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Lim H, Hwang SK, Lee YJ, Kwon S. The Wide Variety of Acute Disseminated Encephalomyelitis in Children: A Clinical Perspective. ANNALS OF CHILD NEUROLOGY 2022. [DOI: 10.26815/acn.2022.00220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Acute disseminated encephalomyelitis (ADEM) is an acute demyelinating inflammatory disorder of the central nervous system. It is characterized by encephalopathy, multifocal neurological deficits, and typical magnetic resonance imaging findings of widespread demyelinating lesions, predominantly involving the white matter of the brain and spinal cord. ADEM mainly affects children and is commonly associated with preceding viral and bacterial infections, and, rarely, vaccinations. Despite substantial advances in the understanding of the association of myelin oligodendrocyte glycoprotein antibody with recurrent forms of ADEM or other demyelinating conditions, specific etiologic agents or biological markers have not been identified. Therefore, the diagnosis of ADEM is still based on clinical and radiological findings and the exclusion of other conditions mimicking ADEM. However, a prompt diagnosis and adequate treatment are crucial because diagnostic delays or inappropriate treatment may lead to unwanted neurological sequelae in some children. There is no standardized treatment protocol for ADEM, but the use of corticosteroids, intravenous immunoglobulin, and plasmapheresis has been associated with good clinical outcomes. Adequate treatment has reportedly resulted in favorable outcomes, with full or almost full recovery in most children with ADEM, although some children may develop neurological sequelae, such as cognitive impairment and motor deficits. Further studies are needed to identify biological clues and optimal treatment protocols to minimize the incidence of neurological sequelae.
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Blair TC, Manoharan M, Rawlings-Rhea SD, Tagge I, Kohama SG, Hollister-Smith J, Ferguson B, Woltjer RL, Frederick MC, Pollaro J, Rooney WD, Sherman LS, Bourdette DN, Wong SW. Immunopathology of Japanese macaque encephalomyelitis is similar to multiple sclerosis. J Neuroimmunol 2016; 291:1-10. [PMID: 26857488 PMCID: PMC4748211 DOI: 10.1016/j.jneuroim.2015.11.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 11/24/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
Japanese macaque encephalomyelitis (JME) is an inflammatory demyelinating disease that occurs spontaneously in a colony of Japanese macaques (JM) at the Oregon National Primate Research Center. Animals with JME display clinical signs resembling multiple sclerosis (MS), and magnetic resonance imaging reveals multiple T2-weighted hyperintensities and gadolinium-enhancing lesions in the central nervous system (CNS). Here we undertook studies to determine if JME possesses features of an immune-mediated disease in the CNS. Comparable to MS, the CNS of animals with JME contain active lesions positive for IL-17, CD4+ T cells with Th1 and Th17 phenotypes, CD8+ T cells, and positive CSF findings.
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Affiliation(s)
- Tiffany C Blair
- Vaccine and Gene Therapy Institute, Oregon Health & Science University (OHSU), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Minsha Manoharan
- Vaccine and Gene Therapy Institute, Oregon Health & Science University (OHSU), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Stephanie D Rawlings-Rhea
- Vaccine and Gene Therapy Institute, Oregon Health & Science University (OHSU), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Ian Tagge
- Advanced Imaging Research Center, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - Steven G Kohama
- Division of Neuroscience, Oregon National Primate Research Center (ONPRC), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Julie Hollister-Smith
- Division of Neuroscience, Oregon National Primate Research Center (ONPRC), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Betsy Ferguson
- Division of Neuroscience, Oregon National Primate Research Center (ONPRC), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Randall L Woltjer
- Department of Pathology, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - Meredith C Frederick
- Department of Neurology, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - James Pollaro
- Advanced Imaging Research Center, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - William D Rooney
- Advanced Imaging Research Center, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - Larry S Sherman
- Division of Neuroscience, Oregon National Primate Research Center (ONPRC), 505 NW 185th Avenue, Beaverton, OR 97006, United States.
| | - Dennis N Bourdette
- Department of Neurology, OHSU, 3181 SW Sam Jackson Park Road, Portland, OR 97239, United States.
| | - Scott W Wong
- Vaccine and Gene Therapy Institute, Oregon Health & Science University (OHSU), 505 NW 185th Avenue, Beaverton, OR 97006, United States; Division of Pathobiology and Immunology, ONPRC, 505 NW 185th Avenue, Beaverton, OR 97006, United States.
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Esposito S, Di Pietro GM, Madini B, Mastrolia MV, Rigante D. A spectrum of inflammation and demyelination in acute disseminated encephalomyelitis (ADEM) of children. Autoimmun Rev 2015; 14:923-9. [PMID: 26079482 PMCID: PMC7105213 DOI: 10.1016/j.autrev.2015.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 06/09/2015] [Indexed: 11/15/2022]
Abstract
Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disease of the central nervous system that involves multifocal areas of the white matter, rarely the gray matter and spinal cord, mainly affecting children and mostly occurring 1-2weeks after infections or more rarely after vaccinations. Though a specific etiologic agent is not constantly identified, to evaluate carefully patient's clinical history and obtain adequate samples for the search of a potential ADEM causal agent is crucial. In the case of a prompt diagnosis and adequate treatment, most children with ADEM have a favorable outcome with full recovery, but in the case of diagnostic delays or inappropriate treatment some patients might display neurological sequelae and persistent deficits or even show an evolution to multiple sclerosis. The suspicion of ADEM rises on a clinical basis and derives from systemic and neurologic signs combined with magnetic resonance imaging of the central nervous system. Other advanced imaging techniques may help an appropriate differential diagnosis and definition of exact disease extension. Although there is no standardized protocol or management for ADEM, corticosteroids, intravenous immunoglobulin, and plasmapheresis have been successfully used. There is no marker that permits to identify the subset of children with worse prognosis and future studies should try to detect any biological clue for prevision of neurologic damage as well as should optimize treatment strategies using an approach based on the effective risk of negative evolution.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giada Maria Di Pietro
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Madini
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Vincenza Mastrolia
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Donato Rigante
- Institute of Pediatrics, Università Cattolica Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
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Li Z, Luo S, Ou J, Huang R, Wang Y. Persistent pseudobulbar affect secondary to acute disseminated encephalomyelitis. SOCIOAFFECTIVE NEUROSCIENCE & PSYCHOLOGY 2015; 5:26210. [PMID: 25792370 PMCID: PMC4366481 DOI: 10.3402/snp.v5.26210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 02/07/2015] [Accepted: 02/09/2015] [Indexed: 06/04/2023]
Abstract
Pseudobulbar affect (PBA) is a common complication of central nervous system diseases such as stroke, multiple sclerosis, and other neurological diseases, but it remains under-recognized and under-treated in the clinic. PBA caused by acute disseminated encephalomyelitis (ADEM) has rarely been reported. Here, we report a 30-year-old Chinese woman who has experienced PBA from ADEM for 7 years. The patient's principal manifestations were extreme emotions or tears when she saw, heard, or spoke about sad news or other sad things; the durations of these unmanageable emotions were often less than 30 sec, and they occurred at frequencies that ranged from one to several times a day. Occasionally, she laughed uncontrollably while people were talking despite a lack of funny or sad stimuli in the conversation or the surrounding environment. Thus, her social functioning was impaired. This case indicates that the long-term PBA can occur secondarily to ADEM, and this possibility should be considered clinically to ensure timely identification and treatment.
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Affiliation(s)
- Zhendong Li
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China;
| | - Shijian Luo
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Jianying Ou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Rihe Huang
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
| | - Ying Wang
- Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-Sen University, Zhuhai, China
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Abstract
Demyelinating disease can acutely affect the central or peripheral nervous system in the forms of acute disseminated encephalomyelitis, acute inflammatory demyelinating polyradiculoneuropathy, and related disorders. Rarely, demyelination can affect the central and peripheral nervous system simultaneously in a disorder that has been described as acute severe combined demyelination. We describe a 54-year-old woman who presented with rapidly progressive ascending paralysis and areflexia with abnormalities in cerebrospinal fluid, electrodiagnostic studies, and magnetic resonance imaging of the brain and cervical spine. She had antibodies to GD1a and responded to treatment with intravenous immunoglobulin and corticosteroids. Our case illustrates that, even in severe form, acute combined central and peripheral demyelination may be considered a treatment responsive and potentially reversible disease.
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Mahgoub N, Adegbola O, Alexopoulos GS. Acute demyelinating encephalomyelitis presenting with psychiatric symptoms. Int J Geriatr Psychiatry 2013; 28:1318. [PMID: 24190330 DOI: 10.1002/gps.3978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nahla Mahgoub
- Weill Medical College of Cornell University/New York Presbyterian Hospital, White Plains, NY, USA
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Affiliation(s)
- Dennis W Simon
- Department of Critical Care Medicine, The Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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