Acute Transverse Myelitis and Acute Disseminated Encephalomyelitis

ADEM is a polyfocal, typically monophasic demyelinating event with encephalopathy. •ATM is a focal, typically monophasic demyelinating event without encephalopathy. •Consensus recommends follow-up neuroimaging 3 months after initial presentation of ADEM to establish a new baseline and then again between 9-12 months after clinical onset to rule out ongoing disease activity. •Recurrent events after the first 3 months may represent multiphasic ADEM if encephalopathy is present. In the absence of encephalopathy, one must evaluate for a relapsing demyelinating syndrome. •Based on some research evidence as well as consensus, workup in all patients with suspected ADEM or ATM should include MRI of the brain and spine with and without contrast and a lumbar puncture. Patients should also all be tested for NMO aquaporin 4 antibodies and MOG abs in the serum. •Based primarily on consensus due to lack of relevant clinical studies, treatment recommendations for both ADEM and ATM are for high dose IV steroids alone or in combination with IVIg. Plasma exchange can be used in refractory or severe cases. •Based on some research evidence as well as consensus, supportive care with urodynamic studies, pain management and rehabilitation services should be initiated early in the treatment of ATM. •Neuropsychology follow-up should be highly considered in long-term treatment of ADEM. © 2020 American Academy of Pediatrics. All rights reserved.