Types of neuroinflammatory disorders
Multiple sclerosis (MS) is the most common neuroinflammatory disorder, characterised by relapsing-remitting or progressive neurological deficits due to demyelination and axonal damage. Acute disseminated encephalomyelitis (ADEM) typically occurs in children after infection or vaccination, producing multifocal neurological symptoms and encephalopathy. CNS vasculitis involves inflammation of brain blood vessels and may be primary (PACNS) or secondary to systemic autoimmune disease.
Other neuroinflammatory conditions include neuromyelitis optica spectrum disorder (NMOSD), MOG antibody disease, sarcoidosis with CNS involvement, and paraneoplastic encephalitis. Each requires specific diagnostic criteria and treatment approaches. Misdiagnosis can lead to inappropriate treatment � for example, treating NMOSD as MS may worsen outcomes because some MS disease-modifying therapies are harmful in NMOSD.
- Multiple sclerosis � relapsing-remitting or progressive
- ADEM � post-infectious, typically in children
- CNS vasculitis � blood vessel inflammation
- NMOSD and MOG disease � important MS mimics
- Sarcoidosis and paraneoplastic encephalitis
Related: Neurologist Kathmandu → · Dr. Jitendra Knowledge Hub → · ICHD-3 Topic →
Diagnostic evaluation and immunotherapy
Evaluation requires MRI brain and spinal cord with gadolinium to characterise lesion distribution and activity patterns. CSF analysis looks for oligoclonal bands, pleocytosis, and elevated protein. Blood tests exclude systemic autoimmune disease (ANA, ESR, CRP, ANCA) and paraneoplastic antibodies. Specific antibody testing (AQP4-IgG for NMOSD, MOG-IgG for MOG disease) is essential to distinguish MS from its mimics.
Treatment depends on the specific disorder. MS uses disease-modifying therapies (interferon, glatiramer, fingolimod, natalizumab, ocrelizumab). NMOSD requires different agents (rituximab, eculizumab, inebilizumab). ADEM is typically treated with high-dose corticosteroids. CNS vasculitis requires corticosteroids and cyclophosphamide. Accurate diagnosis is critical because treatments for one condition may be harmful for another. Dr. Jitendra Prasad Yadav (NMC 8029) provides neuroinflammatory evaluation and treatment planning at Kathmandu Neurology Clinic, Durbar Marg, Opposite of Yak & Yeti Hotel.
| Disorder | Key Diagnostic Feature | First-line Treatment |
|---|---|---|
| MS | Dissemination in space and time on MRI | Disease-modifying therapies |
| NMOSD | AQP4-IgG antibody positive | Rituximab, eculizumab, inebilizumab |
| MOG disease | MOG-IgG antibody positive | Corticosteroids, rituximab |
| ADEM | Multifocal lesions, encephalopathy | High-dose corticosteroids |
| CNS vasculitis | Vessel wall enhancement on MRI | Corticosteroids, cyclophosphamide |