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Reflections from a NMOSD case with serum AQP4-Ab negativity but CSF positivity: narrative review of how to interpret AQP4-Ab test results.

ABSTRACT: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system. The differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease. The discovery of anti-aquaporin-4 antibody (AQP4-Ab) enabled clinicians to diagnose NMOSD relatively earlier and more easily, as the AQP4-Ab can mediate the pathogenesis of NMOSD. Testing for AQP4-Ab in the serum of patients can play a crucial role in the diagnosis of NMOSD. Three-quarters of patients with NMOSD have serum immunoglobulin-G (IgG) autoantibodies to the AQP4 channel. Nevertheless, the test results for AQP4-Ab can be affected by several factors, such as assay methods, clinical stages, the types of treatment, sample status, and pre-test error, among others. In patients with seronegative NMOSD, it would be better to test serum and CSF AQP4-Ab together to improve the positive rate, especially when NMOSD is highly suspected. This article aims to update readers on the recent developments in AQP4-Ab testing and how to interpret the results of the AQP4-Ab test.

SUBMITTER: Xue Q

PROVIDER: S-EPMC10116420 | biostudies-literature | 2023 Apr

REPOSITORIES: biostudies-literature

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Reflections from a NMOSD case with serum AQP4-Ab negativity but CSF positivity: narrative review of how to interpret AQP4-Ab test results.

Xue Qun Q Cao Shugang S Rui Qianyun Q

Annals of translational medicine 20210714 7

Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system. The differential diagnosis of NMOSD in clinical practice is often challenging despite the phenotypical and serological characteristics of the disease. The discovery of anti-aquaporin-4 antibody (AQP4-Ab) enabled clinicians to diagnose NMOSD relatively earlier and more easily, as the AQP4-Ab can mediate the pathogenesis of NMOSD. Testing for AQP4-Ab in the serum of patients can p ...[more]

PMID: 37090050

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Project description:ObjectiveAquaporin-4-antibody-seropositive (AQP4-IgG+) Neuromyelitis Optica Spectrum Disorder (NMOSD) and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disorder (MOGAD) are relapsing neuroinflammatory diseases, frequently leading to chronic pain. In both diseases, the spinal cord (SC) is often affected by myelitis attacks. We hypothesized that regional SC volumes differ between AQP4-IgG + NMOSD and MOGAD and that pain intensity is associated with lower SC volumes. To evaluate changes in the SC white matter (WM), gray matter (GM), and pain intensity in patients with recent relapses (myelitis or optic neuritis), we further profiled phenotypes in a case series with longitudinal imaging and clinical data.MethodsCross-sectional data from 36 participants were analyzed in this retrospective study, including 20 AQP4-IgG + NMOSD and 16 MOGAD patients. Pain assessment was performed in all patients by the Brief Pain Inventory and painDETECT questionnaires. Segmentation of SC WM, GM, cervical cord volumes (combined volume of WM + GM) was performed at the C2/C3 cervical level. WM% and GM% were calculated using the cervical cord volume as a whole per patient. The presence of pain, pain severity, and clinical disability was evaluated and tested for associations with SC segmentations. Additionally, longitudinal data were deeply profiled in a case series of four patients with attacks between two MRI visits within one year.ResultsIn AQP4-IgG + NMOSD, cervical cord volume was associated with mean pain severity within 24 h (β = -0.62, p = 0.009) and with daily life pain interference (β = -0.56, p = 0.010). Cross-sectional analysis showed no statistically significant SC volume differences between AQP4-IgG + NMOSD and MOGAD. However, in AQP4-IgG + NMOSD, SC WM% tended to be lower with increasing time from the last attack (β = -0.41, p = 0.096). This tendency was not observed in MOGAD. Our case series including two AQP4-IgG + NMOSD patients revealed SC GM% increased by roughly 2% with either a myelitis or optic neuritis attack between visits. Meanwhile, GM% decreased by 1-2% in two MOGAD patients with a myelitis attack between MRI visits.ConclusionIn AQP4-IgG + NMOSD, lower cervical cord volume was associated with increased pain. Furthermore, cord GM changes were detected between MRI visits in patients with disease-related attacks in both groups. Regional SC MRI measures are pertinent for monitoring disease-related cord pathology in AQP4-IgG + NMOSD and MOGAD.

Dataset Information

Reflections from a NMOSD case with serum AQP4-Ab negativity but CSF positivity: narrative review of how to interpret AQP4-Ab test results.

Publications

Reflections from a NMOSD case with serum AQP4-Ab negativity but CSF positivity: narrative review of how to interpret AQP4-Ab test results.

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