Table 4.

Main pediatric studies on corticosteroid (CS) therapy in acute disseminated encephalomyelitis (ADEM).

References	Authors/Year	Type of Study	Population	Treatment	Oral Taper	Additional Treatment	Outcome
Acute disseminated encephalomyelitis: a long-term follow-up study of 84 pediatric patients [33]	Tenembaum et al., Neurology, 2002	Prospective study	84 patients (0.4–16 years) with ADEM	80 children treated with CSs: -43 patients treated with IV DEX 1 mg/kg/day for 10 days -21 patients IV MP 30 mg/kg/day if weight ≤30 kg, 1 g/day if weight ≥30 kg for 3 to 5 days followed by PO 1 mg/kg/day for 10 days -10 patients treated with PO 2 mg/kg/day for 10 days -6 patients received oral deflazacort 3 mg/kg/day	Steroid oral tapering over 4 to 6 weeks	-29 patients: antiepileptic -58 Acyclovir -36 ICU -14 artificial ventilation	Median EDSS score of 3 (0 to 6.5) for 25 patients treated with IV DEX Median EDSS score of 1 (0 to 3) for 21 patients treated with IV MP (all patients with similar clinical involvement) (p = 0.029) No steroid dependency
Acute disseminated encephalomyelitis, multiphasic disseminated encephalomyelitis and multiple sclerosis in children [34]	Dale et al., Brain, 2000	Prospective study	48 children: 28 with ADEM, 7 with MDEM, 13 with MS (3–16 years)	25 patients with ADEM/MDEM treated with IV MP 30 mg/kg/day for 5 days	PO	-Antibiotics/antivirals (66%)	Comparison of mean length of steroid treatment: -relapsing MDEM group (n = 6) ->only 3.17 w (range 0.5–8 weeks) -non-relapsing ADEM group (n = 19) ->6.3 weeks (range 0.5–16 weeks)
Acute disseminated encephalomyelitis in children: outcome and prognosis [35]	Anlar et al., Neuropediatrics, 2003	Multicenter prospective study	46 patients (13 mo–15 years) with ADEM	40 patients treated with CSs at the first attack: 28 patients received IV MP 20–30 mg/kg/day for 5 days 2 patients not treated	18 patients PO 2–6 weeks	-12 patients Acyclovir -3 patients antibiotics -3 patients IVIG	High-dose MP associated with fewer complications (p = 0.02) Relapses in 2/8 (25%) of patients treated with high-dose MP within 7 days during first attack Relapses in 11/31 (35%) of patients who did not receive MP treatment within 7 d at the first attack. (outcome evaluated in 39 patients with follow-up >12 m) Tapering steroids over 3 w or longer associated with a lower relapse rate (difference statistically insignificant)
Acute disseminated encephalomyelitis: a review of 18 cases in childhood [36]	Gupte et al., J. Paediatrics Child Health, 2003	Retrospective study	18 children (3.5 months- 17 years) with ADEM	-8 patients: IV MP 20 mg/kg/day for 3–5 days -2 patients: IV DEX for 3–10 days -2 patients: only PO for 6 weeks -5 patients: no treatment	After IV CSs (n=10): PO 2 mg/kg/day, tapering over 4–6 weeks	-2 children with early relapses:sec ond pulse of CSs -1 patient: IVIG	Follow-up of 3 months–4 years: -good outcomes -two relapses after the cessation of steroids, complete recovery after second pulse of steroid -five children with ongoing disabilities
Acute disseminated encephalomyelitis in childhood: epidemiologic, clinical and laboratory features [37]	Leake et al., Pediatric Infectious Diseases Journal, 2004	Prospective and retrospective study	42 patients (10 months -18 years) with ADEM	-33 patients: IV MP or DEX -9 patients: no treatment	Oral CSs	- 8/33 patients treated with second-line therapy IVIGs 1 g/kg/day	No statistically significant differences between CS-treated and untreated patients regarding the duration of hospitalization (p = 0.43) and hospital readmission (p = 0.67)