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Response: Treatment of multiple sclerosis as a single disease based on the body-pathology-environment model

Published:October 06, 2022DOI:https://doi.org/10.1016/j.msard.2022.104222
      Professor Abdorreza Naser Moghadasi, in his letter “Treatment of Multiple Sclerosis as a single disease based on the body-pathology-environment Model”, suggests that multiple sclerosis (MS) should be considered a type of connectomopathy in that the entire connectome of the brain is involved (
      • Moghadasi A.N.
      Treatment of multiple sclerosis as a single disease based on the body-pathology-environment model.
      ). He states the evidence for this can be seen in the extensive involvement of the brain observed with imaging methods. I would argue that viewing MS as a connectomopathy only explains the clinical manifestations of the disease which disrupts neuronal connections (
      • Moghadasi A.N.
      Treatment of multiple sclerosis as a single disease based on the body-pathology-environment model.
      ). However, this does not address the definition of MS as a disease entity and what makes MS unique as a disease. Many MS mimics also disrupt the connectome, but from a pathological perspective these diseases are not MS, for example, neurosarcoidosis, neurosyphilis, vasculitis, small vessel disease, adrenomyeloneuropathy and HTLV-1 associated myelopathy (
      • Miller D.H.
      • Weinshenker B.G.
      • Filippi M.
      • Banwell B.L.
      • Cohen J.A.
      • Freedman M.S.
      • Galetta S.L.
      • Hutchinson M.
      • Johnson R.T.
      • Kappos L.
      • Kira J.
      • Lublin F.D.
      • McFarland H.F.
      • Montalban X.
      • Panitch H.
      • Richert J.R.
      • Reingold S.C.
      • Polman C.H.
      Differential diagnosis of suspected multiple sclerosis: a consensus approach.
      ).
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