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Multiple sclerosis or HTLV-I myelitis?

Neurological Unit, Beth Israel Hospital, and Department of Neurology, Harvard Medical School (Dr. Poser), Boston, MA; Neuroepidemiology Branch, National Institute of Neurological Disorders and Stroke (Dr. Roman), Bethesda, MD; and the Neurology Service, Hôpital P. Zobda-Quitman (Dr. Vernant), Fort-de-France, Martinique, French West Indies.

Several authors have demonstrated the presence of antibodies against the HTLV-I retrovirus in patients with MS. Considerable controversy exists regarding the etiologic significance, if any, of this finding, but the presence of these antibodies in the blood or CSF of MS patients has led to reconsideration of that diagnosis in certain cases. It is recommended that, before the diagnosis of MS is changed to that of HTLV-I-associated chronic myelitis, at least 2 of the following abnormalities be present: (1) clinical or electrophysiologic involvement of peripheral nerve or muscle; (2) the presence of oligoclonal bands in the serum; (3) the presence in blood or CSF of lymphocytes with multilobed nuclei; (4) a positive serologic test for syphilis; (5) the presence of a sicca syndrome; and (6) the presence of pulmonary lymphocytic alveolitis.

Address correspondence and reprint requests to Dr. Charles M. Poser, Beth Israel Hospital, 330 Brookline Avenue, Boston, MA 02215.

Received June 19, 1989. Accepted for publication in final form December 11, 1989.

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