ADEM is a rare disease and no medications have been specifically approved by the US Food and Drug Administration (FDA) to treat it, however, treatment for ADEM could include the following:
- High dose intravenous (IV) corticosteroids (typically methylprednisolone) are the front-line treatment for ADEM. These medications are usually given over a three- to five-day course, followed or not by a tapering dose of steroids given orally (by mouth) over a few days. The goal is to reduce inflammation and speed recovery from the disease.
- If a patient does not improve after IV methylprednisolone, the next line treatment option may be a process called plasmapheresis or plasma exchange. This is a treatment in which the blood is circulated through a machine that withdraws components of the immune system from the blood circulation, reducing inflammation. It is usually a process which takes a few hours and is done every other day for 10 to 14 days, often as part of a hospital stay. It may require the placement of a central venous catheter to allow for blood to be removed from the system rapidly.
- Another approach to treatment is IV immune globulin (IVIG). This is an intravenous treatment using a blood product that has been shown to reduce the activity in certain immune diseases, including ADEM. Treatment is usually given for a few hours daily over five days for ADEM.
- In very rare and severe cases that do not respond to less toxic therapies (steroids, IVIG and/or plasma exchange), a chemotherapy called “cyclophosphamide” may be used for treatment.
Although the long-term prognosis for children with ADEM varies, most children make a complete or nearly complete recovery, including those children with initially severe symptoms. For most children, recovery begins within days and continues for up to one year. Some patients can have residual symptoms such as blurred vision, weakness or numbness.
Steroid treatment can reduce some ongoing symptoms and may stop new symptoms from developing, although the latter is not proven.
Reviewed by Elias Sotirchos, MD November 2019