Annals of Indian Academy of Neurology
: 2011  |  Volume : 14  |  Issue : 3  |  Page : 222--223

Authors' reply

Mahesh Kamate1, Vivek Chetal1, Venkatesh Tonape1, Niranjana Mahantshetti1, Virupaxi Hattiholi2,  
1 Department of Pediatrics, KLE University's J N Medical College, Belgaum, Karnataka, India
2 Department of Radiology, KLE University's J N Medical College, Belgaum, Karnataka, India

Correspondence Address:
Mahesh Kamate
Department of Paediatrics, KLE University«SQ»s J N Medical College, Belgaum - 590 010, Karnataka

How to cite this article:
Kamate M, Chetal V, Tonape V, Mahantshetti N, Hattiholi V. Authors' reply.Ann Indian Acad Neurol 2011;14:222-223

How to cite this URL:
Kamate M, Chetal V, Tonape V, Mahantshetti N, Hattiholi V. Authors' reply. Ann Indian Acad Neurol [serial online] 2011 [cited 2022 Jan 29 ];14:222-223
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We appreciate the comments made by Radhakrishna [1] and colleagues and would like to clarify few of the concerns raised by them. Childhood multiple sclerosis (MS) was not seen in our series with 15 patients of childhood inflammatory demyelinating disorders (CIDD). We fully agree that there is a need to follow the cases with the diagnosis of clinically isolated syndrome (CIS) for possible evolution into MS. We are following-up these patients every 6 months for possible recurrence of deficits or occurrence of new symptoms. This is one of the advantages of the new consensus definition as it separates Acute disseminated encephalomyelitis (ADEM) from CIS. [2] Previously, both of these were clubbed under ADEM. Patients with a diagnosis of CIS need a close follow-up as these patients, when compared with a diagnosis with ADEM, are at a higher chance of developing MS at follow-up. Although the concept of recurrent ADEM existed earlier, there was a lot of ambiguity in use of terms like recurrent ADEM, relapsing ADEM and multiphasic ADEM. The new consensus definition has cleared the confusion and given clear guidelines to the use of these terms. Uniform use of the consensus definition by all those involved in the treatment of CIDD would help in taking up large follow-up and therapeutic trials in patients with CIDD.

Coming to inclusion of one patient with HIV and ADEM in our series, we agree that progressive multifocal leucoencephalopathy (PML) was a possibility, although the normal premorbid state, short aggressive clinical profile, recent seroconversion of the patient and absence of opportunistic infections made us label it as ADEM. Specific polymerase chain reaction (PCR) tests for JC virus could not be carried out. There are reports of ADEM occurring in primary HIV infection. [3],[4] Because of similar findings, a differentiation of ADEM from PML may be impossible on the basis of magnetic resonance imaging features alone. [5] Clinical and laboratory information is necessary. However, we do admit that in the absence of PCR for JC virus results, the possibility of PML cannot be ruled out in that particular patient, although it appeared unlikely.


1Radhakrishna H. Comment on: Central nervous system inflammatory demyelinating disorders of childhood. Ann Indian Acad Neurol 2011;14:222-3.
2Krupp LB, Banwell B, Tenembaum S. Consensus definitions proposed for pediatric multiple sclerosis and related disorders. Neurology 2007;68 (Suppl 2):S7-12.
3Mogensen TH, Marinovskij E, Larsen CS. Acute demyelinizating encephalomyelitis as initial presentation of primary HIV infection. Scand J Infect Dis 2007;39:630-4.
4Allen SH, Malik O, Lipman MC, Johnson MA, Wilson LA. Acute demyelinating encephalomyelitis in a patient with HIV infection. J Infect 2002;45:62-4.
5Van der Knaap MS, Valk J. Progressive multifocal leucoencephalopathy. In: Magnetic resonance of myelination and myelin disorders. 3rd ed. Berlin: Springer-Verlag; 2005. p. 628-34.