Intravenous Immunoglobulin in the Treatment of Patient with Acute Disseminated Encephalomyelitis: Case Report

Abstract

Background: Acute disseminated encephalomyelitis (ADEM) is a monophasic process nevertheless sometimes aggravated by relapses (so-called multiphase course of the disease). The treatment of ADEM must be targeted at reducing clinical manifestations of the disease and prevention of its relapses. Case Presentation: We report a 42-year old woman with a diagnosis of acute disseminated encephalomyelitis. The patient received intravenous immunoglobulin in the dose of 0.4 g per 1 kg of body mass within 5 days 1 month after the hormonal pulse-therapy. The treatment was followed by monthly administration of human normal immunoglobulin – 0.4 g per 1 kg of body mass within 24 months as a method of ADEM monotherapy. The positive dynamics of clinical symptoms was recorded 5 days after the beginning of the treatment (tendon anisoreflexia and swaying reduced). The treatment was followed by monthly administration of human normal immunoglobulin in the dose of 0.4 mg/kg. Three, nine and eighteen months after the beginning of the treatment the patient had two more MRI investigations of the brain that showed positive dynamics of the disease: reduction of demyelination foci and no accumulation of contrast agents. Her neurological deficits disappeared completely in 3 months. No relapses were observed over 24 months of observation. Conclusion: This case report confirms a positive therapeutic efficacy of intravenous immunoglobulin in the treatment of patient with ADEM – reduction of clinical manifestations of the disease, in particular a decrease in neurological deficit level. Monthly intravenous immunoglobulin administration also helps to prevent the disease relapses (multiphase ADEM course).