title: Acute disseminated encephalomyelitis progressing to multiple sclerosis: are infectious triggers involved?
abstract: Acute disseminated encephalomyelitis (ADEM) and multiple sclerosis (MS) are demyelinating disorders affecting the central nervous system. An autoimmune aetiology has been proposed for both. ADEM principally affects adolescents following acute infection by a variety of pathogens and has also been reported to occur following vaccination. ADEM typically resolves following medical treatment, whereas MS follows a more relapsing and remitting course. The pathogenesis of MS remains unclear, but it is thought that a combination of infectious and non-infectious environmental factors and host genetics act synergistically to cause disease. A variety of viruses, including Epstein Barr virus, cytomegalovirus, herpes simplex virus and varicella zoster virus, have been implicated as possible infectious triggers. The similar clinical and pathological presentation of ADEM and MS presents a diagnostic challenge for distinguishing ADEM from a first episode of MS. Some cases of ADEM progress to MS for reasons that are not currently clear. This review examines the evidence for infectious agents as triggers for ADEM progressing to MS and suggests potential methods that may facilitate identification of infectious agents that may be responsible for the pathogenesis of ADEM to MS.
authors.affiliation: Institute of Liver Studies, Division of Transplantation Immunology and Mucosal Biology, King's College London School of Medicine at King's College Hospital, Denmark Hill Campus, London, SE5 9RS, UK, daniel.s.smyk@doctors.org.uk.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Smyk
authors.forename: Anaïs K
authors.initials: AK
authors.lastname: Alexander
authors.forename: Mary
authors.initials: M
authors.lastname: Walker
authors.forename: Martin
authors.initials: M
authors.lastname: Walker
mesh_terms: D000818:Animals; D001323:Autoantibodies / Q000276:immunology; D004673:Encephalomyelitis, Acute Disseminated / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D006801:Humans; D018716:Molecular Mimicry; D009103:Multiple Sclerosis / Q000453:epidemiology* / Q000209:etiology / Q000276:immunology; D063308:Myelin-Oligodendrocyte Glycoprotein / Q000276:immunology; D012141:Respiratory Tract Infections / Q000453:epidemiology*; D014777:Virus Diseases / Q000453:epidemiology*
chemical_list: D001323:Autoantibodies; C571326:MOG protein, human; D063308:Myelin-Oligodendrocyte Glycoprotein