title: Effectiveness of intravenous immunoglobulin treatment in adult patients with steroid-resistant monophasic or recurrent acute disseminated encephalomyelitis.
abstract: Randomized Controlled Trials have not let established the best pharmacological management of Acute Disseminated Encephalomyelitis (ADEM). High dose steroids are usually employed with good results, but in a few cases the clinical outcome is poor. In other patients, particularly those affected by the site restricted ADEM variants (myelitis), the disease shows a recurrent course resembling that of Multiple Sclerosis. We present here five patients, 3 of them affected by classic disseminated encephalomyelitis and 2 by a post infectious myelitis, which showed a good response to intravenous immunoglobulin (IVIg) after steroid treatment failure. In our report high dose steroids administration was substantially uneffective in all but one case, who showed a good response only during the first episode. On the contrary IVIg injection (0,4 gr/kg/day) produced a marked functional improvement in all patients starting within the first five days of drug administration and reaching a maximum within three weeks. One patient experienced a good effect nothwithstanding a steady dysability. In all cases, clinical evidence was supported by MRI controls showing improving posttreatment changes.
authors.affiliation: Neurological Institute IRCCS C: Mondino, Pavia, Italy. enrico.marchioni@mondino.it
authors.forename: E
authors.initials: E
authors.lastname: Marchioni
authors.forename: K
authors.initials: K
authors.lastname: Marinou-Aktipi
authors.forename: C
authors.initials: C
authors.lastname: Uggetti
authors.forename: M
authors.initials: M
authors.lastname: Bottanelli
authors.forename: A
authors.initials: A
authors.lastname: Pichiecchio
authors.forename: D
authors.initials: D
authors.lastname: Soragna
authors.lastname: PiccoloG
authors.forename: F
authors.initials: F
authors.lastname: Imbesi
authors.forename: A
authors.initials: A
authors.lastname: Romani
authors.forename: M
authors.initials: M
authors.lastname: Ceroni
mesh_terms: D000368:Aged; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D004185:Disability Evaluation; D004305:Dose-Response Relationship, Drug; D004351:Drug Resistance / Q000502:physiology*; D004673:Encephalomyelitis, Acute Disseminated / Q000188:drug therapy* / Q000276:immunology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D013256:Steroids; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000893:Anti-Inflammatory Agents; D016756:Immunoglobulins, Intravenous; D013256:Steroids