Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis

BACKGROUND: Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome i...

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Autores principales: Juryńczyk, Maciej, Klimiec-Moskal, Elżbieta, Kong, Yazhuo, Hurley, Samuel, Messina, Silvia, Yeo, Tianrong, Jenkinson, Mark, Leite, Maria Isabel, Palace, Jacqueline
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738499/
https://www.ncbi.nlm.nih.gov/pubmed/34043042
http://dx.doi.org/10.1007/s00415-021-10619-1
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author Juryńczyk, Maciej
Klimiec-Moskal, Elżbieta
Kong, Yazhuo
Hurley, Samuel
Messina, Silvia
Yeo, Tianrong
Jenkinson, Mark
Leite, Maria Isabel
Palace, Jacqueline
author_facet Juryńczyk, Maciej
Klimiec-Moskal, Elżbieta
Kong, Yazhuo
Hurley, Samuel
Messina, Silvia
Yeo, Tianrong
Jenkinson, Mark
Leite, Maria Isabel
Palace, Jacqueline
author_sort Juryńczyk, Maciej
collection PubMed
description BACKGROUND: Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment. OBJECTIVE: In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome. METHODS: Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD/MS discriminators. RESULTS: Four subgroups were identified. Patients from Group 1 termed “MS-like” (n = 6) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 (“spinal MS-like”, 8) had short-segment myelitis and no MS-like brain lesions. Group 3 (“classic NMO-like”, 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 (“NMO-like with brain involvement”, 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49, p = 0.003) and decreased thalamus volume (0.84 vs. 0.98, p = 0.04). CONCLUSIONS: NMOSD/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10619-1.
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spelling pubmed-87384992022-01-20 Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis Juryńczyk, Maciej Klimiec-Moskal, Elżbieta Kong, Yazhuo Hurley, Samuel Messina, Silvia Yeo, Tianrong Jenkinson, Mark Leite, Maria Isabel Palace, Jacqueline J Neurol Original Communication BACKGROUND: Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment. OBJECTIVE: In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome. METHODS: Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD/MS discriminators. RESULTS: Four subgroups were identified. Patients from Group 1 termed “MS-like” (n = 6) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 (“spinal MS-like”, 8) had short-segment myelitis and no MS-like brain lesions. Group 3 (“classic NMO-like”, 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 (“NMO-like with brain involvement”, 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49, p = 0.003) and decreased thalamus volume (0.84 vs. 0.98, p = 0.04). CONCLUSIONS: NMOSD/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00415-021-10619-1. Springer Berlin Heidelberg 2021-05-27 2022 /pmc/articles/PMC8738499/ /pubmed/34043042 http://dx.doi.org/10.1007/s00415-021-10619-1 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Original Communication
Juryńczyk, Maciej
Klimiec-Moskal, Elżbieta
Kong, Yazhuo
Hurley, Samuel
Messina, Silvia
Yeo, Tianrong
Jenkinson, Mark
Leite, Maria Isabel
Palace, Jacqueline
Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
title Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
title_full Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
title_fullStr Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
title_full_unstemmed Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
title_short Elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
title_sort elucidating distinct clinico-radiologic signatures in the borderland between neuromyelitis optica and multiple sclerosis
topic Original Communication
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738499/
https://www.ncbi.nlm.nih.gov/pubmed/34043042
http://dx.doi.org/10.1007/s00415-021-10619-1
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