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...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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Springer Berlin Heidelberg
2021
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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. |
format | Online Article Text |
id | pubmed-8738499 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Springer Berlin Heidelberg |
record_format | MEDLINE/PubMed |
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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