Walsh & Hoyt: Treatment and Prognosis

Most patients with myelinoclastic diffuse sclerosis follow a progressive unremitting course that ends in death within a few months or years; however, some patients experience spontaneous temporary or permanent improvement, and rare patients survive for a decade or longer. Patients may also improve after being treated with systemic corticosteroids administered orally, IV, or both. The patient reported by Lana-Peixoto and dos Santos experienced improvement in vision from hand motions in each eye to 20/20. Konkol et al. reported improvement in an 8-year-old boy after IV administration of adrenocorticotropic hormone and cyclophosphamide. Patientswho improve clinically generally show disappearance or shrinkage of the lesions seen on neuroimaging studies. Neurosurgical resection also has a role in treatment, and IV-Ig was used successfully in one case series.