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Acute disseminated encephalomyelitis, or ADEM, can be frightening in many ways, not the least of which is that it can give a patient the fear of developing multiple sclerosis.

One of the biggest problems with diagnosing and understanding multiple sclerosis fully is that there are multiple conditions, ailments, and diseases that mimic the symptoms of MS. In fact, because there area so many that present as multiple sclerosis, doctors go through a rigorous process with patients who are symptomatic prior to diagnosing the degenerative disease.

Fortunately, not all people showing these symptoms are suffering from the long term disease that has no cure. In fact, if there is no recurrence of symptoms, it could actually be something as simple as acute disseminated encephalomyelitis (ADEM). While the technical name may sound frightening, and the symptoms can be, it is not something that generally causes any permanent damage, as is the case in MS.

Here are some of the similarities that cause patients to worry they have multiple sclerosis, as well as some of the differences doctors look for in order to negate the possibility of MS.

What is ADEM?

ADEM is when the body attacks the brain, spinal cord, and possibly the optic nerve (all in total known as the central nervous system, or CNS) in a way that causes inflammation and damages the myelin, or the white coating that protects the nerves and pushes signals through the nervous system faster.

While there hasn’t be a definitive determination as to what causes ADEM, theories point to two different scenarios that seem to be culprits in causing the immune reaction.

  1. The patient has had a viral or bacterial infection, usually within the last two to three weeks. The theory is that the immune system not only attacks the infiltrating virus or bacteria but also sees the myelin as a foreign substance to be attacked.
  2. The patient has been vaccinated for measles, mumps, or rubella, or a combination thereof, in the last three months. The theory remains that the immune system responds to the vaccine but also overreacts and attacks the myelin.

Symptoms and similarities

The symptoms of ADEM are what make it so similar to multiple sclerosis. Several symptoms are common between the two ailments, and doctors have to consider the circumstances to determine whether to diagnose ADEM or to continue testing for MS.

Some of the common symptoms include:

  • Weakness in the limbs
  • Numbness or tingling in the extremities and face
  • Balance issues
  • Difficulty with smooth gait
  • Sudden changes to mood and/or behavior
  • Loss of or blurred vision
One of the ways to distinguish ADEM as a temporary condition from MS as a permanent disease is to consider the circumstances under which the symptoms occurred, as well as who it affects.

 

ADEM vs MS: Differences

There are several notable differences between ADEM and multiple sclerosis, mostly related to who the typical patient is and the circumstances surrounding the onset.

  • While MS typically strikes people between the ages of 18 and 40, with women at a much higher risk, ADEM is most likely to occur in children under the age of 10 (though it can happen to anyone), and boys are at a slightly higher risk.
  • In most cases, ADEM only occurs once, which means that there is almost never a recurrence. On the other hand, the definition of multiple sclerosis is that the patient sees a relapse of symptoms.
  • With MS, after a relapse or episode, there are typically new scars (lesions) that appear on the brain, showing additional damage. On the other hand, ADEM episodes would most likely show no scarring at all.
  • ADEM has other symptoms that are not common in multiple sclerosis patients, such as:
    • Headache
    • Fever
    • Confusion
    • Overwhelming sleepiness
    • Seizures
    • Nausea
    • Vomiting
    • Coma (in severe cases)

However, there are some cases of MS, including pediatric onset, in which these symptoms may appear in MS.

  • While multiple sclerosis doesn’t have a seasonal affiliation, ADEM does. It occurs more frequently in winter and spring than during the other six months of the year.
  • By contrast, ADEM does not have specific locations where it is more prevalent, whereas MS does. With multiple sclerosis, frequency of cases is higher in more temperate, cooler climates. In fact, the further away from the Equator, the higher the prevalence of MS.
  • ADEM doesn’t require ongoing medication. A doctor may prescribe anti-inflammatory drugs, such as ibuprofen, in mild cases or, in more severe cases, corticosteroids, which are very tough at fighting inflammation. A course of intravenous steroids is administered in the hospital, with a follow up of oral steroids upon release. However, with multiple sclerosis, there are a number of potential drugs prescribed, including immunosuppressants that limit the functionality of the immune system to reduce its attack on the CNS.
  • For most patients with ADEM, recovery begins within a few days of the onset, and over the course of a few months, symptoms disappear entirely. For a few, who experienced significant damage to the myelin, some symptoms may be permanent, though extremely mild. For patients with multiple sclerosis, symptoms will fade (remission) but come back (relapse) over and over. Eventually, this will cause compounding damage and degeneration, which leads to disability. The disease is also not curable and progresses.

Conclusion

Acute disseminated encephalomyelitis, or ADEM, can be frightening in many ways, not the least of which is that it can give a patient the fear of developing multiple sclerosis. On top of that, there is the likelihood of hospital time, as well as a remote possibility of lingering permanent impairments. Any condition that threatens a sense of normalcy and requires this amount of medical attention is concerning.

However, it isn’t a lifelong ailment like multiple sclerosis, which means there is true recovery. With multiple sclerosis, managing the symptoms is something a patient will need to do for the rest of their lives, with medication and therapy throughout the course of the progressive disease to help control symptoms and slow advancement. With either condition, it’s important to consult with a physician as soon as possible to start the process of diagnosis and treatment, which will help reduce long term effects from both ADEM and MS.

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