Relationship of ADEM to MS

A central issue to understand the pathogenesis of MS is its relationship to ADEM. It is important to reliably distinguish MS from ADEM in order to initiate appropriate long-term therapy, but they share considerable overlap in their epidemiologic, clinical, CSF, imaging, and pathologic features. This often makes reliably distinguishing between the two difficult when encountering patients with a single demyelinating event. ADEM is likely over diagnosed in clinical practice, and cases of "relapsing" ADEM lack pathological verification. Pathologically, the limited extent and pattern of demyelination help distinguish ADEM from MS lesions. However, the existence of "transitional" cases with features of both MS and ADEM provide some support for a shared pathogenic relationship.

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