Faculty Opinions recommendation of International consensus diagnostic criteria for neuromyelitis optica spectrum disorders.

Pathological yawning is rarely observed in cerebral or spinal diseases. A 67-year-old woman was admitted with a seven-day progressive hemisyndrome with left-sided limb ataxia and hypesthesia. The patient yawned with a high frequency, partially in salve-like episodes. MRI showed a cervical myelitis over more than three vertebral segments up to the lower medulla and Aquaporin-4-antibodies were positive (diagnostic criteria for a Neuromyelitis optica spectrum disorder were fulfilled). Under treatment with methylprednisolone, followed by plasmapheresis and immunoadsorption, clinical symptoms were regressive and the frequency of yawning completely normalized. When observing pathological yawning, even in the absence of other cerebral or brainstem symptoms, one should be aware of NMOSD as a possible cause.

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Seronegative neuromyelitis optica spectrum disorder patients diagnosed using new diagnostic criteria

Multiple Sclerosis Journal ◽

10.1177/1352458515615954 ◽

2016 ◽

Vol 22 (10) ◽

pp. 1371-1375 ◽

Cited By ~ 6

Author(s):

Akiyuki Uzawa ◽

Masahiro Mori ◽

Tomohiko Uchida ◽

Hiroki Masuda ◽

Ryohei Ohtani ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Diagnostic Criteria ◽

Neuromyelitis Optica ◽

Oligoclonal Bands ◽

Neuromyelitis Optica Spectrum Disorder ◽

Neuromyelitis Optica Spectrum Disorders ◽

Resonance Imaging ◽

Protein Levels ◽

Spectrum Disorders ◽

Aqp4 Antibody

Background: Recently, new diagnostic criteria for neuromyelitis optica spectrum disorders (NMOSD) were published. Objective: Our primary aim was to evaluate the usefulness of the new diagnostic criteria in anti-aquaporin 4 (AQP4) antibody-negative cases. Methods: Consecutive 471 patients whose anti-AQP4 antibody was measured at Chiba University were reviewed. Results: Four anti-AQP4 antibody negative-patients, who fulfilled the new diagnostic criteria for NMOSD but not 2006 diagnostic criteria for neuromyelitis optica (NMO), were identified. They showed high cerebrospinal fluid interleukin-6 and glial fibrillary acidic protein levels, an absence of oligoclonal bands and/or cloud-like enhancement on magnetic resonance imaging, which are compatible findings for NMO. Conclusion: The new diagnostic criteria are clinically useful in seronegative NMOSD.

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Utility of aquaporin-4 antibody assay in patients with neuromyelitis optica spectrum disorders

Multiple Sclerosis Journal ◽

10.1177/1352458512472748 ◽

2013 ◽

Vol 19 (8) ◽

pp. 1060-1067 ◽

Cited By ~ 21

Author(s):

Sung-Min Kim ◽

Patrick Waters ◽

Mark Woodhall ◽

Jee-Young Kim ◽

Jee-Eun Kim ◽

...

Keyword(s):

Diagnostic Criteria ◽

Neuromyelitis Optica ◽

Transverse Myelitis ◽

Poor Response ◽

Aquaporin 4 ◽

Time Interval ◽

Neuromyelitis Optica Spectrum Disorders ◽

Antibody Assay ◽

The Poor ◽

Spectrum Disorders

Objective: Our aim was to evaluate the utility of aquaporin-4 antibodies (AQP4-Ab) in patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: The clinical and radiological characteristics of 78 patients with NMOSD and 22 with multiple sclerosis (MS), who were tested for AQP4-Ab by a cell-based assay, were assessed. Results: The mean time interval between symptom onset and development of optic neuritis and myelitis was 39.9 months in neuromyelitis optica (NMO). About 40% of patients with limited NMO would have fulfilled the diagnostic criteria for MS in the absence of the antibody assay results. In patients with longitudinally extensive transverse myelitis, positive AQP4-Ab assay results were associated with the poor response to acute steroid treatment and asymptomatic visual evoked potential abnormality. Presence of either painful tonic spasm associated with myelitis or severe disability at onset had high specificity and relatively high sensitivity in differentiating NMOSD with AQP4-Ab from MS. Conclusions: The AQP4-Ab assay can facilitate the early diagnosis of NMO and prevent limited NMO from being misdiagnosed as MS. It can predict the poor response to first-line acute-phase treatment and probably detect the subclinical optic nerve involvement in subgroups of NMOSD. Lastly, it will contribute to the upcoming revision of the current diagnostic criteria for NMO.

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