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More on Multiple Sclerosis and Neuromyelitis Optica

More on Multiple Sclerosis and Neuromyelitis Optica In an interesting article from the series “Controversies in Neurology,” different points of view address the topic of whether multiple sclerosis (MS) and neuromyelitis optica (NMO) are distinct diseases or parts of a unique nosological spectrum.1,2 These views should be considered in the light of the following, additional points. First, oligoclonal bands, a hallmark of MS, tend to disappear over time when present in the cerebrospinal fluid of patients with NMO.3 Second, an intrathecal, polyspecific immune response to measles, rubella, and zoster virus (MRZ reaction) is detectable in about 80% of patients with MS but rarely in NMO (1 of 20 patients in our series)4 and helps in differential diagnosis. Third, titers of anti–Epstein-Barr virus nuclear antigen antibodies in patients with MS are higher than in controls5 and in NMO patients with NMO (mean [SEM] values: 13.5 [1.4] DU/mL, n = 16 for NMO; 18.9 [1.0], n = 23 for MS; 11.6 [1.5], n = 37 for blood donors; P < .002, MS vs NMO/blood donors; D. Franciotta, MD; S. Jarius, MD; 2007, unpublished data). Fourth, new recombinant assays for anti-aquaporin-4 antibodies can increase diagnostic sensitivity (91%6) and specificity (98.6%7-100%6) for NMO, reinforcing their role as robust disease markers. These points, which refer to biological aspects of the 2 diseases, show how the humoral immune response in MS is clonally stable, deranged toward polyspecific B-cell activation, and reminiscent of interactions with neurotropic viruses, whereas NMO is differently oriented toward the production of specific antibodies with useful diagnostic meaning. These observations support the hypothesis that MS and NMO are distinct diseases within the heterogeneous group of inflammatory demyelinating disorders of the central nervous system. However, a gray zone between the 2 diseases may exist because MS possibly evolved from NMO.8 Back to top Article Information Correspondence: Dr Franciotta, IRCCS, Neurological Institute C. Mondino, via Mondino 2, Pavia 27100, Italy (diego.franciotta@mondino.it). Financial Disclosure: None reported. References 1. Weinshenker BG Neuromyelitis optica is distinct from multiple sclerosis. Arch Neurol 2007;64 (6) 899- 901PubMedGoogle ScholarCrossref 2. Galetta SLBennett J Neuromyelitis optica is a variant of multiple sclerosis. Arch Neurol 2007;64 (6) 901- 903PubMedGoogle ScholarCrossref 3. Bergamaschi RTonietti SFranciotta D et al. Oligoclonal bands in Devic's neuromyelitis optica and multiple sclerosis: differences in repeated cerebrospinal fluid examinations. Mult Scler 2004;10 (1) 2- 4PubMedGoogle ScholarCrossref 4. Jarius SBergamaschi RFranciotta D et al. MRZ reaction is a useful tool in the diagnostic workup of patients with suspected NMO. J Neurol 2006;253(suppl 2)II/123Google Scholar 5. Ascherio AMunch M Epstein-Barr virus and MS. Epidemiology 2000;11 (2) 220- 224PubMedGoogle ScholarCrossref 6. Takahashi TFujihara KNakashima I et al. Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO. Brain 2007;130 (pt 5) 1235- 1243PubMedGoogle ScholarCrossref 7. Paul FJarius SAktas O et al. Antibody to aquaporin 4 in the diagnosis of NMO. PLoS Med 2007;4 (4) e133PubMedGoogle ScholarCrossref 8. Compston A ‘The marvellous harmony of the nervous parts’: the origins of MS. Clin Med 2004;4 (4) 346- 354PubMedGoogle ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Neurology American Medical Association

More on Multiple Sclerosis and Neuromyelitis Optica

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References (10)

Publisher
American Medical Association
Copyright
Copyright © 2007 American Medical Association. All Rights Reserved.
ISSN
0003-9942
DOI
10.1001/archneur.64.12.1802-a
pmid
18071052
Publisher site
See Article on Publisher Site

Abstract

In an interesting article from the series “Controversies in Neurology,” different points of view address the topic of whether multiple sclerosis (MS) and neuromyelitis optica (NMO) are distinct diseases or parts of a unique nosological spectrum.1,2 These views should be considered in the light of the following, additional points. First, oligoclonal bands, a hallmark of MS, tend to disappear over time when present in the cerebrospinal fluid of patients with NMO.3 Second, an intrathecal, polyspecific immune response to measles, rubella, and zoster virus (MRZ reaction) is detectable in about 80% of patients with MS but rarely in NMO (1 of 20 patients in our series)4 and helps in differential diagnosis. Third, titers of anti–Epstein-Barr virus nuclear antigen antibodies in patients with MS are higher than in controls5 and in NMO patients with NMO (mean [SEM] values: 13.5 [1.4] DU/mL, n = 16 for NMO; 18.9 [1.0], n = 23 for MS; 11.6 [1.5], n = 37 for blood donors; P < .002, MS vs NMO/blood donors; D. Franciotta, MD; S. Jarius, MD; 2007, unpublished data). Fourth, new recombinant assays for anti-aquaporin-4 antibodies can increase diagnostic sensitivity (91%6) and specificity (98.6%7-100%6) for NMO, reinforcing their role as robust disease markers. These points, which refer to biological aspects of the 2 diseases, show how the humoral immune response in MS is clonally stable, deranged toward polyspecific B-cell activation, and reminiscent of interactions with neurotropic viruses, whereas NMO is differently oriented toward the production of specific antibodies with useful diagnostic meaning. These observations support the hypothesis that MS and NMO are distinct diseases within the heterogeneous group of inflammatory demyelinating disorders of the central nervous system. However, a gray zone between the 2 diseases may exist because MS possibly evolved from NMO.8 Back to top Article Information Correspondence: Dr Franciotta, IRCCS, Neurological Institute C. Mondino, via Mondino 2, Pavia 27100, Italy (diego.franciotta@mondino.it). Financial Disclosure: None reported. References 1. Weinshenker BG Neuromyelitis optica is distinct from multiple sclerosis. Arch Neurol 2007;64 (6) 899- 901PubMedGoogle ScholarCrossref 2. Galetta SLBennett J Neuromyelitis optica is a variant of multiple sclerosis. Arch Neurol 2007;64 (6) 901- 903PubMedGoogle ScholarCrossref 3. Bergamaschi RTonietti SFranciotta D et al. Oligoclonal bands in Devic's neuromyelitis optica and multiple sclerosis: differences in repeated cerebrospinal fluid examinations. Mult Scler 2004;10 (1) 2- 4PubMedGoogle ScholarCrossref 4. Jarius SBergamaschi RFranciotta D et al. MRZ reaction is a useful tool in the diagnostic workup of patients with suspected NMO. J Neurol 2006;253(suppl 2)II/123Google Scholar 5. Ascherio AMunch M Epstein-Barr virus and MS. Epidemiology 2000;11 (2) 220- 224PubMedGoogle ScholarCrossref 6. Takahashi TFujihara KNakashima I et al. Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO. Brain 2007;130 (pt 5) 1235- 1243PubMedGoogle ScholarCrossref 7. Paul FJarius SAktas O et al. Antibody to aquaporin 4 in the diagnosis of NMO. PLoS Med 2007;4 (4) e133PubMedGoogle ScholarCrossref 8. Compston A ‘The marvellous harmony of the nervous parts’: the origins of MS. Clin Med 2004;4 (4) 346- 354PubMedGoogle ScholarCrossref

Journal

Archives of Neurology – American Medical Association

Published: Dec 1, 2007

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