1
|
Lim H, Hwang SK, Lee YJ, Kwon S. The Wide Variety of Acute Disseminated Encephalomyelitis in Children: A Clinical Perspective. Ann Child Neurol 2022. [DOI: 10.26815/acn.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating inflammatory disorder of the central nervous system. It is characterized by encephalopathy, multifocal neurological deficits, and typical magnetic resonance imaging findings of widespread demyelinating lesions, predominantly involving the white matter of the brain and spinal cord. ADEM mainly affects children and is commonly associated with preceding viral and bacterial infections, and, rarely, vaccinations. Despite substantial advances in the understanding of the association of myelin oligodendrocyte glycoprotein antibody with recurrent forms of ADEM or other demyelinating conditions, specific etiologic agents or biological markers have not been identified. Therefore, the diagnosis of ADEM is still based on clinical and radiological findings and the exclusion of other conditions mimicking ADEM. However, a prompt diagnosis and adequate treatment are crucial because diagnostic delays or inappropriate treatment may lead to unwanted neurological sequelae in some children. There is no standardized treatment protocol for ADEM, but the use of corticosteroids, intravenous immunoglobulin, and plasmapheresis has been associated with good clinical outcomes. Adequate treatment has reportedly resulted in favorable outcomes, with full or almost full recovery in most children with ADEM, although some children may develop neurological sequelae, such as cognitive impairment and motor deficits. Further studies are needed to identify biological clues and optimal treatment protocols to minimize the incidence of neurological sequelae.
Collapse
|
2
|
Massa S, Fracchiolla A, Neglia C, Argentiero A, Esposito S. Update on Acute Disseminated Encephalomyelitis in Children and Adolescents. Children (Basel) 2021; 8:280. [PMID: 33917395 DOI: 10.3390/children8040280] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/01/2021] [Accepted: 04/01/2021] [Indexed: 12/12/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, inflammatory demyelinating disease of the central nervous system (CNS) that usually affects children and young adults after an infection or vaccination. The presence of several conditions mimicking ADEM, added to the lack of specific biomarkers, makes diagnosis potentially hard. Prompt diagnosis is necessary to start adequate treatment to improve the clinical course and long-term outcome. Because of its heterogeneity in both clinical presentation and course, challenges remain in establishing the most appropriate therapeutic approach in each patient. The aim of this review is to provide an update on management of this disease with a focus on acute treatment and to give suggestions for future research. We showed that there are currently no guidelines that help clinicians manage ADEM and therapeutic decisions are often made on a case-by-case basis. Further studies are necessary to identify clinical, laboratory, and instrumental criteria that could be correlated with outcomes and guide clinicians in choosing when and what treatment should be given in each case.
Collapse
|
3
|
Da Silva RC, Aguiar GB, Kamer C, Farias L, Matsuda J. Acute Disseminated Encephalomyelitis Related to a Cytomegalovirus Infection in an Immunocompetent Patient. Cureus 2021; 13:e12795. [PMID: 33628664 PMCID: PMC7892279 DOI: 10.7759/cureus.12795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cytomegalovirus (CMV) infection can cause acute disseminated encephalomyelitis (ADEM). However, it is rare in immunocompetent people. We describe a 17-year-old patient who was brought with flu-like symptoms. After one week, she experienced rapidly progressive weakness in all four extremities, followed by coma. The neurologic examination showed no response to verbal and pain stimuli. A Babinski sign was noted in both lower extremities, along with clonus and hyperreflexia in all four limbs. Brain magnetic resonance imaging (MRI) demonstrated extensive areas of hyperintense signal on fluid-attenuated inversion recovery (FLAIR) sequences in the white matter which was asymmetrically distributed in both hemispheres, as well as in the brainstem and cerebellar peduncles, compatible with acute demyelinating lesions. Cerebrospinal fluid (CSF) showed mild lymphocytic pleocytosis and normal glucose levels. Polymerase chain reaction to herpes simplex virus was negative. Serum immunoglobulin G (IgG) and immunoglobulin M (IgM) were positive for cytomegalovirus. The patient was treated with methylprednisolone pulse therapy for five days. Subsequently, the patient showed neurologic improvement with the recovery of consciousness and muscle strength. In terms of prognosis, in patients with ADEM, the sooner the diagnosis, the better the outcome. The cornerstone of treatment is immunosuppression with steroids. Some patients require intravenous immunoglobulin G (IVIG) or plasmapheresis, and in refractory cases, cyclophosphamide is used.
Collapse
Affiliation(s)
- Rafael C Da Silva
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | | | - Carolina Kamer
- Medicine, School of Medicine, Universidade para o Desenvolvimento do Alto, Rio do Sul, BRA
| | - Lais Farias
- Medicine, School of Medicine, Universidade para o Desenvolvimento do Alto, Rio do Sul, BRA
| | - Josie Matsuda
- Medicine, School of Medicine, Universidade para o Desenvolvimento do Alto, Rio do Sul, BRA
| |
Collapse
|
4
|
Tripathi PP, Hans R, Sharma RR, Lamba DS, Paul P, Sankhyan N, Bhagwat C, Singh P. Role of Plasma Exchange in a Steroid- and IVIG-Refractory Patient with Acute Disseminated Encephalomyelitis: A Case Report. Transfus Med Hemother 2020; 47:420-423. [PMID: 33173460 DOI: 10.1159/000504987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 11/12/2019] [Indexed: 11/19/2022] Open
Abstract
Background Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease usually affecting children and is treated with high-dose steroid therapy. Case Report An 8-year boy presented with limbs weakness and complete loss of vision and was resistant to steroid therapy. He was further treated with plasma exchange and showed full recovery from the neurological deficit. Conclusion Therapeutic plasma exchange appears to be effective in ADEM patients in reversing the neuropathological process especially refractory to steroids and intravenous immunoglobulin.
Collapse
Affiliation(s)
- Parmatma Prasad Tripathi
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Rekha Hans
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Preeti Paul
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Naveen Sankhyan
- Department of Paediatric Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Chandana Bhagwat
- Department of Paediatric Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Paramjeet Singh
- Department of Radio Diagnosis and Imaging, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
5
|
Press CA, Kirschen M, LaRovere K, Risen S, Guilliams KP, Chung M, Griffith J, Erklauer J, Peariso K, Ducharme-Crevier L, Shah SS, Hall M, Wainwright MS. Variation in Treatment and Outcomes of Children With Acute Disseminated Encephalomyelitis. Hosp Pediatr 2020; 10:159-165. [PMID: 31996356 DOI: 10.1542/hpeds.2019-0129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To characterize variation in treatments and outcomes of pediatric patients admitted to children's hospitals with acute disseminated encephalomyelitis (ADEM). METHODS In this retrospective cohort study, we used data from the Pediatric Health Information System. Children >30 days old who were hospitalized from 2010 to 2015 with ADEM were included. Variables analyzed were treatments and admission to an ICU. Primary outcomes were discharge disposition and readmissions for relapses (ADEM readmissions) or for continued comorbidities (non-ADEM readmissions). RESULTS A total of 954 patients with ADEM had 1117 admissions. Treatments included steroids (80%), immunoglobulin (22%), and plasmapheresis (6.6%); 15% of admissions included none of these treatments. Treatments varied by center (P < .001). Thirty-four percent of admissions included ICU admission, which was associated with an increased number and duration of treatments (P < .01). The discharge disposition was home in 85% of admissions; home with health services, rehab facility, or other in 13.6%; and mortality in 1.4%. Twelve percent (117 of 954) of patients had >1 admission for ADEM. Treatment choice and ICU stay were not associated with ADEM readmissions. Sixteen percent (181 of 1101) of ADEM admissions had a non-ADEM readmission within 90 days. Prolonged ICU hospitalization was associated with non-ADEM readmission (adjusted odds ratio 1.9; P = .017) and decreased likelihood of discharge from the hospital to home (adjusted odds ratio 0.1; P < .001). After adjusting for ICU duration, treatment choice and duration were not associated with non-ADEM readmission or hospital disposition. CONCLUSIONS Significant variation in ADEM treatment exists across centers. Admission to an ICU for ADEM was associated with increased immunotherapy, additional health services at discharge, and readmission for diagnoses other than ADEM.
Collapse
Affiliation(s)
- Craig A Press
- University of Colorado and Children's Hospital Colorado, Aurora, Colorado;
| | | | | | - Sarah Risen
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Kristin P Guilliams
- School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri
| | | | - Jennifer Griffith
- School of Medicine, Washington University in St Louis and St Louis Children's Hospital, St Louis, Missouri
| | - Jennifer Erklauer
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Katrina Peariso
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | | | - Samir S Shah
- Department of Pediatrics, University of Cincinnati and Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Matt Hall
- Children's Hospital Association, Lenexa, Kansas; and
| | - Mark S Wainwright
- Department of Neurology, Seattle Children's Hospital, Seattle, Washington
| |
Collapse
|
6
|
Cole J, Evans E, Mwangi M, Mar S. Acute Disseminated Encephalomyelitis in Children: An Updated Review Based on Current Diagnostic Criteria. Pediatr Neurol 2019; 100:26-34. [PMID: 31371120 DOI: 10.1016/j.pediatrneurol.2019.06.017] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 06/25/2019] [Accepted: 06/26/2019] [Indexed: 11/16/2022]
Abstract
Acute disseminated encephalomyelitis is an inflammatory disorder of the central nervous system. Uniform diagnostic criteria for acute disseminated encephalomyelitis did not exist until publication of expert-defined consensus definitions by the International Pediatric Multiple Sclerosis Society Group in 2007, with updates in 2013. In the expanding field of pediatric neuroimmunology, consistent diagnostic criteria are essential to correctly categorize patients as increasing information regarding prognosis and management becomes available. Scientific literature is relatively lacking in review articles on International Pediatric Multiple Sclerosis Society Group-defined acute disseminated encephalomyelitis. This review focuses primarily on references applying the International Pediatric Multiple Sclerosis Society Group criteria for acute disseminated encephalomyelitis presenting specific, up-to-date, and translatable information regarding the epidemiology, pathophysiology, clinical features, diagnosis, management, and prognosis of acute disseminated encephalomyelitis in the pediatric population.
Collapse
Affiliation(s)
- Jordan Cole
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri.
| | - Emily Evans
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri
| | - Martin Mwangi
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri
| | - Soe Mar
- Pediatric Multiple Sclerosis and Demyelinating Diseases Center, Washington University in St. Louis, St. Louis, Missouri
| |
Collapse
|
7
|
Savransky A, Rubstein A, Rios MH, Vergel SL, Velasquez MC, Sierra SP, Marcarian G, Alba R, Pugliese AM, Tenembaum S. Prognostic indicators of improvement with therapeutic plasma exchange in pediatric demyelination. Neurology 2019; 93:e2065-e2073. [PMID: 31645471 DOI: 10.1212/wnl.0000000000008551] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/19/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES To determine the safety and clinical benefit of therapeutic plasma exchange (TPE) as rescue therapy in children with acute inflammatory demyelinating CNS syndromes and to identify baseline prognostic indicators of treatment improvement. METHODS This single-center retrospective pediatric cohort included all consecutive patients admitted to our hospital over the period from 2003 to 2017 because of a steroid-refractory acute CNS event presumed to be inflammatory who required TPE. Functional status assessment to identify improvement included the following performance category scales: visual outcome, bladder control, gait, and Expanded Disability Status Scale (EDSS). These assessments were performed before and after TPE in every patient. RESULTS Sixty-five children requiring TPE to treat 78 CNS attacks were included for analysis. Median age at TPE was 10.5 years (1.9-18 years); 45% were girls. Seropositivity (aquaporin-4 water channel-immunoglobulin G [IgG] or myelin oligodendrocyte glycoprotein-IgG) was found in 20 of 42 (48%) patients. Attack phenotypes leading to TPE were optic neuritis (ON) in 42%, longitudinally extensive transverse myelitis (LETM) in 31%, ON + LETM in 15%, and other combined syndromes in 11%. Overall, moderate to marked neurologic improvement was observed in 72% of children at the end of TPE and in 88.5% at 6 months of follow-up. Lower baseline scores on the EDSS, visual outcome, and gait scales were found to be independent prognostic indicators of treatment benefit. Sex, age at onset and at TPE, attack phenotype, disease duration, and time from attack onset to TPE initiation were not significantly associated with treatment outcome. Adverse events were observed in 31 of 524 (5.9%) procedures, being severe in 4. CONCLUSIONS TPE was an effective rescue therapy associated with functional improvement. No therapeutic window for TPE initiation was identified in this pediatric cohort. Overall frequency of adverse events was low; however, serious events should be anticipated and avoided. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that for children with acute inflammatory demyelinating CNS syndromes, TPE leads to functional improvement.
Collapse
Affiliation(s)
- Andrea Savransky
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Adrian Rubstein
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Marina Huaman Rios
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Silvana L Vergel
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Mabel Castro Velasquez
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Sara Perez Sierra
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Gabriela Marcarian
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Romina Alba
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Ana M Pugliese
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina
| | - Silvia Tenembaum
- From the Department of Neurology (A.S., M.H.R., S.L.V., M.C.V., S.P.S., S.T.) and Transfusion Medicine (G.M., R.A., A.M.P.), National Pediatric Hospital Dr. J.P. Garrahan; and Private Institute of Statistics (A.R.), Buenos Aires, Argentina.
| |
Collapse
|
8
|
Galardi MM, Gaudioso C, Ahmadi S, Evans E, Gilbert L, Mar S. Differential Diagnosis of Pediatric Multiple Sclerosis. Children (Basel) 2019; 6:children6060075. [PMID: 31163654 PMCID: PMC6617098 DOI: 10.3390/children6060075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/16/2019] [Accepted: 05/20/2019] [Indexed: 01/28/2023]
Abstract
The differential diagnosis of pediatric multiple sclerosis (MS) can be broad and pose diagnostic challenges, particularly at initial presentation. Among demyelinating entities, neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibodies (MOG-ab) associated disorders, and acute disseminated encephalomyelitis (ADEM) are now well-known as unique disease processes and yet continue to overlap with MS in regards to clinical presentation and imaging. In non-inflammatory entities, such as metabolic disorders and leukodystrophies, an erroneous diagnosis of MS can be made even while applying appropriate diagnostic criteria. Knowing the epidemiology, typical clinical presentation, diagnostic criteria, and ancillary test results in each disease, can aid in making the correct diagnosis by contrasting these features with those of pediatric MS. Determining the correct diagnosis early, allows for efficient and effective treatment as well as appropriate prognostication.
Collapse
Affiliation(s)
| | - Cristina Gaudioso
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | - Saumel Ahmadi
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | - Emily Evans
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | - Laura Gilbert
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA.
| | - Soe Mar
- Department of Neurology, Washington University in St. Louis, St. Louis, MO 63110, USA.
| |
Collapse
|
9
|
Abstract
Plasma exchange has been widely used in autoimmune neurological diseases and is the standard treatment for myasthenia gravis crisis and Guillain-Barre syndrome. A growing body of research suggests that, in the clinical application of steroid-responsive encephalopathy, such as for Hashimoto's encephalopathy, limbic encephalitis, systemic lupus erythematosus encephalopathy, ANCA-associated vasculitis encephalopathy, and acute disseminated encephalomyelitis, plasma exchange is a safe, and effective option when steroids or other immunosuppressive therapies are ineffective in the short term or when contraindications are present. Additionally, plasma exchange can also be used alone or in combination with steroids, immunoglobulins, or other immunosuppressive agents to treat steroid-responsive encephalopathy. This paper reviews the clinical application of plasma exchange in steroid-responsive encephalopathy, including its indications, onset time, course, curative effects, and side effects.
Collapse
Affiliation(s)
- Yuting Jiang
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xin Tian
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yixue Gu
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Feng Li
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xuefeng Wang
- Chongqing Key Laboratory of Neurology, Department of Neurology, the First Affiliated Hospital of Chongqing Medical University, Chongqing, China.,Center of Epilepsy, Beijing Institute for Brain Disorders, Beijing, China
| |
Collapse
|
10
|
Chu B, Cunha J, Germiniani F, Rossetto C, Borghi F, Paiva E. ENCEFALOMIELITE DISSEMINADA AGUDA (ADEM) HEMORRÁGICA NO LÚPUS ERITEMATOSO SISTÊMICO (LES): RELATO DE 2 CASOS. Revista Brasileira de Reumatologia 2017. [DOI: 10.1016/j.rbr.2017.07.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
11
|
Vitaliti G, Tabatabaie O, Matin N, Ledda C, Pavone P, Lubrano R, Serra A, Di Mauro P, Cocuzza S, Falsaperla R. The usefulness of immunotherapy in pediatric neurodegenerative disorders: A systematic review of literature data. Hum Vaccin Immunother 2016; 11:2749-63. [PMID: 26266339 DOI: 10.1080/21645515.2015.1061161] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Immunotherapeutic strategies to treat neurodegenerative disorders have inspired the scientific community. The aim of our review is to address the translational aspects of neuroimmunology to describe the efficacy of immunotherapy in the treatment of pediatric neurodegenerative disorders. In the studies we analyzed IVIG were found to be efficient in the treatment of post-streptococcal neurodegenerative disorders, even if in PANDAS, plasma-exchange (PE) showed a higher efficiency. IVIG were also successfully used in ADEM and Guillan-Barré syndrome. In Sydenham Chorea the use of methylprednisolone was found in most cases as efficient as IVIG, while in Tourette's Syndrome, Colecoxib was successfully used in one patient. Pediatric Multiple Sclerosis seems to respond better to immunosuppressant agents (Mitoxantrone, Cyclophosphamide, Natalizumab), as well as Neuromyelitis optica (Rituximab, Mycofenolate). The importance of this review relies in the attempt to draw standardized guidelines for immunotherapy in pediatric neurodegeneratve disorders.
Collapse
Affiliation(s)
- Giovanna Vitaliti
- a Acute and Emergency Paediatric and General Paediatric Operative Unit; Policlinico-Vittorio Emanuele Hospital; University of Catania ; Catania , Italy
| | | | - Nassim Matin
- b School of Medicine; Tehran University of Medical Sciences ; Tehran , Iran
| | - Caterina Ledda
- c Hygiene and Public Health; Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia"; University of Catania ; Catania , Italy
| | - Piero Pavone
- a Acute and Emergency Paediatric and General Paediatric Operative Unit; Policlinico-Vittorio Emanuele Hospital; University of Catania ; Catania , Italy
| | - Riccardo Lubrano
- d Pediatric Department ; Pediatric Nephrology Operative Unit of the Sapienza University of Rome ; Rome , Italy
| | - Agostino Serra
- e ENT Department G.F. Ingrassia ; Policlinico-Vittorio Emanuele University Hospital; University of Catania ; Catania , Italy
| | - Paola Di Mauro
- e ENT Department G.F. Ingrassia ; Policlinico-Vittorio Emanuele University Hospital; University of Catania ; Catania , Italy
| | - Salvatore Cocuzza
- e ENT Department G.F. Ingrassia ; Policlinico-Vittorio Emanuele University Hospital; University of Catania ; Catania , Italy
| | - Raffaele Falsaperla
- a Acute and Emergency Paediatric and General Paediatric Operative Unit; Policlinico-Vittorio Emanuele Hospital; University of Catania ; Catania , Italy
| |
Collapse
|
12
|
de Seze J, Lebrun C, Stojkovic T, Ferriby D, Chatel M, Vermersch P. Is Devic's neuromyelitis optica a separate disease? A comparative study with multiple sclerosis. Mult Scler 2016; 9:521-5. [PMID: 14582780 DOI: 10.1191/1352458503ms947oa] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Devic's neuromyelitis optica (NMO) associates optic neuritis and myelopathy without other neurological signs. Many patients with NMO may be diagnosed as having multiple sclerosis (MS). However, there have been no previous studies comparing these two patho logies and it is still unclear if NMO is a separate entity or a subtype of MS. In the present study, we compared a series of NMO patients with a series of MS patients for whom optic neuritis or myelopathy was the presenting symptom, in order to determine the place of NMO in the spectrum of MS. We retrospectively studied 30 patients diagnosed with NMO and we compared these patients with 50 consecutive MS cases revealed by optic neuritis or acute myelopathy. MS patients were only included if a relapse occurred demonstrating time and space dissemination. We compared the two groups in terms of clinical presentatio n, laboratory findings (MRI and C SF) and clinical outcome. NMO patients were older and more frequently women than MS patients but the difference was not significant. C SF and MRI data were clearly different: oligoclonal bands (O C B) were found in 23% of NMO cases and 88% of MS (P B/0.001), abnormal brain MRI data were observed in 10% of NMO cases and 66% of MS (P B/0.001) and a large spinal cord lesion was observed in 67% of NMO cases and 7.4% of MS cases (P B/0.001). C linical outcome was evaluated as more severe in the NMO group (P B/0.001). O n the basis of clinical data, all NMO patients but three had dissemination in time and space. When we included MRI parameters, only two of the NMO patients met criteria for MS and one of the MS patients met criteria for NMO. O ur study demonstrates that NMO and MS should be considered as two different entities. The respective criteria for NMO and MS were able to distinguish these two patho logies but only when MRI data were applied. This finding could have implications for future therapeutic trials.
Collapse
Affiliation(s)
- J de Seze
- Department of Neurology, Hôpital R. Salengro, University of Lille, France.
| | | | | | | | | | | |
Collapse
|
13
|
Khair AM. Utility of Plasmapheresis in Autoimmune-Mediated Encephalopathy in Children: Potentials and Challenges. Neurol Res Int 2016; 2016:7685807. [PMID: 27239341 DOI: 10.1155/2016/7685807] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 03/31/2016] [Accepted: 04/10/2016] [Indexed: 12/29/2022] Open
Abstract
Autoimmune-mediated encephalopathy in children continues to constitute a diagnostic and therapeutic challenge in pediatric population. Utility and usefulness in this clinical setting of plasmapheresis have seldom been evaluated in current pediatric literature. Children with immune-mediated encephalopathies represent a uniquely different group among patients presenting to intensive care units or neurological services worldwide. Arriving at a final diagnosis is not an easy task for treating physicians. It is very crucial to consider early use of first-line immunotherapy modalities, save those children's lives and improve outcomes. Plasmapheresis is an emerging, potentially beneficial first-line therapy in such patients. However, indications, value, logistics, and procedural difficulties are often faced. This study is mainly meant to review the current knowledge in regard to the clinical value of plasmapheresis in children with immune-mediated encephalopathy.
Collapse
|
14
|
Çelik T, Çelik Ü, Kömür M, Tolunay O, Dönmezer Ç, Yıldızdas D. Treatment of Lyme neuroborreliosis with plasmapheresis. J Clin Apher 2015; 31:476-8. [DOI: 10.1002/jca.21430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 08/07/2015] [Accepted: 08/12/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Tamer Çelik
- Department of Pediatric Neurology; Adana Numune Research and Training Hospital; Adana Turkey
| | - Ümit Çelik
- Department of Pediatric Infection; Adana Numune Research and Training Hospital; Adana Turkey
| | - Mustafa Kömür
- Department of Pediatric Neurology; Adana Numune Research and Training Hospital; Adana Turkey
| | - Orkun Tolunay
- Department of Pediatrics; Adana Numune Research and Training Hospital; Adana Turkey
| | - Çiğdem Dönmezer
- Department of Pediatrics; Adana Numune Research and Training Hospital; Adana Turkey
| | - Dinçer Yıldızdas
- Department of Pediatric Intensive Care Unit; Cukurova University Faculty of Medicine; Adana Turkey
| |
Collapse
|
15
|
Borras-Novell C, García Rey E, Perez Baena LF, Jordan Garcia I, Catella Cahiz D, Cambra F. Therapeutic plasma exchange in acute disseminated encephalomyelitis in children. J Clin Apher 2015; 30:335-9. [DOI: 10.1002/jca.21388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Accepted: 01/14/2015] [Indexed: 12/18/2022]
Affiliation(s)
| | | | | | | | | | - Francisco Cambra
- Pediatric Intensive Care Unit; Hospital Sant Joan De Déu; Barcelona Spain
| |
Collapse
|
16
|
Bigi S, Banwell B, Yeh EA. Outcomes after early administration of plasma exchange in pediatric central nervous system inflammatory demyelination. J Child Neurol 2015; 30:874-80. [PMID: 25246301 DOI: 10.1177/0883073814545883] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/01/2014] [Indexed: 12/20/2022]
Abstract
The use of plasma exchange has been described in steroid-refractory central nervous system inflammatory demyelination in adults, but less has been published regarding its use in children and adolescents. We describe 12 children treated with plasma exchange for acute severe central nervous system inflammatory demyelination. The clinical attack leading to plasma exchange included symptomatic spinal cord lesions in 10 and symptomatic brainstem lesions in 2 children. Diagnosis was acute transverse myelitis in 6, relapsing-remitting multiple sclerosis in 5, and acute disseminated encephalomyelitis in 1 child. Adverse events related to plasma exchange necessitating intervention were observed in 3 children. Median Expanded Disability Status Scale score at plasma exchange start was 7.5 (range 4-9.5). At 3 months, 7 children were ambulatory without aid (Expanded Disability Status Scale score of ≤4). This retrospective study suggests that plasma exchange can be effective in ameliorating symptoms in severe pediatric central nervous system inflammatory demyelination, although lack of randomization or control group limits the ability to attribute this outcome entirely to plasma exchange.
Collapse
Affiliation(s)
- Sandra Bigi
- The Hospital for Sick Children, Division of Neurology, Toronto, Ontario, Canada
| | - Brenda Banwell
- The Hospital for Sick Children, Division of Neurology, Toronto, Ontario, Canada The Children's Hospital of Philadelphia, Division of Neurology, Philadelphia, PA, USA
| | - E Ann Yeh
- The Hospital for Sick Children, Division of Neurology, Toronto, Ontario, Canada
| |
Collapse
|
17
|
|
18
|
Sarioglu B, Kose SS, Saritas S, Kose E, Kanik A, Helvaci M. Severe acute disseminated encephalomyelitis with clinical findings of transverse myelitis after herpes simplex virus infection. J Child Neurol 2014; 29:1519-23. [PMID: 24525997 DOI: 10.1177/0883073813513334] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND ADEM is a central nervous disease that leads to myelin damage as a result of autoimmune response that develops after infections or vaccination. Herpes Simplex Virus (HSV) infection rarely leads to ADEM. PATIENT 25-month-old male due to urinary retention, paradoxical respiration and muscle weakness after herpetic gingivostomatitis diagnosed as transverse myelitis. In follow-up with cranial and spinal magnetic resonance imaging multiple lesions were demonstrated. Electroneuromyography findings were compatible with acute sensorimotor neuropathy, serum anti-GM2 antibodies and Herpes Simplex Virus (HSV) Type 1/2 IgM / IgG detected negative and positivite, respectively. With these findings he was diagnosed acute disseminated encephalomyelitis (ADEM) following HSV infection. Although acyclovir, intravenous immunoglobulin, methylprednisolone and plasmapheresis therapies, he is still in intensive physical therapy program with heavy sequel. RESULTS In our case, ADEM demonstrated transverse myelitis clinic after HSV infection which is rarely seen in literature. As well as clinic and spinal imaging findings, cranial imaging findings helped establishment of ADEM diagnosis. CONCLUSION To our best knowledge, HSV is a rare etiological and probably the poor prognostic factor of ADEM.
Collapse
Affiliation(s)
- Berrak Sarioglu
- Department of Pediatric Neurology, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Seda Sirin Kose
- Department of Pediatrics, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Serdar Saritas
- Department of Pediatrics, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Engin Kose
- Department of Pediatrics, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Ali Kanik
- Department of Pediatrics, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Helvaci
- Department of Pediatrics, Izmir Tepecik Training and Research Hospital, Izmir, Turkey
| |
Collapse
|
19
|
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute multifocal demyelinating disease of the central nervous system that typically follows an infectious illness. Its clinical course in most cases is monophasic; however, relapsing ADEM is rarely seen, which poses a diagnostic challenge for distinguishing this disease from multiple sclerosis (MS). Although typically encountered in children, it also occurs in adults with disease characteristics slightly different from the pediatric cases. Formerly, ADEM occurred particularly often in children with measles. However, the illness most often follows a non-descript viral or even bacterial infectious illness. ADEM occurs throughout the world, and may even be more common in less-developed countries, where MS is rare, than in developed ones, where MS is common. Children seldom get MS as opposed to adults, indicating that ADEM constitutes a distinct entity from MS. The prognosis of ADEM is generally good, but severe neurologic sequelae after ADEM are occasionally seen. In this chapter, the etiology, clinical/laboratory/radiologic characteristics, treatment options, and prognosis of ADEM are discussed.
Collapse
Affiliation(s)
- Adil Javed
- Department of Neurology, University of Chicago, Chicago, IL, USA.
| | - Omar Khan
- Department of Neurology, Wayne State University, Detroit, MI, USA
| |
Collapse
|
20
|
Ichikawa K, Motoi H, Oyama Y, Watanabe Y, Takeshita S. Fulminant form of acute disseminated encephalomyelitis in a child treated with mild hypothermia. Pediatr Int 2013; 55:e149-51. [PMID: 24330300 DOI: 10.1111/ped.12180] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 11/29/2022]
Abstract
We describe the case of a 3-year-old boy diagnosed with the fulminant form of acute disseminated encephalomyelitis (ADEM). He developed general fatigue, fever, drowsiness and difficulty in walking. He had extensive multiple high-intensity lesions in the white matter of the cerebrum and cerebellum, which are typical findings of ADEM. He became comatose and developed decerebrate rigidity with severe brain edema despite high-dose methylprednisolone therapy, and then was subjected to mild hypothermia therapy, and given i.v. immunoglobulin. The patient recovered remarkably with the sequela of only mild action tremor. The patient was considered to have acute hemorrhagic leukoencephalitis (AHLE), an extremely severe form of ADEM, in terms of the rapidly deteriorating clinical course and neuroimaging features. It was speculated that AHLE and ADEM might be a continuous disease spectrum. It is considered that the severe brain edema associated with ADEM or AHLE is a suitable indication for mild hypothermia therapy.
Collapse
Affiliation(s)
- Kazushi Ichikawa
- Department of Pediatrics, Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | | |
Collapse
|
21
|
Marin SE, Callen DJ. The magnetic resonance imaging appearance of monophasic acute disseminated encephalomyelitis: an update post application of the 2007 consensus criteria. Neuroimaging Clin N Am 2013; 23:245-66. [PMID: 23608688 DOI: 10.1016/j.nic.2012.12.005] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
22
|
Koziolek M, Mühlhausen J, Friede T, Ellenberger D, Sigler M, Huppke B, Gärtner J, Müller GA, Huppke P. Therapeutic Apheresis in Pediatric Patients with Acute CNS Inflammatory Demyelinating Disease. Blood Purif 2013; 36:92-7. [DOI: 10.1159/000354077] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2013] [Accepted: 06/19/2013] [Indexed: 11/19/2022]
|
23
|
Lee DH, Linker RA. The role of myelin oligodendrocyte glycoprotein in autoimmune demyelination: a target for multiple sclerosis therapy? Expert Opin Ther Targets 2012; 16:451-62. [DOI: 10.1517/14728222.2012.677438] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
24
|
Affiliation(s)
- M Alexander
- Department of Neurological Sciences, Christian Medical College, Vellore, India
| | | |
Collapse
|
25
|
Hagiwara H, Sakamoto S, Katsumata T, Katayama Y. Acute disseminated encephalomyelitis developed after Mycoplasma pneumoniae infection complicating subclinical measles infection. Intern Med 2009; 48:479-83. [PMID: 19293551 DOI: 10.2169/internalmedicine.48.1740] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 26-year-old man developed acute disseminated encephalomyelitis (ADEM) after Mycoplasma pneumoniae infection, and was admitted after developing disturbed consciousness. Magnetic resonance images revealed lesions in the midbrain, bilateral internal capsules, left corona radiata, white matter of the left occipital lobe, and thoracic spinal cord. He was diagnosed with subclinical measles infection since no anthema was observed despite the fact that his serum and cerebrospinal fluid samples were positive for measles IgM antibodies. ADEM following mixed infection with measles and M. pneumoniae is rare, and it is not clear whether an additional infection with measles influenced the onset of ADEM after M. pneumoniae infection. Symptoms did not improve with steroid or immunoglobulin treatment, but improvement in symptoms was observed after plasmapheresis.
Collapse
Affiliation(s)
- Hiroshi Hagiwara
- Divisions of Neurology, Nephrology, and Rheumatology, Department of Internal Medicine, Nippon Medical School, Tokyo.
| | | | | | | |
Collapse
|
26
|
Abstract
The advent of MRI has contributed to increase the interest and awareness in childhood white matter disorders. A major priority is to distinguish transient and self-limited demyelinating syndromes like disseminated encephalomyelitis (DEM), from life-long diseases like multiple sclerosis (MS). However, the term DEM has been inconsistently applied across studies due to the lack of clear clinical and neuroimaging diagnostic criteria. The present review summarizes the available literature on DEM in children, outlines the main clinical and neuroimaging features at presentation, pathogenesis and outcome, and its differentiation from other conditions with acute impact in the CNS. The recently proposed clinical definitions for monophasic disseminated encephalomyelitis and its relapsing variants are discussed, and controversies surrounding the diagnosis of MS in children are addressed.
Collapse
Affiliation(s)
- Silvia N Tenembaum
- Department of Neurology, National Paediatric Hospital Dr. J. P. Garrahan, Buenos Aires, Argentina.
| |
Collapse
|
27
|
Shinozaki K, Oda S, Sadahiro T, Nakamura M, Abe R, Nakamura S, Hattori N, Hirano S, Hattori T, Hirasawa H. A Case Report of Plasmapheresis in the Treatment of Acute Disseminated Encephalomyelitis. Ther Apher Dial 2008; 12:401-5. [DOI: 10.1111/j.1744-9987.2008.00617.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
28
|
Ryan LJ, Bowman R, Zantek ND, Sherr G, Maxwell R, Clark HB, Mair DC. Use of therapeutic plasma exchange in the management of acute hemorrhagic leukoencephalitis: a case report and review of the literature. Transfusion 2007; 47:981-6. [PMID: 17524086 DOI: 10.1111/j.1537-2995.2007.01227.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Acute hemorrhagic leukoencephalitis (AHLE) is a rare, fatal, central nervous demyelinating disease characterized by a rapid fulminant clinical course. Successful management requires early diagnosis, aggressive management of cerebral edema, and immunosuppression. Therapeutic plasma exchange (TPE) is infrequently used and commences after initial management fails. CASE REPORT A 31-year-old man presented with right arm weakness, whose symptoms rapidly progressed to hemiplegia and aphasia. The patient was initially managed with glucocorticosteroids. Decompressive craniotomy and brain biopsies were performed when his intracranial pressure increased. Brain biopsy findings were consistent with AHLE. Mycoplasma pneumonia immunoglobulin G and immunoglobulin M serologies revealed recent infection. Despite surgical and medical management, he decompensated on Day 11, and TPE was initiated. The patient received a total of 10 TPE treatments. On the fourth day of TPE treatment, he was extubated. Twenty-one days after TPE began, he was ambulating with near normal muscle strength and was discharged. Four months after initial presentation, the patient has normal strength and is working full-time. CONCLUSIONS AHLE has a fulminant course requiring accurate and rapid diagnosis. Successful therapy requires aggressive management of intracranial pressure and immunosuppression. Two other reports of AHLE document successful management with TPE. Each of these patients survived with minimal neurologic impairments. Given the likely immune-mediated nature of this disease, combined treatment of steroids, surgery, and TPE may lead to shorter hospital stays and improved neurologic outcomes. Clinical studies are needed to further study the effect of TPE on neurologic outcome in AHLE.
Collapse
Affiliation(s)
- Lori J Ryan
- Division of Transfusion Medicine, Department of Laboratory Medicine and Pathology, University of Minnesota Medical Center University of Minnesota, Minneapolis, Minnesota 55455, USA.
| | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Encephalitis is uncommon but is a neurological emergency which must be considered in a patient presenting with altered consciousness. Encephalitis is a diffuse inflammatory process of the brain parenchyma associated with evidence of brain dysfunction. The presentation of encephalitis can be acute or chronic. The aetiology of encephalitis can be broadly divided into two major subtypes. (1) Infection-related encephalitis which is a direct consequence of pathogenic viral, bacterial or parasitic agents. Herpes simplex virus (HSV) and varicella-zoster virus (VZV) are the most common cause of acute infectious encephalitis. (2) Autoimmune-mediated encephalitis which is mediated by an aberrant immune response. This can be triggered by a recent viral infection or vaccination. An example of this would be acute disseminated encephalitis (ADEM). This article will focus on the medical management of acute encephalitis. This will involve an extensive overview of the literature reviewing the diagnosis, investigation and treatment of acute viral encephalitis, ADEM and acute haemorrhagic leukoencephalopathy (AHLE). Encephalitis can also present chronically, and some of the different types of chronic encephalitis will be discussed.
Collapse
Affiliation(s)
- Mark J Stone
- Department of Neurology, University Hospital of North Staffordshire, Stoke-on-Trent, UK.
| | | |
Collapse
|
30
|
Abstract
Multiple sclerosis (MS) has been described for more than a century, but its cause remains unknown. Numerous reports were written concerning borderline forms of the disease. In the present review we present MS related disorders such as neuromyelitis optica and acute demyelinating encephalomyelitis.
Collapse
Affiliation(s)
- J de Seze
- Clinique Neurologique, Hôpital Civil, place de l'Hôpital, BP 426, 67091 Strasbourg Cedex.
| |
Collapse
|
31
|
Abstract
The term post-infectious encephalomyelitis (PIEM) is frequently used interchangeably with acute disseminated encephalomyelitis (ADEM), although technically PIEM occurs after a known infection whereas with ADEM there is no antecedent infection. PIEM represents one of the primary demyelinating disorders of the central nervous system, along with multiple sclerosis and Devic's disease. There is no specific diagnostic test for any of these conditions and at onset it may be difficult to differentiate between ADEM and the first attack of multiple sclerosis. However, there are clinical and magnetic resonance imaging features that allow differentiation between PIEM/ADEM and a relapsing disease such as multiple sclerosis. Some patients improve spontaneously; most improve with methylprednisolone. If that fails, plasma exchange or intravenous immunoglobulin may be effective.
Collapse
Affiliation(s)
- Cornelia Mihai
- SUNY Upstate Medical University, 750 E. Adams Street, Syracuse, NY 13210, USA.
| | | |
Collapse
|
32
|
Abstract
The techniques of haemapheresis originated in the development of centrifugal devices separating cells from plasma and later on plasma from cells. Subsequently membrane filtration was developed allowing for plasma-cell separation. The unspecificity of therapeutic plasma exchange led to the development of secondary plasma separation technologies being specific, semi-selective or selective such as adsorption, filtration or precipitation. In contrast on-line differential separation of cells is still under development. Whereas erythrocytapheresis, granulocytapheresis, lymphocytapheresis and stem cell apheresis are technically advanced, monocytapheresis may need further improvement. Also, indications such as erythrocytapheresis for the treatment of polycythaemia vera or photopheresis though being clinically effective and of considerable importance for an appropriate disease control are to some extent under debate as being either too costly or without sufficient understanding of the mechanism. Other forms of cell therapy are under development. Rheohaemapheresis as the most advanced technology of extracorporeal haemorheotherapy is a rapidly developing approach contributing to the treatment of microcirculatory diseases and tissue repair. Whereas the control of a considerable number of (auto-) antibody mediated diseases is beyond discussion, the indication of apheresis therapy for immune complex mediated diseases is quite often still under debate. Detoxification for artificial liver support advanced considerably during the last years, whereas conclusions on the efficacy of septicaemia treatment are debatable indeed. LDL-apheresis initiated in 1981 as immune apheresis is well established since 24 years, other semi-selective or unspecific procedures, allowing for the elimination of LDL-cholesterol among other plasma components are also being used. Correspondingly Lp(a) apheresis is available as a specific, highly efficient elimination procedure superior to techniques which also eliminate Lp(a). Quality control systems, more economical technologies as for instance by increasing automation, influencing the over-interpretation of evidence based medicine especially in patients with rare diseases without treatment alternative, more insight into the need of controlled clinical trials or alternatively improved diagnostic procedures are among others tools ways to expand the application of haemapheresis so far applied in cardiology, dermatology, haematology, immunology, nephrology, neurology, ophthalmology, otology, paediatrics, rheumatology, surgery and transfusion medicine.
Collapse
Affiliation(s)
- Helmut Borberg
- German Haemapheresis Centre, Deutsches Haemapherese Zentrum, Maarweg 165, D-50 825 Köln, Germany.
| |
Collapse
|
33
|
Lu RP, Keilson G. Combination regimen of methylprednisolone, IV immunoglobulin, and plasmapheresis early in the treatment of acute disseminated encephalomyelitis. J Clin Apher 2006; 21:260-5. [PMID: 16868969 DOI: 10.1002/jca.20103] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is a demyelinating disease of the central nervous system that is associated with significant morbidity and mortality. Early recognition of the disease is of paramount importance; however, treatment options are limited because only case reports and small series are available in the literature. We report a case of a 42 year-old previously healthy man, whom we treated successfully with a combination regimen of methylprednisolone, IV immunoglobulin, and plasmapheresis early in the course of the disease.
Collapse
Affiliation(s)
- Rommel P Lu
- Department of Medicine, Saint Vincent Hospital at Worcester Medical Center, Worcester, Massachusetts 01608, USA.
| | | |
Collapse
|
34
|
Abstract
Multiple sclerosis (MS) has been described for more than a century, but its cause remains unknown. Numerous reports have been written concerning borderline types of the disease. In the present paper we present the pseudo-tumoral variants of MS (so called Balo's, Marburg's and Schilder's forms), demographic variants (young and elderly onset of MS), related disorders (neuromyelitis optica and acute demyelinating encephalomyelitis). We also discuss the differential diagnosis with other auto-immune diseases.
Collapse
Affiliation(s)
- J De Seze
- Clinique Neurologique, Hôpital Civil, Strasbourg.
| |
Collapse
|
35
|
Stüve O, Nessler S, Hartung HP, Hemmer B, Wiendl H, Kieseier BC. [Acute disseminated encephalomyelitis. Pathogenesis, diagnosis, treatment, and prognosis]. Nervenarzt 2005; 76:701-7. [PMID: 15580467 DOI: 10.1007/s00115-004-1842-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Acute disseminated encephalomyelitis (ADEM) is typically a monophasic, demyelinating disease of the CNS that predominantly affects children. Typically, its clinical symptoms follow an infection or vaccination. In this regard, numerous viral and bacterial pathogens as well as several vaccinations have been associated with ADEM. Studies from animal models suggest that primary and secondary autoimmune responses may contribute to CNS inflammation and demyelination in ADEM. The diagnosis of ADEM is strongly suggested by a close temporal relationship between a viral infection or immunization and the onset of neurologic symptoms, and it is supported by extensive, multifocal, subcortical white-matter disease on brain magnetic resonance imaging. While mild lymphocytic pleocytosis and elevated proteins are detectable in the CSF in ADEM, oligoclonal bands are not always present. Treatment of this disorder consists of anti-inflammatory and immunosuppressive therapies, and the prognosis is generally considered favorable.
Collapse
Affiliation(s)
- O Stüve
- Neurologische Klinik, Heinrich-Heine-Universität Düsseldorf.
| | | | | | | | | | | |
Collapse
|
36
|
Gaudry P, Lantheaume S, Renard JL, Koulmann PH, Ponties JE. The follow-up of acute disseminated encephalomyelitis in a comatose pregnant woman. Eur J Obstet Gynecol Reprod Biol 2005; 124:123-5. [PMID: 16099583 DOI: 10.1016/j.ejogrb.2005.06.031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2004] [Revised: 03/25/2005] [Accepted: 06/30/2005] [Indexed: 11/30/2022]
|
37
|
Khurana DS, Melvin JJ, Kothare SV, Valencia I, Hardison HH, Yum S, Faerber EN, Legido A. Acute disseminated encephalomyelitis in children: discordant neurologic and neuroimaging abnormalities and response to plasmapheresis. Pediatrics 2005; 116:431-6. [PMID: 16061599 DOI: 10.1542/peds.2004-2038] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To describe our experience with acute disseminated encephalomyelitis (ADEM), focusing on (1) the relationship between clinical course and MRI findings and (2) the response to plasmapheresis in a subgroup of patients. METHODS A retrospective record review was conducted of 13 children who were admitted as inpatients with the diagnosis of ADEM during the period 1998-2003. RESULTS Diagnosis was established by clinical signs and symptoms, cerebrospinal fluid changes and multifocal involvement of deep gray and white matter based on MRI. Initial therapy was high-dose methylprednisolone and intravenous immunoglobulin in 12 patients. One child improved spontaneously. Six of 12 children did not improve with corticosteroid treatment. All 6 had an acute progressive course neurologically, and 5 of them also showed a delay in the onset of neuroimaging changes, eventually developing lesions in the deep gray matter and brainstem. This latter group received 5 sessions of plasmapheresis and recovered over the course of several months with varying degrees of residual neurologic deficits. CONCLUSIONS Presentation of ADEM with delayed development of MRI lesions in deep gray matter and brainstem may herald a prolonged clinical course and lack of response to glucocorticoid therapy. Plasmapheresis might be an effective therapeutic intervention in these patients. The role of plasmapheresis versus corticosteroids and intravenous immunoglobulin as a primary treatment of ADEM needs to be investigated further.
Collapse
Affiliation(s)
- Divya S Khurana
- Department of Pediatrics, St Christopher's Hospital for Children, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA.
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
A 10-year-old boy presented with anarthria and bilateral central faciolinguovelopharyngeomasticatory paralysis with "automatic voluntary dissociation" suggestive of Foix-Chavany-Marie syndrome or anterior opercular syndrome following a nonspecific upper respiratory infection. Brain magnetic resonance imaging revealed bilateral subcortical perisylvian demyelination in addition to multiple subcortical white-matter demyelination. The clinicoradiologic picture suggested acute disseminated encephalomyelitis. The child recovered completely following intravenous methylprednisolone and intravenous immunoglobulin therapy. This is the first report of anterior opercular syndrome in childhood acute disseminated encephalomyelitis.
Collapse
|
39
|
Abstract
High-dose corticosteroid administration has been regarded as the main therapy for acute disseminated encephalomyelitis (ADEM). However, some patients with ADEM do not respond well to this treatment. We successfully used plasmapheresis to treat 2 patients who had ADEM. We also compared our patients' symptoms and clinical outcomes to those from previous reports. Plasmapheresis may be indicated not only for severe cases that fail to improve after high-dose corticosteroid treatment but also for first-line treatment. Additional large, controlled, double-blinded trials are needed to clarify the role of plasmapheresis in ADEM.
Collapse
Affiliation(s)
- Chin-Hsien Lin
- Department of Neurology, National Taiwan University Hospital, Taipei
| | | | | |
Collapse
|
40
|
Abstract
Postinfectious forms of encephalomyelitis, also termed acute disseminated encephalomyelitis (ADEM), form one of several categories of inflammatory demyelinating disorders of the central nervous system (CNS). Recent large, retrospective case series have refined our understanding of the clinical, laboratory, and neuroimaging characteristics of ADEM. The differences between childhood and adult ADEM, risks of development of multiple sclerosis, and the contributions of recent studies to refining the nosology of CNS demyelinating syndromes are discussed.
Collapse
Affiliation(s)
- Dean M Wingerchuk
- Department of Neurology, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA.
| |
Collapse
|