Multiple Sclerosis Journal 21(9)
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SAGE journals Multiple Sclerosis Journal 2015, Vol. 21(9) 1216
Correspondence to: Roberta Lanzillo Multiple Sclerosis Centre, Department of Neuroscience, Reproductive Science and
Odontostomatology, Federico II University of Naples, Via Pansini 5, Napoli, 80131, Italy. [email protected] [email protected]
Solitary sclerosis: Experience from three French tertiary care centres
patient received immunosuppressive treatment. Data collection and follow up of these patients is ongoing.
DOI: 10.1177/ 1352458515570405 © The Author(s), 2015. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav
Dear Editor, We read with interest the article from Lattanzi et al.1 reporting eight cases of patients with a solitary demyelinating lesion in the cervico-medullary junction. In France, one case of solitary sclerosis was reported in 20132 and this prompted us to collect data about patients followed in French tertiary care multiple sclerosis (MS) centres who presented with the same phenotype. To date, we have collected five cases (three women and two men) followed in three University Centres (Montpellier, Nice and Paris). Mean age at onset was 45.3 years (35–63). The clinical presentation was progressive hemiparesis in four cases and progressive monoparesis in one case. Mean Expanded Disability Status Scale (EDSS) score at onset was 3.2 (2.5–4). The solitary lesion was located in the cervico-medullary junction in three cases and in the upper cervical cord in two cases. One patient had brain Magnetic Resonance Imaging (MRI) spectroscopy of the normal-appearing white matter which revealed an increase of choline and myoinositol compatible with a demyelinating process. In all cases, the paraclinical investigations exclu-ded all potential differential diagnoses. All patients had extensive metabolic, infectious and immunological screening which was unremarkable. Neuro-myelitis optica (NMO) antibodies were negative for all patients. Visual Evoked Potentials (VEP) and Electromyography (EMG) were normal for all patients, as well as thoracic-abdominal pelvis computed tomography scan. In our cohort, all of the patients but one had a positive CSF analysis with detection of oligoclonal bands and this is an important distinction from the cohort reported by Lattanzi et al. and is a major point regarding the documentation of suspected demyelinating disease. Our finding is consistent with previously reported cases in the literature.3
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SAGE journals
Mean follow-up duration in our cohort is 51 months (20–120). Mean EDSS score at last evaluation is 3.8 (3–6.5). We observed a slowly progressive accumulation of disability with no documented relapse. Three patients were treated with corticosteroids with a positive effect in one patient. Two patients responded to fampridine. No
Our preliminary results confirm Lattanzi’s report describing solitary sclerosis as a focal form of MS. However, we suggest that the presence of oligoclonal bands in the CSF study is important to support this diagnosis, and to exclude differential diagnosis such as slowly evolving tumours. Acknowledgements Club Francophone de la Sclérose en Plaques author group: David Laplaud, Faycal Derouiche, Loic Chambaud, Clotilde Boulay, Jean C Ouallet, Lucien Rumbach, Audrey Kopf, Marie Fleury, Irina Malikova, Christian Zaenker, Gilles Edan, Thibault Moreau, Frederic Blanc, Nicolas Collongues, Pascal B Saverne, Pierre Louiset, Sophie Pittion, Pierre Clavelou, Frederic Taithe, Patrick Vermersch, Alain Creange, Olivier Gout, Anne M Guennoc, Marc Coustans, Gregory Taurin, Francois Lallement, Francois Rouhart, William Camu, Eric Thouvenot, Pierre Labauge, Pierrette Seeldrayers. References 1.
Lattanzi S, Logullo F, Di Bella P, et al. Multiple sclerosis, solitary sclerosis or something else? Mult Scler 2014; 20(14): 1819–1824.
2.
Ayrignac X, Carra-Dalliere C, Homeyer P, et al. Solitary sclerosis: Progressive myelopathy from solitary demyelinating lesion. A new entity? Acta Neurol Belg 2013; 113: 533–534.
3.
Schmalstieg WF, Keegan BM and Weinshenker BG. Solitary sclerosis: Progressive myelopathy from solitary demyelinating lesion. Neurology 2012; 78: 540–544.
5
Mikael Cohen, Christine Lebrun Department of Neurology, Hopital Pasteur, France Xavier Ayrignac, Pierre Labauge Hopital Gui de Chauliac, CHU Montpellier, France Rana Assouad Hopital Pitié Salpétrière, Department of Neurology, Paris, France Correspondence to: Mikael Cohen Department of Neurology, Hopital Pasteur, Neurologie, 30 Voie Romaine, 06000 Nice, France. [email protected]
1216 http://msj.sagepub.com
Downloaded from msj.sagepub.com at UNIV NEBRASKA LIBRARIES on August 28, 2015
Visit SAGE journals online http://msj.sagepub.com
SAGE journals Multiple Sclerosis Journal 2015, Vol. 21(9) 1216
Correspondence to: Roberta Lanzillo Multiple Sclerosis Centre, Department of Neuroscience, Reproductive Science and
Odontostomatology, Federico II University of Naples, Via Pansini 5, Napoli, 80131, Italy. [email protected] [email protected]
Solitary sclerosis: Experience from three French tertiary care centres
patient received immunosuppressive treatment. Data collection and follow up of these patients is ongoing.
DOI: 10.1177/ 1352458515570405 © The Author(s), 2015. Reprints and permissions: http://www.sagepub.co.uk/ journalsPermissions.nav
Dear Editor, We read with interest the article from Lattanzi et al.1 reporting eight cases of patients with a solitary demyelinating lesion in the cervico-medullary junction. In France, one case of solitary sclerosis was reported in 20132 and this prompted us to collect data about patients followed in French tertiary care multiple sclerosis (MS) centres who presented with the same phenotype. To date, we have collected five cases (three women and two men) followed in three University Centres (Montpellier, Nice and Paris). Mean age at onset was 45.3 years (35–63). The clinical presentation was progressive hemiparesis in four cases and progressive monoparesis in one case. Mean Expanded Disability Status Scale (EDSS) score at onset was 3.2 (2.5–4). The solitary lesion was located in the cervico-medullary junction in three cases and in the upper cervical cord in two cases. One patient had brain Magnetic Resonance Imaging (MRI) spectroscopy of the normal-appearing white matter which revealed an increase of choline and myoinositol compatible with a demyelinating process. In all cases, the paraclinical investigations exclu-ded all potential differential diagnoses. All patients had extensive metabolic, infectious and immunological screening which was unremarkable. Neuro-myelitis optica (NMO) antibodies were negative for all patients. Visual Evoked Potentials (VEP) and Electromyography (EMG) were normal for all patients, as well as thoracic-abdominal pelvis computed tomography scan. In our cohort, all of the patients but one had a positive CSF analysis with detection of oligoclonal bands and this is an important distinction from the cohort reported by Lattanzi et al. and is a major point regarding the documentation of suspected demyelinating disease. Our finding is consistent with previously reported cases in the literature.3
Visit SAGE journals online http://msj.sagepub.com
SAGE journals
Mean follow-up duration in our cohort is 51 months (20–120). Mean EDSS score at last evaluation is 3.8 (3–6.5). We observed a slowly progressive accumulation of disability with no documented relapse. Three patients were treated with corticosteroids with a positive effect in one patient. Two patients responded to fampridine. No
Our preliminary results confirm Lattanzi’s report describing solitary sclerosis as a focal form of MS. However, we suggest that the presence of oligoclonal bands in the CSF study is important to support this diagnosis, and to exclude differential diagnosis such as slowly evolving tumours. Acknowledgements Club Francophone de la Sclérose en Plaques author group: David Laplaud, Faycal Derouiche, Loic Chambaud, Clotilde Boulay, Jean C Ouallet, Lucien Rumbach, Audrey Kopf, Marie Fleury, Irina Malikova, Christian Zaenker, Gilles Edan, Thibault Moreau, Frederic Blanc, Nicolas Collongues, Pascal B Saverne, Pierre Louiset, Sophie Pittion, Pierre Clavelou, Frederic Taithe, Patrick Vermersch, Alain Creange, Olivier Gout, Anne M Guennoc, Marc Coustans, Gregory Taurin, Francois Lallement, Francois Rouhart, William Camu, Eric Thouvenot, Pierre Labauge, Pierrette Seeldrayers. References 1.
Lattanzi S, Logullo F, Di Bella P, et al. Multiple sclerosis, solitary sclerosis or something else? Mult Scler 2014; 20(14): 1819–1824.
2.
Ayrignac X, Carra-Dalliere C, Homeyer P, et al. Solitary sclerosis: Progressive myelopathy from solitary demyelinating lesion. A new entity? Acta Neurol Belg 2013; 113: 533–534.
3.
Schmalstieg WF, Keegan BM and Weinshenker BG. Solitary sclerosis: Progressive myelopathy from solitary demyelinating lesion. Neurology 2012; 78: 540–544.
5
Mikael Cohen, Christine Lebrun Department of Neurology, Hopital Pasteur, France Xavier Ayrignac, Pierre Labauge Hopital Gui de Chauliac, CHU Montpellier, France Rana Assouad Hopital Pitié Salpétrière, Department of Neurology, Paris, France Correspondence to: Mikael Cohen Department of Neurology, Hopital Pasteur, Neurologie, 30 Voie Romaine, 06000 Nice, France. [email protected]
1216 http://msj.sagepub.com
Downloaded from msj.sagepub.com at UNIV NEBRASKA LIBRARIES on August 28, 2015
