Akut dissemineret encefalomyelitis. Afgraensning, behandling, prognose og evidens
Engelsk titel: Acute disseminated encephalomyelitis. Definition, treatment, prognosis and evidence
Läs online
Författare:
Sönderby Christensen P
;
Östergaard JR
Email: pias@dadlnet.dk
Språk: Dan
Antal referenser: 13
Dokumenttyp:
Artikel
UI-nummer: 08051113
Sammanfattning
Introduction: Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of the central nervous system. It is difficult to distinguish between ADEM and multiple sclerosis (MS) and the treatment is much discussed. The purpose of this study was to evaluate the treatment and prognosis for children with ADEM and to evaluate the level of evidence in treatment. Materials and methods: Medical records were found by searching for diagnoses and reviewed retrospectively. The level of evidence in treatment was evaluated by searching PubMed, EMBASE and The Cochrane Library. Results: 11 children met the original inclusion criteria, acute or subacute onset of multifocal symptoms and MRI consistent with ADEM. The treatment was varied. Nine children had complete recovery. One child developed multiphasic disseminated encephalomyelitis or MS. One child developed epilepsy and cognitive deficits. There were no randomized controlled trials (RCT) but several larger case-series and cohort studies. Conclusions: The lack of controlled clinical trials may explain the varied treatment. In severe ADEM, intravenous high-dose corticosteroids are based on evidence grade C recommendation. In general, ADEM has a favorable prognosis. At initial presentation it is important to consider MS as a differential diagnosis.