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Warfarin for multiple sclerosis?

G. Ruiz‐Irastorza, M.A. Khamashta
DOI: http://dx.doi.org/10.1093/qjmed/93.8.497 497-499 First published online: 1 August 2000

In 1983, Poser et al.1 established their criteria for the diagnosis of multiple sclerosis (MS). In the same year, Hughes2 described the association between thrombosis, abortion, cerebral disease and lupus anticoagulant. These reports have eventually become connected. Today, almost 20 years later, there are enough data to consider antiphospholipid syndrome (APS), or Hughes' syndrome, as a major differential in the diagnosis of definite or probable MS according to Poser's criteria.

Arterial thrombosis is a major feature of Hughes' syndrome, central nervous system vessels being among the most frequently affected.3 The resulting clinical event is generally a stroke. However, more complex manifestations may include multifocal sensory, motor or cognitive dysfunction, optic neuritis, transverse myelitis and a combination of the last two (Devic's syndrome). Different areas are often affected during the progression of the disease. Magnetic resonance imaging (MRI) studies in these patients frequently show multiple T2 hyperintense brain lesions. This combination—relapsing/remitting multifocal neurological symptoms plus the MRI findings—may closely resemble MS.

In recent years, the number of patients in the medical literature diagnosed with MS and later shown to have antiphospholipid antibodies (aPL) has grown substantially. In 1994, Scott et al.4 reported four patients presenting with multiple neurological manifestations, including vertigo, aphasia, unilateral visual loss, diplopia or hemiparesis, in different combinations over several years, with variable degrees of recovery after the episodes. All had white-matter lesions and all had received the clinical label of MS. Anticardiolipin antibodies (aCL) of the IgG isotype were positive at medium to high levels in the four patients, and lupus anticoagulant (LA) was also found in three of them. In addition, all but one patient …