Highlights
- •Neuromyelitis optica is more common than multiple sclerosis in Thailand.
- •AQP4-IgG is mandatory for diagnosis in CNS inflammatory disease.
- •AQP4-IgG guides physicians for appropriate management.
Abstract
Background
Neuromyelitis optica (NMO) is more prevalent than multiple sclerosis (MS) in the Asian
population. AQP4-IgG as a specific biomarker for NMO has not been systematically validated
in Thai patients.
Objective
To identify the proportion of central nervous system demyelinating disease of Thai
patient in one of referral center and examine its clinico-serological correlation
with AQP4-IgG status.
Method
Cross sectional collected sera from patients who visited or were admitted to Prasat
Neurological Institute from November 2009 to August 2010 were tested for serum AQP4-IgG
levels. Patient information was reviewed and diagnoses of MS and clinical isolated
syndrome (CIS) were made using the Revised McDonald criteria 2005. Diagnosis of NMO
was made using the Revised NMO criteria 2006 (except for AQP4-IgG status) and NMO
spectrum disorder (NMOSD) criteria 2007.
Results
Sixty-one patients were identified including 12 with NMO, 25 with limited form of
NMO, 16 with relapsing remitting MS (RRMS), and 8 with CIS. AQP4-IgG was found in
65% of patients in the NMOSD group. In the MS/CIS group, 2 were AQP4-IgG seropositive.
Pleocytosis was significantly higher in the NMOSD group than the MS/CIS group. Cranial
MRI revealed that the size and degree of brain lesions were similar in all study groups.
However, spinal MRI showed that the MS/CIS groups had a higher prevalence of short
segment myelitis and a higher abundance of white matter (p<0.05) than NMOSD group. AQP4-IgG seropositive samples correlated with female patients
and the presence of optic neuritis.
Conclusion
NMOSD is more common than MS in Thai patients. Moreover, AQP4-IgG is highly specific
for NMOSD. Spinal MRI can effectively distinguish NMOSD from MS patients. AQP4-IgG
seropositivity is highly correlated with females and the presence of optic neuritis.
Keywords
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Article info
Publication history
Published online: July 22, 2013
Accepted:
June 19,
2013
Received in revised form:
June 16,
2013
Received:
February 1,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
