NMO-IgG predicts the outcome of recurrent optic neuritis.

Department of Neurology, Mayo Clinic College of Medicine, 200 First St SW, Rochester, MN 55905, USA.
Neurology (Impact Factor: 8.3). 07/2008; 70(23):2197-200. DOI: 10.1212/01.wnl.0000303817.82134.da
Source: PubMed

ABSTRACT To determine the prognostic value of neuromyelitis optica (NMO)-immunoglobulin G (IgG) in patients with recurrent optic neuritis (ON). The aquaporin-4-specific serum autoantibody, NMO-IgG, is a biomarker for NMO and relapsing transverse myelitis. Recurrent ON may herald multiple sclerosis (MS) or NMO, or it may occur as an isolated syndrome. The prognosis and response to therapy differs in each of these contexts.
We evaluated 34 patients who were tested for NMO-IgG between 2000 and 2007 and who had two or more episodes of ON without satisfying a diagnosis of MS or NMO prior to serologic testing. Clinical data were available for 25 Mayo Clinic patients (5 NMO-IgG positive and 20 NMO-IgG negative) and for an additional 9 seropositive patients whose serum was referred to the Mayo Clinic Neuroimmunology laboratory for testing.
Twenty percent of the patients with recurrent ON seen at Mayo Clinic were seropositive. All NMO-IgG-positive patients (vs 65% NMO-IgG-negative patients) had at least one attack with visual acuity in the affected eye worse than 20/200 (p = 0.05). In seropositive patients for whom long-term follow-up was possible (median 8.9 years after the initial ON), 6 of 12 (50%) experienced an episode of myelitis and fulfilled criteria for NMO. In contrast, 1 of 15 seronegative patients (6.7%) fulfilled McDonald criteria for MS (p = 0.03). Seropositive patients had a final visual score which was worse than that of seronegative patients (p = 0.02).
Neuromyelitis optica (NMO)-immunoglobulin G seropositivity predicts poor visual outcome and development of NMO. Seropositive recurrent optic neuritis is a limited form of NMO.

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    ABSTRACT: Background: Approximately 30–50% of idiopathic optic neuritis (ION) patients experience one or multiple episodes of recurrence. The aim of this study was to search for risk factors for ION recurrence. Methods: Clinical data on hospitalized patients diagnosed with ION between January 2003 and January 2011 at the First Affiliated Hospital of Guangxi Medical University were retrospectively collected. Univariate and multivariate analyses were performed on factors that might cause ION recurrence. In total, 115 ION cases (32 recurrent and 83 non-recurrent cases) with complete data were analyzed. The length of the follow-up period ranged from 12 to 108 months (median: 42 months). Results: The univariate analysis showed that the recurrence rate for unilateral ION was higher than that for bilateral ION (40% vs. 12%, p = 0.001). Underlying diseases had a significant impact on recurrence (p,0.001): the recurrence rates due to neuromyelitis optica (NMO), multiple sclerosis (MS), demyelinating lesions alone of the central nervous system, and unknown causes were 89%, 70%, 41%, and 8.7%, respectively. The multivariate analysis showed that the factors causing relatively high recurrence rates included NMO (odds ratio [OR], 73.5; 95% confidence interval [CI], 7.3 to 740.9), MS (OR, 33.9; 95% CI, 5.2 to 222.2), and demyelinating lesions alone (OR, 8.9; 95% CI, 2.3 to 34.4), unilateral involvement (OR, 5.7; 95% CI, 1.5 to 21.3), relatively low initial glucocorticoid dosage (equivalent to #100 mg prednisone/day) (OR, 4.3; 95% CI, 1.0 to 17.9). Conclusion: Underlying diseases, laterality (unilateral or bilateral), and initial glucocorticoid dosage are important risk factors of ION recurrence. Clinical physicians are advised to treat ION patients with a sufficient dose of glucocorticoid in the initial treatment stage to reduce the recurrence risk.
    PLoS ONE 09/2014; · 3.53 Impact Factor
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    ABSTRACT: Neuromyelitis optica (NMO) can be distinguished from MS by clinical, radiological and serological findings, especially the tendency for spinal cord lesions to be longer than 3 vertebral segments during acute attacks and the presence of aquaporin-4 autoantibodies in NMO. The spectrum of NMO is broader than previously realized and includes recurrent myelitis, recurrent optic neuritis, certain cerebral presentations, including intractable vomiting and posterior reversible encephalopathy. It may coexist with other systemic autoimmune diseases, including systemic lupus erythematosus and Sjogren's syndrome. Whether NMO has a predilection for individuals of Asian ancestry or whether there are differences between NMO and Asian optic-spinal MS other than arbitrary definitions remains to be clarified. Further epidemiological studies using comparable diagnostic criteria, radiological studies and serological tests are required.
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    ABSTRACT: The neuromyelitis optica (NMO) is a demyelinating disease of central nervous system central. Discovery of anti-AQP4 broadened the spectrum to limited forms (NMOSD). The objective is to describe the clinical, laboratory, neuroimaging and treatment in these patient groups (NMO and NMOSD). Material and methods We review 15 medical records, retrospectively, of patients with NMO/NMOSD at 2 centers in the Buenos Aires City from the period 2009 to 2013. Results Group 1: definite NMO (n = 7), female: 6/7, age: median: 34 years, anti-AQP4 positive: 2/5, negative: 3/5, was not performed: 2/7, negative OCB: 7/7. First attack: NO: 5, ATM: 2, relapsing clinical course: 4/7, monophasic: 3/7, brain MRI: Normal: 2/7, nonspecific lesions: 5/7. Spinal MRI: longitudinal extensive MTA (LETM): 7/7. Acute treatment: methylprednisolone: 7/7; preventive: meprednisone assosiated with azathioprine: 7/7. Group2: NMOSD limited (n = 8) (ON recurrent (n = 3), ON alone (n = 3) and MTA alone (n 2)) female: 7/8, age: median: 30 years, anti - AQP4 positive: 8/8, BOC positive: 2/8. MRI brain: Normal: 2/8, nonspecific lesions 5/8. Spinal RM: LETM: 2/8. Acute treatment: methylprednisolone: 8/8; preventive: meprednisone associated an azathioprine: 8/8. Conclusions The NMO/NMOSD was observed in young women and the most common manifestation of onset was unilateral ON. Diagnostic studies most relevant were spinal MRI with the presence of longitudinal extensive myelitis transverse in all cases of definite NMO and isolated myelitis and the anti-AQP4 were positive in 100% cases of limited NMO.
    Neurología Argentina. 10/2014;

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