogenesis, clinical features, and diagnosis".)
Children with ADEM typically present with fever, meningeal signs, acute encephalopathy, and evidence of inflammation in blood and cerebrospinal fluid. Thus, consideration should be given to treatment with broad-spectrum antibiotics and acyclovir until an infectious etiology is excluded. (See "Bacterial meningitis in children older than one month: Treatment and prognosis", section on 'Empiric therapy' and "Bacterial meningitis in the neonate: Treatment and outcome", section on 'Antimicrobial therapy' and "Viral meningitis: Management, prognosis, and prevention in children", section on 'Empiric therapy'.)
The mainstay of treatment for ADEM is high-dose intravenous glucocorticoids . Glucocorticoids may be started at the time of the patient's presentation and can be used concurrently with antibiotics and acyclovir. Additional options include intravenous immune globulin and plasma exchange . However, the effectiveness of these treatments (glucocorticoids, intravenous immune globulin, and plasma exchange) for ADEM has not been definitively confirmed, as there are no prospective clinical trial data to determine optimal treatment, including dose or duration.
Glucocorticoids — In several small observational studies, treatment of ADEM with intravenous methylprednisolone (10 to 30 mg/kg per day, maximum 1000 mg daily) or dexamethasone (1 mg/kg per day) for three to five days, followed by oral glucocorticoid taper over four to six weeks, was associated with full recovery in approximately 60 to 90 percent of patients [3-5].
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