Open AccessDiagnostic pitfalls in neuromyelitis optica spectrum disorders
Author(s) -
Michalina Jasiak-Zatońska,
AUTHOR_ID,
Sławomir Michalak,
Wojciech Kozubski,
Alicja Kalinowska-Łyszczarz,
AUTHOR_ID,
AUTHOR_ID,
AUTHOR_ID
Publication year - 2021
Publication title -
aktualności neurologiczne
Language(s) - English
Resource type - Journals
eISSN - 2451-0696
pISSN - 1641-9227
DOI - 10.15557/an.2021.0019
Subject(s) - neuromyelitis optica , medicine , multiple sclerosis , optic neuritis , acute disseminated encephalomyelitis , spectrum disorder , myelin oligodendrocyte glycoprotein , demyelinating disorder , myelitis , pathology , central nervous system , spinal cord , immunology , experimental autoimmune encephalomyelitis , psychiatry
Neuromyelitis optica spectrum disorders are autoimmune disorders of the centralnervous system marked by inflammatory demyelination, axonal loss and astrocytopathy,associated with lesions in the brain and in the spinal cord and with the presence ofantibodies against aquaporin 4 (AQP4-IgG). Various studies on neuromyelitis opticaspectrum disorders broaden the knowledge about their immunopathogenesis, clinicalcourse, immunological assays, and magnetic resonance imaging findings. Nevertheless, inclinical practice differential diagnosis remains challenging, particularly in casesseronegative for AQP4-IgG. Essential clinical syndromes in neuromyelitis optica spectrumdisorders, namely optic neuritis and acute myelitis, could also be observed in multiplesclerosis and other demyelinating diseases of the central nervous system. The early andaccurate diagnosis is essential due to different prognosis and treatment strategies inthese diseases. For example, therapies used in multiple sclerosis, includingbeta-interferons, natalizumab, fingolimod and alemtuzumab, may not only be ineffectivein neuromyelitis optica spectrum disorders but even harmful and provoke relapses.Therefore, in a patient with a clinical neurological syndrome accompanied bydemyelinating lesions in the central nervous system several investigative studies shouldbe undertaken, including serological assays [AQP4-IgG, antibodies against myelinoligodendrocyte glycoprotein (MOG-Ab)], the cerebrospinal fluid examination and magneticresonance imaging of the brain and spinal cord, and interpreted with caution. Due toclinical similarities and relatively common misdiagnoses, there is a need to summarisethe typical and atypical clinical, laboratory and radiographic features in neuromyelitisoptica spectrum disorders to avoid diagnostic pitfalls and inappropriatetreatment.