Tumefactive demyelination: a clinico-radiological dilemma
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Background: The diagnostic criteria for multiple sclerosis have evolved over time and currently the 2010 McDonald criteria are the most widely accepted. These criteria allow the diagnosis of multiple sclerosis to be made at the clinically isolated syndrome stage provided certain criteria are met on a single magnetic resonance brain scan. Our hypothesis was that neurologists in Scotland did not use these criteria routinely.
Multiple sclerosis is a leading cause of disability in young adults, with the Scottish population suffering the highest prevalence in Europe. Disease-modifying therapies, including beta-interferon (IFN-b), are increasingly used to minimise relapse frequency in the majority of patients who present with a relapsing-remitting disease pattern. Unfortunately, neutralising antibodies (NABs) may develop against IFN-b and are associated with reduced efficacy. These antibodies may be detected using a serum sample.
This review is based in part on a presentation given by Dr Mackillop at the Neurology Symposium on 4 October 2012 at the Royal College of Physicians of Edinburgh.