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Relapse Patterns in NMOSD: Evidence for Earlier Occurrence of Optic Neuritis and Possible Seasonal Variation
Elham Khalilidehkordi1, Laura Clarke1, Simon Arnett1
1Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD, Australia.
Frontiers in Neurology
|July 3, 2020
Summary
Neuromyelitis optica spectrum disorder (NMOSD) relapses are more severe than multiple sclerosis (MS) relapses, with distinct patterns in optic neuritis and transverse myelitis attacks. NMOSD relapses also show a potential seasonal bias.
Area of Science:
- Neuroimmunology
- Neurology
- Clinical Research
Background:
- Neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) are inflammatory demyelinating diseases with overlapping clinical presentations.
- Differentiating between NMOSD and MS is crucial for appropriate treatment and management.
- Relapse characteristics can provide insights into the underlying pathophysiology of these conditions.
Purpose of the Study:
- To compare the relapse patterns and characteristics between patients with NMOSD and age-/sex-matched controls with MS.
- To identify key differences in relapse types, frequency, and outcomes between NMOSD and MS.
- To investigate potential age- and seasonal-related variations in relapse occurrence for NMOSD.
Main Methods:
- Retrospective analysis of relapse data from 75 NMOSD cases and 101 MS controls across Australia and New Zealand.
- Data collection included demographic and clinical information via a standardized questionnaire.
- Statistical analysis was performed to compare relapse frequencies, types, and outcomes between the two groups.
Main Results:
- Spinal cord and optic neuritis attacks were most common in both NMOSD and MS.
- Optic neuritis and area postrema relapses were significantly more frequent in NMOSD (p < 0.001, P = 0.002, respectively).
- Other brainstem attacks were more common in MS (p < 0.001). Optic neuritis predominated before age 30 in NMOSD, shifting to transverse myelitis post-30. NMOSD relapses were more likely to receive immunotherapy and had poorer recovery.
- A trend towards reduced NMOSD relapses from February to April (p=0.065) was observed, suggesting a possible spring-summer seasonal bias.
Conclusions:
- Optic neuritis and transverse myelitis are the primary relapse types in both NMOSD and MS, with age-dependent prevalence shifts in NMOSD.
- NMOSD relapses are generally more severe, requiring more intensive treatment and resulting in less complete recovery compared to MS.
- A potential seasonal influence on NMOSD relapse occurrence warrants further investigation.
