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Spinal Cord Lesions and Atrophy in NMOSD with AQP4-IgG and MOG-IgG Associated Autoimmunity

Overview
Journal Mult Scler
Publisher Sage Publications
Specialty Neurology
Date 2018 Nov 27
PMID 30475082
Citations 23
Authors
Affiliations
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Abstract

Background: Spinal cord (SC) affection is a hallmark symptom of neuromyelitis optica spectrum disorders (NMOSD). Patients with aquaporin-4 (AQP4-IgG+) or myelin oligodendrocyte glycoprotein (MOG-IgG+) antibody seropositivity show this overlapping clinical phenotype.

Objective: Quantitative comparison of SC lesions and atrophy in AQP4-IgG+ and MOG-IgG+ NMOSD.

Methods: AQP4-IgG+ ( = 38), MOG-IgG+ ( = 15) NMOSD patients and healthy controls (HC,  = 24) were analysed for SC lesion (prevalence, length, location), atrophy as mean upper cervical cord area (MUCCA), Expanded Disability Status Scale (EDSS), timed 25-foot walk speed (T25FWS) and 9-hole peg test (9HPT) measures.

Results: In total, 92% (35/38) of AQP4-IgG+ and 53% (8/15) of MOG-IgG+ patients had myelitis attacks (χ = 6.47,  = 0.011). 65.8%/26.7% of AQP4-/MOG-IgG+ patients had chronic SC lesions (χ = 5.16,  = 0.023), with similar proportions in cervical, upper thoracic and lower thoracic cord, and no length differences. MUCCA was decreased in AQP4-IgG+ ( = -2.27,  = 0.028), but not MOG-IgG+ patients ( = 0.58,  = 0.57) compared to HC. MUCCA associated with myelitis attacks (rho = -0.33,  = 0.016), EDSS (rho = -0.31,  = 0.030), pyramidal functional score (rho = -0.42,  = 0.003), T25FWS ( = 0.43,  = 0.010) and 9HPT Z-score ( = 0.32,  = 0.037), regardless of antibody status.

Conclusion: AQP4-IgG+ patients had more myelitis attacks, SC lesions and SC atrophy was more pronounced than in MOG-IgG+ patients. MUCCA is associated with clinical myelitis attacks and disability in all NMOSD patients.

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Hua T, Fan H, Duan Y, Tian D, Chen Z, Xu X J Neurol. 2024; 271(6):3595-3609.

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Asseyer S, Zmira O, Busse L, Pflantzer B, Schindler P, Schmitz-Hubsch T Front Neurol. 2024; 15:1308498.

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Delimiting MOGAD as a disease entity using translational imaging.

Oertel F, Hastermann M, Paul F Front Neurol. 2024; 14:1216477.

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Understanding the Pathophysiology and Magnetic Resonance Imaging of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders.

Cacciaguerra L, Rocca M, Filippi M Korean J Radiol. 2023; 24(12):1260-1283.

PMID: 38016685 PMC: 10700997. DOI: 10.3348/kjr.2023.0360.