Clinical Characteristics of Subacute vs. Acute Presentations of Neuromyelitis Optica Spectrum Disorder
Humza Qureshi1, Ashutosh Gupta2, Aswathi Sajeendran2, Anjali Patel1, Donald Barone2, Cris Constantinescu2, Olga Thon2, Judy Diep2
1Cooper Medical School of Rowan University, 2Cooper Neurological Institute
Objective:
To elucidate whether subacute initial presentations of neuromyelitis optica spectrum disorder (NMOSD) exhibit different clinical characteristics than acute presentations.
Background:
NMOSD is a demyelinating auto-immune disease involving blood-brain barrier disruption and repeated immune infiltration of the central nervous system. Patients experience symptoms ranging from vision loss to extremity weakness. Existing studies on NMOSD have largely focused on acute presentations while subacute presentations and their management remain underexplored.
Design/Methods:
A multi-center retrospective cohort study of patients in southern New Jersey diagnosed with NMOSD was undertaken. Subacute NMOSD presentations were defined as symptoms lasting more than 7 days and acute presentations as less than 7 days. Data was collected on patients’ ages, sex, symptoms, CSF findings, anti-AQP-4 positivity, initial treatment, and relapse after initial presentation.
Results:
From 43 NMOSD patients, 34 patients with acuity data were included of whom 15 had subacute presentations. Subacute patients had a younger median age than acute patients (36 years, IQR: 31.5-39 vs. 37 years, IQR: 29-46.5) with a lower proportion of males (13.3% vs. 42.1%). The most common subacute presenting symptom was sensory loss (53.3%). Lower extremity weakness (52.6%) and visual symptoms (52.6%) were most common for acute patients. Inflammatory CSF findings, defined as WBC count >5 cells/μL or protein >50 mg/dL, were less common in subacute (60.0% vs. 63.2%) patients. Anti-AQP-4 positivity was more common in subacute patients (53.3% vs. 26.3%). Steroids alone were the most common initial treatment for subacute (53.3%) and acute (47.4%) patients. Combined steroid and plasmapheresis treatment was less common in subacute patients (33.3% vs. 42.1%). Relapse was more common in subacute than acute patients (60.0% vs. 42.1%).
Conclusions:
While subacute NMOSD presentations may trend toward greater association with female sex, sensory symptoms, non-inflammatory CSF findings, anti-AQP-4 positivity, and relapse than acute presentations, additional studies with larger sample sizes are needed to validate these trends.
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