Acute disseminated encephalomyelitis(ADEM) is a medical condition which leads to similar clinical presentation to multiple sclerosis which sometimes makes the two conditions quite hard to differentiate. Still, since MS (multiple sclerosis), especially in children, has specific characteristics and is responsible for specific results obtained after laboratory testing, definitive diagnosis can be eventually achieved.
Unlike multiple sclerosis, which is a relapsing and remitting illness, ADEM has only one phase. Both of them affect children, although ADEM typically develops in prepubertal children.
How to Differentiate MS and ADEM
In case of MS there are certain abnormalities found on cerebrospinal fluid immunoglobulin studies. These are not typical for ADEM. On the other hand, the onset of ADEM generally follows febrile prodromal illness or immunization. Once it fully develops, the condition is characterized by prominent constitutional signs and encephalopathy of different degree.
However, the similarity between the two conditions remains. What is more, there are several more neurological conditions which are taken into consideration when making differential diagnosis. They include optic neuritis, transverse myelitis and Devic syndrome. There may also be similarities with acute cerebellar ataxia and Guillain-Barré syndrome. All in all, it is essential to memorize that both conditions develop as a consequence of multiple factors (genetics, exposure to infectious agents etc). Only in case of ADEM the patient develops symptoms and signs of the diseases soon after a viral infection or immunization while there is no such connection in case of MS.
ADEM is generally treated with high doses of corticosteroids which are administered intravenously. Even though certain number of patients may recover within hours, in majority noticeable progress becomes visible after several days. In case corticosteroids fail to provide with desirable results, patients receive intravenous immune globulin (IVIG). This treatment is also indicated when corticosteroids can worsen the already existing viral infection. Some doctors even combine these two treatments. The combination is prescribed in severe cases of ADEM.
Surgical care is required in case of hyperactive ADEM and the onset of certain complications such as elevated intracranial pressure, hemorrhagic brain purpura and non-Reye syndrome. The outcome of surgical interventions is variable.
Patients who have developed severe problems with breathing or circulatory collapse are transferred into an intensive care unit (ICU).
In spite of aggressive treatment some patients develop postinfectious demyelination syndromes which occur due to the presence of brain edema. This is more frequent if a person is suffering from brucellosis or malaria.