Brain abnormalities in neuromyelitis optica
Introduction
Neuromyelitis optica (NMO) is an idiopathic demyelinating and inflammatory disease that preferentially involve the optic nerve and spinal cord. Multiple sclerosis (MS) also can mimic NMO, but it is crucial to differentiate the two, because NMO has different clinical characteristics, treatment response, prognosis, and different pathomechanism from MS [1], [2], [3], [4], [5]. Owing to its topographic characteristics, NMO was previously known to be free of brain parenchyma with normal brain MRI reports [1]. Therefore, before the revision of NMO criteria by Wingerchuk et al. in 2006 [6], NMO and MS was distinguished by their brain MRI findings. Recently, however, numerous studies have reported incidences of abnormalities in the brain MRIs of NMO [1], [2], [3], [4], [7], [8], [9], [10], [11], [12]. Diagnostic criteria were revised to partially exclude patients to those who had brain MRI findings thought to be specific for MS using the Paty criteria [6].
There have been only few reports that studied brain lesion in NMO with the Asian population. The aim of this study was to evaluate the frequency of brain MRIs that can be detected in Korean NMO patients and characterize the findings that might be helpful for distinguishing NMO from MS. Also, we sought if there were any shared features in the brain MRI between NMO and MS, especially focusing on whether any NMO patients have lesions fulfilling the MS spatial distribution criteria or not.
Section snippets
Study population
Consecutive Korean patients who visited the Department of Neurology and Pediatrics, Seoul National University Hospital (Seoul, Korea) during January 1, 2008–March 1, 2010 and diagnosed with NMO by the 2006 revised Wingerchuk's criteria [6] were included in this study. 17 patients were enrolled. We performed a retrospective review of the medical records and imaging profiles for all patients. We recorded their demographic features, age of symptom onset, relapse frequency with annualized relapse
Clinical features
A total of 17 NMO patients, of a single ethnic group who are residing in Korea, were included in this study. Demographic and clinical features were summarized in Table 1. 14 patients (82%) were women, which also showed high prevalence among females, consistent with previous reports [1], [3], [4], [8]. 3 patients were pediatrics who had onset of symptoms before the age of 18 years. Mean age at onset was 34.0 ± 13.4 years and mean follow up duration was 62.9 ± 65.9 months. 94% of the patients had a
Discussion
Our study found that about 64.7% of Korean NMO patients had brain MRI abnormality during their clinical follow up periods. This frequent involvement of brain parenchyma in NMO patients have been reported in many different countries since the 21st century (Table 4). However, there exist limitations in interpreting and comparing the results of these studies because they did not employ the same imaging technique protocols and some only evaluated initial brain MRI for detecting the presence of
Acknowledgements
The authors thank to Professor Angela Vincent in University of Oxford for AQP-4 antibody detection. This work was supported in part by grant no. 07-2010-0720 from the Korean Ministry for Health, Welfare, and Family Affairs funds and by grant no. 06-2007-0800 from Seoul National University Hospital.
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