Acute disseminated encephalomyelitis (ADEM)
ADEM can occur in both adults and children, although it is more common in children. ADEM generally appears after a viral illness, or rarely after vaccination. The symptoms of ADEM can resemble a Multiple Sclerosis (MS) attack, although ADEM usually does not recur.
The initial treatment of ADEM often includes steroids and supportive care. Other immunomodulatory agents such as IVIG may be used in refractory cases.
The relationship between ADEM and MS is not well understood, and in approximately 5-10% of cases, patients with ADEM may develop MS, NMOSD, or other forms of recurrent disease later in life. There are some recurrent or multiphasic forms of ADEM, which in some cases can be difficult to distinguish from MS.
Optic neuritis
Optic neuritis refers to an inflammatory demyelinating attack on the optic nerves. Symptoms can include blurred or loss of vision as well as eye pain. Optic neuritis can occur in MS patients or can occur in isolation.
Steroid treatments are often used to reduce the symptoms of optic neuritis. Other immunomodulatory agents such as plasmapheresis or IVIG may be used in refractory cases.
Some cases of optic neuritis may develop MS, NMOSD, or MOG antibody associated disease recurrent disease and may require disease modifying treatment.
Transverse myelitis
Transverse myelitis is an inflammatory demyelinating attack on the spinal cord. Symptoms include back pain, leg weakness, and bowel and bladder dysfunction. Transverse myelitis can occur in patients with MS or in isolation.
The initial treatment for transverse myelitis is intravenous steroids; however, other immunomodulatory agents such as plasmapheresis or IVIG may be used in refractory cases.
Some cases of optic neuritis may develop MS, NMOSD or MOG antibody associated disease/recurrent disease and may require disease modifying treatment.