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Neurology Neuroimmunology & Neuroinflammation
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Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder

  • robert laureno, neurologist, Georgetown University
Submitted November 29, 2022

Goldschmidt et al. discuss a patient who experienced episodes of myelitis and other demyelinative lesions over a 40 year course.1 When she was 18 the clinical and imaging features met criteria for multiple sclerosis. she received treatment for this disease for decades. When she was 57 the detection of longitudinally extensive myelitis and AQP4 antibodies led to the diagnosis of NMOSD. The authors conclude that the patient likely developed two different demyelinative diseases, one in her youth and another in her sixth decade. When we neurologists confront a disease which meets criteria for more than one disorder, perhaps we should follow the example of the rheumatologists and refer to it as an overlap disease. Because this term is uncertain, it has the advantage of reminding us that current concepts and categories of demyelinative disease may not endure as long as the principle of Ockham. 

1. Goldschmidt C, Galetta SL, Lisak RP. Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2022

Disclosure: The author reports no relevant disclosures.

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