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Review
. 2022 May;80(5 Suppl 1):137-142.
doi: 10.1590/0004-282X-ANP-2022-S109.

Differential diagnosis of demyelinating diseases: what's new?

Ana Beatriz Ayroza Galvão Ribeiro Gomes  1 , Tarso Adoni  1   2
Affiliations
Review

Differential diagnosis of demyelinating diseases: what's new?

Ana Beatriz Ayroza Galvão Ribeiro Gomes et al. Arq Neuropsiquiatr. 2022 May.

Abstract
in English, Portuguese

Background: Acquired demyelinating disorders lead to overlapping visual, pyramidal, sensory, autonomic, and cerebellar deficits and may lead to severe disability. Early diagnosis and start of treatment are fundamental towards preventing further attacks and halting disability.

Objective: In this paper we provide an updated overview of the differential diagnoses of acquired demyelinating disorders.

Methods: We performed a critical targeted review of the diagnoses of the most prevalent demyelinating disorders: multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD).

Results: We discuss the workup, diagnostic criteria and new biomarkers currently being used for the diagnosis of these disease entities taking into account the particularities of the Brazilian population and healthcare system.

Conclusion: A comprehensive analysis of medical history, physical examination, biomedical and imaging data should be performed to obtain differential diagnosis. Diagnostic criteria should be mindfully employed considering ethnic and environmental particularities of each patient.

Antecedentes:: Doenças desmielinizantes adquiridas levam a déficits visuais, piramidais, sensitivos, autonômicos e cerebelares que se sobrepõem e podem conduzir a grave incapacidade. O diagnóstico e o início de tratamento precoces são fundamentais para a prevenção de surtos e ocorrência de incapacidade.

Objetivo:: Neste artigo, apresentamos uma visão geral atualizada sobre o diagnóstico diferencial de doenças desmielinizantes adquiridas.

Métodos:: Realizamos uma revisão crítica sobre o diagnóstico das doenças desmielinizantes mais prevalentes: esclerose múltipla (EM), doença do espectro neuromielite óptica (NMOSD) e doença associada ao anticorpo contra a glicoproteína da mielina do oligodendrócito (MOGAD).

Resultados:: Discutimos a investigação, os critérios diagnósticos e os novos biomarcadores atualmente empregados para o diagnóstico dessas doenças, levando em conta as particularidades da população e sistema de saúde brasileiros.

Conclusão:: Uma análise minuciosa do histórico médico, exame neurológico e exames biomédicos e de imagem deve ser realizada para se fazer um diagnóstico diferencial de doença desmielinizante. Critérios diagnósticos devem ser empregados cautelosamente considerando-se particularidades étnicas e ambientais de cada paciente.

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Conflict of interest statement

Conflict of interest: ABAGRG: received travel grants from Biogen and Roche; TA: received compensation for participating on Advisory Boards in the last 5 years from: Alexion, Biogen, Sanofi-Genzyme, Merck-Serono, Novartis, Roche and Teva Neuroscience; has received travel grants from Biogen, Merck-Serono and Roche.

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