Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation.

Elham Khalilidehkordi,Mark Slee,Wallace Brownlee,Angela Vincent,Sofia Jimenez Sanchez,Sudarshini Ramanathan,Sandeep Bhuta,John D Pollard,Roger Silvestrini,David Gillis,Trevor J Kilpatrick,Mark Woodhall,Celia Chen,John King,Bruce J Brew,Andrew J Kornberg,Laura Clarke,Jing Sun,Ernest Willoughby,Chandi Das,William M Carroll,Simon Hawke,Helmut Butzkueven,John Parratt,Allan G Kermode,Stefan Blum,Patrick Waters,Mike Boggild,Wajih Bukhari,Russell C Dale,Steve Vucic,Stephen W Reddel,Robert Heard,Fabienne Brilot,Ian Sutton,Simon Arnett,Alan Coulthard,Marzena J Fabis-Pedrini,Saman Heshmat,David Abernethy,Cameron Shaw,Karyn Boundy,Suzanne Hodgkinson,Matthew A Brown ,Christine Bundell ,Jim Stankovich ,Michael Barnett ,Christopher D Lynch ,Jennifer Pereira ,Deborah Mason ,David A Fulcher ,Eppie M Yiu ,Bruce Taylor ,Jeannette Lechner‐Scott ,Andrew Henderson ,Richard Wong ,C Kneebone ,Judith M Spies ,Cullen O’gorman ,Mark Marriott ,Pamela Mccombe ,Kerri Prain ,Ming Lin ,Richard Macdonell ,Michael D Walsh ,Simon Broadley

doi:10.3389/fneur.2020.00537

Abstract

Neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) show overlap in their clinical features. We performed an analysis of relapses with the aim of determining differences between the two conditions. Cases of NMOSD and age- and sex-matched MS controls were collected from across Australia and New Zealand. Demographic and clinical information, including relapse histories, were recorded using a standard questionnaire. There were 75 cases of NMOSD and 101 MS controls. There were 328 relapses in the NMOSD cases and 375 in MS controls. Spinal cord and optic neuritis attacks were the most common relapses in both NMOSD and MS. Optic neuritis (p < 0.001) and area postrema relapses (P = 0.002) were more common in NMOSD and other brainstem attacks were more common in MS (p < 0.001). Prior to age 30 years, attacks of optic neuritis were more common in NMOSD than transverse myelitis. After 30 this pattern was reversed. Relapses in NMOSD were more likely to be treated with acute immunotherapies and were less likely to recover completely. Analysis by month of relapse in NMOSD showed a trend toward reduced risk of relapse in February to April compared to a peak in November to January (P = 0.065). Optic neuritis and transverse myelitis are the most common types of relapse in NMOSD and MS. Optic neuritis tends to occur more frequently in NMOSD prior to the age of 30, with transverse myelitis being more common thereafter. Relapses in NMOSD were more severe. A seasonal bias for relapses in spring-summer may exist in NMOSD.

Highlights

Neuromyelitis optica spectrum disorders (NMOSD) have been recognized as having a distinct clinical and radiological phenotype which helps to differentiate these patients from those with multiple sclerosis (MS) [1]
The auto regressive integrated moving average analysis indicated a marginal significance of month on number of relapses per month with coefficient = 0.531 C95% CI−0.678 – 1.13, P = 0.082) and adjusted coefficient = 3.677
The present data indicate that the commonest relapse types seen in NMOSD are transverse myelitis and optic neuritis and

Summary

Introduction

Neuromyelitis optica spectrum disorders (NMOSD) have been recognized as having a distinct clinical and radiological phenotype which helps to differentiate these patients from those with multiple sclerosis (MS) [1]. The identification of antibodies to the water channel aquaporin-4 (AQP4) in a significant proportion of patients with NMOSD [3] has greatly aided the diagnosis and treatment of this condition. We analyze the specific details of relapse patterns, use of acute therapies and temporal patterns both in relation to the calendar year and across the lifespan of the disease These data are compared with an age- and sex-matched cohort of MS cases collected from the same region with the aim of identifying distinct patterns of relapse that might further assist in the early identification of cases of NMOSD and provide information about potential trigger factors

Methods

Results

Conclusion