title: First diagnostic criteria for atopic myelitis with special reference to discrimination from myelitis-onset multiple sclerosis.
abstract: OBJECTIVE
  To establish the first evidence-based diagnostic criteria for atopic myelitis (AM) enabling it to be discriminated from myelitis-onset multiple sclerosis (MS), which is a difficult differential diagnosis.
  
  
  METHODS
  Sixty-nine consecutive AM patients examined from 1996 to 2010 at Kyushu University hospital, who fulfilled the empirical definition of AM (2003), and 51 myelitis-onset MS patients in whom allergen-specific IgE was measured, were enrolled. The first available brain MRI findings were compared between the two. Then, we compared the clinical and laboratory features between the 16 AM cases who did not meet the Barkhof brain MRI criteria for MS after more than 5 years follow-up and 51 myelitis-onset MS cases. Based on the discriminative findings, we established diagnostic criteria for AM and calculated the sensitivity and specificity.
  
  
  RESULTS
  AM patients had a significantly lower frequency of Barkhof brain lesions on baseline MRI than myelitis-onset MS patients. AM patients had a significantly higher frequency of present and/or past history of atopic disease and hyperIgEemia, and higher cerebrospinal fluid levels of interleukin 9 and CCL11/eotaxin, but a lower frequency of oligoclonal IgG bands than myelitis-onset MS patients. Our proposed diagnostic criteria for AM demonstrated 93.3% sensitivity and 93.3% specificity for AM against myelitis-onset MS, with 82.4% positive predictive value and 97.7% negative predictive value.
  
  
  CONCLUSIONS
  Our first evidence-based criteria for AM show high sensitivity and specificity, and would be useful clinically.
authors.affiliation: Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Isobe
authors.forename: Yuji
authors.initials: Y
authors.lastname: Kanamori
authors.forename: Tomomi
authors.initials: T
authors.lastname: Yonekawa
authors.forename: Takuya
authors.initials: T
authors.lastname: Matsushita
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Shigeto
authors.forename: Nobutoshi
authors.initials: N
authors.lastname: Kawamura
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Kira
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis*; D009187:Myelitis / Q000175:diagnosis*; D009902:Optic Neuritis / Q000175:diagnosis*; D013577:Syndrome; D055815:Young Adult