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Spinal cord lesions and atrophy in NMOSD with AQP4-IgG and MOG-IgG associated autoimmunity

Authors

  • C. Chien
  • M. Scheel
  • T. Schmitz-Hübsch
  • N. Borisow
  • K. Ruprecht
  • J. Bellmann-Strobl
  • F. Paul
  • A.U. Brandt

Journal

  • Multiple Sclerosis Journal

Citation

  • Mult Scler J 25 (14): 1926-1936

Abstract

  • BACKGROUND: Spinal cord (SC) affection is a hallmark symptom of neuromyelitis optica spectrum disorders (NMOSD). Patients with aquaporin-4 (AQP4-IgG+) or myelin oligodendrocyte glycoprotein (MOG-IgG+) antibody seropositivity show this overlapping clinical phenotype. OBJECTIVE: Quantitative comparison of SC lesions and atrophy in AQP4-IgG+ and MOG-IgG+ NMOSD. METHODS: AQP4-IgG+ (n = 38), MOG-IgG+ (n = 15) NMOSD patients and healthy controls (HC, n = 24) were analysed for SC lesion (prevalence, length, location), atrophy as mean upper cervical cord area (MUCCA), Expanded Disability Status Scale (EDSS), timed 25-foot walk speed (T25FWS) and 9-hole peg test (9HPT) measures. RESULTS: In total, 92% (35/38) of AQP4-IgG+ and 53% (8/15) of MOG-IgG+ patients had myelitis attacks (χ(2) = 6.47, p = 0.011). 65.8%/26.7% of AQP4-/MOG-IgG+ patients had chronic SC lesions (χ(2) = 5.16, p = 0.023), with similar proportions in cervical, upper thoracic and lower thoracic cord, and no length differences. MUCCA was decreased in AQP4-IgG+ ( t = -2.27, p = 0.028), but not MOG-IgG+ patients ( t = 0.58, p = 0.57) compared to HC. MUCCA associated with myelitis attacks (rho = -0.33, p = 0.016), EDSS (rho = -0.31, p = 0.030), pyramidal functional score (rho = -0.42, p = 0.003), T25FWS ( r = 0.43, p = 0.010) and 9HPT Z-score ( r = 0.32, p = 0.037), regardless of antibody status. CONCLUSION: AQP4-IgG+ patients had more myelitis attacks, SC lesions and SC atrophy was more pronounced than in MOG-IgG+ patients. MUCCA is associated with clinical myelitis attacks and disability in all NMOSD patients.


DOI

doi:10.1177/1352458518815596