What is the key event in the pathophysiology of acute disseminated encephalomyelitis (ADEM)?

Updated: Nov 08, 2018
  • Author: J Nicholas Brenton, MD; Chief Editor: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS  more...
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Answer

Disturbance of the blood-brain barrier is likely to be an important event. The elaboration of antibodies occurs but remains of uncertain significance. In particular, multiple researchers have demonstrated the presence of serum IgG antibodies to myelin oligodendrocyte glycoprotein (MOG) in up to 40% of children with ADEM, [51, 52, 53] though these antibodies do not appear to be specific to ADEM. Still the presence of anti-MOG antibodies in ADEM may affect the nature and course of the disease. A recent study has demonstrated that MOG-positive ADEM patients are more likely to have large, bilateral and widespread lesions and longitudinally extensive transverse myelitis on MRI and are more likely to have a favorable clinical outcome when compared to MOG-negative ADEM patients. [49]


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