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Neuromyelitis optica spectrum disorder: do patients positive and negative for anti–aquaporin-4 antibodies present distinct entities? A Colombian perspective
Espectro de neuromielitis óptica: ¿seropositivo para la anticuaporina es una entidad diferente de los pacientes que son seronegativos? Una perspectiva de Colombia
P.A. Ortiz Salasa,b,
Corresponding author
portizs@cardioinfantil.org

Corresponding author.
, M. Gaviria Carrilloa,c, G.A. Cortés Bernalc, K. Moreno Medinad, L.F. Roae, J.H. Rodríguez Quintanaa,b,e
a Servicio de Neurología, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
b Universidad del Rosario, Grupo Neuros, Bogotá, Colombia
c Universidad del Rosario, Programa de Neurología, Bogotá, Colombia
d Departamento de Investigaciones, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia
e Hospital Universitario Mayor, Mederi, Bogotá, Colombia
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was considered a subtype of multiple sclerosis with more severe impairment of the optic nerve and the spinal cord&#46; In 2004&#44; the identification of antibodies targeting aquaporin-4 &#40;AQP4-Ab&#41;&#44; a CNS water channel&#44; in patients with NMO enabled researchers to understand this condition as a disease with a different pathophysiological basis to that described in patients with multiple sclerosis&#44; in which humoural immunity plays a fundamental role&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The international consensus diagnostic criteria for NMOSD&#44; based on the positive or negative test results for these antibodies&#44; were published in 2015&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The pathophysiology of AQP4-Ab&#8211;seropositive NMOSD is widely known&#59; it is considered an immunoglobulin-G&#8211;mediated astrocytopathy that causes complement activation&#44; leading to irreversible astrocyte loss through the formation of the membrane attack complex&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> However&#44; the pathophysiology of AQP4-Ab&#8211;seronegative NMOSD is still under research&#59; it has even been shown that 42&#37; of seronegative patients are positive for anti&#8211;myelin oligodendrocyte glycoprotein antibodies&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Previous studies have shown that&#44; in some cases&#44; the course of the disease may vary according to serostatus&#46;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#8211;10</span></a> Thus&#44; seropositive patients tend to be younger and to present a higher degree of disability&#44; although current studies report discrepancies in the clinical presentation&#44; the course&#44; and the severity of the disease&#44; probably due to the limited number of epidemiological studies published&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Previous studies have shown different behaviour of NMOSD and different responses to a new immunomodulatory treatment &#40;satralizumab&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> according to serostatus&#44; leading to the hypothesis that the condition in seronegative patients is distinct to that of seropositive patients&#46; The aim of this study is to analyse demographic&#44; clinical&#44; paraclinical&#44; and prognostic characteristics according to serostatus&#44; in order to determine whether seronegative and seropositive patients present distinct entities&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Patients</span><p id="par0020" class="elsevierStylePara elsevierViewall">We performed a retrospective&#44; observational&#44; case-series study to analyse data from 2 high-level hospitals in Bogot&#225; &#40;Colombia&#41;&#44; between 2013 and the first quarter of 2019&#46; We included patients aged 18 years and older&#44; with a diagnosis of NMO&#44; who attended the emergency department &#40;new diagnoses or relapses in previously diagnosed patients&#41; and met the international consensus diagnostic criteria for NMOSD&#44; whose serostatus was known and who had undergone MRI studies at the admitting hospital&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">We gathered data on demographic variables &#40;sex&#44; age of onset&#44; and age at relapse&#41;&#44; disease course &#40;monophasic or polyphasic&#41;&#44; topographical location of the lesion &#40;spine&#44; brainstem&#44; optic nerve&#41;&#44; symptom reported by the patient &#40;sensory&#44; motor&#44; sphincter&#44; vertigo&#44; or visual symptoms &#91;visual acuity impairment or diplopia&#93;&#41;&#44; anatomical lesion location in the MRI &#40;spinal cord&#44; diencephalon&#44; brainstem&#44; hemispheres&#44; corpus callosum&#44; optic nerve&#44; or optic chiasm&#41;&#44; degree of disability according to the Expanded Disability Status Scale &#40;EDSS&#41;&#44; the treatment received for the relapse&#44; and the use of any disease-modifying treatment at the time of relapse&#46; Clinical histories were reviewed by a neurologist and a final-year neurology resident&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">MRI and paraclinical variables</span><p id="par0030" class="elsevierStylePara elsevierViewall">MRI studies were performed with a 1&#46;5 T scanner using T2-&#44; T2-FLAIR&#44; and T1-weighted sequences &#40;with and without administration of contrast&#41; with 3-5 mm thick slices&#46; Contrast was dosed at 0&#46;1 mmol&#47;kg of bodyweight&#44; with a minimum delay of 5 minutes and maximum delay of 13 minutes between contrast injection and acquisition of the contrast-enhanced T1-weighted sequence&#46; MRI studies of the brain or the spinal cord were performed according to the symptoms and the findings of the neurological examination&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">AQP4-Ab determination was performed by cell-based indirect immunofluorescence assay&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Statistical analysis</span><p id="par0040" class="elsevierStylePara elsevierViewall">This study was presented to our hospital&#8217;s research committee&#59; as this a retrospective&#44; observational&#44; non-interventional study&#44; informed consent was not required&#46; Statistical analysis was performed using the SPSS statistical software&#44; version 22&#46; For the analysis of demographic&#44; clinical&#44; and imaging variables&#44; results are expressed as absolute frequencies in the case of qualitative variables and medians and 25th and 75th percentiles for quantitative variables&#46; We used the Mann&#8211;Whitney U test to compare quantitative variables and the chi-square test to compare qualitative variables in patients positive&#47;negative for AQP4-Ab&#46; <span class="elsevierStyleItalic">P</span>-values &#60; &#46;05 were considered statistically significant&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><p id="par0045" class="elsevierStylePara elsevierViewall">We included 42 patients&#44; 7 of whom were excluded due to incomplete data&#46; Twenty-six patients were women&#44; median age was 50 years &#40;p25-p75&#58; 28-56&#41;&#44; and the median age at NMO&#47;NMOSD onset was 46&#46;5 years &#40;34&#46;2-54&#41;&#46; All patients were of mixed race&#46; Most patients presented sensory &#40;n &#61; 26&#41; and motor &#40;n &#61; 25&#41; clinical symptoms&#59; 20 scored &#62; 5 on the EDSS&#44; and 6 presented a concomitant autoimmune disease&#46; Of the 35 patients&#44; 9 consulted due to a first episode&#46; <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the clinical characteristics of our sample&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0050" class="elsevierStylePara elsevierViewall">According to the findings of brain and cervical and thoracic spinal MRI studies&#44; the most frequently affected region was the spinal cord&#44; both at the cervical and thoracic levels&#46; Longitudinally extensive transverse myelitis &#40;LETM&#41; was observed in 21 patients&#46; <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> describes MRI lesion characteristics according to their location&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Twenty patients were seropositive for AQP4-Ab&#46; <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> presents the distribution of demographic and clinical variables according to serological findings&#46; It is noteworthy that the median age at onset of NMO&#47;NMOSD was higher in AQP4-Ab&#8211;seropositive patients &#40;49 years&#44; p25-p75&#58; 39-56&#41; than in seronegative patients &#40;40 years&#44; 29-48&#46;2&#41; and that the majority of motor manifestations were observed in AQP4-Ab&#8211;seropositive patients &#40;16 vs 9 in seronegative patients&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; No statistically significant differences were found in demographic and clinical variables between AQP4-Ab&#8211;seropositive and seronegative patients&#44; except for the older median age &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;03&#41; and higher prevalence of optic nerve involvement in seropositive patients &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;036&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Regarding brain and cervical and thoracic spinal MRI findings&#44; lesions were distributed similarly in AQP4-Ab&#8211;seropositive and seronegative patients&#59; the main difference in brain MRI studies was the prevalence of optic nerve injuries&#44; which were more frequent in seropositive patients &#40;n &#61; 15&#41; than in seronegative patients &#40;n &#61; 6&#41;&#46; <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a> shows the anatomical distribution of MRI findings according to AQP4-Ab serology results&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Lastly&#44; laboratory results detected monoclonal bands in 2 patients&#44; and the CSF analysis revealed predominantly lymphocytic pleocytosis in 4 cases and predominantly monocytic pleocytosis in 2&#44; with median protein levels of 45 mg&#47;dL &#40;32-76&#41; and median glucose levels of 59&#46;5 mg&#47;dL &#40;47-72&#46;5&#41;&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Discussion</span><p id="par0070" class="elsevierStylePara elsevierViewall">Few studies have addressed the clinical manifestations of NMO and NMOSD&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Worldwide prevalence of these disorders is variable&#44; with large disparities between the estimations available to date&#59; the local prevalence of the disease remains unknown&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;14</span></a> Our study contributes data at the local and regional levels&#44; detailing the demographic and clinical characteristics of patients with NMO&#47;NMOSD attended at 2 reference centres in Bogot&#225; &#40;Colombia&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">The main aim of our study was to expand our knowledge on the course of NMO and NMOSD and the clinical and paraclinical characteristics of patients&#44; using the 2015 international consensus diagnostic criteria for NMOSD&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;15</span></a> NMO is an antibody-mediated inflammatory disease affecting the CNS&#44; preferentially the optic nerves and spinal cord&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;16&#44;17</span></a> as shown by our study&#44; which revealed a high frequency of optic nerve involvement &#40;n &#61; 21&#41; as compared to the other regions analysed in the MRI study&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">We included a total of 35 patients who met the selection criteria&#59; this sample size is similar to those reported in previous case series&#46;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;12&#44;18</span></a> Our patients presented a median age of onset of 46&#46;5 years &#40;p25-p75&#58; 34&#46;2-54&#41; whereas previous studies have reported symptom onset at approximately 39 years of age&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;17&#44;19</span></a> which may suggest that the age of symptom onset was older in our study population&#46; Our findings are consistent with those of other authors&#44; who report that symptom onset occurs later in patients with NMO than in patients with multiple sclerosis&#44; with the latter presenting an age of onset between 20 and 40 years&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0085" class="elsevierStylePara elsevierViewall">The presence of AQP4-Ab in patients with NMO is associated with faster progression and more severe disability&#44; which may lead to a higher mortality rate&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Seropositive results for AQP4-Ab were observed in 20 patients&#44; 15 of whom were women&#46; Previous studies have reported that AQP4-Ab&#8211;seropositive women present more severe disability and more frequent association with other autoimmune diseases&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;12&#44;19&#44;21</span></a> In our study&#44; we found greater disability among AQP4-Ab&#8211;seropositive patients&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A multi-centre study conducted in France&#44; Japan&#44; the United States&#44; and the United Kingdom reported a high frequency of brainstem symptoms including vomiting and hiccups in non-white patients with NMO&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> In our study&#44; the most frequent clinical manifestations were spinal symptoms &#40;sensory &#91;n &#61; 25&#93; and motor &#91;n &#61; 26&#93;&#41;&#44; followed by bilateral optic nerve symptoms &#40;n &#61; 15&#41;&#46; We observed no clinical manifestations of area postrema syndrome or diencephalic syndrome&#59; this finding is consistent with the data reported by the first local study performed in the city of Bogot&#225;&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0095" class="elsevierStylePara elsevierViewall">Previous studies have analysed the presence of concomitant autoimmune diseases&#59; however&#44; in our study&#44; we only observed 6 cases of autoimmune diseases&#58; 4 cases of Sj&#246;gren syndrome and 2 of antiphospholipid syndrome&#46; These figures coincide with previous reports<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#59; for instance&#44; the study by Reyes et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> also performed in Colombia&#44; found no associated autoimmune conditions&#46; However&#44; Reyes et al&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> did obtain positive results for antinuclear antibodies &#40;a frequent finding in patients with NMO&#41; in patients not meeting criteria for systemic lupus erythematosus&#44; as well as the presence of anti-DNA antibodies&#44; ANCAs&#44; and anti-Ro antibodies&#59; these findings were obtained in immunological tests of patients not meeting the diagnostic criteria for autoimmune inflammatory diseases&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">A multi-centre study performed in France&#44; Germany&#44; Turkey&#44; and the United Kingdom observed an association between late age of disease onset in AQP4-Ab&#8211;seropositive patients and a high risk of motor disability&#46; In patients with late onset &#40;&#8805; 50 years&#41;&#44; the prevalence of LETM was 66&#37;&#44; compared to 28&#37; for optic neuritis&#46;<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;25</span></a> In our study population&#44; most AQP4-Ab&#8211;seropositive patients with NMO were older than 50 years&#44; and presented spinal cord lesions and LETM&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">We identified some differences between groups in clinical and imaging characteristics&#44; but only age and optic nerve involvement showed statistically significant differences &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;03&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">The main strengths of our study are the combination of data of patients from 2 reference centres in the city of Bogot&#225; &#40;Colombia&#41;&#59; the reporting of demographic&#44; clinical&#44; and imaging data of great relevance&#59; and the analysis of results according to AQP4-Ab serology results&#46; The main limitations are related to the retrospective nature of data collection&#44; which resulted in missing data in some clinical records&#44; and occasionally a lack of diagnostic clarity&#44; which led to the exclusion of some eligible patients from the database&#46; Information and measurement bias were avoided by cross-analysing the clinical records and&#44; when possible&#44; reviewing laboratory and imaging findings at both centres&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">A larger sample of patients would be needed to analyse whether serostatus enables us to classify this condition as 2 distinct entities&#46; The group of seronegative patients must undergo testing for other antibodies &#40;anti&#8211;aquaporin 1 and 9&#44; anti&#8211;myelin oligodendrocyte glycoprotein antibodies&#41;&#44; and even repeat the test for AQP4-Ab if it was performed after starting immunosuppression or using a technique other than cell-based analysis &#40;microscopy or flow cytometry&#41;&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Conclusion</span><p id="par0120" class="elsevierStylePara elsevierViewall">AQP4-Ab seropositivity in patients with NMO&#47;NMOSD seems to be related to specific clinical&#44; imaging&#44; and analytical characteristics&#46; In our study&#44; we found statistically significant differences in age of onset and prevalence of optic nerve involvement &#40;uni- or bilaterally&#41;&#44; which should be further studied in larger population samples&#46;</p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Funding</span><p id="par0125" class="elsevierStylePara elsevierViewall">This study received no funding of any kind&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0130" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Neuromyelitis optica &#40;NMO&#41; is an inflammatory disease of the central nervous system characterised by attacks of optic neuritis and longitudinally extensive transverse myelitis&#46; The discovery of anti&#8211;aquaporin-4 &#40;anti-AQP4&#41; antibodies and specific brain MRI findings as diagnostic biomarkers have enabled the recognition of a broader and more detailed clinical phenotype&#44; known as neuromyelitis optica spectrum disorder &#40;NMOSD&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">This study aimed to determine the demographic and clinical characteristics of patients with NMO&#47;NMOSD with and without seropositivity for anti-AQP4 antibodies&#44; in 2 quaternary-level hospitals in Bogot&#225;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Our study included patients &#62; 18 years of age and diagnosed with NMO&#47;NMOSD and for whom imaging and serology results were available&#44; assessed between 2013 and 2017 at the neurology departments of hospitals providing highly complex care&#46; Demographic&#44; clinical&#44; and imaging data were gathered and compared in patients with and without seropositivity for anti-AQP4 antibodies&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">The sample included 35 patients with NMO&#47;NMOSD&#59; the median age of onset was 46&#46;5 years &#40;P25-P75&#44; 34&#46;2-54&#46;0&#41;&#59; most patients had sensory &#40;n &#61; 25&#41; and motor manifestations &#40;n &#61; 26&#41;&#44; and a concomitant autoimmune disease was identified in 6&#46; Twenty patients were seropositive for anti-AQP4 antibodies&#46; Only age and presence of optic nerve involvement showed statistically significant differences between groups &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;03&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Clinical&#44; imaging&#44; and laboratory variables showed no major differences between patients with and without anti-AQP4 antibodies&#44; with the exception of age of onset and presence of optic nerve involvement &#40;uni- or bilateral&#41;&#59; these factors should be studied in greater detail in larger populations&#46;</p></span>"
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">La neuromielitis &#243;ptica es una enfermedad inflamatoria del sistema nervioso central&#44; caracterizada por ataques de neuritis &#243;ptica y mielitis transversa longitudinalmente extensa&#46; El descubrimiento del biomarcador diagn&#243;stico anticuerpo anti-acuaporina-4 y los hallazgos imagenol&#243;gicos en resonancia magn&#233;tica cerebral han permitido el reconocimiento de un fenotipo cl&#237;nico m&#225;s amplio y detallado denominado espectro neuromielitis &#243;ptica&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivo</span><p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Determinar las caracter&#237;sticas demogr&#225;ficas y cl&#237;nicas de los pacientes diagnosticados con NMO&#47;NMOSD&#44; de acuerdo con la seropositividad del anticuerpo&#44; en dos instituciones de cuarto nivel de complejidad en Bogot&#225;&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">M&#233;todos</span><p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Se realiz&#243; un estudio tipo serie de casos&#46; Fueron incluidos aquellos pacientes &#62; 18 a&#241;os con diagn&#243;stico de NMO&#47;NMOSD&#44; valorados en el Servicio de Neurolog&#237;a de dos hospitales de alta complejidad entre los a&#241;os 2013 y 2017&#44; con disponibilidad de estudios imagenol&#243;gicos y resultados de serolog&#237;a&#46; Se evaluaron variables demogr&#225;ficas&#44; cl&#237;nicas e imagenol&#243;gicas&#44; y se realiz&#243; un an&#225;lisis de estas variables&#44; seg&#250;n seropositividad del Ac-AQP4&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 35 pacientes con NMO&#47;NMOSD&#44; la mediana de edad de inicio fue de 46&#44;5 a&#241;os &#40;P25-P75 &#61; 34&#44;2-54&#44;0&#41;&#44; la mayor&#237;a de los pacientes tuvo manifestaciones cl&#237;nicas a nivel sensitivo &#40;n &#61; 25&#41; y motor &#40;n &#61; 26&#41;&#44; en seis &#40;n &#61; 6&#41; pacientes se identific&#243; una enfermedad autoinmune concomitante&#46; Se encontr&#243; seropositividad en 20 pacientes&#46; Encontramos algunas diferencias en las caracter&#237;sticas cl&#237;nicas e imagenol&#243;gicas&#44; pero solo la edad y el compromiso de nervio &#243;ptico mostraron diferencia estad&#237;sticamente significativa &#40;p &#61; 0&#44;03&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">No se encontraron grandes diferencias cl&#237;nicas&#44; imagenol&#243;gicas y de laboratorio&#44; seg&#250;n la seropositividad del Ac-AQP4&#44; excepto en la edad de inicio y el compromiso de nervio &#243;ptico &#40;uni o bilateral&#41;&#44; pero deben ser estudiadas de manera m&#225;s detallada en poblaciones m&#225;s amplias&#46;</p></span>"
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                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Sphincter&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Brainstem&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Optic neuritis&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60; 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62; 5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Polyphasic&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Intravenous steroids&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Combination therapy &#40;steroids &#43; plasmapheresis<span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">23&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Oral corticosteroids&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Interferons&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Rituximab&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Antiphospholipid syndrome&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unilateral optic neuritis&nbsp;\t\t\t\t\t\t\n
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Article information
ISSN: 21735808
Original language: English
DOI:10.1016/j.nrleng.2020.08.022
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