The Effect of Immunoadsorption Therapy in Acute Disseminated Encephalomyelitis(Special Issue in Hornor of the Retirement of Professor Toshiko Takemiya at the Department of Neurology, Tokyo Women's Medical University)

Acute disseminated encephalomyelitis (ADEM) seems to be an immune-mediated demyelinating disorder of the central nervous system (CNS). Corticosteroid administration is a commonly used treatment for ADEM. Recently, several reports on the successful use of plasmapheresis (PP) in ADEM were presented. We described the efficacy of PP as the immunoadsorption therapy (IAT) for two patients with severe ADEM who did not respond to corticosteroids. One patient developed stupor, bilateral facial weakness, bulbar palsy and tetraplegia, and the other patient developed delirium, muscle weakness of the arms and legs, and external ophthalmoplegia from the administration of corticosteroid. After IAT, both patients recovered remarkably well. Laboratory studies revealed a elevation of the IgG index, an increase in suppressor-inducer T cells and activated T cells, and that anti-GQ1b antibody was positive in the peripheral blood. These abnormalities improved after IAT. The mechanism of efficacy of IAT is unknown, but IAT might correct the immune function by modulating cytokines and removing the toxic substances, which lead to the autoimmune response in the CNS. Our observations suggested that IAT may be a beneficial treatment for severe ADEM