Acute disseminated encephalomyelitis laboratory findings

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

Antibodies like anti-MOG antibodies are found in the serum of patients suffering from ADEM. A lumbar puncture is also useful for evaluation of the changes in the Cerebrospinal fluid (CSF).

Laboratory Findings

Antibodies

High titers of anti-MOG antibodies are found in the acute phase, which tends to decrease and eventually disappear over time^[1]^[2].
IgG autoantibodies targeting myelin autoantigens such as MBP, alpha-B crystalline and PLP may help distinguish ADEM from MS^[3].
Presence of serum anti-AQP4-IgG antibodies rules out a diagnosis of ADEM.

CSF studies

Non-specific lymphocytic pleocytosis and elevated albumin levels^[4]
Transient ^[5] oligoclonal banding with a median frequency of 12.5% (range 0-29%)^[6] in children and higher in the adult cases (37.5-58%)^[5].
Identification of the pathogen by specific cell-culture techniques or PCR^[7]^[8]. The high prevalence of neurtropic viruses in the general population may lead to a spurious PCR result, making it difficult to prove a causal relation.

References

↑ Baumann M, Sahin K, Lechner C, Hennes EM, Schanda K, Mader S; et al. (2015). “Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein”. J Neurol Neurosurg Psychiatry. 86 (3): 265–72. doi:10.1136/jnnp-2014-308346. PMID 25121570.
↑ Di Pauli F, Mader S, Rostasy K, Schanda K, Bajer-Kornek B, Ehling R; et al. (2011). “Temporal dynamics of anti-MOG antibodies in CNS demyelinating diseases”. Clin Immunol. 138 (3): 247–54. doi:10.1016/j.clim.2010.11.013. PMID 21169067.
↑ Van Haren K, Tomooka BH, Kidd BA, Banwell B, Bar-Or A, Chitnis T; et al. (2013). “Serum autoantibodies to myelin peptides distinguish acute disseminated encephalomyelitis from relapsing-remitting multiple sclerosis”. Mult Scler. 19 (13): 1726–33. doi:10.1177/1352458513485653. PMC 4411183. PMID 23612879.
↑ Schwarz S, Mohr A, Knauth M, Wildemann B, Storch-Hagenlocher B (2001). “Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients”. Neurology. 56 (10): 1313–8. doi:10.1212/wnl.56.10.1313. PMID 11376180.
↑ ^5.0 ^5.1 O’Riordan JI, Gomez-Anson B, Moseley IF, Miller DH (1999). “Long term MRI follow-up of patients with post infectious encephalomyelitis: evidence for a monophasic disease”. J Neurol Sci. 167 (2): 132–6. doi:10.1016/s0022-510x(99)00160-4. PMID 10521553.
↑ Gupte G, Stonehouse M, Wassmer E, Coad NA, Whitehouse WP (2003). “Acute disseminated encephalomyelitis: a review of 18 cases in childhood”. J Paediatr Child Health. 39 (5): 336–42. doi:10.1046/j.1440-1754.2003.00154.x. PMID 12887662.
↑ Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M (2003). “Epstein-Barr virus infections of the central nervous system”. Intern Med. 42 (1): 33–40. doi:10.2169/internalmedicine.42.33. PMID 12583615.
↑ Riedel K, Kempf VA, Bechtold A, Klimmer M (2001). “Acute disseminated encephalomyelitis (ADEM) due to Mycoplasma pneumoniae infection in an adolescent”. Infection. 29 (4): 240–2. doi:10.1007/s15010-001-1173-z. PMID 11545490.

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[pmid25121570-1] Baumann M, Sahin K, Lechner C, Hennes EM, Schanda K, Mader S; et al. (2015). “Clinical and neuroradiological differences of paediatric acute disseminating encephalomyelitis with and without antibodies to the myelin oligodendrocyte glycoprotein”. J Neurol Neurosurg Psychiatry. 86 (3): 265–72. doi:10.1136/jnnp-2014-308346. PMID 25121570.

[pmid21169067-2] Di Pauli F, Mader S, Rostasy K, Schanda K, Bajer-Kornek B, Ehling R; et al. (2011). “Temporal dynamics of anti-MOG antibodies in CNS demyelinating diseases”. Clin Immunol. 138 (3): 247–54. doi:10.1016/j.clim.2010.11.013. PMID 21169067.

[pmid23612879-3] Van Haren K, Tomooka BH, Kidd BA, Banwell B, Bar-Or A, Chitnis T; et al. (2013). “Serum autoantibodies to myelin peptides distinguish acute disseminated encephalomyelitis from relapsing-remitting multiple sclerosis”. Mult Scler. 19 (13): 1726–33. doi:10.1177/1352458513485653. PMC 4411183. PMID 23612879.

[pmid11376180-4] Schwarz S, Mohr A, Knauth M, Wildemann B, Storch-Hagenlocher B (2001). “Acute disseminated encephalomyelitis: a follow-up study of 40 adult patients”. Neurology. 56 (10): 1313–8. doi:10.1212/wnl.56.10.1313. PMID 11376180.

[pmid10521553-5] 5.0 ^5.1 O’Riordan JI, Gomez-Anson B, Moseley IF, Miller DH (1999). “Long term MRI follow-up of patients with post infectious encephalomyelitis: evidence for a monophasic disease”. J Neurol Sci. 167 (2): 132–6. doi:10.1016/s0022-510x(99)00160-4. PMID 10521553.

[pmid12887662-6] Gupte G, Stonehouse M, Wassmer E, Coad NA, Whitehouse WP (2003). “Acute disseminated encephalomyelitis: a review of 18 cases in childhood”. J Paediatr Child Health. 39 (5): 336–42. doi:10.1046/j.1440-1754.2003.00154.x. PMID 12887662.

[pmid12583615-7] Fujimoto H, Asaoka K, Imaizumi T, Ayabe M, Shoji H, Kaji M (2003). “Epstein-Barr virus infections of the central nervous system”. Intern Med. 42 (1): 33–40. doi:10.2169/internalmedicine.42.33. PMID 12583615.

[pmid11545490-8] Riedel K, Kempf VA, Bechtold A, Klimmer M (2001). “Acute disseminated encephalomyelitis (ADEM) due to Mycoplasma pneumoniae infection in an adolescent”. Infection. 29 (4): 240–2. doi:10.1007/s15010-001-1173-z. PMID 11545490.

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