Monday, 30 September 2013

Trying to Distinguish from NMO

Huh SY, Min JH, Kim W, Kim SH, Kim HJ, Kim BJ, Kim BJ, Lee KH.The usefulness of brain MRI at onset in the differentiation of multiple sclerosis and seropositive neuromyelitis optica spectrum disorders.
Mult Scler. 2013 Sep  [Epub ahead of print]

BACKGROUND:Although neuromyelitis optica (NMO) is a central nervous system (CNS) autoimmune disease distinct from multiple sclerosis (MS). NMO and NMO spectrum disorder (NMOSD) sometimes show asymptomatic lesions on brain magnetic resonance imaging (MRI) at onset, and even present with symptomatic brain involvement.
OBJECTIVES:We investigated whether brain MRI at onset can be helpful for the differentiation of MS and NMOSD.
METHODS:We retrospectively analyzed initial brain MRIs, performed within three months of onset, in patients with MS (n = 51) and anti-aquaporin4-antibody-positive patients with NMOSD (n = 67).
RESULTS: NMOSD patients met the Paty (37%) and Barkhof (13%) criteria, and the criteria of the European Magnetic Imaging in MS (MAGNIMS) study group (9%), for MS. Ovoid lesions perpendicular to the lateral ventricle, isolated juxtacortical lesions in U-fibers and isolated ovoid/round cortical lesions were found only in MS patients, whereas longitudinal corticospinal tract lesions, extensive hemispheric lesions, periependymal lesions surrounding the lateral ventricle and cervicomedullary lesions were found only in NMOSD patients.
CONCLUSIONS: Our study suggests that it is difficult to differentiate MS from NMOSD by the fulfillment of the MRI criteria for MS on brain MRI at onset; however, the characteristic morphology of brain lesions is highly useful for the early differentiation of the two disorders.

NMO was originally called Devic's MS. This is characterized by lesions of the spinal cord and optic nerve, abit like EAE. More recently this has been shown to be associated with the production of antibodies against a water channel called aquaporin 4 and a few myelin proteins. It is important to distinguish this from more classical MS as the treatments are different. This study uses MRI and it cannot pigeon hole people into one or other of the diseases but it can aid in the decision making 

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