Clinical features and frequency of area postrema syndrome in neuromyelitis optica spectrum disorder: A single-center study in Mexico

Abstract

Area postrema syndrome (APS) is a group of conditions associated with attacks of nausea/vomiting, intractable hiccups, and narcolepsy that emerge during neuromyelitis optic spectrum disorder (NMOSD). The appearance of these symptoms is used as a diagnostic criterion for neuromyelitis optica in clinic. Frequency and clinical features of APS is poorly reported and even unknown in Latin America. We aimed to exhaustively describe APS in NMOSD patients from a tertiary medical center in Mexico City. A survey-based, cross-sectional, single-center study was performed from October 2020 to October 2021. Validated pregnancy-unique quantification of emesis and nausea (PUQE) scoring system and Epworth sleepiness scale were used for identifying nausea/vomiting and narcolepsy symptoms, respectively. Also, a simple two-option questionnaire was applied for determining hiccups frequency. Further clinical data was extracted from medical record. Fifty outpatients met inclusion criteria for NMOSD and were included in the study. Mean age was 45.5 (± SD 14.34) years old. At diagnosis, this population had a mean age of 39.7 (± SD 13.15) years. Women were more prone to develop some of theses conditions (64.0%). The frequency of isolated APS symptoms at onset was 36.0% for nausea/vomiting, 14.0% for narcolepsy, and 22.0% for intractable hiccups. Combination of nausea/vomiting and hiccups was more frequent (10%) than other combined symptoms. APS is a core clinical manifestation in Mexican NMOSD patients with a higher incidence in women.