Neuromyelitis optica IgG predicts relapse after longitudinally extensive transverse myelitis

• Published in: Annals of neurology Vol. 59; no. 3; pp. 566 - 569
• Main Authors: Weinshenker, Brian G., Wingerchuk, Dean M., Vukusic, Sandra, Linbo, Linda, Pittock, Sean J., Lucchinetti, Claudia F., Lennon, Vanda A.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01-03-2006; Willey-Liss
• Subjects: Adult; Aged; Biological and medical sciences; Biomarkers - blood; Chi-Square Distribution; Female; Follow-Up Studies; Hematologic and hematopoietic diseases; Humans; Immunoglobulin G - blood; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Magnetic Resonance Imaging - methods; Male; Medical sciences; Middle Aged; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Myelitis, Transverse - cerebrospinal fluid; Myelitis, Transverse - complications; Myelitis, Transverse - pathology; Neurology; Neuromyelitis Optica - blood; Neuromyelitis Optica - immunology; Predictive Value of Tests; Prospective Studies; Recurrence; Retrospective Studies; Serologic Tests - methods; Statistics, Nonparametric; Eye disease; Relapse; Nervous system diseases; Cranial nerve disease; Optic nerve; Visual pathway; Central nervous system disease; IgG; Neurooptic myelitis; Spinal cord disease; Inflammatory disease; Transverse myelitis
• ISSN: 0364-5134; 1531-8249
• DOI: 10.1002/ana.20770

Objective
We investigated whether neuromyelitis optica (NMO) IgG seropositivity at the initial presentation of longitudinally extensive transverse myelitis (LETM) predicts relapse of myelitis or development of optic neuritis.
Methods
Prospective study of patients with initial LETM who were tested for the presence of NMO‐IgG.
Results
Eleven of 29 patients (37.9%) were seropositive after a first attack of LETM spanning three or more vertebral segments on magnetic resonance imaging. Of 23 patients followed up for 1 year, none of 14 who were seronegative experienced a relapse or developed optic neuritis. Of 9 seropositive patients, 5 developed a second event: 4 of 9 (44%) developed recurrent transverse myelitis and 1 of 9 (11%) developed optic neuritis (p = 0.004).
Interpretation
LETM represents an inaugural or limited form of NMO in a high proportion of patients. The 40% of patients who are seropositive for NMO‐IgG are at high risk for relapse. Ann Neurol 2006