The Prevalence and Predictive Factors of Painful Tonic Spasm in Patients with Neuromyelitis Optica Spectrum Disorder (NMOSD)

2020 ◽  
Vol 103 (12) ◽  
pp. 1354-1361
Keyword(s):  
Plasma Exchange ◽  
Tobacco Use ◽  
Neuromyelitis Optica ◽  
Spectrum Disorder ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Good Recovery ◽  
Factors Associated ◽  
Pain Medications ◽  
Study Results ◽  
Tonic Spasm

Background: Painful tonic spasm (PTS) is a complication frequently observed in patients with neuromyelitis optica spectrum disorder (NMOSD). Objective: To identify the prevalence of PTS, compare the factors associated with the occurrence of PTS, define the characteristics of PTS, and correlate the medication and prognostic factors with good recovery from PTS in patients with NMOSD. Materials and Methods: A retrospective study was performed in patients with definite NMOSD in the Prasat Neurological Institute between January 1, 2014 and December 31, 2018. The prevalence and characteristics of PTS were explored. The characteristics and factors associated with the occurrence of PTS were investigated. Moreover, the factors associated with PTS recovery and pain medications were further analyzed in the present study. Results: The prevalence of PTS in patients with NMOSD was 37.81%. The factors associated with the occurrence of PTS were the presence of acute myelitis (p=0.002, OR 39.00, 95% CI 3.89 to 391.23), and tobacco use (p=0.048, OR 13.38, 95% CI 1.02 to 175.52). In the subgroup analyses of the factors associated with PTS recovery, plasma exchange (p=0.007, OR 24.70, 95% CI 2.43 to 251.57), and Expanded Disability Status Scale range 1.0 to 4.5 (p=0.008, OR 6.92, 95% CI 1.67 to 28.65) were related to the recovery from PTS. While non-recovery was correlated with older age at last visit (p=0.013, OR 1.09, 95% CI 1.02 to 1.17) and longer segments of cord lesions (p=0.016, OR 1.21, 95% CI 1.04 to 1.42). Conclusion: The present study supports that PTS is one of the common complications in patients with NMOSD in Thailand. The presence of acute myelitis and the tobacco use are associated with the presence of PTS. Plasma exchange treatment in the acute phase of NMOSD may be associated with good recovery from PTS, and longer segments of spinal cord lesions is correlated with poor recovery outcomes. The control of these factors may prevent the occurrence of PTS or at least facilitate the recovery from PTS in these patients. Keywords: Neuromyelitis optica spectrum disorder (NMOSD), Painful tonic spasm (PTS)

scholarly journals Seronegative Neuromyelitis Optica Spectrum Disorder following Exposure to Hepatitis B Vaccination

2015 ◽  
Vol 7 (1) ◽  
pp. 78-83 ◽  
Author(s):  
Richard Heekin ◽  
Chetan Gandhy ◽  
Derrick Robertson
Keyword(s):  
Hepatitis B ◽  
Plasma Exchange ◽  
Neuromyelitis Optica ◽  
Brain Mri ◽  
Transverse Myelitis ◽  
Spectrum Disorder ◽  
Demyelinating Diseases ◽  
Oligoclonal Bands ◽  
Hepatitis B Vaccination ◽  
Neuromyelitis Optica Spectrum Disorder

Controversy exists regarding a potential link between exposure to recombinant hepatitis B vaccine (HBV) and central nervous system demyelinating diseases. Here, we present a case of seronegative neuromyelitis optica spectrum disorder (NMOSD) following exposure to HBV. A 28-year-old man developed painful eye movements 11 days after exposure to HBV. Within 24 h, he experienced vision loss, ascending numbness, and ataxia. T-spine MRI showed a cord lesion spanning T6-T9. Brain MRI showed bilateral optic nerve contrast enhancement and a right-sided internal capsule lesion. Cerebrospinal fluid analysis was normal, including negative oligoclonal bands and normal IgG index. AQP4-IgG serology was negative. The patient's visual symptoms improved after treatment with steroids and plasma exchange. He received plasma exchange weekly for 4 weeks with decreased numbness and tingling as well as improved coordination. Treatment with mycophenolate mofetil was started, and the patient remains clinically stable with near resolution of his prior symptoms. Neuromyelitis optica is characterized by optic neuritis and/or longitudinally extensive transverse myelitis. While our patient tested seronegative for AQP4-IgG (which remains negative in 10-50% of NMOSD cases, despite testing with the most sensitive assays available), he did meet NMOSD diagnostic criteria. In a literature review, we found 7 cases of NMOSD onset or relapse associated with exposure to various vaccines, but to our knowledge this represents the first published report of NMOSD onset following exposure to HBV. While causality between vaccination and CNS demyelinating disease remains elusive, it is important to report these cases to help develop safer vaccinations and provoke further inquiry into the pathogenesis of NMOSD.

scholarly journals Neuromyelitis Optica Spectrum Disorder: A Case Report of Effective Combination Immunosuppressant, Corticosteroids, and Therapeutic Plasma Exchange

2019 ◽  
Vol 7 (20) ◽  
pp. 3433-3436
Author(s):  
Laura Tambunan ◽  
K. Ritarwan ◽  
K. P. Surbakti
Keyword(s):  
Magnetic Resonance ◽  
Plasma Exchange ◽  
Neuromyelitis Optica ◽  
Evoked Potential ◽  
Serum Antibody ◽  
Therapeutic Plasma Exchange ◽  
Spectrum Disorder ◽  
Resonance Spectroscopy ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
The Brain

BACKGROUND: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease that causes severe demyelination, especially in the optic nerve and spinal cord with typical clinical manifestations of acute optic neuritis and transverse myelitis. The symptoms can occur simultaneously or separated by a variable period. NMOSD is associated with serum aquaporin antibodies 4 immunoglobulin G (AQP4-IgG). CASE PRESENTATION: We report a case of a 22-year-old male with complaints of weakness of all four limbs, impaired vision, urinary incontinence, and dyspnea. The Expanded Disability Status Scale (EDSS) was nine. Spinal magnetic resonance imaging (MRI) showed longitudinal extensive transversal myelitis. The brain MRI showed a normal impression, whereas the brain magnetic resonance spectroscopy (MRS) examination showed a description of the mild demyelination process. The serum antibody AQP4 (AQP4-IgG) results were seronegative, the cerebrospinal fluid examination was normal, and the oligoclonal band was negative. The ophthalmoscopic examination found bilateral papillary atrophy but optical coherence tomography (OCT) was still normal. Somatosensory evoked potential and visual evoked potential examinations were abnormal. The patient was diagnosed with NMOSD and was given combination immunosuppressant therapy, corticosteroids, and therapeutic plasma exchange. The patient experienced significant improvement with EDSS decreased to six. CONCLUSION: In the case of relapsing NMOSD patient, combination therapy of immunosuppressants, corticosteroids, and TPE was used. There were significant improvements from EDSS nine to six.

scholarly journals Effect of plasma exchange in neuromyelitis optica spectrum disorder: A systematic review and meta‐analysis

2020 ◽  
Vol 7 (11) ◽  
pp. 2094-2102
Author(s):  
Punchika Kosiyakul ◽  
Sakdipat Songwisit ◽  
Patompong Ungprasert ◽  
Sasitorn Siritho ◽  
Naraporn Prayoonwiwat ◽  
...  
Keyword(s):  
Systematic Review ◽  
Plasma Exchange ◽  
Neuromyelitis Optica ◽  
Meta Analysis ◽  
Spectrum Disorder ◽  
Neuromyelitis Optica Spectrum Disorder

scholarly journals Successful treatment of neuromyelitis optica spectrum disorder by early initiation of plasma exchange

2015 ◽  
Vol 55 (1) ◽  
pp. 41-44 ◽  
Author(s):  
Aya Koda ◽  
Satoshi Kaneko ◽  
Shinya Asayama ◽  
Kengo Fujita ◽  
Hirofumi Kusaka
Keyword(s):  
Plasma Exchange ◽  
Neuromyelitis Optica ◽  
Successful Treatment ◽  
Early Initiation ◽  
Spectrum Disorder ◽  
Neuromyelitis Optica Spectrum Disorder

scholarly journals Telitacicept Following Plasma Exchange in the Treatment of Subjects With Recurrent NMOSD: Study Protocol for a Single-Center, Single-Arm, Open-Label Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Jie Ding ◽  
Yu Cai ◽  
Ye Deng ◽  
Xianguo Jiang ◽  
Meichun Gao ◽  
...  
Keyword(s):  
Plasma Exchange ◽  
Neuromyelitis Optica ◽  
Demyelinating Disease ◽  
Spectrum Disorder ◽  
Index Number ◽  
Neuromyelitis Optica Spectrum Disorder ◽  
Single Center ◽  
Open Label ◽  
Clinical Trial Registration ◽  
Total Period

Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease that recurrently relapses and leads to severe disability. The available choices for disease prevention are few or intolerable. Previous studies suggested that telitacicept may provide a promising therapeutic strategy for autoimmune diseases involving B cells. Therefore, this study aims to assess the effectiveness and safety of telitacicept for recurrent NMOSD.Methods: We will perform a single-arm, single-center, open-label, specialist study with a total enrollment of eight participants. The treatment regimen includes plasma exchange three times and subcutaneous injection of telitacicept for 46 cycles, with a total period of 48 weeks. The primary endpoint is the time to first recurrence after enrollment. Secondary endpoints are Expanded Disability Status Scale (EDSS) score, Opticospinal Impairment Scale (OSIS) score, Hauser Ambulation Index, number of lesions on MRI, and changes in visual evoked potential (VEP), optical coherence tomography (OCT) and immunologic status. All adverse events after medication will be documented and investigated.Discussion: This study will explore the safety and effectiveness of telitacicept following plasma exchange regarding the time to recurrence in neuromyelitis optica spectrum disorder (NMOSD) for the first time.Clinical Trial Registration:Chictr.org.cn, identifier ChiCTR1800019427

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