• Mult. Scler. · Dec 2019

    Spinal cord lesions and atrophy in NMOSD with AQP4-IgG and MOG-IgG associated autoimmunity.

    • Claudia Chien, Michael Scheel, Tanja Schmitz-Hübsch, Nadja Borisow, Klemens Ruprecht, Judith Bellmann-Strobl, Friedemann Paul, and Alexander U Brandt.
    • NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.
    • Mult. Scler. 2019 Dec 1; 25 (14): 1926-1936.

    BackgroundSpinal cord (SC) affection is a hallmark symptom of neuromyelitis optica spectrum disorders (NMOSD). Patients with aquaporin-4 (AQP4-IgG+) or myelin oligodendrocyte glycoprotein (MOG-IgG+) antibody seropositivity show this overlapping clinical phenotype.ObjectiveQuantitative comparison of SC lesions and atrophy in AQP4-IgG+ and MOG-IgG+ NMOSD.MethodsAQP4-IgG+ (n = 38), MOG-IgG+ (n = 15) NMOSD patients and healthy controls (HC, n = 24) were analysed for SC lesion (prevalence, length, location), atrophy as mean upper cervical cord area (MUCCA), Expanded Disability Status Scale (EDSS), timed 25-foot walk speed (T25FWS) and 9-hole peg test (9HPT) measures.ResultsIn total, 92% (35/38) of AQP4-IgG+ and 53% (8/15) of MOG-IgG+ patients had myelitis attacks (χ2 = 6.47, p = 0.011). 65.8%/26.7% of AQP4-/MOG-IgG+ patients had chronic SC lesions (χ2 = 5.16, p = 0.023), with similar proportions in cervical, upper thoracic and lower thoracic cord, and no length differences. MUCCA was decreased in AQP4-IgG+ (t = -2.27, p = 0.028), but not MOG-IgG+ patients (t = 0.58, p = 0.57) compared to HC. MUCCA associated with myelitis attacks (rho = -0.33, p = 0.016), EDSS (rho = -0.31, p = 0.030), pyramidal functional score (rho = -0.42, p = 0.003), T25FWS (r = 0.43, p = 0.010) and 9HPT Z-score (r = 0.32, p = 0.037), regardless of antibody status.ConclusionAQP4-IgG+ patients had more myelitis attacks, SC lesions and SC atrophy was more pronounced than in MOG-IgG+ patients. MUCCA is associated with clinical myelitis attacks and disability in all NMOSD patients.

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