Serum Creatine Kinase in Patients with Neuromyelitis Optica Spectrum Disorder

There have been reports of elevated serum creatine kinase (CK) and myopathy in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD). Such findings have raised the possibility that myopathies may be a part of the spectrum of NMOSD. The incidence of elevated CK in NMOSD remains unknown. We sou...

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Published in:Journal of neuroimmunology Vol. 330; pp. 87 - 89
Main Authors: Shouman, Kamal, Prieto, Pilar G., Stino, Amro M., Lisak, Robert P.
Format: Journal Article
Language:English
Published: Netherlands Elsevier B.V 15-05-2019
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Summary:There have been reports of elevated serum creatine kinase (CK) and myopathy in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD). Such findings have raised the possibility that myopathies may be a part of the spectrum of NMOSD. The incidence of elevated CK in NMOSD remains unknown. We sought to assess the potential association between hyperCKemia, myopathy, and NMOSD, and the potential role of screening for muscle involvement using serum CK. We reviewed records of all aquaporin 4 (AQP4) antibody-seropositive and seronegative NMOSD patients who had CK levels evaluated at two major academic medical centers. Of 199 total NMOSD patients, CK levels were checked in 43, and elevated, on at least one occasion, in 4. In 1 patient, CK was elevated during an NMO exacerbation. A myopathic process occurring with NMOSD was suggested in 2 of 4 patients in the form of symptomatic complaint of myalgias and associated MRI signal change. Unexplained hyperCKemia was found on one or more occasion in 4 of 43 tested NMOSD patients. Testing NMOSD patients for serum CK may reveal otherwise unsuspected myopathy. More formally powered, prospective assessment of the incidence and utility of CK in NMOSD is needed. Several studies have pointed to a potential association between NMOSD and hyperCKemia and/or subclinical myopathy, although the exact pathophysiologic basis remains elusive. [Display omitted] •Elevated creatine kinase (CK) as well as subclinical myopathy have been reported in the context of NMO spectrum disorders (NMOSD).•The exact pathophysiologic basis for this association remains unknown.•4 out of 43 NMOSD patients in our series had idiopathic hyperCKemia, which is higher than healthy population prevalence.•No consistent indication could be identified as to reasons for testing of CK in NMOSD patients, even when levels were elevated.•Screening for hyperCKemia in NMOSD could be considered, although its role remains to be validated in more systematic, prospective studies.
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ISSN:0165-5728
1872-8421
DOI:10.1016/j.jneuroim.2018.12.008