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Home arrow Environment arrow Inflammatory Disorders of the Nervous System: Pathogenesis, Immunology, and Clinical Management
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MS Versus ADEM

It is a great dilemma to many neurologists whether a first demyelinating attack is in fact a clinically isolated syndrome, that requires an immunomodulatory agents to delay the onset of second attack or it is a monophasic form of ADEM not requiring further immunomodulation or suppression. The underlying immunopathogenesis of MS and ADEM is different, and patients with ADEM are expected to have complete or significant recovery without developing further attacks. In certain patients the line between MS and ADEM is blurry, and such determination is difficult. Certain relative features assist neurologists to separate these two diseases. Patients with ADEM are generally much younger (younger than 10 years), and there is no gender difference, while the peak age for MS is 29 years, and females are more predisposed than males. In certain cases, ADEM follows viral infections or happens after vaccination. Such prior events are usually absent in MS patients. Patients with ADEM develop meningoencephalitis with seizures, while these features are scarce among MS population. Neuroimaging of the brain in ADEM reveals giant contrast-enhancing lesions with involvement of white and gray matter, while the MS lesions are smaller, patchy, and ovoid. Longitudinal MR imaging in ADEM demonstrates resolution of demyelinating lesions, while in MS the neurologists encounter development of more lesions. Examination of CSF shows much higher number of lymphocytes in ADEM, while in MS the number of lymphocytes is typically less than 50/mm3. Oligoclonal bands may or may not be present in the CSF of ADEM patients, while they are present in the CSF of up to 94% of patients with relapsing MS. Both diseases show a favorable therapeutic response to corticosteroids.

 
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