The Efficacy of Intravenous Immunoglobulin in the Treatment of Patients with Acute Disseminated Encephalomyelitis

Background: Acute disseminated encephalomyelitis (ADEM) is a monophaseprocess nevertheless sometimes aggravated by relapses (so-called multiphasecourse of the disease). In such case the treatment must be targeted at reducing clinical manifestations of the disease and prevention of its relapses. The aim of our work was to analyze efficacy of intravenous immunoglobulin as therapeutic option in the treatment of patients with ADEM.

Methods: Therapeutic efficacy of intravenous immunoglobulin was analyzed in the treatment of 47 patients with ADEM: 19 men and 28 women aged 17–53 (average index 31.7±1.6). All patients were being treated at the Kiev city centre of multiple sclerosis (Kiev city hospital number 4, Alexandrovskaya City Clinical Hospital, Kiev city, Ukraine) and were under observation for 2 years. The patients were randomly separated into two groups depending on the treatment method. The treatment in both main and control group was preceded by premedication with hormonal pulse-therapy, using methylprednisolone in the dose of 500-1000 mg daily in 200 ml of isotonic sodium chloride solution (within 5 days). The patients of the main group were daily administrated intravenous immunoglobulin in the dose of 0.4 g per 1 kg of mass of body 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. The participants of this group were given placebo treatment (200 ml of isotonic sodium chloride solution).

Results: One month after beginning of the treatment in patients of both groups we observed the decrease of neurological deficit, measured according to the EDSS scale, compared to the indices before treatment (p<0.01). 24 months after beginning of the treatment even more significant reduction of the level of neurological disorders of the patients of the main group (p<0.05) and its increase in the patients of the control group (p<0.05) was observed, which is explained by development of demyelination disease relapses over a 24-month observation period. Over a 24-month observation period, the patients of the main group had 2 relapses of disseminated encephalomyelitis, the patients of the control group–7 relapses, two of them demonstrated transformation of ADEM into MS.

Conclusions: The investigation proved positive therapeutic efficacy of intravenous immunoglobulin in the treatment of patients with ADEM–reduction of clinical manifestations of the disease, in particular a decrease in neurological deficit level. Monthly intravenous immunoglobulin administration also has great prognostic significance for prevention of the disease relapses (multiphase ADEM course).