Abstract: Objective　To explore the efficacy and safety of plasma exchange in the treatment of acute disseminated encephalomyelitis (ADEM) in children. Method　The clinical data of ADEM in 2 children were retrospectively analyzed. The related literature from January 1998 to January 2018 were retrieved from WanFang database and PubMed database and analyzed. Results　Two boys aged 5 and 2 years respectively had fever, convulsion, consciousness disturbance and other manifestations of encephalopathy. Imaging showed multiple white matter lesions, which met the diagnostic criteria of ADEM. After the treatment with high dose of hormone and immunoglobulin, the disease still progressed and patients had the increased muscle weakness, deeper coma and respiratory failure. After ventilator-assisted breathing and plasma exchange about 2 weeks after diagnosis, the symptoms were rapidly relieved and the patients had gradual recovery of consciousness and muscle strength, and was successfully weaned from the ventilator. The two boys were followed up for 1 year and 6 months respectively, and no neurological symptoms were found. Conclusion　Plasma exchange can be used as a salvage treatment when children with ADEM do not respond well to high-dose steroids and gamma globulin therapy and the disease progressed rapidly.

Key words: 　acute disseminated encephalomyelitis;　plasma exchange;　child