Acute disseminated encephalomyelitis medical therapy: Difference between revisions
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*[[Prophylactic]] [[anticoagulation]] for [[prevention]] of [[deep vein thrombosis]] in [[high-risk]] [[patients]] | *[[Prophylactic]] [[anticoagulation]] for [[prevention]] of [[deep vein thrombosis]] in [[high-risk]] [[patients]] | ||
===[[Immunomodulation]]=== | ===[[Immunomodulation]]=== | ||
====[[Steroids]]==== | ====[[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]]. | |||
==References== | ==References== | ||
Revision as of 07:23, 21 November 2022
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Acute disseminated encephalomyelitis Microchapters |
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Differentiating Acute disseminated encephalomyelitis from other Diseases |
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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]
- 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
Immunomodulation
Steroids[1]
- 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[2].
- The dose is 10-30mg/kg/day up to a maximum of 1g/day for 3-5days (Class IV)[3].
- 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.
References
- ↑ 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.
- ↑ 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.
- ↑ 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.