Recurrent ADEM

My child was diagnosed with a brain tumor then changed to ADEM.  She has been sympton free for almost 4 months, then yesterday we noticed some of the symptoms coming back.  We have a doctor that we go to, but we have trouble taking to him because he's short and to the point. Will this continue to happen after this relapse?  Will this also require hospitalization and medication?

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

ADEM (i.e., acute disseminated encephalomyelitis) is an immune-mediated process that affects the central nerve system. It typically has an abrupt onset within a few days to weeks after a viral infection or immunization. It can be difficult to diagnose since it has similar clinical and imaging features as certain neoplasms and multiple sclerosis (MS). The diagnosis includes a thorough history and examination, CSF study, and MRI. If questions still remain as to the diagnosis, a biopsy may be pursued. Treatment typically includes high dose steroids. Case reports do suggest that intravenous immunoglobulins or plasma exchange are useful. The prognosis depends on the underlying etiology. In general, patients may still have signs and symptoms 1-6 months after the initial event. Some have suggested that ultimately 50-75% of patients make full recovery. Unlike MS, ADEM is considered a monophasic, self-limiting disease meaning that recurrence is rare.    

Without the ability to examine and get a more thorough history, it is impossible to comment on whether hospitalization is needed for your child. I do encourage you to have your child evaluated by his/her neurologist.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.