# Adult-Onset Acute Disseminated Encephalomyelitis in Elderly Filipino Patients: A Case Report and Review of the Literature

## TL;DR

This paper reports two elderly Filipino patients with adult-onset ADEM who worsened despite treatment, highlighting challenges in diagnosis and prognosis.

## Contribution

The novelty lies in presenting clinical outcomes of adult-onset ADEM in elderly Filipino patients, emphasizing diagnostic and treatment challenges.

## Key findings

- Two elderly patients with adult-onset ADEM progressed despite high-dose steroids, IVIg, and plasma exchange.
- Local data on ADEM prognosis in adults is scarce, and outcomes are less favorable compared to children.
- ADEM diagnosis in the elderly poses clinical challenges due to atypical presentation and poor response to treatment.

## Abstract

Acute disseminated encephalomyelitis (ADEM) is an autoimmune disease characterized by inflammation of the cerebral hemispheres, brainstem, cerebellum, and spinal cord, often preceded by prodromal infections or vaccinations. The mainstay of treatment is immunosuppression with high-dose steroid therapy, intravenous immunoglobulin (IVIg), or plasma exchange (PE). While most pediatric patients improve with treatment, the prognosis in adults is less favorable. Local studies reporting the epidemiology, prevalence, incidence, treatment outcomes, and prognosis of ADEM are scarce. This case series presents two elderly Filipino female patients diagnosed with adult-onset ADEM who were treated with high-dose steroid therapy, IVIg, and PE. However, both patients experienced disease progression and eventually succumbed five months after the onset of illness. This study also highlights the diagnostic dilemma that clinicians may face when diagnosing ADEM in the elderly population, along with the treatment challenges and clinical outcomes in patients with a progressive disease course.