Intravenous Immunoglobulin versus Methylprednisolone in Children with Acute Disseminated Encephalomyelitis: A Randomized Control Trial

Background: Acute disseminated encephalomyelitis (ADEM) is an immune-mediated, demyelinating disease of the central nervous system (CNS) affecting children and young adults after an infection or vaccination. Because of its heterogeneity in both clinical presentation and course, challenges remain in establishing the most appropriate therapeutic approach in each patient. The present study is a randomised controlled trial with the objective of assessing the neurological recovery in children with ADEM at intervals after completion of treatment with IVIG using IV methylprednisolone as a control. The secondary objectives were to assess the duration of hospital stay, residual neurologic deficits including mortality and other adverse reactions in the two treatment groups. Methods: A randomised controlled trial was conducted in the Department of Pediatrics, IMS, BHU comprising of 22 children aged 0-18 years with diagnosis of ADEM randomly allocated to Group I (12 children, received IV Methylprednisolone) and Group II (10 children, received Intravenous immunoglobulin) and assessed for neurological recovery using modified Rankin scale at 1 week, 1 month and 3 months after treatment completion. Duration of hospital stay, mortality and adverse reactions of drugs were also compared in both the groups. Results: Neurological recovery at 1weekis comparable between both groups however, in long term (at 3 months) both the groups had 3 patients (25% of group I and 30% of group II) with neurological deficit. The mean duration of hospital stay was comparable in two groups. Two (9.09%) patients of group I expired during treatment. In methylprednisolone group, 25% subjects developed hyperglycemia and hypertension whereas in IVIg group, 10% children developed hypersensitivity reaction and 20% developed fever and back pain. Conclusion: Intravenous immunoglobulin hastens the clinical recovery in children with ADEM as compared to IV methylprednisolone but the overall morbidity, long term neurological sequel is similar with both the drugs.