Aquaporin-4 immuneglobulin g testing in 36 consecutive jamaican patients with inflammatory central nervous system demyelinating disease.

Sherri Sandy,Amza Ali,Terence A.R Seemungal,Sean J Pittock

doi:10.4081/ni.2014.5395

Abstract

Epidemiological studies of neuromyelitis optica (NMO) in Jamaica are lacking. Here we reviewed the clinical records of 700 patients undergoing neurological evaluation at the Kingston Public Hospital, the largest tertiary institution in Jamaica over a 4 month period. We investigated the diagnostic utility of Aquaporin-4 ImmuneglobulinG (AQP4-IgG) testing in 36 consecutive patients with a diagnosis of an inflammatory demyelinating disorder (IDD) of the central nervous system (CNS). Patients were classified into 3 categories: i) NMO, n=10; ii) multiple sclerosis (MS), n=14 and iii) unclassified IDD (n=12). All sera were tested for AQP-IgG status by cell binding assay (Euroimmun). No MS cases were positive. Ninety per cent of NMO cases were positive. Four of 12 patients with unclassified IDD tested positive for AQP4-IgG. AQP4-IgG seropositivity was associated with a lower socioeconomic status, higher EDSS (P=0.04) and lower pulmonary function than the seronegative cases (P=0.007). Aquaporin-4 autoimmunity may account for a significant proportion of Jamaican CNS IDDs.

Highlights

Introduction transfected HEK293 cells provided in kit form Normally distributed continuous variables by EUROIMMUN (Luebeck Germany) were were compared by t-test otherwise Mannused to detect AQP4-specific IgG
Thirty six consecutive patients with IDD were identified among 700 patients undergoing evaluation at the Kingston Public Hospital (KPH) neurology clinic over a 4 month period and classified into 3 categories: i) neuromyelitis o optica (NMO) [n=10; Wingerchuk 1999 criteria (9 relapsing/1 monophasic)]; ii) multiple sclerosis (MS) [n=14; McDonald 2005 criteria (11 relapsing remitting, 1 secondary and 2 primary progressive)]; iii) unclassified where patients failed to fulfill either MS or NMO criteria and distinction from MS and NMO was not possible resulting in unclear treatment plan (n=12).[6,7]
Introduction transfected HEK-293 cells provided in kit form Normally distributed continuous variables by EUROIMMUN (Luebeck Germany) were were compared by t-test otherwise Mannused to detect AQP4-specific IgG

Summary

Materials and Methods

Thirty six consecutive patients with IDD were identified among 700 patients undergoing evaluation at the Kingston Public Hospital (KPH) neurology clinic over a 4 month period and classified into 3 categories: i) NMO [n=10; Wingerchuk 1999 criteria (9 relapsing/1 monophasic)]; ii) MS [n=14; McDonald 2005 criteria (11 relapsing remitting, 1 secondary and 2 primary progressive)]; iii) unclassified where patients failed to fulfill either MS or NMO criteria and distinction from MS and NMO was not possible resulting in unclear treatment plan (n=12).[6,7] These unclassified cases included: recurrent optic neuritis (n=7), longitudinally extensive transverse myelitis (LETM, n=2), single TM with optic disc pallor (visual acuity/evoked potentials normal), multifocal presentation (n=1), brainstem CIS with multifocal lesions on MRI (n=1). 2014 Licensee PAGEPress, Italy Neurology International 2014; 6:5395 doi:10.4081/ni.2014.5395

Outcome measurements

Results

Impaired vision Other presentation

Expanded Disability Status Scale