Medication Summary

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

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)

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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)

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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.

Follow-up

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Media Gallery

Fatal case of ADEM involving the brainstem in a 13-month-old.
Typical childhood ADEM in 7-year-old. Note tendency to involve gray-white junction, the fact that the lesion margins are less well defined than typical MS plaques, and that the deep white matter lesions are not oriented perpendicularly to the ventricular surface as is typical in MS.
Typical adolescent multiple sclerosis findings on MRI. Note the tendency of lesions to exhibit sharp margins, to be elongated, to occur in deep white matter or corpus callosum sparing the cortical gray-white junction, and to be oriented perpendicularly to the ventricular surface.

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Author

J Nicholas Brenton, MD Associate Professor of Pediatrics and Neurology, University of Virginia School of Medicine

J Nicholas Brenton, MD is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, Child Neurology Society

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cycle Pharmaceuticals, I-ACT for Children.

Coauthor(s)

Robert Stanley Rust, Jr, MD, MA Former Thomas E Worrell Jr Professor of Epileptology and Neurology, Co-Director of FE Dreifuss Child Neurology and Epilepsy Clinics, Director, Child Neurology, University of Virginia School of Medicine; Chair-Elect, Child Neurology Section, American Academy of Neurology

Robert Stanley Rust, Jr, MD, MA is a member of the following medical societies: American Academy of Neurology, American Epilepsy Society, American Headache Society, American Neurological Association, Child Neurology Society, International Child Neurology Association, Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Glenn Lopate, MD Associate Professor, Department of Neurology, Division of Neuromuscular Diseases, Washington University in St Louis School of Medicine; Consulting Staff, Department of Neurology, Barnes-Jewish Hospital

Glenn Lopate, MD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, Phi Beta Kappa

Disclosure: Nothing to disclose.

Chief Editor

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS † Professor Emeritus of Neurology and Psychiatry, Clinical Professor of Medicine, Clinical Professor of Family Medicine, Clinical Professor of Neurosurgery, State University of New York Upstate Medical University; Neuroscience Director, Department of Neurology, Crouse Irving Memorial Hospital

Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American College of Forensic Examiners Institute, American College of International Physicians, American College of Physicians, American Heart Association, American Stroke Association, National Association of Managed Care Physicians, Royal College of Physicians, Royal College of Physicians and Surgeons of Canada, Royal College of Surgeons of England, Royal Society of Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Christopher Luzzio, MD Clinical Assistant Professor, Department of Neurology, University of Wisconsin at Madison School of Medicine and Public Health

Christopher Luzzio, MD is a member of the following medical societies: American Academy of Neurology

Disclosure: Nothing to disclose.