Acute Disseminated Encephalomyelitis Medication

Updated: Dec 06, 2017
  • Author: J Nicholas Brenton, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

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Anti-inflammatory Agents

Class Summary

These agents have anti-inflammatory properties and cause profound and varied metabolic effects. Both corticosteroids and intravenous IVIG modify the body's immune response to diverse stimuli.

Methylprednisolone (Adlone, Medrol, Solu-Medrol, Depo-Medrol)

Considerable experience has accumulated in the use of various corticosteroids in the treatment of ADEM. No conclusive evidence exists that this form of therapy is effective. The weight of evidence at present supports the view that corticosteroids may shorten the time to onset of improvement. Whether this form of therapy shortens time to maximal recovery is unclear, and whether deleterious effects, such as enhancement of tendency to recurrence, exist is unknown. Generally, however, this form of therapy appears, within the considerable limits of present knowledge, to be safe. The usual approach is administration of methylprednisolone for 3-5 d IV (or the equivalent dose of some other anti-inflammatory corticosteroid). The initial dose should be administered under close supervision because rare instances of anaphylaxis after initial dose have been reported.

Human immune globulin (Gammagard, Gamimune, Sandoglobulin, IVIg)

Believed to treat conditions associated with inflammation and immune dysregulation by neutralizing circulating myelin antibodies through anti-idiotypic antibodies. May down-regulate proinflammatory cytokines, including IFN-gamma. Blocks Fc receptors on macrophages, suppresses inducer T and B cells, and augments suppressor T cells; blocks complement cascade. May promote remyelination. May increase CSF IgG modestly.

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