Abstract

Objective: Differentiation between neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in the early phase is challenging but crucial for treatment and prognosis.Methods: We performed a prospective cross-sectional study to discriminate NMOSD from MS by evaluating retinal degeneration in optical coherence tomography (OCT) after a first-ever optic neuritis (ON) episode. Seventy-three NMOSD patients and 38 MS patients with ON at least 3 months prior were assessed by OCT, best-corrected visual acuity (VA), and 2.5% low-contrast VA. Multivariate linear regression models were used for comparisons. Receiver operating characteristic curves and Youden index were used for determining the discriminative value of retinal nerve fiber layer thickness (RNFL) and VA in distinguishing NMOSD from MS.Results: Among eyes with retinal degeneration after a first-ever ON episode (n = 93), NMOSD eyes (n = 60) presented thinner RNFL (p < 0.001) and worsened VA (p < 0.001) relative to MS eyes (n = 33). Furthermore, a RNFL thinner than 78.9 μm had a specificity of 93.9% for NMOSD; combined with a VA of <0.4 decimal, these characteristics provided 100% specificity for NMOSD.Conclusions: The first-ever ON eyes showed more severe retina degeneration in patients with NMOSD than MS, which could establish a cut-off of RNFL thickness and VA to distinguish NMOSD from MS in the early phase.

Highlights

  • The early and accurate distinction of neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) is important, as the prognosis and treatments for these two diseases are very different [1, 2]

  • Axonal injury occurs to a greater extent in NMOSD, whereas the demyelination associated with MS occurs with some preservation of axons [1]

  • Eyes were categorized into six groups: MS without optic neuritis (ON) episodes (N = 38), MS with a single ON episode (N = 33), MS with multiple ON episodes (N = 5), NMOSD without ON episodes (N = 45), NMOSD with a single ON episode (N = 60), and NMOSD with multiple ON episodes (N = 41) (Table 2)

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Summary

Introduction

The early and accurate distinction of neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) is important, as the prognosis and treatments for these two diseases are very different [1, 2]. Optical coherence tomography (OCT) has been used to measure the thickness of retinal nerve fiber layer (RNFL) and the macular volume (MV) in patients with MS and NMOSD [2, 4]. The RNFL consists of retinal ganglion cell axons that coalesce to form the optic nerve [7]. A significant decrease in RNFL thickness and MV has been known to occur in the eyes of patients with MS, with and without a history of ON [2]. These abnormalities were found to correlate with brain atrophy in MS [9]

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