ADEM Vaccine Injuries
What is Acute Disseminated Encephalomyelitis (ADEM)?
Acute disseminated encephalomyelitis (ADEM) is characterized by a brief but widespread attack of inflammation in the brain and spinal cord that damages myelin – the protective covering of nerve fibers. ADEM often follows viral or bacterial infections, or less often, vaccination for measles, mumps, or rubella.
The symptoms of ADEM appear rapidly, beginning with encephalitis-like symptoms such as fever, fatigue, headache, nausea and vomiting, and in the most severe cases, seizures and coma.
ADEM typically damages white matter (brain tissue that takes its name from the white color of myelin), leading to neurological symptoms such as visual loss (due to inflammation of the optic nerve) in one or both eyes, weakness even to the point of paralysis, and difficulty coordinating voluntary muscle movements (such as those used in walking). ADEM is sometimes misdiagnosed as a severe first attack of multiple sclerosis (MS), since the symptoms and the appearance of the white matter injury on brain imaging may be similar.
How is ADEM diagnosed?
The diagnosis of ADEM is often determined both clinically and radiologically. While there is no specific test or biological marker to make the diagnosis of ADEM, most treating physicians will rely upon lab results, lumbar punctures and MRIs of the brain.
Laboratory studies include a complete blood count and cultures, and serologic studies are performed on blood and cerebrospinal fluid to detect bacterial and viral organisms.
A lumbar puncture is useful confirm an inflammatory process by the increased white blood cells or increased protein concentration in the cerebrospinal fluid (CSF).
An MRI of the brain and spine is important to see if there are any lesions on the brain that would be characteristic of ADEM. It is possible that an MRI may be normal early in a person’s medical course, thereby making a repeat MRI a necessity later in the medical course.
What is the prognosis for ADEM?
Corticosteroid therapy typically helps hasten recovery from most ADEM symptoms. The long-term prognosis for individuals with ADEM is generally favorable. For most individuals, recovery begins within days, and within six months the majority of ADEM patients will have total or near total recoveries. Others may have mild to moderate lifelong impairment ranging from cognitive difficulties, weakness, loss of vision, or numbness.
Severe cases of ADEM can be fatal but this is a very rare occurrence. ADEM can recur, usually within months of the initial diagnosis, and is treated by restarting corticosteroids.
What treatment is available for ADEM?
Treatment for ADEM is targeted at suppressing inflammation in the brain using anti-inflammatory drugs. Most individuals respond to several days of intravenous corticosteroids such as methylprednisolone, followed by oral corticosteroid treatment.
When corticosteroids fail to work, plasmapheresis or intravenous immunoglobulin therapy are possible secondary treatment options that are reported to help in some severe cases.
Can ADEM be caused by vaccines?
ADEM has been known to be triggered by infections and vaccines. Many studies have evaluated whether vaccines actually cause ADEM. While there are no studies to suggest a definitive causal connection between vaccines and ADEM, many of the studies do associate a causal connection, and there are many instances where the vaccine was the only preceding causal agent to a person’s ADEM diagnosis. In such instances, the studies allude to the conclusion that vaccines can and do cause ADEM.
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