Skip to main content

CSF pleocytosis and expansion of spinal lesions in Japanese Multiple sclerosis with special reference to the new diagnostic criteria

Abstract

New diagnostic criteria for multiple sclerosis (MS) were recently proposed from the international panel on the diagnosis of MS, and they include exclusion criteria, such as lesions extending over more than two vertebral segments on spinal MRI and CSF pleocytosis of more than 50/mm3. We reviewed the clinical features of 158 patients who satisfied the diagnostic criteria for MS except for having the above atypical paraclinical findings. All patients exhibited two or more clinical attacks and objective clinical evidence of multiple lesions without any evidence of other disorders. Thirty–three (20.9%) patients had one or both atypical paraclinical findings. Twenty–one out of the 33 patients were classified as having optico–spinal MS (OSMS), and the other 12 as non–OSMS patients with atypical large expanding or destructive cerebral, cerebellar or brainstem lesions on MRI as well as one or both atypical paraclinical findings. Based on this heterogeneity in clinical findings in MS, there is an urgent need to develop a common general concept of the “MS” syndromes, and the ethnic–related heterogeneity should be considered in the revised criteria for the diagnosis of MS.

This is a preview of subscription content, access via your institution.

References

  1. Bitsch A, Bruck W (2002) Differentiation of multiple sclerosis subtypes: implications for treatment. CNS drugs 16:405–418

    CAS  PubMed  Google Scholar 

  2. de Seze J, Lebrun C, Stojkovic T, Ferriby D, Chatel M, Vermersch P (2003) Is Devic’s neuromyelitis optica a separate disease? A comparative study with multiple sclerosis. Mult Scler 9:521–525

    CAS  PubMed  Google Scholar 

  3. Fardet L, Genereau T, Mikaeloff Y, Fontaine B, Seilhean D, Cabane J (2003) Devic’s neuromyelitis optica: study of nine cases. Acta Neurol Scand 108:193–200

    CAS  PubMed  Google Scholar 

  4. Fukazawa T, Hamada T, Kikuchi S, Sasaki H, Tashiro K (1996) Antineutrophil cytoplasmic antibodies and the optic–spinal cord of multiple sclerosis in Japan. J Neurol Neurosurg Psychiatry 61:203–204

    CAS  Google Scholar 

  5. Fukazawa T, Hamada T, Tashiro K, Moriwaka F, Yanagihara T (1990) Acute transverse myelopathy in multiple sclerosis. J Neurol Sci 100:217–222

    CAS  PubMed  Google Scholar 

  6. Fukazawa T, Hamada T, Moriwaka F, Tashiro K (1994) Acute transverse myelopathy in MS clinical considerations. Int MSJ 1:27–33

    Google Scholar 

  7. Fukazawa T, Kikuchi S, Niino M, Yabe I, Hamada T, Tashiro K (2003) Multiphasic demyelinating disorder with acute transverse myelitis in Japanese. J Neurol 250:624–626

    PubMed  Google Scholar 

  8. Fukazawa T, Kikuchi S, Sasaki H, Hamada K, Hamada T, Miyasaka K, Tashiro K (1997) Anti–nuclear antibodies and the optic–spinal form of multiple sclerosis. J Neurol 244:483–488

    CAS  PubMed  Google Scholar 

  9. Fukazawa T, Kikuchi S, Sasaki H, Hamada K, Hamada T, Miyasaka K, Tashiro K (1998) The significance of oligoclonal bands in multiple sclerosis in Japan: Relevance of immunogenetic backgrounds. J Neurol Sci 158:209–214

    CAS  PubMed  Google Scholar 

  10. Fukazawa T, Kikuchi S, Sasaki H, Yabe I, Miyagishi R, Hamada T, Tashiro K (2000a) Genomic HLA profiles of MS in Hokkaido, Japan: Important role of DPB1*0501 allele. J Neurol 247:175–178

    CAS  Google Scholar 

  11. Fukazawa T, Tashiro K, Hamada T, Moriwaka F, Matsumoto A, Shima K, Maruo Y (1992) Multiple sclerosis in Hokkaido, the northernmost island of Japan: Prospective analyses of clinical features. Intern Med 31:349–352

    CAS  PubMed  Google Scholar 

  12. Fukazawa T, Yamasaki K, Ito H, Kikuchi S, Minohara M, Horiuchi I, Tsukishima E, Sasaki H, Hamada T, Nishimura Y, Tashiro K, Kira J (2000b) Both the HLA–DPB1 and –DRB1 alleles correlate with risk for multiple sclerosis in Japanese: clinical phenotypes and gender as important factors. Tissue Antigens 55:199–205

    CAS  Google Scholar 

  13. Ito, H, Yamasaki K, Kawano Y, Horiuchi I, Yun C, Nishimura Y, Kira J (1998) HLA–DP–associated susceptibility to the optico–spinal form of multiple sclerosis in the Japanese. Tissue Antigens 52:179–182

    CAS  PubMed  Google Scholar 

  14. Kikuchi S, Fukazawa T, Niino M, Yabe I, Miyagishi R, Hamada T, Hashimoto SA, Tashiro K (2003) HLA–related subpopulations of MS in Japanese with and without oligoclonal IgG bands. Neurology 60:647–651

    CAS  PubMed  Google Scholar 

  15. Kira J, Kanai T, Nishimura Y, Yamasaki K, Matsushita S, Kawano Y, Hasuo K, Tobimatsu S, Kobayashi T (1996) Western versus Asian types of multiple sclerosis: Immunogenetically and clinically distinct disorders. Ann Neurol 40:569–574

    CAS  PubMed  Google Scholar 

  16. Lau KK, Wong LKS, Chan YW, Li HL, Wong V (2002) Epidemiological study of multiple sclerosis in Hong Kong Chinese: questionnaire study. Hong Kong Med J 8:77–80

    CAS  PubMed  Google Scholar 

  17. Lucchinetti C, Bruck W, Parisi J, Scheithauser B, Rodriguez M, Lassmann H (2000) Heterogeneity of multiple sclerosis lesions: implications for the pathogenesis of demyelination. Ann Neurol 47:707–717

    CAS  PubMed  Google Scholar 

  18. Lycklama a Nijeholt GJ, Barkhof F, Scheltens P, Castelijins JA, Ader H, van Waesberghe JH, Polman C, Jongen SJH, Valk J (1997) MR of the spinal cord in multiple sclerosis: Relation to clinical subtypes and disability. AJNR 18:1041–1048

    PubMed  Google Scholar 

  19. Ma JJ, Nishimura M, Mine H, Saji H, Ohta M, Saida K, Ozawa K, Kawakami H, Saida, T, Uchiyama T (1998) HLADRB1 and tumor necrosis factor gene polymorphisms in Japanese patients with multiple sclerosis. J Neuroimmunol 92:109–112

    CAS  PubMed  Google Scholar 

  20. Mandler RN, Ahmed W, Dencoff JE (1998) Devic’s neuromyelitis optica: a prospective study of seven patients treated with prednisone and azathioprine. Neurology 51:1219–1220

    CAS  PubMed  Google Scholar 

  21. McDonald WI, Compston A, Edan G, Goodkin D, Hartung HP, Lublin FD, McFarland HF, Paty DW, Polman CH, Reingold SC, Sandberg–Wollheim M, Sibley W, Thompson A, Van den Noort S, Weinshenker BY, Wolinsky JS (2001) Recommended diagnostic criteria for multiple sclerosis: Guidelines from the international panel on the diagnosis of multiple sclerosis. Ann Neurol 50:121–127

    CAS  PubMed  Google Scholar 

  22. Misu T, Fijihara K, Nakashima I, Miyazawa I, Okita N, Takase S, Itoyama Y (2002) Pure optic–spinal form of multiple sclerosis in Japan. Brain 125:2460–2468

    PubMed  Google Scholar 

  23. Miyazawa I, Fujihara K, Itoyama Y (2001) Neuromyelitis optica (Devic’s disease) and optic–spinal form multiple sclerosis. Brain Nerve (Japanese) 53:901–910

    CAS  PubMed  Google Scholar 

  24. Nakashima I, Fujihara K, Itoyama, Y (1999) Oligoclonal IgG bands in Japanese multiple sclerosis patients. J Neuroimmunol 15:205–206

    Google Scholar 

  25. Oksenberg JR, Baranzini SE, Barcellos LF, Hauser SL (2001) Multiple sclerosis: Genomic rewards. J Neuroimmunol 113:171–184

    CAS  PubMed  Google Scholar 

  26. Ono T, Zambenedetti MR, Yamasaki K, Kawano Y, Kamikawaji N, Ito H, Sakurai M, Nishimura Y, Kira J, Kanazawa I, Sasazuki T (1998) Molecular analysis of HLA class I (HLA–A and –B) and HLA class II (HLA–DRB1) genes in Japanese patients with multiple sclerosis (Western type and Asian type). Tissue Antigens 52:539–542

    CAS  PubMed  Google Scholar 

  27. O’Riordan JI, Gallagher HL, Thompson AJ, Howard RS, Kingsley DPE, Thompson EJ, McDonald WI, Miller DH (1996) Clinical, CSF, and MRI findings in Devic’ neuromyelitis optica. J Neurology Neurosurg Psychiatry 60:382–387

    CAS  Google Scholar 

  28. Poser CM (1994) The epidemiology of multiple sclerosis: A general overview. Ann Neurol 36(S2):S180–S193

    PubMed  Google Scholar 

  29. Poser CM, Paty DW, Scheinberg L, McDonald WI, Davis FA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: Guidelines for research protocols. Ann Neurol 13:227–231

    CAS  PubMed  Google Scholar 

  30. Shiraki H (1970) Neuromyelitis optica (Devic disease). Clin Neurol 28:2235–2249

    CAS  Google Scholar 

  31. Shibasaki H, McDonald WI, Kuroiwa Y (1981) Racial modification of clinical picture of multiple sclerosis: comparison between British and Japanese patients. J Neurol Sci 49:253–271

    CAS  PubMed  Google Scholar 

  32. Weinshenker BG (2001) Plasma exchange for severe attacks of inflammatory demyelinating diseases of the central nervous system. J Clin Apheresis 16:39–42

    PubMed  Google Scholar 

  33. Weinshenker BG (2003) Neuromyelitis optica: what is and what it might be. Lancet 361:889–890

    PubMed  Google Scholar 

  34. Wingerchuk DM, Hogancamp WF, O’Brien PC, Weinshenker BG (1999) The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 53:1107–1114

    CAS  PubMed  Google Scholar 

  35. Yamasaki K, Horiuchi I, Minohara M, Kawano Y, Ohyagi Y, Yamada T, Mihara F, Ito, H, Nishimura Y, Kira J (1999) HLA–DPB1*0501 associated opticospinal multiple sclerosis: clinical, neuroimaging and immunogenetic studies. Brain 122:1689–1696

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. Fukazawa.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Fukazawa, T., Kikuchi, S., Miyagishi, . et al. CSF pleocytosis and expansion of spinal lesions in Japanese Multiple sclerosis with special reference to the new diagnostic criteria. J Neurol 252, 824–829 (2005). https://doi.org/10.1007/s00415-005-0753-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00415-005-0753-8

Key words

  • multiple sclerosis
  • optico–spinal MS
  • diagnostic criteria
  • CSF pleocytosis
  • MRI findings