Acute disseminated encephalomyelitis risk factors
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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
Risk Factors
Infections
- The pathogens remain mostly unknown.
- The prodromal phase is characterised by flu-like symptoms (56-61%) and non-specific upper respiratory or gastrointestinal manifestations. The latent period varies from 4 to 41 days.
- Viral exanthems usually precede the onset of pediatric ADEM.
- The most common associated pathogens are viruses namely, Epstein-Barr, measles, mumps, rubella, coxsackie B. Bacteria like Borrelia burgdorferi, Legionella and Mycoplasma are infrequently reported.
- ADEM shows a seasonal variation with increased incidence in winter and spring, probably due to the changes in the distribution of the implicated agents.
Vaccinations
- Immunization is the precipitating factor for less than 5% of ADEM cases.
- The most frequent occurrences are with the vaccines of measles, mumps and rubella.
- The latent period varies from 2 to 30 days.
Genetic susceptibility
- An association between ADEM and HLA-DR genes has been elucidated in a recent study.
- Patients with congenital adrenal hyperplasia or acquired adrenal insufficiency have been reported to suffer from a sequelae of encephalopathy with white matter lesions.