Risk factors associated with permanent disability in neuromyelitis optica spectrum disorders

Time to Disability Milestones and Annualized Relapse Rates in NMOSD and MOGAD

OBJECTIVE

To investigate accumulation of disability in neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) in a changing treatment landscape. We aimed to identify risk factors for the development of disability milestones in relation to disease duration, number of attacks, and age.

METHODS

We analyzed data from individuals with NMOSD and MOGAD from the German Neuromyelitis Optica Study Group registry. Applying survival analyses, we estimated risk factors and computed time to disability milestones as defined by the Expanded Disability Status Score (EDSS).

RESULTS

We included 483 patients: 298 AQP4-IgG+ NMOSD, 52 AQP4-IgG-/MOG-IgG- NMOSD patients, and 133 patients with MOGAD. Despite comparable annualized attack rates, disability milestones occurred earlier and after less attacks in NMOSD patients than MOGAD patients (median time to EDSS 3: AQP4-IgG+ NMOSD 7.7 (95% CI 6.6-9.6) years, AQP4-IgG-/MOG-IgG- NMOSD 8.7) years, MOGAD 14.1 (95% CI 10.4-27.6) years; EDSS 4: 11.9 (95% CI 9.7-14.7), 11.6 (95% lower CI 7.6) and 20.4 (95% lower CI 14.1) years; EDSS 6: 20.1 (95% CI 16.5-32.1), 20.7 (95% lower CI 11.6), and 37.3 (95% lower CI 29.4) years; and EDSS 7: 34.2 (95% lower CI 31.1) for AQP4-IgG+ NMOSD). Higher age at onset increased the risk for all disability milestones, while risk of disability decreased over time.

INTERPRETATION

AQP4-IgG+ NMOSD, AQP4-IgG-/MOG-IgG- NMOSD, and MOGAD patients show distinctive relapse-associated disability progression, with MOGAD having a less severe disease course. Investigator-initiated research has led to increasing awareness and improved treatment strategies appearing to ameliorate disease outcomes for NMOSD and MOGAD. ANN NEUROL 2024;95:720-732.

Predicting time to serologic diagnosis of AQP4+ NMOSD based on clinical factors and social determinants of health

BACKGROUND

Early serologic diagnosis and initiation of targeted therapy are associated with better outcomes in aquaporin-4 IgG positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD).

OBJECTIVE

To determine predictors of time to serologic diagnosis of AQP4+ NMOSD.

METHODS

In CANOPTICS, a multi-centre, Canadian cohort study of NMOSD, we retrospectively evaluated time from the first clinical attack to first positive AQP4-IgG serology. We used a multivariable negative binomial regression model to evaluate possible predictors of time to diagnosis.

RESULTS

We identified 129 participants with AQP4+ NMOSD from 7 centres. Diagnostic delay of >1 month was observed in 82 (63.6 %). Asian compared to European (White) ethnicity (IRR:0.40, 95 % CI:0.21-0.78), female sex (IRR:0.56, 95 % CI:0.32-0.99), later calendar year (IRR:0.84, 95 % CI:0.81-0.86), and hospitalization for the first attack (IRR:0.35, 95 % CI:0.20-0.62) were associated with shorter times to serologic diagnosis. We did not observe any overall effect of Afro-Caribbean ethnicity, but in exploratory analyses, Afro-Caribbean individuals with low income had longer times to diagnosis.

CONCLUSION

More than 60 % of patients with NMOSD experienced delays to AQP4-IgG serologic diagnosis in this cohort. Given evidence of more adverse long-term outcomes in Afro-Caribbean individuals with NMOSD, intersectional effects of ethnicity and social determinants of health merit further study.

Frequency of cognitive impairment in patients with neuromyelitis optica spectrum disorder in Mexico

Background

Between 29% and 67% of neuromyelitis optica spectrum disorder patients have cognitive alterations.

Objective

To assess the frequency of cognitive impairment in patients with neuromyelitis optica spectrum disorder in Mexico using the Brief International Cognitive Assessment for Multiple Sclerosis.

Methods

We evaluated 40 neuromyelitis optica spectrum disorder patients and 40 healthy controls from Mexico.

Results

28 (70.0%) patients with neuromyelitis optica spectrum disorder had cognitive impairment in two or more cognitive domains. Student´s T test showed statistically poor performance by neuromyelitis optica spectrum disorder patients compared to healthy controls on all three neuropsychological test scores. This significant difference was observed on the Symbols Digit Modalities Test (t = 8.875; p ≤ 0.001); California Verbal Learning Test-II memory (t = 10.418; p ≤ 0.001); and Brief Visuospatial Memory Test Revised (t = 6.123; p ≤ 0.001).

Conclusions

This study showed that 70% of neuromyelitis optica spectrum disorder patients exhibited cognitive impairment in two or more cognitive domains. Determining the frequency of cognitive impairment will guide the decision of Neuropsychologists in planning cognitive rehabilitation across various domains.

Investigation on marital status of patients with neuromyelitis optica spectrum disorders in China

BACKGROUND

Neuromyelitis optica spectrum disorders (NMOSD) may have a great impact on patients' marriage, and marital status may also affect patients' compliance and prognosis. We investigated the marital status of 494 NMOSD patients in China to explore the mutual influence between them.

METHODS

A cross-sectional survey was conducted by the online questionnaires or telephone follow-up. Basic information of all respondents was analyzed from NMOSD-database of West China hospital. All 444 married respondents finished self-assessment of NMOSD's effect on marriage and over 80% of them accepted Marital Cumulative Damage Score (MCDS).

RESULTS

The proportion of unmarried male patients is higher than female (23.1% vs. 9.0%), especially in youth stage (44.0% vs. 20.2%). However, the females reported bigger impacts on their marriage among married NMOSD patients (97.5% vs. 70.7%). Compared to married patients, divorced patients costed more in hospital every time (29,857.1 CNY vs. 15,577.2 CNY), received longer education (12.75 years vs. 9.36 years), had longer duration of disease (117.16 vs. 93.62 months), more relapses (5.50 vs. 3.73) and higher EDSS score (3.58 vs. 2.59). EDSS scores are associated with MCDS (R²=0.267, P<0.0001), and divorced patients have higher MCDS (P<0.01). Decreased group activities (84.1%), declined working ability (73.7%) and alienation from friends (72.54%) are the first three factors in MCDS.

CONCLUSION

NMOSD exerts cumulative damage for patients' marriage, and the progression of NMOSD is more likely to lead to marital breakdown. Healthy marriage may improve the prognosis of patients by providing the psychological support and improving treatment compliance.