Effectiveness of intravenous immunoglobulin treatment in adult patients with steroid-resistant monophasic or recurrent acute disseminated encephalomyelitis

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.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anti-Inflammatory Agents / therapeutic use*
  • Disability Evaluation
  • Dose-Response Relationship, Drug
  • Drug Resistance / physiology*
  • Encephalomyelitis, Acute Disseminated / drug therapy*
  • Encephalomyelitis, Acute Disseminated / immunology*
  • Encephalomyelitis, Acute Disseminated / physiopathology
  • Female
  • Humans
  • Immunoglobulins, Intravenous / therapeutic use*
  • Male
  • Middle Aged
  • Steroids
  • Treatment Failure
  • Treatment Outcome


  • Anti-Inflammatory Agents
  • Immunoglobulins, Intravenous
  • Steroids