Asymptomatic MRI lesions in pediatric-onset AQP4-IgG positive NMOSD

Paolilo, Renata Barbosa; Rimkus, Carolina de Medeiros; Paz, José Albino da; Pereira, Samira Luisa Apóstolos; Callegaro, Dagoberto; Sato, Douglas Kazutoshi

doi:10.1016/j.msard.2022.104215

Cited by 4 publications

(4 citation statements)

References 27 publications

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“…The actual occurrence rate of ASLs in AQP4-NMOSD patients remains uncertain. Paolilo et al 4 monitored MRI findings of 16 pediatric AQP4-NMOSD patients, identifying ASLs in one case (6.3%), indicating a potentially higher incidence of ASLs. However, in a cohort of 220 AQP4-NMOSD cases, attack-associated silent lesions were mainly localized in the brain, with only three attack ASLs discovered among 331 spinal MRIs (0.9%); new ASLs during remission were identified in 1 of 116 patients (0.9%) and 2 of 200 spinal cord remission MRIs (1%).…”

Section: Discussionmentioning

confidence: 99%

“…The actual occurrence rate of ASLs in AQP4‐NMOSD patients remains uncertain. Paolilo et al 4 . monitored MRI findings of 16 pediatric AQP4‐NMOSD patients, identifying ASLs in one case (6.3%), indicating a potentially higher incidence of ASLs.…”

Section: Discussionmentioning

confidence: 99%

“…In MS, the presence of new asymptomatic lesions on MRI aids in diagnosing the disease in patients with clinically isolated syndromes and can be used for therapeutic monitoring and prognostic assessment 3 . In contrast, disability accumulation in NMOSD seems closely linked to attacks, with asymptomatic lesions indicating ongoing disease activity found in only a small fraction of NMOSD patients 4–10 . These asymptomatic lesions can emerge during attacks or remission, suggesting MRI's heightened sensitivity compared to clinical symptoms.…”

Section: Introductionmentioning

confidence: 99%

“… 3 In contrast, disability accumulation in NMOSD seems closely linked to attacks, with asymptomatic lesions indicating ongoing disease activity found in only a small fraction of NMOSD patients. 4 , 5 , 6 , 7 , 8 , 9 , 10 These asymptomatic lesions can emerge during attacks or remission, suggesting MRI's heightened sensitivity compared to clinical symptoms. Performing a one‐off MRI scan following an acute episode seems reasonable, allowing a reestablishment of the imaging baseline and enabling comparisons with future relapses.…”

Section: Introductionmentioning

confidence: 99%

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Asymptomatic spinal lesions in patients with AQP4‐IgG‐positive NMOSD: A real‐world cohort study

Cao,

Zhu,

et al. 2024

Ann Clin Transl Neurol

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ObjectiveThis study aims to explore the frequency and influencing factors of asymptomatic spinal lesions (ASLs) and their impact on subsequent relapses in patients with AQP4‐IgG‐positive NMOSD (AQP4‐NMOSD) in a real‐world setting.MethodsWe retrospectively reviewed clinical information and spinal MRI data from AQP4‐NMOSD patients who had at least one spinal cord MRI during their follow‐ups. Kaplan–Meier curves and Cox proportional hazards models were employed to ascertain potential predictors of remission ASLs and to investigate factors associated with subsequent relapses.ResultsIn this study, we included 129 patients with AQP4‐NMOSD and reviewed 173 spinal MRIs during attacks and 89 spinal MRIs during remission. Among these, 6 ASLs (3.5%) were identified during acute attacks, while 8 ASLs (9%) were found during remission. Remission ASLs were linked to the use of immunosuppressive agents, particularly conventional ones, whereas no patients using rituximab developed ASLs (p = 0.005). Kaplan–Meier curve analysis indicated that patients with ASLs had a significantly higher relapse risk (HR = 4.658, 95% CI: 1.519–14.285, p = 0.007) compared to those without. Additionally, the use of mycophenolate mofetil (HR = 0.027, 95% CI: 0.003–0.260, p = 0.002) and rituximab (HR = 0.035, 95% CI: 0.006–0.203, p < 0.001) significantly reduced the relapse risk. However, after accounting for other factors, the presence of ASLs did not exhibit a significant impact on subsequent relapses (HR = 2.297, 95% CI: 0.652–8.085, p = 0.195).InterpretationASLs may be observed in patients with AQP4‐NMOSD. The presence of ASLs may signify an underlying inflammatory activity due to insufficient immunotherapy. The administration of immunosuppressive agents plays a key role in the presence of remission ASLs and the likelihood of subsequent relapses.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%