Cerebral Cortex Involvement in Neuromyelitis Optica Spectrum Disorder
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초록
Background and Purpose Brain lesions involving the cerebral cortex are rarely described in patients with neuromyelitis optica spectrum disorder (NMOSD), in contrast to multiple sclerosis. We investigated cerebral cortex involvement using conventional brain magnetic resonance imaging (MRI) in anti-aquaporin-4 (AQP4)-antibody-positive NMOSD patients. Methods The study enrolled 215 NMOSD patients who were seropositive for the anti-AQP4 antibody from 5 referral hospitals, and retrospectively analyzed their demographic, clinical, and MRI findings. Abnormal cerebral cortex lesions on brain MRI were identified by a neuroradiologist and two neurologists using consensus. Results Most of the 215 enrolled patients (87%) were female. The median age at onset was 22.5 years (range: 15–36 years) and the mean follow-up duration was 123 months. Brain lesions were found in 143 of 194 patients (74%) in whom MRI was performed during follow-up. Brain lesions involving the cerebral cortex were identified in 6 of these 194 patients (3.1%). Five of the patients were female, and the six patients together had a median age of 29 years (range: 15–36 years) at the time of lesion presentation. Three of them showed leptomeningeal enhancement in the lesions. At presentation of the cortex-involving lesions, five of these patients were not being treated at the time of presentation, while the sixth was being treated with interferon-beta. Conclusions Although rare, cortical involvement occurs in NMOSD and is commonly combined with leptomeningeal enhancement. We speculate that this occurs only in patients who are not treated appropriately with immunosuppressant drugs.
Abstract
Background and Purpose Brain lesions involving the cerebral cortex are rarely described in patients with neuromyelitis optica spectrum disorder (NMOSD), in contrast to multiple sclerosis. We investigated cerebral cortex involvement using conventional brain magnetic resonance imaging (MRI) in anti-aquaporin-4 (AQP4)-antibody-positive NMOSD patients. Methods The study enrolled 215 NMOSD patients who were seropositive for the anti-AQP4 antibody from 5 referral hospitals, and retrospectively analyzed their demographic, clinical, and MRI findings. Abnormal cerebral cortex lesions on brain MRI were identified by a neuroradiologist and two neurologists using consensus. Results Most of the 215 enrolled patients (87%) were female. The median age at onset was 22.5 years (range: 15–36 years) and the mean follow-up duration was 123 months. Brain lesions were found in 143 of 194 patients (74%) in whom MRI was performed during follow-up. Brain lesions involving the cerebral cortex were identified in 6 of these 194 patients (3.1%). Five of the patients were female, and the six patients together had a median age of 29 years (range: 15–36 years) at the time of lesion presentation. Three of them showed leptomeningeal enhancement in the lesions. At presentation of the cortex-involving lesions, five of these patients were not being treated at the time of presentation, while the sixth was being treated with interferon-beta. Conclusions Although rare, cortical involvement occurs in NMOSD and is commonly combined with leptomeningeal enhancement. We speculate that this occurs only in patients who are not treated appropriately with immunosuppressant drugs.
참고문헌 (21)
- Wingerchuk DM, "International consensus diagnostic criteria for neuromyelitis optica spectrum disorders", Neurology, 85, pp.177~189 (2015)
- 김우준, "New Insights into Neuromyelitis Optica", Journal of Clinical Neurology, 7(3), pp.115~127 (2011), 대한신경과학회
- Kim HJ, "MRI characteristics of neuromyelitis optica spectrum disorder:an international update", Neurology, 84, pp.1165~1173 (2015)
- Kim JE, "Brain abnormalities in neuromyelitis optica", J Neurol Sci, 302, pp.43~48 (2011)
- Kim SM, "Cortical oscillopsia without nystagmus, an isolated symptom of neuromyelitis optica spectrum disorder with anti-aquaporin 4 antibody", Mult Scler, 18, pp.244~247 (2012)
- Wingerchuk DM, "The spectrum of neuromyelitis optica", Lancet Neurol, 6, pp.805~815 (2007)
- Lennon VA, "A serum autoantibody marker of neuromyelitis optica:distinction from multiple sclerosis", Lancet, 364, pp.2106~2112 (2004)
- Takahashi T, "Establishment of a new sensitive assay for anti-human aquaporin-4 antibody in neuromyelitis optica", Tohoku J Exp Med, 210, pp.307~313 (2006)
- Kim W, "Quantitative measurement of anti-aquaporin-4 antibodies by enzyme-linked immunosorbent assay using purified recombinant human aquaporin-4", Mult Scler, 18, pp.578~586 (2012)
- Calabrese M, "No MRI evidence of cortical lesions in neuromyelitis optica", Neurology, 79, pp.1671~1676 (2012)
- Kister I, "Ultrahigh-field MR (7 T) imaging of brain lesions in neuromyelitis optica", Mult Scler Int, 2013, pp.398259~ (2013)
- Popescu BF, "Absence of cortical demyelination in neuromyelitis optica", Neurology, 75, pp.2103~2109 (2010)
- Cabrera-Gomez JA, "Conventional brain MRI in neuromyelitis optica", Eur J Neurol, 19, pp.812~819 (2012)
- Puthenparampil M, "Cortical relapses in multiple sclerosis", Mult Scle, 22(9) (2015)
- Kim W, "Brain abnormalities as an initial manifestation of neuromyelitis optica spectrum disorder", Mult Scler, 17, pp.1107~1112 (2011)
- Kim SH, "A longitudinal brain magnetic resonance imaging study of neuromyelitis optica spectrum disorder", PLoS One, 9, pp.e108320~ (2014)
- Wingerchuk DM, "Acute disseminated encephalomyelitis, transverse myelitis, and neuromyelitis optica", Continuum (Minneap Minn), 19(4 Multiple Sclerosis), pp.944~967 (2013)
- Okumura A, "Anti-aquaporin 4 antibody-positive acute disseminated encephalomyelitis", Brain Dev, 37, pp.339~343 (2015)
- Magaña SM, "Posterior reversible encephalopathy syndrome in neuromyelitis optica spectrum disorders", Neurology, 72, pp.712~717 (2009)
- Long Y, "Brain gadolinium enhancement along the ventricular and leptomeningeal regions in patients with aquaporin-4 antibodies in cerebral spinal fluid", J Neuroimmunol, 269, pp.62~67 (2014)
- Pittock SJ, "Neuromyelitis optica and non organ-specific autoimmunity", Arch Neurol, 65, pp.78~83 (2008)