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May 2008

Differential Diagnosis Between Acute Disseminated Encephalomyelitis and Multiple Sclerosis During the First Episode—Reply

Arch Neurol. 2008;65(5):672-677. doi:10.1001/archneur.65.5.677-a

In reply

My coauthors and I thank Tavazzi and colleagues for their interesting remarks. We apologize for missing some references, especially the article by Marchioni et al1 from 2005. This very interesting article mostly referred to postinfectious inflammatory disorders rather than ADEM. It focused on postinfectious disorders with central nervous system involvement but also peripheral nervous system involvement, with about 40% of cases having peripheral nervous system lesions and only 20% having cerebral involvement. In this study, 80% of patients had myelitis as compared with 65% in our study.1,2 Furthermore, the study by Marchioni and colleagues was not performed to assess the risk to evolve to clinically definite MS. We think that the designs of the 2 studies were clearly different, probably owing in part to the lack of clear definition of what ADEM is. It is surprising to observe that no patients in the study by Marchioni and colleagues were evaluated for MS as compared with about 30% in our study and others.1-4

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