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Multiple sclerosis or HTLV-I myelitis?
C M Poser1, G C Roman, J C Vernant
1Neurological Unit, Beth Israel Hospital, Boston, MA 02215.
Abstract:
Several authors have demonstrated the presence of antibodies against the HTLV-I retrovirus in patients with MS. Considerable controversy exists regarding the etiologic significance, if any, of this finding, but the presence of these antibodies in the blood or CSF of MS patients has led to reconsideration of that diagnosis in certain cases. It is recommended that, before the diagnosis of MS is changed to that of HTLV-I-associated chronic myelitis, at least 2 of the following abnormalities be present: (1) clinical or electrophysiologic involvement of peripheral nerve or muscle; (2) the presence of oligoclonal bands in the serum; (3) the presence in blood or CSF of lymphocytes with multilobed nuclei; (4) a positive serologic test for syphilis; (5) the presence of a sicca syndrome; and (6) the presence of pulmonary lymphocytic alveolitis.
Insights
Antibodies to Human T-lymphotropic virus type I (HTLV-I) are found in multiple sclerosis (MS) patients, raising diagnostic questions. Specific criteria are proposed to differentiate MS from HTLV-I-associated chronic myelitis.
Area of Science:
- Neurology
- Immunology
- Virology
Background:
- Presence of Human T-lymphotropic virus type I (HTLV-I) antibodies in patients with multiple sclerosis (MS) has been reported.
- The etiologic significance of HTLV-I antibodies in MS remains controversial.
- This finding necessitates careful diagnostic evaluation to distinguish MS from HTLV-I-associated myelitis.
Purpose of the Study:
- To provide diagnostic criteria for differentiating multiple sclerosis (MS) from HTLV-I-associated chronic myelitis.
- To guide clinicians in cases where HTLV-I antibodies are detected in MS patients.
Main Methods:
- Review of existing literature on HTLV-I antibodies in MS patients.
- Establishment of a set of diagnostic criteria for HTLV-I-associated chronic myelitis.
Main Results:
- The presence of HTLV-I antibodies alone is insufficient for diagnosing HTLV-I-associated chronic myelitis.
- At least two specific additional abnormalities are recommended for diagnosis.
Conclusions:
- Careful consideration and specific diagnostic criteria are essential when HTLV-I antibodies are found in MS patients.
- Recommended criteria include peripheral nerve/muscle involvement, oligoclonal bands, specific lymphocyte morphology, syphilis, sicca syndrome, or pulmonary lymphocytic alveolitis.