Neuromyelitis Optica Spectrum Disorders in North Indian Population: Experience from a Tertiary Care Center

Sachdeva, Julie; Goyal, Manoj; Singh, Ramandeep; Kapila, Aastha Takkar; Singh, Paramjeet; Saikia, Biman; Lal, Vivek

doi:10.4103/0028-3886.355118

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…These results were very much similar to another Indian hospital-based cohort. [ 24 ] One of the NMOSD patients, who presented with altered sensorium, was a known Aquaporin 4 positive NMOSD patient with three relapses in the past, and she was on rituximab therapy. She had a history of gradually worsening cognitive disturbances over a period of two years, and this patient ultimately did not survive after being bedridden for two months.…”

Section: Discussionmentioning

confidence: 99%

Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center

Sivaroja,

Sowmini,

Muralidharan

et al. 2024

JNRP

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Objectives: Demyelinating diseases of central nervous system (CNS) are a broad spectrum of conditions with autoimmune process against myelin. In a resource limited country like India, it is imperative to perform proper clinical evaluation, neuroimaging to differentiate among various categories of CNS demyelinating diseases to decide regarding further workup and treatment. The objective of our study was to determine clinical presentation, imaging findings, serology results, diagnosis, and treatment outcome of primary demyelinating disorders of CNS. Materials and Methods: In this prospective study, a total of 44 patients were enrolled over a period of 1 year. After proper evaluation, patients were categorized into different groups applying newer diagnostic criteria. Patients were treated with steroids, appropriate immunomodulatory therapy, and outcomes were analyzed. Results: The majority of cases were of neuromyelitis optica spectrum disorder (NMOSD) (45.5%) with an overall female-to-male ratio of 3.4:1 and mean age of presentation was 30.5 ± 11.15. Myelitis (52.3%) followed by optic neuritis (45.5%) was the most common initial presentation. The most common site of involvement on magnetic resonance imaging was the spinal cord (particularly the cervicodorsal cord). The majority showed good response to therapy (77.27%) and two patients did not survive. Conclusion: Higher disability observed among seropositive NMOSD patients warrants aggressive treatment during the first attack itself. It is important to suspect myelin oligodendrocyte glycoprotein antibody disease in patients with preceding viral infection. A good outcome in the majority is likely due to the availability of serological assays and aggressive immunomodulatory therapy.

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Section: Discussionmentioning

confidence: 99%

Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center

Sivaroja,

Sowmini,

Muralidharan

et al. 2024

JNRP

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“…8,9 Many countries cannot access a consistent supply of oral antitransplant medicines, let alone intravenous regulatory agencies-approved DMTs for NMO. Based on clinical experience and several reports from geographically diverse settings, [10][11][12][13][14][15] this often leads to one of the following suboptimal situations in lowerincome countries: no immunosuppressive therapy, intermittent immunosuppression, under-dosing, chronic oral steroids with their various side effects, or use of cyclophosphamide or methotrexate with serious potential risks to women of childbearing potential. Rituximab, an efficacious agent in NMO, usually given intravenously, remains variably available, and even biosimilars of rituximab are too costly for many health systems.…”

mentioning

confidence: 99%

“…Tracking disease incidence and outcomes to identify missed opportunities-Monitoring and evaluation of NMO treatment in lower-income settings could clarify the true incidence, prevalence, and outcomes of NMO during optimal care and alert clinicians when current efforts are insufficient. To date, many reports on NMOSD in lowest-income settings report few data on treatment and clinical outcomes, [10][11][12][13][14][15][16] necessitating vigilance and monitoring of future regional and global efforts.…”

mentioning

confidence: 99%

“…Tracking disease incidence and outcomes to identify missed opportunities —Monitoring and evaluation of NMO treatment in lower-income settings could clarify the true incidence, prevalence, and outcomes of NMO during optimal care and alert clinicians when current efforts are insufficient. To date, many reports on NMOSD in lowest-income settings report few data on treatment and clinical outcomes, 10–16 necessitating vigilance and monitoring of future regional and global efforts. Emerging registries should include details on antibody status and testing, neuroimaging, DMT dose and timing, unified definitions of relapse, and a combination of self-reported and assessed clinical disability measures.…”

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confidence: 99%

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Rectifying global inequities in neuromyelitis optica diagnosis and treatment

Mateen

2023

Mult Scler

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The standard of care for patients with neuromyelitis optica (NMO) has become highly unequal globally. Sufficient data have been published to demonstrate that NMO is a disabling—and at times, fatal—disease needing preventive immunosuppressive treatment. Since 2019, there are multiple regulatory authority-approved disease-modifying therapies (DMTs) for aquaporin-4 antibody seropositive NMO for patients. Reframing the picture of NMO globally is now needed. When considered as a disease of high mortality when left untreated, parallel programs to those for cancer, HIV/AIDS, or tuberculosis can be considered. Nine collective goals for rectifying global inequities in NMO diagnosis and treatment are proposed.

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Comparison of clinico-radiological profile, optical coherence tomography parameters, and outcome in MOGAD and Neuromyelitis optica spectrum disorder subtypes: A prospective observational study

Dhar

Kumar

Tiwari

et al. 2023

JNRP

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Objectives: The objectives of the study were to compare the clinico-radiological profile, optical coherence tomography (OCT) parameters and outcome in Myelin Oligodendrocyte Glycoprotein-IgG-associated disorders (MOGAD) and Neuromyelitis Optica Spectrum disorder subtypes. Materials and Methods: This prospective study involved collection of data regarding neurological assessment, neuroimaging, cerebrospinal fluid analysis, OCT parameters, treatment and outcome. Disease severity and disability were assessed using Expanded Disability Status Scale and modified Rankin scale. Patients were categorized into aquaporin-4 (AQP4+), MOGAD, and double negative (DN; both AQP4 and MOG negative). Results: Among 31 patients included, 42% were AQP4+, 32.2% were MOGAD, and 25.7% were DN. The median age at onset was comparable (AQP4+ vs. MOGAD vs. DN = 28 years vs. 24.4 years vs. 31.5years; P = 0.31). Females predominated in AQP4+ compared to MOGAD group (76.9% vs. 30%; P = 0.02). Majority of patients (73.5%) had a relapsing course with a median of two (range = 1–9) relapses. Ninety-nine demyelinating events occurred: Transverse myelitis (TM) in 60/99 (60.6%), optic neuritis (ON) in 43/99 (43.4%), area postrema (AP) syndrome in 20/99 (20.1%), and optico-spinal syndrome in 10/99 (10.1%). ON was common in MOGAD than AQP4+ patients (58.6% vs. 32.1%; P = 0.03). Spinal cord and brain lesions on magnetic resonance imaging (MRI) were seen in 90.3% and 54.8% patients, respectively. A significantly higher proportion of AQP4+ patients showed longitudinally extensive transverse myelitis as compared to MOGAD group (69.2 % vs. 20 %; P = 0.04), specifically involving dorsal cord (92.3% vs. 50%; P = 0.02). MRI brain lesions, especially involving AP, was frequent in DN than MOGAD (47.1% vs. 6.9%; P = 0.003) and AQP4+ (47.1% vs. 18.9%; P = 0.03) patients. AQP4+ group showed significant nasal RNFL thinning on OCT (P = 0.04). Although 6-month good functional outcome was better in MOGAD than DN and AQP4+ (80% vs. 71.4% vs. 41.7%) groups, they were comparable (P = 0.13). Conclusion: Nearly three-fourth of our patients showed a relapsing course, with TM being the most common clinical presentation. AQP4+ group showed female preponderance, frequent dorsal cord longitudinally extensive transverse myelitis, less frequent ON, and greater nasal RNFL thinning compared to MOGAD group. MRI brain lesions were more common in DN patients. All three groups exhibited good response to pulse corticosteroids and showed a comparable functional outcome at 6-month follow-up.

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Neuromyelitis Optica Spectrum Disorders in North Indian Population: Experience from a Tertiary Care Center

Cited by 3 publications

References 15 publications

Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center

Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center

Rectifying global inequities in neuromyelitis optica diagnosis and treatment

Comparison of clinico-radiological profile, optical coherence tomography parameters, and outcome in MOGAD and Neuromyelitis optica spectrum disorder subtypes: A prospective observational study

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