Walsh & Hoyt: Treatment

The treatment of patients with ADEM is primarily supportive. Control of fever and seizures, reduction of increased ICP by medical or surgical methods, and prolonged assisted ventilation may be necessary. Hyperimmune gamma globulin is of no benefit. Systemic corticosteroids are given to some patients in an effort to reduce both the severity and duration of neurologic dysfunction; however, both nonrandomized and randomized studies show no modification of the clinical course or recovery, and one retrospective study of patients with ADEM found a higher mortality and morbidity among patients who received systemic corticosteroids. Because more severely affected patients would be those most likely to receive corticosteroids, these data were reanalyzed, including only patients admitted in coma. Even then, death rates were higher among patients treated with systemic corticosteroids. If ADEM is the closest clinical correlate to experimental allergic encephalomyelitis, then lessons from the laboratory would suggest avoiding abrupt withdrawal of steroid therapy. Plasmapheresis and treatment with IV-Ig may be beneficial in the treatment of ADEM, but no large series confirms their efficacy. With aggressive supportive therapy, even patients who experience long periods of coma eventually may recover with little or no neurologic sequelae.