Has your child suddenly developed unusual symptoms? Let's talk about ADEM (Acute Disseminated Encephalomyelitis).

Imagine, your child has had a mild cold for two or three days and is now feeling a little better. But suddenly, along with the fever, the child's behavior changes, he has difficulty walking , and his words become slurred when he speaks. It is very normal for any mother or father to be scared when seeing something like this. ADEM, which is a rare but serious condition that can cause symptoms like these, is what we are talking about today.

What exactly is ADEM?

Simply put, ADEM (Acute Disseminated Encephalomyelitis) is a rare inflammatory condition that affects the brain and spinal cord. In Sinhala, it can be called acute disseminated encephalomyelitis, but since those words are a bit complicated, we will use the name ADEM. This condition is most commonly seen among children.

Our nerves are like electrical wires. These nerve fibers have a protective covering around them. We call this myelin . It's like the plastic sheath on an electrical wire. This myelin sheath is what allows nerve messages to travel quickly and accurately. In ADEM, our body's own immune system mistakenly attacks and damages this myelin sheath. This disrupts the transmission of nerve messages in the brain and spinal cord.

Although the symptoms can be severe, the best thing is that there is treatment for it and most people make a full recovery .

What are the symptoms of ADEM?

The symptoms of ADEM can come on suddenly and get worse quickly. A child may experience one or more of these symptoms.

Causes and risk factors for developing ADEM

Doctors believe that ADEM is an autoimmune disease . This means that our own immune system mistakenly attacks our own healthy cells and tissues. It's like our own army attacking our own country.

The exact cause of this immune system disorder is not yet known, but it often occurs after a child has recovered from a common viral infection, such as a cold, flu, or stomach ache .

Very rarely, ADEM has been reported after receiving some vaccines. However, research has not yet proven a direct link between vaccines and ADEM. Sometimes, these symptoms can occur for no apparent reason.

What are the risk factors?

• Age: More than 80% of ADEM patients are children under the age of 10. The rest are older children.
• Gender: Male children are slightly more likely to develop it than female children.
• Weather: In some countries, cases are more common during the winter and spring.

What is the difference between ADEM and MS (Multiple Sclerosis)?

Another disease that has similar symptoms to ADEM is multiple sclerosis (MS). Both diseases damage the myelin sheath. As a result, symptoms such as muscle weakness, numbness, and vision problems can be seen in both. However, there are clear differences between the two.

How is ADEM diagnosed?

There is no single test to diagnose ADEM. Your doctor will carefully examine your symptoms and try to rule out other conditions that have similar symptoms. Two main tests are used to do this.

1. MRI scan: A test that uses magnetic fields and radio waves to produce detailed images of the brain and spinal cord. The brain damage seen in ADEM and MS can look different on these images. In ADEM, the damage may be more widespread.

2. Lumbar Puncture: This involves using a very small needle to take a small amount of cerebrospinal fluid from the spine and testing it. In ADEM, the fluid may have an increased number of white blood cells. Some of the proteins seen in MS are not seen in ADEM.

These tests can also rule out brain infections such as meningitis.

What are the treatments for ADEM?

The main goal of treatment is to quickly control the inflammation in the brain and spinal cord and stop the immune system's mistaken attack. This requires the child to be hospitalized for a week or two.

• Corticosteroids: Most people start treatment with high-dose steroids given intravenously (IV). This can help your child feel better within a few hours. After a few days, the medication will be gradually tapered down to a pill or syrup over a period of several weeks.
• Other treatments: If steroid medications are not suitable for the child or are ineffective, there are other treatments that calm the immune system.
• Plasmapheresis: In this, a machine takes the child's blood, filters out the harmful antibodies, and returns the purified blood to the body.
• Intravenous Immunoglobulin (IVIG): Antibodies obtained from healthy people are given to the child through a vein, which controls the activity of the child's immune system.

After leaving the hospital, the child may need physical therapy, occupational therapy, or speech therapy.

How is the outlook?

This is the most important thing. Most children with ADEM recover completely. However, this recovery process can be a slow one. It can take 4-6 weeks or even a year to fully recover.

Sometimes, children may not recover from all symptoms. They may continue to have things like vision problems or muscle weakness. Schooling may also be affected.

Most of the time (8 out of 10 times) ADEM only happens once. But rarely, it can happen again within a few months. In very rare cases, a child who has ADEM can later develop MS. In less than 2% of cases, ADEM can be fatal. That's why it's so important to seek medical advice as soon as symptoms appear.

ADEM, Acute Disseminated Encephalomyelitis, Brain Allergy, Children's Diseases, Neurological Diseases, Myelin, MS in Sinhala