Treatment with broad-spectrum antibiotics and acyclovir is recommended until an infectious cause is excluded. Once the diagnosis of ADEM is established, steroids remain the mainstay of treatment. High-dose intravenous (IV) corticosteroids are recommended.[1,2,6,7] Methylprednisolone should be administered at a dose of 10-30 mg/kg/day for 3-5 days. Oral steroid taper is recommended only in patients who continue to show clinical symptoms after completion of the high-dose IV glucocorticoid treatment. The chief alternative treatment option is IV immunoglobulin, given at a dose of 2 g/kg/day for 2-3 days[14,15,16,17]; this is especially preferred in cases where meningoencephalitis cannot be excluded or there is an insufficient response to corticosteroids. Plasma exchange should be considered for patients who fail to respond to treatment with glucocorticoids and IV immunoglobulin.[18,19,20] It may be of particular benefit in patients with ADEM-associated myelopathy. The preferred regimen is a total of 6 exchanges, one every other day, with each exchange consisting of 1-1.5 plasma volumes.
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