Neuromyelitis Optica Spectrum Disorder in Central America and the Caribbean: A Multinational Clinical Characterization Study

Abstract

Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0–52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren’s syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0–3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08–0.41) and 0.73/100,000 (incidence 0.02–0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region.

Optical coherence tomography angiography in neuro-ophthalmology

“…Neuromyelitis optica spectrum disorder (NMOSD) also known as Devic's disease is an autoimmune inflammatory demyelinating disorder of the central nervous system characterized by acute inflammatory attacks of the optic nerve and spinal cord [40]. Astrocytic aquaporin-4 water channel, which is expressed at the blood–brain barrier, is the target of the IgG antibodies and IL-6 thus, leading to barrier dysfunction [41].…”

Rectifying global inequities in neuromyelitis optica diagnosis and treatment: A critical view from Latin America

“…Although not sufficient, a growing amount of new evidence regarding epidemiology, clinical and neuroimaging (magnetic resonance imaging (MRI)), treatment strategies, guidelines, 2 access, 4 and test availability 5 have been recently reported in different LATAM studies. NMOSD prevalence in Ecuador, 6 Venezuela, 7 Brazil, 8 Colombia, 9 and CAC 10 was published. It ranges from 0.73 to 4.52/100,000 inhabitants and a higher NMOSD prevalence was associated with greater included afro-descendant populations (Brazil).…”