Prevention and Treatment of the Osmotic Demyelination Syndrome: A Review

The osmotic demyelination syndrome (ODS) is a central nervous system disorder that results from neuronal damage related to abrupt fluctuations of osmolality. In spite of the possibility of full or partial recovery in a considerable proportion of cases, ODS is still categorized as a disorder with poor prognosis that may lead to severe permanent disability or death. Efforts towards the better understanding of the nature of the disorder and the development of effective modes of prevention and treatment continued since Adams, et al., in 1959, first identified the syndrome. Prevention of the ODS that is related to hyponatremia overcorrection starts from the differentiation between chronic and acute hyponatremia, goes through defining a target and method for serum sodium elevation, and ends with re-lowering the unpredicted overly rapid rise of serum sodium. Treatment of the ODS with re-lowering the serum sodium has been evaluated in an animal study and human case reports. Treatment with plasmapheresis and/or intravenous immunoglobulin has been also reported. In the absence of controlled human studies, treatment options for the ODS remain devoid of certainty and validity. Patients who have already developed the syndrome may require longterm intensive supportive therapy looking for a possible complete or partial recovery.