Unravelling the clinical complexity of myelin oligodendrocyte glycoprotein antibody-associated acute disseminated encephalomyelitis in children: a comprehensive analysis.

We present four different cases of acute disseminated encephalomyelitis (ADEM) within the Indian paediatric population. It is important to recognise how a single disease can manifest in various ways. Here, we emphasise the role of immunosuppression in treating ADEM. In all four cases, treatment was initiated based on clinical suspicion, even before confirming the demyelinating cause through laboratory or radiological tests. The degree of immunosuppression employed varied depending on the complexity of each case and their response to treatment. Case 1 demonstrated significant improvement in visual acuity after a 5-day course of high-dose methylprednisolone. In contrast, Case 4 represented a starkly different outcome, where despite undergoing therapeutic plasmapheresis, the disease remained uncontrollable, ultimately leading to the child's unfortunate demise. Cases 2 and 3 involved patients with severe clinical conditions necessitating intensive care and mechanical ventilation. They exhibited a remarkable response to immunosuppressive therapy, gradually regaining neurological function.