Rev Neurol France
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The application of de Seze et al. criteria (2007) to patients presenting a first severe acute demyelinating event helps to distinguish acute disseminated encephalomyelitis (ADEM) from other CNS inflammatory diseases, with 83% sensitivity and 95% specificity. We applied these criteria to 14 patients who presented a first severe acute demyelinating event and whose later clinical course enabled clear identification of the neurological diagnosis. ⋯ Applying the new criteria, we did not find the same sensitivity, specificity, and positive and negative predictive values as in the original article. The lack of specificity arose from the misclassification of MS patients with a tumor-like presentation (two out of five false negatives). One of the explanations is that the clinical criteria used can be part of atypical forms of MS, in particular in its tumor-like presentation. De Seze et al. criteria can be an invaluable help for the clinician in the diagnosis of a first severe demyelinating event. Considering our results, these criteria should not be applied for patients with a tumor-like form of MS. A prospective study in a larger cohort is needed to confirm or invalidate these preliminary results.
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The first French-language case of limbic encephalitis due to anti-N-methyl-D-aspartate receptor to glutamate (NMDA-R) antibodies associated with an ovarian teratoma is reported. ⋯ Owing to the recent description of the association between anti-NMDA-R and limbic encephalitis and the frequent good prognosis reported in the available series and case reports, it is important to search for this association in the not so rare cases of limbic encephalitis when no other cause is disclosed.