Sclerosis and Other Demyelinating Diseases

Samantha S. Soldan, Gregory R Wu, Clyde E. Markowitz, and Dennis L. Kolson 

Keywords Multiple sclerosis experimental allergic encephalomyelitis central nervous system virus cerebrospinal fluid T-cell receptor acute disseminated encephalomyelitis lymphocyte immune system 

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Multiple sclerosis (together with other idiopathic inflammatory demyelinating diseases) is an autoimmune and multifactorial disorder. 

One was a known case of pre-existent multiple sclerosis but the other had no history of neurological diseases. Both had HLA haplotype DR2 and B7, which are associated with multiple sclerosis. A causal link between immunization and demyelination cannot be established from these two case reports, but the time interval would fit a proposed immunological mechanism. In addition, the Centers for Disease Control (CDC) in Atlanta, Georgia, received reports on four cases of chronic demyelinating disease. Several other reports describe related conditions or other forms of neurological disorder. 

Eight cases of nervous system diseases suspected to be either recurrent disseminated encephalitis or multiple sclerosis after hepatitis B immunization have been reported (21). Symptoms started in four cases at 4—14 days after vaccination, and in the other four cases 42-70 days after vaccination. There was a family history of multiple sclerosis in two patients, one of whom had had symptoms compatible with optic neuritis before immunization. In a third patient, there was a history of an episode compatible with Lhermitte s sign. The authors concluded that the risk of demyelinating diseases is unknown. They recommended avoiding hepatitis B immunization in individuals with a personal or familial history of sjmptoms suggestive of an inflammatory or demyelinating disease. 

Other potential adverse responses include malignancy (e.g., lymphoma), liver disease, heart failure, lupuslike disease, irritation around the injection site, and demyelinating disorders that mimic multiple sclerosis.34,70 88 The incidence of these adverse effects, however, seems to be fairly low. For the most part, these drugs provide an acceptable risk-to-benefit ratio for most people with rheumatoid arthritis. Patients should, however, be screened carefully for any risk factors before beginning drug therapy, and should likewise be monitored periodically for any potential adverse reactions to these drugs. 

Cerebral WM changes (WMC) are found in a number of diseases of adulthood, such as the debated Binswanger s disease, multiple sclerosis, acute demyelinating encephalomyelitis, posterior reversible leukoencephalopathy syndrome, cerebral anoxia, leukodystrophies, and mitochondrial encephalopathies, among others. The term leukoaraiosis (LA) is applied for nonspecific WMC, primarily in the elderly, that cannot be attributed to a... 

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