Revised diagnostic criteria for neuromyelitis optica
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TLDR
Revised diagnostic criteria for definite neuromyelitis optica (NMO) that require optic neuritis, myelitis, and at least two of three supportive criteria: MRI evidence of a contiguous spinal cord lesion 3 or more segments in length, onset brain MRI nondiagnostic for multiple sclerosis, or NMO-IgG seropositivity.Abstract:
Background: The authors previously proposed diagnostic criteria for neuromyelitis optica (NMO) that facilitate its distinction from prototypic multiple sclerosis (MS) However, some patients with otherwise typical NMO have additional symptoms not attributable to optic nerve or spinal cord inflammation or have MS-like brain MRI lesions Furthermore, some patients are misclassified as NMO by the authors’ earlier proposed criteria despite having a subsequent course indistinguishable from prototypic MS A serum autoantibody marker, NMO-IgG, is highly specific for NMO The authors propose revised NMO diagnostic criteria that incorporate NMO-IgG status Methods: Using final clinical diagnosis (NMO or MS) as the reference standard, the authors calculated sensitivity and specificity for each criterion and various combinations using a sample of 96 patients with NMO and 33 with MS The authors used likelihood ratios and logistic regression analysis to develop the most practical and informative diagnostic model Results: Fourteen patients with NMO (146%) had extra-optic-spinal CNS symptoms NMO-IgG seropositivity was 76% sensitive and 94% specific for NMO The best diagnostic combination was 99% sensitive and 90% specific for NMO and consisted of at least two of three elements: longitudinally extensive cord lesion, onset brain MRI nondiagnostic for MS, or NMO-IgG seropositivity Conclusions: The authors propose revised diagnostic criteria for definite neuromyelitis optica (NMO) that require optic neuritis, myelitis, and at least two of three supportive criteria: MRI evidence of a contiguous spinal cord lesion 3 or more segments in length, onset brain MRI nondiagnostic for multiple sclerosis, or NMO-IgG seropositivity CNS involvement beyond the optic nerves and spinal cord is compatible with NMOread more
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Journal ArticleDOI
Therapeutic plasma exchange in neuromyelitis optica: a case series.
TL;DR: A review of patients with relapsing NMO presenting for therapeutic plasma exchange (TPE) at the same institution from December 2005 to December 2012 is presented in this article, where a total of 17 TPE series were performed with the average course of therapy being three series with five TPE (ranged 3-7) per series.
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Soluble CD40 ligand contributes to blood-brain barrier breakdown and central nervous system inflammation in multiple sclerosis and neuromyelitis optica spectrum disorder.
TL;DR: CSF sCD40L levels were significantly increased compared to DCs, and were correlated to Qalb, CSF cell counts, protein concentrations, and interleukin-6 levels, whereas it may contribute to CNS inflammation in NMOSD.
Journal ArticleDOI
Aquaporin-4, homeostasis, and neurologic disease
TL;DR: AQP4 is the main aquaporin in the brain and is expressed in highest density in the perivascular and subpial astrocyte end-feet, and is the target of autoimmune attack in neuromyelitis optica (NMO).
Journal ArticleDOI
CD58 polymorphisms associated with the risk of neuromyelitis optica in a Korean population
TL;DR: The genetic variations in CD58 may be associated with the susceptibility of NMO in a Korean population and it is deduced that the G allele of rs1016140 caused an increase of T cell activity, which in turn eased the access of AQP4 antibody into central nervous system (CNS), leading to NMO development.
Journal ArticleDOI
Serum GFAP levels in optic neuropathies
Mithu Storoni,Marcel M. Verbeek,Zsolt Illes,Romain Marignier,Charlotte E. Teunissen,Magda Grabowska,Christian Confavreux,Gordon T. Plant,Gordon T. Plant,Axel Petzold,Axel Petzold +10 more
TL;DR: In contrast to the CSF, neither serum GFAP nor S100B levels were of major diagnostic value for the laboratory supported differential diagnosis between optic neuritis in the context of NMO and other optic neuropathies.
References
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A serum autoantibody marker of neuromyelitis optica : distinction from multiple sclerosis
Vanda A. Lennon,Dean M. Wingerchuk,Thomas J. Kryzer,Sean J. Pittock,C. F. Lucchinetti,Kazuo Fujihara,Ichiro Nakashima,Brian G. Weinshenker +7 more
TL;DR: NMO-IgG is a specific marker autoantibody of neuromyelitis optica and binds at or near the blood-brain barrier that distinguishes neuromyleitis opticas from multiple sclerosis.
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IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel.
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