Effectiveness of intravenous immunoglobulin treatment in adult patients with steroid-resistant monophasic or recurrent acute disseminated encephalomyelitis
Randomized Controlled Trials have not let established the best pharmacological management of Acute Disseminated Encephalomyelitis (ADEM). High dose steroids are usually employed with good results, but in a few cases the clinical outcome is poor. In other patients, particularly those affected by the...
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| Veröffentlicht in: | Journal of neurology 2002, Vol.249 (1), p.100-104 |
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| creator | MARCHIONI, E MARINOU-AKTIPI, K UGGETTI, C BOTTANELLI, M PICHIECCHIO, A SORAGNA, D PICCOLO, G IMBESI, F ROMANI, A CERONI, M |
| description | Randomized Controlled Trials have not let established the best pharmacological management of Acute Disseminated Encephalomyelitis (ADEM). High dose steroids are usually employed with good results, but in a few cases the clinical outcome is poor. In other patients, particularly those affected by the site restricted ADEM variants (myelitis), the disease shows a recurrent course resembling that of Multiple Sclerosis. We present here five patients, 3 of them affected by classic disseminated encephalomyelitis and 2 by a post infectious myelitis, which showed a good response to intravenous immunoglobulin (IVIg) after steroid treatment failure. In our report high dose steroids administration was substantially uneffective in all but one case, who showed a good response only during the first episode. On the contrary IVIg injection (0,4 gr/kg/day) produced a marked functional improvement in all patients starting within the first five days of drug administration and reaching a maximum within three weeks. One patient experienced a good effect nothwithstanding a steady dysability. In all cases, clinical evidence was supported by MRI controls showing improving posttreatment changes. |
| doi_str_mv | 10.1007/PL00007836 |
| format | Article |
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High dose steroids are usually employed with good results, but in a few cases the clinical outcome is poor. In other patients, particularly those affected by the site restricted ADEM variants (myelitis), the disease shows a recurrent course resembling that of Multiple Sclerosis. We present here five patients, 3 of them affected by classic disseminated encephalomyelitis and 2 by a post infectious myelitis, which showed a good response to intravenous immunoglobulin (IVIg) after steroid treatment failure. In our report high dose steroids administration was substantially uneffective in all but one case, who showed a good response only during the first episode. On the contrary IVIg injection (0,4 gr/kg/day) produced a marked functional improvement in all patients starting within the first five days of drug administration and reaching a maximum within three weeks. One patient experienced a good effect nothwithstanding a steady dysability. In all cases, clinical evidence was supported by MRI controls showing improving posttreatment changes.</description><identifier>ISSN: 0340-5354</identifier><identifier>EISSN: 1432-1459</identifier><identifier>DOI: 10.1007/PL00007836</identifier><identifier>PMID: 11954856</identifier><identifier>CODEN: JNRYA9</identifier><language>eng</language><publisher>Berlin: Springer</publisher><subject>Aged ; Anti-Inflammatory Agents - therapeutic use ; Biological and medical sciences ; Disability Evaluation ; Dose-Response Relationship, Drug ; Drug Resistance - physiology ; Encephalomyelitis, Acute Disseminated - drug therapy ; Encephalomyelitis, Acute Disseminated - immunology ; Encephalomyelitis, Acute Disseminated - physiopathology ; Female ; Humans ; Immunoglobulins, Intravenous - therapeutic use ; Immunomodulators ; Male ; Medical sciences ; Middle Aged ; Nervous system (semeiology, syndromes) ; Nervous system as a whole ; Neurology ; Pharmacology. 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High dose steroids are usually employed with good results, but in a few cases the clinical outcome is poor. In other patients, particularly those affected by the site restricted ADEM variants (myelitis), the disease shows a recurrent course resembling that of Multiple Sclerosis. We present here five patients, 3 of them affected by classic disseminated encephalomyelitis and 2 by a post infectious myelitis, which showed a good response to intravenous immunoglobulin (IVIg) after steroid treatment failure. In our report high dose steroids administration was substantially uneffective in all but one case, who showed a good response only during the first episode. On the contrary IVIg injection (0,4 gr/kg/day) produced a marked functional improvement in all patients starting within the first five days of drug administration and reaching a maximum within three weeks. One patient experienced a good effect nothwithstanding a steady dysability. 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High dose steroids are usually employed with good results, but in a few cases the clinical outcome is poor. In other patients, particularly those affected by the site restricted ADEM variants (myelitis), the disease shows a recurrent course resembling that of Multiple Sclerosis. We present here five patients, 3 of them affected by classic disseminated encephalomyelitis and 2 by a post infectious myelitis, which showed a good response to intravenous immunoglobulin (IVIg) after steroid treatment failure. In our report high dose steroids administration was substantially uneffective in all but one case, who showed a good response only during the first episode. On the contrary IVIg injection (0,4 gr/kg/day) produced a marked functional improvement in all patients starting within the first five days of drug administration and reaching a maximum within three weeks. One patient experienced a good effect nothwithstanding a steady dysability. In all cases, clinical evidence was supported by MRI controls showing improving posttreatment changes.</abstract><cop>Berlin</cop><pub>Springer</pub><pmid>11954856</pmid><doi>10.1007/PL00007836</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Anti-Inflammatory Agents - therapeutic use Biological and medical sciences Disability Evaluation Dose-Response Relationship, Drug Drug Resistance - physiology Encephalomyelitis, Acute Disseminated - drug therapy Encephalomyelitis, Acute Disseminated - immunology Encephalomyelitis, Acute Disseminated - physiopathology Female Humans Immunoglobulins, Intravenous - therapeutic use Immunomodulators Male Medical sciences Middle Aged Nervous system (semeiology, syndromes) Nervous system as a whole Neurology Pharmacology. Drug treatments Steroids Treatment Failure Treatment Outcome |
| title | Effectiveness of intravenous immunoglobulin treatment in adult patients with steroid-resistant monophasic or recurrent acute disseminated encephalomyelitis |
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