AQP4 antibody–positive Thai cases
Clinical features and diagnostic problems
Abstract
Objective:
To evaluate the prevalence of aquaporin-4 (AQP4) antibody in Thai patients with idiopathic inflammatory demyelinating CNS diseases (IIDCDs) and to analyze the significance of the autoantibody to distinguish neuromyelitis optica (NMO) and other NMO spectrum disorders (ONMOSDs) from other IIDCDs, especially multiple sclerosis (MS).
Methods:
We retrospectively evaluated 135 consecutive patients with IIDCDs seen at the MS clinic at Siriraj Hospital, Bangkok, Thailand, and classified them into NMO, ONMOSDs, optic-spinal MS (OSMS), classic MS (CMS), and clinically isolated syndrome (CIS) groups in this order with accepted diagnostic criteria. The patients' coded sera were tested separately for AQP4 antibody. Then the relations between the clinical diagnosis and the AQP4 antibody serologic status were analyzed.
Results:
Among the 135 patients, 53 (39.3%) were AQP4 antibody–positive. Although the AQP4 antibody–positive group had features of NMO, such as female predominance, long cord lesions (>3 vertebral bodies), and CSF pleocytosis, only 18 patients (33% of 54) fully met Wingerchuk 2006 criteria except for AQP4 antibody–seropositive status. We also detected some AQP4 antibody–positive patients in the OSMS (4 of 7), CMS (11 of 46), and CIS (1 of 16) groups. These patients had been misdiagnosed with MS because they often had brain lesions and never underwent spinal cord MRI examination or lacked long cord lesions.
Conclusions:
AQP4 antibody was highly prevalent (almost 40%) in Thai patients with IIDCDs. Moreover, only one-third of AQP4 antibody–positive patients fully met Wingerchuk 2006 criteria, and many were misdiagnosed with MS. A sensitive AQP4 antibody assay is required in this region because the therapy for NMO is different from that for MS.
Get full access to this article
View all available purchase options and get full access to this article.
REFERENCES
1.
O'Riordan JI, Gallagher HL, Thompson AJ, et al. Clinical, CSF, and MRI findings in Devic's neuromyelitis optica. J Neurol Neurosurg Psychiatry 1996;60:382–387.
2.
Wingerchuk DM, Hogancamp WF, O'Brien PC, Weinshenker BG. The clinical course of neuromyelitis optica (Devic's syndrome). Neurology 1999;53:1107–1114.
3.
Cree BA, Goodin DS, Hauser SL. Neuromyelitis optica. Semin Neurol 2002;22:105–122.
4.
Lennon VA, Wingerchuk DM, Kryzer TJ, et al. A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 2004;364:2106–2112.
5.
Weinshenker BG, Wingerchuk DM. Neuromyelitis optica: clinical syndrome and the NMO-IgG autoantibody marker. Curr Top Microbiol Immunol 2008;318:343–356.
6.
Weinshenker BG, Wingerchuk DM, Nakashima I, Fujihara K, Lennon VA. OSMS is NMO, but not MS: proven clinically and pathologically. Lancet Neurol 2006;5:110–111.
7.
Palace J, Leite MI, Nairne A, Vincent A. Interferon beta treatment in neuromyelitis optica: increase in relapses and aquaporin 4 antibody titers. Arch Neurol 2010;67:1016–1017.
8.
Shimizu J, Hatanaka Y, Hasegawa M, et al. IFNβ-1b may severely exacerbate Japanese optic-spinal MS in neuromyelitis optica spectrum. Neurology 2010;75:1423–1427.
9.
Wingerchuk DM, Lennon VA, Pittock SJ, Lucchinetti CF, Weinshenker BG. Revised diagnostic criteria for neuromyelitis optica. Neurology 2006;66:1485–1489.
10.
Wingerchuk DM, Lennon VA, Lucchinetti CF, Pittock SJ, Weinshenker BG. The spectrum of neuromyelitis optica. Lancet Neurol 2007;6:805–815.
11.
Weinshenker BG. Neuromyelitis optica in Western countries: establishing diagnostic criteria and characterization of the spectrum. Neurol Asia 2008;13:161–166.
12.
Misu T, Fujihara K, Nakashima I, Sato S, Itoyama Y. Intractable hiccup and nausea with periaqueductal lesions in neuromyelitis optica. Neurology 2005;65:1479–1482.
13.
Magana SM, Matiello M, Pittock SJ, et al. Posterior reversible encephalopathy syndrome in neuromyelitis optica spectrum disorders. Neurology 2009;72:712–717.
14.
Kira J. Multiple sclerosis in the Japanese population. Lancet Neurol 2003;2:117–127.
15.
Osoegawa M, Kira J, Fukazawa T, et al. Temporal changes and geographical differences in multiple sclerosis phenotypes in Japanese: nationwide survey results over 30 years. Mult Scler 2009;15:159–173.
16.
Chong HT. Multiple sclerosis in South East Asia and diagnostic criteria for Asians. Neurol Asia 2008;13:145–146.
17.
Paty DW, Oger JJ, Kastrukoff LF, et al. MRI in the diagnosis of MS: a prospective study with comparison of clinical evaluation, evoked potentials, oligoclonal banding, and CT. Neurology 1988;38:180–185.
18.
Filippi M, Rocca MA. MR imaging of Devic's neuromyelitis optica. Neurol Sci 2004;25(suppl 4):S371–S373.
19.
Pittock SJ, Weinshenker BG, Lucchinetti CF, Wingerchuk DM, Corboy JR, Lennon VA. Neuromyelitis optica brain lesions localized at sites of high aquaporin 4 expression. Arch Neurol 2006;63:964–968.
20.
Pittock SJ, Lennon VA, Krecke K, Wingerchuk DM, Lucchinetti CF, Weinshenker BG. Brain abnormalities in neuromyelitis optica. Arch Neurol 2006;63:390–396.
21.
Polman CH, Reingold SC, Edan G, et al. Diagnostic criteria for multiple sclerosis: 2005 revisions to the “McDonald criteria.” Ann Neurol 2005;58:840–846.
22.
Tintore M, Rovira A, Martinez MJ, et al. Isolated demyelinating syndromes: comparison of different MR imaging criteria to predict conversion to clinically definite multiple sclerosis. AJNR Am J Neuroradiol 2000;21:702–706.
23.
Takahashi T, Fujihara K, Nakashima I, et al. Anti-aquaporin-4 antibody is involved in the pathogenesis of NMO: a study on antibody titre. Brain 2007;130:1235–1243.
24.
Vitali C, Bombardieri S, Moutsopoulos HM, et al. Assessment of the European classification criteria for Sjögren's syndrome in a series of clinically defined cases: results of a prospective multicentre study: the European Study Group on Diagnostic Criteria for Sjögren's Syndrome. Ann Rheum Dis 1996;55:116–121.
25.
Kurtzke JF. Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology 1983;33:1444–1452.
26.
Kim W, Park MS, Lee SH, et al. Characteristic brain magnetic resonance imaging abnormalities in central nervous system aquaporin-4 autoimmunity. Mult Scler 2010;16:1229–1236.
27.
Misu T, Fujihara K, Kakita A, et al. Loss of aquaporin 4 in lesions of neuromyelitis optica: distinction from multiple sclerosis. Brain 2007;130:1224–1234.
28.
Misu T, Takano R, Fujihara K, Takahashi T, Sato S, Itoyama Y. Marked increase in cerebrospinal fluid glial fibrillar acidic protein in neuromyelitis optica: an astrocytic damage marker. J Neurol Neurosurg Psychiatry 2009;80:575–577.
29.
Takano R, Misu T, Takahashi T, Sato S, Fujihara K, Itoyama Y. Astrocytic damage is far more severe than demyelination in NMO: a clinical CSF biomarker study. Neurology 2010;75:208–216.
30.
Bennett JL, Lam C, Kalluri SR, et al. Intrathecal pathogenic anti-aquaporin-4 antibodies in early neuromyelitis optica. Ann Neurol 2009;66:617–629.
31.
Siritho S, Prayoonwiwat N. A retrospective study of multiple sclerosis in Siriraj Hospital, Bangkok, Thailand. Can J Neurol Sci 2007;34:99–104.
32.
de Seze J, Arndt C, Jeanjean L, et al. Relapsing inflammatory optic neuritis: is it neuromyelitis optica? Neurology 2008;70:2075–2076.
33.
Yanagawa K, Kawachi I, Toyoshima Y, et al. Pathologic and immunologic profiles of a limited form of neuromyelitis optica with myelitis. Neurology 2009;73:1628–1637.
34.
Misu T, Fujihara K, Nakashima I, et al. Pure optic-spinal form of multiple sclerosis in Japan. Brain 2002;125:2460–2468.
35.
Nakashima I, Fukazawa T, Ota K, et al. Two subtypes of optic-spinal form of multiple sclerosis in Japan: clinical and laboratory features. J Neurol 2007;254:488–492.
36.
Watanabe S, Misu T, Miyozawa I, et al. Low-dose corticosteroids reduce relapses in neuromyelitis optica: a retrospective analysis. Mult Scler 2007;13:968–974.
37.
Jacob A, Matiello M, Weinshenker BG, et al. Treatment of neuromyelitis optica with mycophenolate mofetil: retrospective analysis of 24 patients. Arch Neurol 2009;66:1128–1133.
38.
Wingerchuk DM. Diagnosis and treatment of neuromyelitis optica. Neurologist 2007;13:2–11.
39.
Barkhof F, Filippi M, Miller DH, et al. Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 1997;120:2059–2069.
40.
Jarius S, Aboul-Enein F, Waters P, et al. Antibody to aquaporin-4 in the long-term course of neuromyelitis optica. Brain 2008;131:3072–3080.
Information & Authors
Information
Published In
Copyright
Copyright © 2011 by AAN Enterprises, Inc.
Publication History
Received: December 5, 2010
Accepted: March 22, 2011
Published online: August 3, 2011
Published in print: August 30, 2011
Disclosure
Dr. Siritho has received funding for travel and speaker honoraria from Merck Serono, Bayer Schering Pharma, and Eisai Inc. and has received research support from Merck Serono and sanofi-aventis. Dr. Nakashima has received funding for travel and speaker honoraria from Bayer Schering Pharma and Biogen Idec; serves on the editorial board of Multiple Sclerosis International; and has received research support from Mitsubishi Tanabe Pharma Corporation and Grants-in-Aid for Scientific Research from the Ministry of Education, Science and Technology. Dr. Takahashi reports no disclosures. Dr. Fujihara serves on scientific advisory boards for Bayer Schering Pharma, Biogen Idec, and Merck Serono; has received funding for travel and speaker honoraria from Bayer Schering Pharma, Biogen Idec, Eisai Inc., Mitsubishi Tanabe Pharma Corporation, Astellas Pharma Inc., Takeda Pharmaceutical Company Limited, and Asahi Kasei Kuraray Medical Co., Ltd.; serves on the editorial board of Clinical and Experimental Neuroimmunology; receives publishing royalties for Clinical Practice Guide of Orthopedic Surgery (Bunkodo, 2007); and has received research support from Bayer Schering Pharma, Biogen Idec, Asahi Kasei Kuraray Medical Co., Ltd, The Chemo-Sero-Therapeutic Research Institute (KAKETSUKEN), Teva Pharmaceutical, Mitsubishi Tanabe Pharma Corporation, Teijin Pharma, Eisai Inc., and Kowa Pharmaceuticals America, Inc. and Grants-in-Aid for Scientific Research from the Ministry of Education, Science and Technology and the Ministry of Health, Labor and Welfare of Japan. Dr. Prayoonwiwat has received funding for travel and speaker honoraria from Bayer Schering Pharma, Eisai Inc., Pfizer Inc, Novartis, and sanofi-aventis and has received research support from Bayer Schering, Merck Serono, and sanofi-aventis.
Authors
Author Contributions
Dr. Siritho: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, contribution of vital reagents/tools/patients, acquisition of data, statistical analysis. Dr. Nakashima: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, study supervision, and obtaining funding. Dr. Takahashi: analysis or interpretation of data, contribution of vital reagents/tools/patients, and acquisition of data. Dr. Fujihara: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, study supervision, and obtaining funding. Dr. Prayoonwiwat: drafting/revising the manuscript, study concept or design, analysis or interpretation of data, contribution of vital reagents/tools/patients, acquisition of data, study supervision, and obtaining funding.
Metrics & Citations
Metrics
Citations
Download Citations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Select your manager software from the list below and click Download.
Cited By
- Cognitive performance in patients with neuromyelitis optica: clinical and imaging characteristics, Scientific Reports, 14, 1, (2024).https://doi.org/10.1038/s41598-024-71176-x
- Potential Role of Antibodies against Aquaporin-1 in Patients with Central Nervous System Demyelination, International Journal of Molecular Sciences, 24, 16, (12982), (2023).https://doi.org/10.3390/ijms241612982
- Characteristics of multiple sclerosis and demyelinating disease in an Asian American population, Multiple Sclerosis Journal, 29, 10, (1216-1228), (2023).https://doi.org/10.1177/13524585231188486
- The epidemiology and burden of neuromyelitis optica spectrum disorder, multiple sclerosis, and MOG antibody-associated disease in a province in Thailand: A population-based study, Multiple Sclerosis and Related Disorders, 70, (104511), (2023).https://doi.org/10.1016/j.msard.2023.104511
- A Study of Neuromyelitis Optica Spectrum Disorders (NMOSD), Neurology India, 70, 3, (1131-1136), (2022).https://doi.org/10.4103/0028-3886.349679
- Longitudinally Extensive Transverse Myelitis: One Disease, Variable Outcomes—A Case Series, Journal of Neurosciences in Rural Practice, 13, (339-342), (2022).https://doi.org/10.1055/s-0042-1743211
- AQP4-IgG-positive neuromyelitis optica spectrum disorder and temporally detected neoplasms: case report and systematic review, Multiple Sclerosis and Related Disorders, 68, (104212), (2022).https://doi.org/10.1016/j.msard.2022.104212
- The aquaporin4-IgG status and how it affects the clinical features and treatment response in NMOSD patients in Egypt, BMC Neurology, 21, 1, (2021).https://doi.org/10.1186/s12883-021-02083-1
- Clinical and radiological features of MS, NMOSD, and MOGAD, and evolution of the diagnostic processes in Thailand, Neurology and Clinical Neuroscience, 9, 4, (282-291), (2021).https://doi.org/10.1111/ncn3.12489
- Neuromyelitis optica spectrum disorder in Asia: Epidemiology and risk factors, Neurology and Clinical Neuroscience, 9, 4, (274-281), (2021).https://doi.org/10.1111/ncn3.12478
- See more
Loading...
View Options
Login options
Check if you have access through your login credentials or your institution to get full access on this article.
Personal login Institutional LoginPurchase Options
The neurology.org payment platform is currently offline. Our technical team is working as quickly as possible to restore service.
If you need immediate support or to place an order, please call or email customer service:
- 1-800-638-3030 for U.S. customers - 8:30 - 7 pm ET (M-F)
- 1-301-223-2300 for customers outside the U.S. - 8:30 - 7 pm ET (M-F)
- [email protected]
We appreciate your patience during this time and apologize for any inconvenience.