Painful Tonic Spasm in Neuromyelitis Optica

Kim, Sung Min; Go, Min Jin; Sung, Jung Joon; Park, Kyung Seok; Lee, Kwang Woo

doi:10.1001/archneurol.2012.112

Cited by 97 publications

(41 citation statements)

References 32 publications

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“…16 Indeed, in a previously reported African-American patient an initial STM attack delayed both NMOSD diagnosis and NMO-appropriate treatment. 9 Other clinical predictors of AQP4-IgG seropositivity in patients with STM included older age, personal history of autoimmunity (e.g., myasthenia gravis) and tonic spasms (recognized to be more frequent in NMO than MS 17 ). Centrally located axial T2-hyperintensities (MS lesions are typically peripheral) 7 and T1-hypointensity were also significant predictors of AQP4-IgG-positivity.…”

Section: Discussionmentioning

confidence: 99%

Short Myelitis Lesions in Aquaporin-4-IgG–Positive Neuromyelitis Optica Spectrum Disorders

et al. 2015

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Section: Discussionmentioning

confidence: 99%

Short Myelitis Lesions in Aquaporin-4-IgG–Positive Neuromyelitis Optica Spectrum Disorders

et al. 2015

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“…The nature and etiology of pain reported by patients with NMOSD is often managed with multiple medication categories, most frequently with anticonvulsants and low-dose tricyclic antidepressants. 31–33 Psychoactive medications included SNRI (duloxetine, venlafaxine, milnacipran), selective serotonin reuptake inhibitors (SSRI; citalopram, escitalopram, sertraline), tricyclic antidepressants (amitriptyline), and atypical antidepressants (mirtazapine).…”

Section: Methodsmentioning

confidence: 99%

Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder

Chavarro

Mealy

Simpson

et al. 2016

Neurol Neuroimmunol Neuroinflamm

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Objective:To investigate depression frequency, severity, current treatment, and interactions with somatic symptoms among patients with neuromyelitis optica spectrum disorder (NMOSD).Methods:In this dual-center observational study, we included 71 patients diagnosed with NMOSD according to the International Panel for NMO Diagnosis 2015 criteria. The Beck Depression Inventory (BDI) was classified into severe, moderate, or minimal/no depressive state category. We used the Fatigue Severity Scale to evaluate fatigue. Scores from the Brief Pain Inventory and the PainDETECT Questionnaire were normalized to estimate neuropathic pain. Psychotropic, pain, and immunosuppressant medications were tabulated by established classes.Results:Twenty-eight percent of patients with NMOSD (n = 20) had BDI scores indicative of moderate or severe depression; 48% of patients (n = 34) endorsed significant levels of neuropathic pain. Severity of depression was moderately associated with neuropathic pain (r = 0.341, p < 0.004) but this relationship was confounded by levels of fatigue. Furthermore, only 40% of patients with moderate or severe depressive symptoms received antidepressant medical treatment. Fifty percent of those treated reported persistent moderate to severe depressive symptoms under treatment.Conclusions:Moderate and severe depression in patients with NMOSD is associated with neuropathic pain and fatigue and is insufficiently treated. These results are consistent across 2 research centers and continents. Future research needs to address how depression can be effectively managed and treated in NMOSD.

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“…The neurological and physical examination should focus not only on the primary symptoms, but also on disease indicators that could suggest alternative diagnoses or concomitant autoimmune disorders, which are frequently present in patients with AQP4-Ab-positive NMO [1, 45, 47]. Special attention should be paid to brainstem symptoms, neuropathic pain, and painful tonic spasm [78], which have been shown to occur more frequently in NMO than in MS, and which have a demonstrated serious impact on quality of life [1, 58–63, 79, 80]. …”

Section: Clinical Evaluation When Nmo Is Suspectedmentioning

confidence: 99%

Update on the diagnosis and treatment of neuromyelitis optica: Recommendations of the Neuromyelitis Optica Study Group (NEMOS)

et al. 2013

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Neuromyelitis optica (NMO, Devic’s syndrome), long considered a clinical variant of multiple sclerosis, is now regarded as a distinct disease entity. Major progress has been made in the diagnosis and treatment of NMO since aquaporin-4 antibodies (AQP4-Ab; also termed NMO-IgG) were first described in 2004. In this review, the Neuromyelitis Optica Study Group (NEMOS) summarizes recently obtained knowledge on NMO and highlights new developments in its diagnosis and treatment, based on current guidelines, the published literature and expert discussion at regular NEMOS meetings. Testing of AQP4-Ab is essential and is the most important test in the diagnostic work-up of suspected NMO, and helps to distinguish NMO from other autoimmune diseases. Furthermore, AQP4-Ab testing has expanded our knowledge of the clinical presentation of NMO spectrum disorders (NMOSD). In addition, imaging techniques, particularly magnetic resonance imaging of the brain and spinal cord, are obligatory in the diagnostic workup. It is important to note that brain lesions in NMO and NMOSD are not uncommon, do not rule out the diagnosis, and show characteristic patterns. Other imaging modalities such as optical coherence tomography are proposed as useful tools in the assessment of retinal damage. Therapy of NMO should be initiated early. Azathioprine and rituximab are suggested as first-line treatments, the latter being increasingly regarded as an established therapy with long-term efficacy and an acceptable safety profile in NMO patients. Other immunosuppressive drugs, such as methotrexate, mycophenolate mofetil and mitoxantrone, are recommended as second-line treatments. Promising new therapies are emerging in the form of anti-IL6 receptor, anti-complement or anti-AQP4-Ab biologicals.

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Painful Tonic Spasm in Neuromyelitis Optica

Abstract: To evaluate the diagnostic utility and clinical characteristics of painful tonic spasm (PTS) in neuromyelitis optica (NMO).

Cited by 97 publications

References 32 publications

Short Myelitis Lesions in Aquaporin-4-IgG–Positive Neuromyelitis Optica Spectrum Disorders

Short Myelitis Lesions in Aquaporin-4-IgG–Positive Neuromyelitis Optica Spectrum Disorders

Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder

Update on the diagnosis and treatment of neuromyelitis optica: Recommendations of the Neuromyelitis Optica Study Group (NEMOS)

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