Infection 20 years earlier is unlikely to cause illness now
Dr. Keith Roach
Question: In 1973, I was hospitalized for three days in an Air Force hospital in Thailand with an unknown viral illness. I quickly recovered and went back to my duties.
In 1992, I started having one problem after another for about six months, culminating in losing my ability to walk in about 10 minutes. My bowels and bladder were paralyzed also.
A doctor at the VA hospital connected the dots with my 1973 illness. The viral illness I had, which was never precisely diagnosed, destroyed the myelin sheath on my nerves, causing me to “short out.” I was given a guess diagnosis of acute disseminated encephalomyelitis. I recovered enough to be able to stand after pushing up with my arms, but that is about all.
What is being done with stem cell research in this or any spinal area? I have heard nothing positive. — A.M.
Answer: Acute disseminated encephalomyelitis is an autoimmune disease of the brain and spinal cord. It can be triggered by infections and sometimes by immunizations (the rabies vaccine was the first to be associated, but the smallpox vaccine and other vaccines also have been implicated). However, symptoms usually begin eight to 21 days after the infection or immunization, with the longest reported time between infection and onset being 45 days. It is hard for me to believe that the infection nearly 20 years earlier could have been the only trigger for this condition.
The symptoms of the disease are very similar to multiple sclerosis, another demyelinating disease of the brain. (The word “demyelinating” refers to the destruction of the myelin sheath, a wrapping around the nerve that insulates the axon, the part of the nerve down which impulses travel. The insulation is essential for proper functioning of the nerve.) In both MS and ADEM, the body’s immune cells see the myelin as an invader and destroy it. It can be difficult to distinguish between ADEM and an initial bout of MS. About 35 percent of people initially diagnosed with ADEM will be diagnosed with MS, usually within the first year.
Unfortunately, only 10 to 46 percent of those affected will completely recover from ADEM. I do not know of any effective treatment for people with long-term symptoms of ADEM, but treatment during the initial phase of the disease (with steroids, plasma exchange or immune globulin) improves the likelihood of a good outcome. I could not find any evidence of benefit from stem cells, although in theory they may help, and I understand studies are ongoing.