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Acute disseminated encephalomyelitis.

J M K Murthy1

  • 1Department of Neurology, The Institute of Neurological Sciences, CARE Hospitals, Nampally, Hyderabad - 500 001, India. drjmk@sol.net.in

Neurology India
|October 23, 2002
PubMed
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Acute disseminated encephalomyelitis (ADEM) is a rare autoimmune disease affecting the central nervous system. While often presenting with favorable outcomes, differentiating ADEM from multiple sclerosis (MS) remains a diagnostic challenge, especially in regions like India.

Area of Science:

  • Neurology
  • Immunology
  • Demyelinating Diseases

Background:

  • Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory demyelinating disease of the central nervous system.
  • Its incidence in India is likely underestimated due to prevalent antecedent events like exanthematous fevers and Semple antirabies vaccination.
  • ADEM is thought to arise from a transient autoimmune response, potentially involving molecular mimicry or non-specific T cell activation.

Purpose of the Study:

  • To review the characteristics, diagnosis, and management of ADEM.
  • To highlight the challenges in differentiating ADEM from the initial presentation of multiple sclerosis (MS).
  • To emphasize the relevance of this differentiation in the context of India's low MS incidence.

Main Methods:

Related Experiment Videos

  • Review of existing evidence on ADEM pathogenesis, clinical presentation, and neuroimaging findings.
  • Discussion of diagnostic criteria and challenges, including CSF analysis and MRI.
  • Exploration of therapeutic approaches based on analogies with MS.

    • Main Results:

    • ADEM is typically a monophasic illness with a good long-term prognosis.
    • MRI reveals extensive, often subcortical white matter lesions, with frequent deep gray matter involvement (e.g., basal ganglia).
    • Oligoclonal bands in CSF are generally absent, and established therapies are lacking, with treatments often extrapolated from MS management.

    Conclusions:

    • Differentiating ADEM from the first attack of MS is crucial for prognosis and treatment, though challenging without definitive biomarkers.
    • Clinical presentation, CSF analysis, and MRI findings are key diagnostic tools, but differentiation can be difficult.
    • Accurate diagnosis is particularly important in regions like India, where MS incidence is lower than in Western countries.