Acute disseminated encephalomyelitis medical therapy: Difference between revisions

Jump to navigation Jump to search
 
(15 intermediate revisions by 2 users not shown)
Line 7: Line 7:


==Medical Therapy==
==Medical Therapy==
===[[Supportive]] Care<ref name="pmid21847331">{{cite journal| author=Alexander M, Murthy JM| title=Acute disseminated encephalomyelitis: Treatment guidelines. | journal=Ann Indian Acad Neurol | year= 2011 | volume= 14 | issue= Suppl 1 | pages= S60-4 | pmid=21847331 | doi=10.4103/0972-2327.83095 | pmc=3152158 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21847331  }} </ref>===
* [[Airway]] protection in [[patients]] with altered [[mental]] status
*[[Mechanical ventilation]] in [[cervical]] [[myelitis]]
*[[Anti-seizure]] [[medications]]
*Correction of [[fluid]] and [[electrolyte]] disturbances
*[[Prophylactic]] [[anticoagulation]] for [[prevention]] of [[deep vein thrombosis]] in [[high-risk]] [[patients]]
*Early initiation of physical, occupational and speech [[therapy]], when applicable, can aid earlier and more complete [[recovery]] in [[pediatric]] [[ADEM]]<ref name="pmid24937355">{{cite journal| author=Carlisi E, Pavese C, Mandrini S, Carenzio G, Dalla Toffola E| title=Early rehabilitative treatment for pediatric acute disseminated encephalomyelitis: case report. | journal=Eur J Phys Rehabil Med | year= 2015 | volume= 51 | issue= 3 | pages= 341-3 | pmid=24937355 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24937355  }} </ref>.
===[[Immunomodulation]]===
====Steroids<ref name="pmid21847331">{{cite journal| author=Alexander M, Murthy JM| title=Acute disseminated encephalomyelitis: Treatment guidelines. | journal=Ann Indian Acad Neurol | year= 2011 | volume= 14 | issue= Suppl 1 | pages= S60-4 | pmid=21847331 | doi=10.4103/0972-2327.83095 | pmc=3152158 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21847331  }} </ref>====
*[[Intravenous]] [[methylprednisolone]] is the [[first-line]] [[drug]], leading to full [[recovery]] in 50-80% of [[patients]]. Concerning [[disability]] status, this [[cohort]] showed significantly better outcomes than the one treated with [[dexamethasone]]<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>.
*The [[dose]] is 10-30mg/kg/day up to a maximum of 1g/day for 3-5days (Class IV)<ref name="pmid9339706">{{cite journal| author=Straub J, Chofflon M, Delavelle J| title=Early high-dose intravenous methylprednisolone in acute disseminated encephalomyelitis: a successful recovery. | journal=Neurology | year= 1997 | volume= 49 | issue= 4 | pages= 1145-7 | pmid=9339706 | doi=10.1212/wnl.49.4.1145 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9339706  }} </ref>.
*[[Oral]] [[corticosteroids]] are gradually tapered over six weeks to reduce the [[risk]] of [[relapses]].
* Their role in late presentation of the [[disease]] is still doubtful.
* Any type of [[vaccination]] should be avoided during the first six months following [[recovery]].
====[[Plasma exchange]] (PE)====
*There is Class Ib evidence for [[plasma exchange]] as the next step in management if [[high-dose]] [[corticosteroids]] fail<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><ref name="pmid11781423">{{cite journal| author=Keegan M, Pineda AA, McClelland RL, Darby CH, Rodriguez M, Weinshenker BG| title=Plasma exchange for severe attacks of CNS demyelination: predictors of response. | journal=Neurology | year= 2002 | volume= 58 | issue= 1 | pages= 143-6 | pmid=11781423 | doi=10.1212/wnl.58.1.143 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11781423  }} </ref><ref name="pmid11578855">{{cite journal| author=Miyazawa R, Hikima A, Takano Y, Arakawa H, Tomomasa T, Morikawa A| title=Plasmapheresis in fulminant acute disseminated encephalomyelitis. | journal=Brain Dev | year= 2001 | volume= 23 | issue= 6 | pages= 424-6 | pmid=11578855 | doi=10.1016/s0387-7604(01)00256-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11578855  }} </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>.
*[[Autonomic dysfunction]] and [[hypotension]] may preclude the use of PE<ref name="pmid11578855">{{cite journal| author=Miyazawa R, Hikima A, Takano Y, Arakawa H, Tomomasa T, Morikawa A| title=Plasmapheresis in fulminant acute disseminated encephalomyelitis. | journal=Brain Dev | year= 2001 | volume= 23 | issue= 6 | pages= 424-6 | pmid=11578855 | doi=10.1016/s0387-7604(01)00256-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11578855  }} </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 (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>.
===Others===
[[Cyclophosphamide]]<ref name="pmid11376180">{{cite journal| author=Schwarz S, Mohr A, Knauth M, Wildemann B, Storch-Hagenlocher B| title=Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients. | journal=Neurology | year= 2001 | volume= 56 | issue= 10 | pages= 1313-8 | pmid=11376180 | doi=10.1212/wnl.56.10.1313 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11376180  }} </ref>, [[rituximab]]<ref name="pmid30626794">{{cite journal| author=Makuuchi Y, Nishimoto M, Yamamoto K, Takahashi T, Kuno M, Nakashima Y | display-authors=etal| title=[Successful treatment with rituximab in acute disseminated encephalomyelitis with whole spinal cord involvement following HLA haploidentical transplantation]. | journal=Rinsho Ketsueki | year= 2018 | volume= 59 | issue= 12 | pages= 2588-2593 | pmid=30626794 | doi=10.11406/rinketsu.59.2588 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=30626794  }} </ref> and [[hypothermia]]<ref name="pmid10426155">{{cite journal| author=Takata T, Hirakawa M, Sakurai M, Kanazawa I| title=Fulminant form of acute disseminated encephalomyelitis: successful treatment with hypothermia. | journal=J Neurol Sci | year= 1999 | volume= 165 | issue= 1 | pages= 94-7 | pmid=10426155 | doi=10.1016/s0022-510x(99)00089-1 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10426155  }} </ref> have been successfully used to treat [[patients]] with [[fulminant]] [[ADEM]].


==References==
==References==

Latest revision as of 10:20, 8 December 2022

Acute disseminated encephalomyelitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Acute disseminated encephalomyelitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Acute disseminated encephalomyelitis medical therapy On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Acute disseminated encephalomyelitis medical therapy

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Acute disseminated encephalomyelitis medical therapy

CDC on Acute disseminated encephalomyelitis medical therapy

Acute disseminated encephalomyelitis medical therapy in the news

Blogs on Acute disseminated encephalomyelitis medical therapy

Directions to Hospitals Treating Acute disseminated encephalomyelitis

Risk calculators and risk factors for Acute disseminated encephalomyelitis medical therapy

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)

Others

Cyclophosphamide[14], rituximab[15] and hypothermia[16] have been successfully used to treat patients with fulminant ADEM.

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. Carlisi E, Pavese C, Mandrini S, Carenzio G, Dalla Toffola E (2015). "Early rehabilitative treatment for pediatric acute disseminated encephalomyelitis: case report". Eur J Phys Rehabil Med. 51 (3): 341–3. PMID 24937355.
  3. 3.0 3.1 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.
  4. 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.
  5. 5.0 5.1 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.
  6. 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.
  7. 7.0 7.1 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.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 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.
  14. Schwarz S, Mohr A, Knauth M, Wildemann B, Storch-Hagenlocher B (2001). "Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients". Neurology. 56 (10): 1313–8. doi:10.1212/wnl.56.10.1313. PMID 11376180.
  15. Makuuchi Y, Nishimoto M, Yamamoto K, Takahashi T, Kuno M, Nakashima Y; et al. (2018). "[Successful treatment with rituximab in acute disseminated encephalomyelitis with whole spinal cord involvement following HLA haploidentical transplantation]". Rinsho Ketsueki. 59 (12): 2588–2593. doi:10.11406/rinketsu.59.2588. PMID 30626794.
  16. Takata T, Hirakawa M, Sakurai M, Kanazawa I (1999). "Fulminant form of acute disseminated encephalomyelitis: successful treatment with hypothermia". J Neurol Sci. 165 (1): 94–7. doi:10.1016/s0022-510x(99)00089-1. PMID 10426155.

Template:WS Template:WH