J Korean Med Assoc.  2013 Aug;56(8):702-708. 10.5124/jkma.2013.56.8.702.

Multiple sclerosis

• Kim KK

• KMID: 1847872
• DOI: http://doi.org/10.5124/jkma.2013.56.8.702

Abstract

Multiple sclerosis (MS) is the most common demyelinating disease affecting the central nervous system of young adults living in the western world. MS should be strongly suspected when a young adult develops one or more neurological episodes consistent with damage to white matter within the central nervous system (CNS), especially when these affect the optic nerves, brainstem, or spinal cord. The patient with relapses, each of which can be attributed to demyelination in the CNS, requires no investigation prior to establishing the diagnosis of clinically definite MS. For a diagnosis of MS, separate anatomical sites within the CNS must have been affected on different occasions, typically three. MS in Asian populations is characterized by the selective and dominant involvement of the optic nerve and spinal cord with some incidence of brainstem lesions. 35-40% of MS cases in Korea are of this optico-spinal type with or without brainstem lesions. Reported cases of neuromyelitis optica spectrum disease (NMOSD), causing severe optic neuritis (ON) and/or longitudinally extensive transverse myelitis, either monophase or with a relapse-remitting pattern, some of which were diagnosed previously as the optico-spinal form of MS in Asia, have increased annually in Korea with the development of the NMO-IgG or aquaporin4-antibody detecting technique. NMO-IgG detection is very important in the diagnosis of early stage of NMOSD and the differentiation of MS and other demyelinating disease. Many new convenient oral drugs or very potent intravenous monoclonal antibodies for targeting VLA-4, CD20, and CD52 may decrease the annual relapse rate and burden of brain-spinal cord lesionsin MS.

Keyword

Demyelinating disease; Multiple sclerosis; Neuromyelitis optica; Neuromyelitis optica-IgG; Aquaporin4 antigen

MeSH Terms

Antibodies, Monoclonal
Asia
Asian Continental Ancestry Group
Brain Stem
Central Nervous System
Demyelinating Diseases
Humans
Incidence
Integrin alpha4beta1
Korea
Multiple Sclerosis
Myelitis, Transverse
Neuromyelitis Optica
Optic Nerve
Optic Neuritis
Recurrence
Spinal Cord
Western World
Young Adult
Antibodies, Monoclonal
Integrin alpha4beta1

Figure

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  Figure 1 Magnetic resonance imaging findings in 27-year-old female patient of multiple sclerosis. (A) Two separate lesions (arrows) of cerical spinal cord in sagital T2 weighted image. (B,C) Multiple scattered small lesions in corpus callosum, medulla (arrows, B), avoid shaped perpendicular to corpus callosum (arrow, C) in sagittal brain fluid attenuated inversion recovery (FLAIR) image. (D,E) Small scattered lesions in right middle cerebellar peduncle (arrow, D) and left lateral medula lesion (arrow, E) in axial FLAIR.

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  Figure 2 Magnetic resonance imaging (MRI) findings in 44-year-old female patient of neuromyelitis optica. (A) Long cord lesions (≥3 vertebral segments, arrow) in saggital T2W image of the thoracic spinal cord. (B) Gadolinium enhanced right optic nerve (arrow) in T1W axial brain MRI. (C) Small isolated lesion of corpus callosum (arrow) in weighted fluid attenuated inversion recovery (FLAIRW) axial brain MRI. (D) Isolated left tegmental upper pons lesion (arrow) in FLAIRW axial brain MRI. (E) Central hypothalamic and midbrain lesions (arrows) in FLAIRW axial brain MRI.

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