非典型的多発性硬化症とは　―どう診療するか―

抄録

Multiple sclerosis (MS) is a demyelinating disorder of the central nervous system characterized by dissemination in space (DIS) and time (DIT). No diagnostic criteria exist at this time to differentiate MS from the other conditions. Currently accepted McDonald criteria were developed to diagnose subjects with clinically isolated syndrome (CIS). To date, typical presentations of MS including MRI findings have been well studied but have applied McDonald criteria only for CIS subjects. The use of typical presentations for diagnosis has not reached consensus for subjects who have experienced more than two episodes due to different lesions. Instead, “no better explanation” has been offered, yet the interpretation of “no better explanation” changes over time and can be different for different investigators. As a result, some investigators offer a diagnosis of atypical MS whereas others conclude that it is an MS mimic. We previously reported distinction between typical and atypical MS with regards to cytokine profiles of cerebrospinal fluids and response to MS–Disease modifying drugs and corticosteroids/immunosuppressants. Therapeutic strategies of atypical MS are proposed in this review paper.