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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 .002, MS vs NMO/blood donors; D. Franciotta, MD; S. Jarius, MD; 2007, unpublished data).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
Correspondence: Dr Franciotta, IRCCS, Neurological Institute C. Mondino, via Mondino 2, Pavia 27100, Italy (diego.franciotta@mondino.it).
Financial Disclosure: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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