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Induction of Experimental Autoimmune Encephalomyelitis in Mice and Evaluation of the Disease-dependent Distribution of Immune Cells in Various Tissues
Published on: May 8, 2016
Disseminated encephalomyelitis and multiple sclerosis: two different diseases - a critical review
1Department of Neurology, Harvard Medical School, Boston, MA, USA. cposer@bidmc.harvard.edu
Acta Neurologica Scandinavica
|September 11, 2007
Summary
Distinguishing between Disseminated Encephalomyelitis (DEM) and Multiple Sclerosis (MS) is crucial for treatment. MRI findings, clinical symptoms like fever and cognitive changes, and lesion characteristics help differentiate these distinct neurological diseases.
Area of Science:
- Neurology
- Immunology
- Radiology
Background:
- Early immunomodulatory treatment for clinically isolated syndrome (CIS) necessitates differentiating Multiple Sclerosis (MS) from Disseminated Encephalomyelitis (DEM).
- DEM and MS are recognized as distinct disease entities with unique clinical, genetic, imaging, and histopathological profiles.
- While more common in children, DEM affects adults and presents with polysymptomatic features not typically seen in MS.
Purpose of the Study:
- To highlight the importance of distinguishing between DEM and MS for appropriate patient management.
- To delineate the key differentiating features between DEM and MS.
Main Methods:
- Comparative analysis of clinical presentations, including fever, altered consciousness, cognitive and aphasic symptoms, and meningism.
- Assessment of cerebrospinal fluid for oligoclonal bands.
- Detailed Magnetic Resonance Imaging (MRI) evaluation of brain and spinal cord lesions, including lesion load, location (thalamus, basal ganglia), size, gadolinium enhancement, and spinal lesion length.
- Analysis of aquaporin-4 antibody status.
Main Results:
- DEM presents with symptoms like fever, altered consciousness, cognitive impairment, and meningism, which are rare in MS. Cerebrospinal fluid oligoclonal bands are infrequent in DEM.
- MRI reveals significant differences: DEM typically shows a heavier lesion load, often affecting the thalamus or basal ganglia, with larger, enhancing lesions early in the disease compared to MS.
- Spinal cord lesions in DEM exceeding three vertebral segments define Neuromyelitis Optica (NMO), which is often a form of DEM, not MS, and can be associated with aquaporin-4 antibodies, also found in some MS and DEM cases.
Conclusions:
- DEM and MS are distinct neurological conditions requiring accurate differentiation for effective treatment strategies.
- MRI is a critical tool for distinguishing DEM from MS, with specific lesion characteristics aiding diagnosis.
- Neuromyelitis Optica (NMO) is predominantly a form of DEM, underscoring the importance of recognizing DEM's unique spectrum and diagnostic markers.
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