Devic's neuromyelitis optica mimicking multiple sclerosis in pregnancy

We studied repeated cerebrospinal fluids of patients with Devic’s neuromyelitis optica (NMO) and multiple sclerosis (MS). Variations of oligoclonal bands (OBs) had opposite trends in the two groups. In MS, O Bs were detected in 399 of 411 patients (97%) and never disappeared. In NMO, O Bs were detected in three of 11 patients (27%) and always disappeared. The hypothesis that NMO and MS follow distinct patho genetic pathways is supported by our findings, which can be useful for the differentiatio n of NMO from MS.

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Is Devic's neuromyelitis optica a separate disease? A comparative study with multiple sclerosis

Multiple Sclerosis Journal ◽

10.1191/1352458503ms947oa ◽

2003 ◽

Vol 9 (5) ◽

pp. 521-525 ◽

Cited By ~ 82

Author(s):

J de Seze ◽

C Lebrun ◽

T Stojkovic ◽

D Ferriby ◽

M Chatel ◽

...

Keyword(s):

Multiple Sclerosis ◽

Optic Neuritis ◽

Neuromyelitis Optica ◽

Brain Mri ◽

Oligoclonal Bands ◽

Time And Space ◽

Laboratory Findings ◽

Therapeutic Trials ◽

The Difference ◽

Devic’S Neuromyelitis Optica

Devic's neuromyelitis optica (NMO) associates optic neuritis and myelopathy without other neurological signs. Many patients with NMO may be diagnosed as having multiple sclerosis (MS). However, there have been no previous studies comparing these two patho logies and it is still unclear if NMO is a separate entity or a subtype of MS. In the present study, we compared a series of NMO patients with a series of MS patients for whom optic neuritis or myelopathy was the presenting symptom, in order to determine the place of NMO in the spectrum of MS. We retrospectively studied 30 patients diagnosed with NMO and we compared these patients with 50 consecutive MS cases revealed by optic neuritis or acute myelopathy. MS patients were only included if a relapse occurred demonstrating time and space dissemination. We compared the two groups in terms of clinical presentatio n, laboratory findings (MRI and C SF) and clinical outcome. NMO patients were older and more frequently women than MS patients but the difference was not significant. C SF and MRI data were clearly different: oligoclonal bands (O C B) were found in 23% of NMO cases and 88% of MS (P B/0.001), abnormal brain MRI data were observed in 10% of NMO cases and 66% of MS (P B/0.001) and a large spinal cord lesion was observed in 67% of NMO cases and 7.4% of MS cases (P B/0.001). C linical outcome was evaluated as more severe in the NMO group (P B/0.001). O n the basis of clinical data, all NMO patients but three had dissemination in time and space. When we included MRI parameters, only two of the NMO patients met criteria for MS and one of the MS patients met criteria for NMO. O ur study demonstrates that NMO and MS should be considered as two different entities. The respective criteria for NMO and MS were able to distinguish these two patho logies but only when MRI data were applied. This finding could have implications for future therapeutic trials.

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Management of multiple sclerosis and neuromyelitis optica in pregnancy and childbearing

Clinical and Experimental Neuroimmunology ◽

10.1111/cen3.12185 ◽

2015 ◽

Vol 6 (1) ◽

pp. 93-98 ◽

Cited By ~ 1

Author(s):

Yuko Shimizu

Keyword(s):

Multiple Sclerosis ◽

Neuromyelitis Optica ◽

In Pregnancy

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Devic’s neuromyelitis optica: a critical review

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000100034 ◽

2008 ◽

Vol 66 (1) ◽

pp. 120-138 ◽

Cited By ~ 36

Author(s):

Marco Aurélio Lana-Peixoto

Keyword(s):

Multiple Sclerosis ◽

Spinal Cord ◽

Neuromyelitis Optica ◽

Brain Mri ◽

Water Channel ◽

Demyelinating Diseases ◽

Aquaporin 4 ◽

Igg Antibody ◽

Vascular Walls ◽

Devic’S Neuromyelitis Optica

Devic's neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating and necrotizing disease characterized by predominant involvement of the optic nerves and spinal cord. In Asian countries relapsing NMO has been known as opticospinal multiple sclerosis. It has long been debated if NMO is a variant of multiple sclerosis (MS) or a distinct disease. Recent studies have shown that NMO has more frequently a relapsing course, and results from attack to aquaporin-4 which is the dominant water channel in the central nervous system, located in foot processes of the astrocytes. Distinctive pathological features of NMO include perivascular deposition of IgG and complement in the perivascular space, granulocyte and eosinophil infiltrates and hyalinization of the vascular walls. These features distinguish NMO from other demyelinating diseases such as MS and acute demyelinating encephalomyelopathy. An IgG-antibody that binds to aquaporin-4, named NMO-IgG has high sensitivity and specificity. Magnetic resonance imaging (MRI) studies have revealed that more frequently there is a long spinal cord lesion that extends through three or more vertebral segments in length. Brain MRI lesions atypical for MS are found in the majority of cases. Treatment in the acute phase includes intravenous steroids and plasma exchange therapy. Immunosupressive agents are recommended for prophylaxis of relapses.

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