Marchioni E, Marinou-Aktipi K, Uggetti C, Bottanelli M, Pichiecchio A, Soragna D, Imbesi F, Romani A, Ceroni M
Neurological Institute IRCCS C: Mondino, Pavia, Italy.
J Neurol. 2002 Jan;249(1):100-4. doi: 10.1007/pl00007836.
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.
随机对照试验尚未确定急性播散性脑脊髓炎（ADEM）的最佳药物治疗方法。通常使用大剂量类固醇，效果良好，但在少数情况下，临床结果不佳。在其他患者中，特别是那些受局限性ADEM变体（脊髓炎）影响的患者，疾病表现出类似多发性硬化症的复发病程。我们在此介绍5例患者，其中3例患有典型的播散性脑脊髓炎，2例患有感染后脊髓炎，在类固醇治疗失败后，他们对静脉注射免疫球蛋白（IVIg）表现出良好反应。在我们的报告中，除1例患者外，大剂量类固醇给药在所有病例中基本无效，该例患者仅在首次发作时表现出良好反应。相反，IVIg注射（0.4克/千克/天）在给药的前五天内开始使所有患者的功能有显著改善，并在三周内达到最大改善效果。1例患者尽管存在持续残疾，但仍有良好效果。在所有病例中，MRI检查结果均支持临床证据，显示治疗后有改善变化。
