[Acute disseminated encephalomyelitis. Definition, treatment, prognosis and evidence].
BACKGROUND
Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system. It is difficult to distinguish between ADEM and multiple sclerosis (MS) and the treatment is much discussed. The purpose of this study was to evaluate the treatment and prognosis for children with ADEM and to evaluate the level of evidence in treatment.


METHODS
Medical records were found by searching for diagnoses and reviewed retrospectively. The level of evidence in treatment was evaluated by searching PubMed, EMBASE and The Cochrane Library.


RESULTS
11 children met the original inclusion criteria, acute or subacute onset of multifocal symptoms and MRI consistent with ADEM. The treatment was varied. Nine children had complete recovery. One child developed multiphasic disseminated encephalomyelitis or MS. One child developed epilepsy and cognitive deficits. There were no randomized controlled trials but several larger case-series and cohort studies.


CONCLUSIONS
The lack of controlled clinical trials may explain the varied treatment. In severe ADEM, intravenous high-dose corticosteroids are based on evidence grade C recommendation. In general, ADEM has a favorable prognosis. At initial presentation it is important to consider MS as a differential diagnosis.
Christensen
Pia Sønderby
PS
Regionshospitalet Herning, Børneafdelingen. pias@dadlnet.dk
Østergaard
John R
JR
D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004673:Encephalomyelitis, Acute Disseminated / Q000175:diagnosis / Q000188:drug therapy; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008279:Magnetic Resonance Imaging; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D011239:Prednisolone / Q000008:administration & dosage; D011379:Prognosis; D012189:Retrospective Studies
D000893:Anti-Inflammatory Agents; D011239:Prednisolone; D008775:Methylprednisolone