Abstract
Interferon-beta (IFN-β) treatment may not be effective in neuromyelitis optica (NMO). Whether the poor response to IFN-β is related to long spinal cord lesions (LSCL) or the NMO disease entity itself is unclear. We evaluated the spinal cord involvement of patients with multiple sclerosis (MS) and NMO, as well as the response after receiving IFN-β. Forty-nine MS and 21 NMO patients treated with IFN-β for at least 2 years from 2002–2008 were enrolled in this study and the treatment response was analyzed 2 years post-treatment. In the study, spinal cord lesions were present in 57.1% (28/49) of the MS patients, of which 16.3% (8/49) presented spinal cord lesions longer than 3 vertebral segments (LSCL). Responses to IFN-β treatment were seen in 69.3% (34/49) of all the MS cases, of which the appropriate response rates were 76.1% (16/21) in MS patients without spinal cord lesions and 37.5% (3/8) in patients with LSCL. Only 14.2% (3/21) of NMO patients responded to IFN-β treatment. In conclusion, spinal cord lesion is common in MS patients in Taiwan. Both NMO and MS patients with LSCL had a poor response to IFN-β treatment. NMO patients had a worse response to IFN-β treatment than MS patients with LSCL, which shows that the crucial structural defect is something other than LSCL such as the elevated serum IL17 level in NMO compared to MS.
Highlights
Long spinal cord lesions (LSCL) of 3 or more vertebral segments are quite a unique phenomenon in neuromyelitis optica (NMO)
In order to determine whether poor response to IFN-b is related to the crucial LSCL or the NMO disease entity itself, we evaluated spinal cord involvement in Taiwanese patients with multiple sclerosis (MS) and NMO and correlated their MRI and anti-aquaporin-4 autoantibodies (AQP4 Ab) with their response to IFN-b in the special clinic for MS at Taipei Veterans General Hospital (VGH) from 2002–2008
Treatment response was seen in 69.3% (34/49) of all MS cases, including 76.1% (16/21) of MS-NSCL patients, 37.5% (3/8) of LSCL patients and 75% (15/20) of short spinal cord lesions (SSCL) patients
Summary
Long spinal cord lesions (LSCL) of 3 or more vertebral segments are quite a unique phenomenon in neuromyelitis optica (NMO). Unlike brain lesions which may have asymptomatic or silent lesions, lesions of the same size in the spinal cord definitely cause more severe symptoms/signs. NMO patients have a poor prognosis compared to those with multiple sclerosis (MS), since the spinal cord lesion itself is crucial in the disability scale. Spinal cord involvement is quite common in MS in Asian countries [1,2]. Some reports have suspected that IFN-b treatment triggers severe exacerbation in patients with NMO or its spectrum form, especially when involved with LSCLs [5,6]. Prior to 2008, NMO and MS were not so well distinguished; IFN-b treatment was the first disease-modifying therapy for these patients
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