Modified zipper method in steroid-resistant ADEM: a case report.

IF 2 4区 医学 Q3 CLINICAL NEUROLOGY
Nihal Akçay, İlyas Bingöl, Hilal Merve Dolu, Behice Kaniye Yılmaz, Demet Tosun
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引用次数: 0

Abstract

Background: Acute disseminated encephalomyelitis (ADEM) is a rare, inflammatory, demyelinating central nervous system disorder typically responsive to corticosteroid therapy. However, some cases are resistant to steroids, requiring alternative treatment options.

Case presentation: We present an 8-year-old male child with steroid-resistant ADEM who underwent treatment with the modified zipper technique, combining intravenous immunoglobulin (IVIG) and therapeutic plasma exchange (TPE). Despite initial high-dose intravenous methylprednisolone, which failed to improve his condition, the patient showed significant clinical and radiological improvement after five cycles of the modified zipper technique.

Methods: The patient received alternating cycles of TPE and IVIG (0.4 g/kg/day) over five cycles, with a 48-hour interval between each TPE and IVIG session. TPE sessions used fresh frozen plasma, followed by IVIG to enhance antibody clearance and immunomodulation.

Results: After two cycles of TPE, clinical improvement was observed. Follow-up MRI on day 15 showed marked regression of white matter lesions. The patient was discharged on day 20 with near-complete recovery. Follow-up at one, three, and six months showed no neurological deficits, and MRI lesions continued to regress.

Conclusions: This case suggests the modified zipper technique as a promising alternative for steroid-resistant ADEM. The combination of TPE and IVIG may provide beneficial effects, but further controlled studies are needed to evaluate its efficacy and safety in broader populations.

改良拉链法治疗类固醇抵抗性ADEM 1例。
背景:急性播散性脑脊髓炎(ADEM)是一种罕见的炎症性脱髓鞘中枢神经系统疾病,通常对皮质类固醇治疗有反应。然而,有些病例对类固醇有耐药性,需要其他治疗方案。病例介绍:我们报告了一名患有类固醇抵抗性ADEM的8岁男童,他接受了改良拉链技术的治疗,结合静脉注射免疫球蛋白(IVIG)和治疗性血浆交换(TPE)。尽管最初大剂量静脉注射甲基强的松龙未能改善他的病情,但在改良拉链技术的五个周期后,患者的临床和放射学表现出显着的改善。方法:患者接受5个周期TPE和IVIG (0.4 g/kg/天)交替治疗,每次TPE和IVIG间隔48小时。TPE阶段使用新鲜冷冻血浆,随后使用IVIG来增强抗体清除和免疫调节。结果:经2个周期TPE治疗后,患者临床表现明显改善。第15天随访MRI显示白质病变明显消退。患者于第20天出院,几乎完全康复。随访1个月、3个月和6个月均未发现神经功能缺损,MRI病变继续消退。结论:本病例提示改良拉链技术是一种有希望的替代类固醇抵抗性ADEM。TPE和IVIG联合使用可能会产生有益的效果,但需要进一步的对照研究来评估其在更广泛人群中的有效性和安全性。
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来源期刊
Acta neurologica Belgica
Acta neurologica Belgica 医学-临床神经学
CiteScore
4.20
自引率
3.70%
发文量
300
审稿时长
6-12 weeks
期刊介绍: Peer-reviewed and published quarterly, Acta Neurologica Belgicapresents original articles in the clinical and basic neurosciences, and also reports the proceedings and the abstracts of the scientific meetings of the different partner societies. The contents include commentaries, editorials, review articles, case reports, neuro-images of interest, book reviews and letters to the editor. Acta Neurologica Belgica is the official journal of the following national societies: Belgian Neurological Society Belgian Society for Neuroscience Belgian Society of Clinical Neurophysiology Belgian Pediatric Neurology Society Belgian Study Group of Multiple Sclerosis Belgian Stroke Council Belgian Headache Society Belgian Study Group of Neuropathology
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