Updated Review Brings New Clarity to ADEM Triggers, Diagnosis, and Treatment in Adults
View StudyPlain-Language Summary
A 2025 narrative review in Brain Sciences examines ADEM in adults, covering the full range of infectious triggers including COVID-19, and the expanding role of MOG antibody testing in differentiating ADEM from related conditions like MOGAD and MS. Early, aggressive treatment remains the key determinant of good outcomes.
Abstract
Acute disseminated encephalomyelitis (ADEM) is a rare, immune-mediated demyelinating disorder of the CNS predominantly affecting children, though adult cases represent a clinically important subset. This narrative review (search period November 2024 to June 2025) examines ADEM etiopathogenesis and clinical features with emphasis on adult presentations.
Infectious triggers discussed include viral (influenza, EBV, HSV, SARS-CoV-2), bacterial, and parasitic agents, as well as post-vaccination, post-transplantation, paraneoplastic, and host-related genetic factors. The role of anti-MOG-IgG antibodies in pathogenesis, diagnosis, and differentiation from MOG antibody-associated disease (MOGAD) is examined in detail; MOG antibody testing is recommended as a standard component of the diagnostic workup. Standard treatment (high-dose corticosteroids, IVIG, plasma exchange) is reviewed with emphasis on early initiation. Diagnostic challenges distinguishing ADEM from MS, other autoimmune encephalitides, and infectious CNS disease are discussed alongside advances in MRI interpretation and biomarker testing.