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Multiple Sclerosis

Article information

J Korean Med Assoc. 2007;50(3):252-258
Publication date (electronic) : 2007 March 31
doi : https://doi.org/10.5124/jkma.2007.50.3.252
Kwang-Kuk Kim, MD
Department of Neurology, University of Ulsan College of Medicine, Korea. kkkim@amc.seoul.kr

Abstract

Multiple Sclerosis (MS) is the most common demyelinating disease affecting the central nervous system of young adults living in western countries. The clinical suspicion of demyelination, as a pathological process, is high when a young adult develops one or more neurological episodes indicating a damage to white matter tracts within the central nervous system, especially when the optic nerve, brainstem, or spinal cord is involved. The patient with episodes disseminating in time, each of which can be attributed to demyelination, requires no investigation prior to establishing the diagnosis of clinically definite MS, if the age of clinical presentation falls between 20 and 50 years, if different anatomical sites within the central nervous system have necessarily been affected on separate occasions, and if the clinical manifestation is typical for MS. MS in Asian populations is characterized by selective and dominant involvement of the optic nerve and spinal cords, as well as some incidence of brainstem lesion and symptoms. About 35~40% of cases of MS in Korea are of this optico-spinal type. Optico-spinal MS (OSMS) generally has a higher female-to-male ratio than conventional MS. OSMS is also characterized by frequent relapses, severe disability, few brain lesions on MRI, and a very lower incidence of oligoclonal bands in CSF. Neuromyelitis Optica (NMO) (Devic syndrome), which causes severe optic neuritis (ON) and longitudinally extensive transverse myelits either with a monophase or relapse-remitting pattern, is rare in Korean. NMO-IgG was reported to be helpful for the diagnosis of early-stage NMO and differential diagnoses of MS.

Keywords: Demyelinating disease; Multiple sclerosis; Neuromyelitis Optica; NMO-IgG; Opticospinal MS

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Article information Continued

Copyright © 2007 Korean Medical Association

Figure 1

Figure 1

Multiple sclerosis lesions (arrows) depicted using (A~F) fast FLAIR, and (G, H)T1-weighted gadolinuim enhanced sequence

Figure 2

Figure 2

Multiple sclerosis. (A)~(C)T2-weighted Saggital MRI and (B-1,2,3) axial MRI of the spinal cord shows multiple small to medium intrinsic lesions, which involve only part of the cord cross-section and extend to the surface of the cord(arrows)

Table 1

Diagnostic Criteria for opticospinal MS (1)

Table 1

Table 2

Diagnostic Criteria for neuromyelitis optica (3)

Diagnosis requires all absolute criteria and one major supportive criterion or two minor supportive criteria

Table 2

Table 3

McDonald criteria for multiple sclerosis: categories of multiple sclerosis (21)

Table 3

Table 4

Diagnostic Criteria for MS: MRI evidence for dissemination in space (21)

Table 4

Notes: i) one spinal cord lesion can substitute for one brain lesion; ii) two T2 lesions plus cerebrospinal fluid oligoclonal bands also constitute evidence for dissemination in space

Table 5

Diagnostic Criteria for MS: MRI evidence for dissemination in time (21)

Table 5