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Published on: August 21, 2017
Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis
Brian G Weinshenker1, Dean M Wingerchuk, Sandra Vukusic
1Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN 55905, USA. weinb@mayo.edu
Objective:
We investigated whether neuromyelitis optica (NMO) IgG seropositivity at the initial presentation of longitudinally extensive transverse myelitis (LETM) predicts relapse of myelitis or development of optic neuritis.
Methods:
Prospective study of patients with initial LETM who were tested for the presence of NMO-IgG.
Results:
Eleven of 29 patients (37.9%) were seropositive after a first attack of LETM spanning three or more vertebral segments on magnetic resonance imaging. Of 23 patients followed up for 1 year, none of 14 who were seronegative experienced a relapse or developed optic neuritis. Of 9 seropositive patients, 5 developed a second event: 4 of 9 (44%) developed recurrent transverse myelitis and 1 of 9 (11%) developed optic neuritis (p = 0.004).
Interpretation:
LETM represents an inaugural or limited form of NMO in a high proportion of patients. The 40% of patients who are seropositive for NMO-IgG are at high risk for relapse.
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