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Plasmapheresis in fulminant acute disseminated encephalomyelitis
R Miyazawa1, A Hikima, Y Takano
1Department of Pediatrics, Gunma University School of Medicine, 3-39-15 Showa-machi, Maebashi, 371-8511, Gunma, Japan. rmiyazaw@med.gunma-u.ac.jp
Insights
Plasmapheresis may effectively treat severe acute disseminated encephalomyelitis (ADEM). This treatment improved a child's consciousness, neurological symptoms, and MRI scans when standard therapies failed.
Area of Science:
- Neurology
- Pediatrics
- Immunology
Background:
- Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune disorder.
- Fulminant ADEM can lead to severe neurological deficits and respiratory failure.
Observation:
- An 11-year-old girl presented with ADEM, progressing to respiratory failure and coma.
- Standard treatments including corticosteroids and intravenous immunoglobulin were ineffective.
Findings:
- Plasmapheresis was administered four times.
- Treatment resulted in improved consciousness, reduced hyperesthesia and ophthalmoplegia, and resolved muscle weakness.
- Brain and spinal cord MRI scans normalized post-plasmapheresis.
Implications:
- Plasmapheresis may be a crucial therapeutic option for fulminant ADEM.
- This case highlights the potential of apheresis in managing severe pediatric neurological emergencies.
- Further research is warranted to establish plasmapheresis protocols for ADEM.
Abstract:
We report an 11-year-old girl with acute disseminated encephalomyelitis (ADEM) who developed respiratory failure and coma despite the use of corticosteroid and intravenous immunoglobulin. We performed plasmapheresis four times, which improved her level of consciousness, hyperesthesia, external ophthalmoplegia and muscle weakness, and led to the normalization of brain and spinal cord MRI. Plasmapheresis might be an effective treatment in cases of fulminant ADEM.