Acute Disseminated Encephalomyelitis (ADEM)

Signs and Symptoms

Symptoms of acute disseminated encephalomyelitis (ADEM) are similar to multiple sclerosis (MS) and therefore the disease is often misdiagnosed as a severe attack of MS. However, there are key differences between the conditions' symptoms, which can be recognized by a neurologist.

Initial symptoms of ADEM occur quickly and intensely as a single, short-lived attack, though some children experience recurrent episodes over a period of months. Symptoms of ADEM may include fever, headaches, fatigue, nausea and vomiting. Changes in your child's consciousness, such as seizures or in severe cases, coma, as well as behavioral changes, such as irritability, are also likely to occur. Other symptoms are caused by myelin damage and include visual disturbances, difficulty coordinating muscle movements and weakness of a single limb or one side of the body.

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Diagnosis

An accurate and early diagnosis of acute disseminated encephalomyelitis (ADEM) is critical in the management of your child's disease and quality of life.

In making a diagnosis of ADEM, your child's doctor will first start by conducting a thorough physical examination, asking about any symptoms your child is experiencing, including when they started and how they've eased or progressed over time. Your child's doctor will also record their full medical history, including information about your immediate and extended family's medical history.

Next, a series of tests will be conducted, including a magnetic resonance imaging (MRI) of the brain and spinal cord to look for lesions, or areas of damage that may indicate ADEM and rule out other disorders such as multiple sclerosis (MS). An MRI scan is a non-invasive procedure that uses powerful magnets to construct clear, detailed pictures of brain and spinal cord tissues. Recent brain lesions are more typical in ADEM, but can also happen in MS. Old "inactive" lesions usually indicate MS, which often causes brain lesions before symptoms become obvious.

Your child may also have a lumbar puncture or spinal tap to determine if there are abnormalities in their cerebrospinal fluid (CSF). The CSF is the fluid that bathes, cushions and protects the brain and spinal cord. It flows through the skull and spine in the subarachnoid space, which is the area inside the arachnoid membrane. Typically, in ADEM, CSF contains abnormally elevated levels of white blood cells and protein.

A diagnosis of ADEM is based upon an evaluation of your child's symptoms along with the results of their physical exam and tests.

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Treatment

Children and adolescents with acute disseminated encephalomyelitis (ADEM) receive treatment at our Pediatric Multiple Sclerosis Center. Our team of experts specialize in ADEM and related diseases. We work with each patient to develop a unique treatment plan, including long-term follow-up care specifically tailored to his or her needs. When necessary, we also collaborate with other specialists at UCSF or elsewhere to ensure that your child receives the most comprehensive care possible. Additionally, because we are part of an international network of six pediatric MS centers sponsored by the National Multiple Sclerosis Society, we have access to the latest information, research and treatments.

The majority of children with ADEM will respond partially or completely to corticosteroid therapy, which diminishes symptoms by suppressing inflammation in the brain and spinal cord. When corticosteroids fail to work, plasmapheresis, intravenous immunoglobulintherapy or immunosuppressive therapy may be prescribed.

Your child's treatment may also include other medications to treat their symptoms, as well as supportive care to help them recover both physically and mentally, which may take weeks to months. Some children experience problems with their memory, especially short-term memory. They also may experience emotional disturbances. Rest alternated with mental and physical exercise will be recommended for rehabilitation. Our team of experts includes a physical therapist, speech therapist and neuropsychologist who can work directly with your child to help him or her recover.

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