Antibody responses against gastrointestinal antigens are common in MS and AQP4-seropositive NMO/NMO-SD, especially in longitudinally extensive myelitis.

Background: The long-term effect of neuromyelitis optica (NMO) on the brain is not well established. Methods: After 22 years of NMO, a patient’s brain was examinedbyquantitative T1- and T2-weighted mono- and biexponential diffusion and proton spectroscopy. It was compared to 3 cases with short-term NMO and 20 healthy subjects. Results: Although routine T1- and T2-weighted images appeared to be normal, quantitative T1-, T2- and diffusion-weighted magnetic resonance imaging identified areas with high diffusivity and altered relaxation time in ‘normal appearing white matter’ (NAWM). In such abnormal NAWM regions, biexponential diffusion analysis and quantitative spectroscopy indicated extracellular edema and axonal loss, respectively. Repeated analysis 6 months later identified the same alterations. Such patchy alterations were not detectable in the NAWM of the 3 cases with short-term NMO, and they were also not quantitatively different from the controls. Conclusion: After NMO of 22-year duration, metabolic changes, altered diffusivity and magnetic resonance relaxation features of patchy brain areas may suggest tissue damage in NAWM that persist for at least 6 months.

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