Acute Disseminated Encephalomyelitis (ADEM): Short Term Motor Outcome of Hospital Admitted Patients

Introduction: Among the neuroinflammatory disorder of CNS, Acute Disseminated Encephalomyelitis (ADEM) is a multifocal, subacute or acute onset disease that has got the current interest of neurologists for its better outcome. Very few studies have been carried out on ADEM particularly in adults of our country. So we performed the study to describe short term motor outcomes of hospital admitted ADEM patients.
Objective: To assess the motor outcome of hospital admitted ADEM patients at 06 weeks of steroid. Methods: A prospective, observational study was conducted over 18 (eighteen) months period from May 2014 to November 2015 on 50 (fifty) patients of ADEM of all age groups at the neurology department of Chittagong Medical College Hospital (CMCH), Chittagong, Bangladesh. Results: The core of our results shows that most subjects (56%) were of 40-60 years whereas 12% were of <20 Years. 62% was a middle-class group and the male gender (52%) predominated in the study.
Infection has got an important association in that study and 52% of patients gave a preceding history of viral infection within 04 weeks of ADEM symptoms. During the assessment of short term motor outcome, we found 74% of patients improved with a mortality rate of 24% and 02% was dropped out cases. Highly significant (p<0.001) improvement of disability status measured in the modified Rankin Scale (mRS) seen in most patients. Among 37 follow up cases 30 (81.1%) patients had initial unfavorable mRS (Score 4-5). After treatment at 06 weeks, mRS Score improved into favorable (Score 0-3) in 31 (83.8%) patients. Regarding motor variables highly significant improvement also found in GCS, best motor response, muscle power (MRC grade) in upper and lower limbs, deep tendon reflexes, and plantar response. The range of initial GCS was 4-15 which improved into 9-15 after treatment at 06 weeks in 37 improved study subjects. 34% of patients got motor or motor parts of mixed cranial nerve palsy. Improvement was significant (p<0.05) for cranial nerve palsy, motor seizure but non-significant (p>0.05) for motor aphasia. CSF reactivity was seen in 66% of 44 CSF studied ADEM cases where the mean of raised protein was 76.11mg/dl with a range of 42-135mg/dl. Conclusion: In our study, short term motor outcome was good in 74% of patients which is highly significant. Further reading click here

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