Revised diagnostic criteria for neuromyelitis optica
Reads0
Chats0
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
Citations
More filters
Journal ArticleDOI
Myasthenia gravis and neuromyelitis optica spectrum disorder: a multicenter study of 16 patients.
Maria Isabel Leite,Ester Coutinho,Marco Aurélio Lana-Peixoto,S Apostolos,Patrick Waters,Douglas Kazutoshi Sato,L Melamud,Monica Marta,A Graham,Jennifer Spillane,Alex Villa,Dagoberto Callegaro,Ernestina Santos,A.M. da Silva,Sven Jarius,Robert Howard,Ichiro Nakashima,Gavin Giovannoni,Camilla Buckley,David Hilton-Jones,Angela Vincent,Jacqueline Palace +21 more
TL;DR: Although both conditions are rare, the association of MG and NMOSD occurs much more frequently than by chance and the MG appears to follow a benign course and the antibody titers against AQP4 and AChR tend to change in opposite directions.
Body fl uid biomarkers in multiple sclerosis
Manuel Comabella,M Comabella +1 more
TL;DR: The study of multiple sclerosis can benefit from the use of biomarkers because of the disease's inherent heterogeneity as discussed by the authors, and large gaps remain between exploratory biomarkers proposed in many studies, validated biomarkers, and biomarkers that are integrated into routine clinical practice.
Journal ArticleDOI
Intractable vomiting as the initial presentation of neuromyelitis optica
Metha Apiwattanakul,Bogdan F. Gh. Popescu,Marcelo Matiello,Brian G. Weinshenker,Claudia F. Lucchinetti,Vanda A. Lennon,Andrew McKeon,Adam F. Carpenter,Gary M. Miller,Sean J. Pittock +9 more
TL;DR: Clinical, pathologic and neuroimaging observations suggest the aquaporin‐4–rich area postrema may be a first point of attack in neuromyelitis optica.
Journal ArticleDOI
Cerebrospinal fluid antibodies to aquaporin-4 in neuromyelitis optica and related disorders: frequency, origin, and diagnostic relevance
Sven Jarius,Diego Franciotta,Friedemann Paul,Klemens Ruprecht,Roberto Bergamaschi,Paulus S. Rommer,Reinhard Reuss,Christian Probst,Wolfgang Kristoferitsch,Klaus-Peter Wandinger,Brigitte Wildemann +10 more
TL;DR: AQP4-Ab are detectable in the CSF of most patients with NMOSD, mainly during relapse, and are highly specific for this condition, according to the unique localisation of the target antigen at the blood brain barrier.
Journal ArticleDOI
Interferon beta-1b exacerbates multiple sclerosis with severe optic nerve and spinal cord demyelination
TL;DR: IFNB-1b should not be administered to demyelinating patients with genetic and clinical characteristics mimicking NMO such as HLA DPB1*0501 allele, longitudinally extensive spinal cord lesion, blindness and CSF pleocytosis even if they have symptomatic cerebral lesions as typically seen in MS.
References
More filters
Journal ArticleDOI
Applied Logistic Regression.
TL;DR: Applied Logistic Regression, Third Edition provides an easily accessible introduction to the logistic regression model and highlights the power of this model by examining the relationship between a dichotomous outcome and a set of covariables.
Journal ArticleDOI
Recommended diagnostic criteria for multiple sclerosis: Guidelines from the International Panel on the Diagnosis of Multiple Sclerosis
W. Ian McDonald,A Compston,Gilles Edan,Donald E. Goodkin,Hans-Peter Hartung,Fred D. Lublin,Henry F. McFarland,Donald W. Paty,Chris H. Polman,Stephen C. Reingold,Magnhild Sandberg-Wollheim,William A. Sibley,Alan J. Thompson,Stanley van den Noort,Brian Y. Weinshenker,Jerry S. Wolinsky +15 more
TL;DR: The revised criteria facilitate the diagnosis of MS in patients with a variety of presentations, including “monosymptomatic” disease suggestive of MS, disease with a typical relapsing‐remitting course, and disease with insidious progression, without clear attacks and remissions.
Book
Clinical Epidemiology: A Basic Science for Clinical Medicine
TL;DR: Clinical Epidemiology is a book dedicated to H.L. Mencken, Kurt Vonnegut, Jr., Douglas Adams, and the Emperor's New Clothes and Physicians and others who wish to recognize key clinical epidemiologic features of the diagnosis and management of patients will benefit from reading.
Journal ArticleDOI
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.
Journal ArticleDOI
IgG marker of optic-spinal multiple sclerosis binds to the aquaporin-4 water channel.
TL;DR: It is shown that NMO-IgG binds selectively to the aquaporin-4 water channel, a component of the dystroglycan protein complex located in astrocytic foot processes at the blood-brain barrier, which may represent the first example of a novel class of autoimmune channelopathy.
Related Papers (5)
International consensus diagnostic criteria for neuromyelitis optica spectrum disorders
Dean M. Wingerchuk,Brenda Banwell,Jeffrey Bennett,Philippe Cabre,William M. Carroll,Tanuja Chitnis,Jérôme De Seze,Kazuo Fujihara,Benjamin Greenberg,Anu Jacob,Sven Jarius,Marco Aurélio Lana-Peixoto,Michael J. Levy,Jack H. Simon,Silvia Tenembaum,Anthony Traboulsee,Patrick Waters,Kay E. Wellik,Brian G. Weinshenker +18 more