Manjunath Netravathi1, Jitender Saini2, Anita Mahadevan3, Bollampalli Hari-Krishna1, Ravi Yadav1, Pramod Kumar Pal1, Parthasarathy Satishchandra1. 1. Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India. 2. Department of Neuroimaging & Interventional Radiology (NIIR), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India. 3. Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
Abstract
BACKGROUND: Recently, pruritus has been recognised as an important association with neuromyelitis optica spectrum disorders (NMOSD). OBJECTIVE: To determine the clinical and radiological characteristics of patients with NMOSD and pruritus. METHODS AND RESULTS: Among 57 consecutive patients with NMOSD, 15 (26.3% women) reported pruritus. All had aquaporin-4 (AQP4) antibodies. The mean age was 34.5 ± 9.1 years, age at onset was 31.3 ± 11.0 years and the duration of illness was 3.9 ± 3.1 years. Pruritus preceded the neurological disturbances in all the patients. Predominant patients experienced pruritus in the cervical dermatome (66.7%) followed by cervicothoracic region (13.3%), trigeminal nerve (13.3%) and lumbar region (6.7%). Lesions extending from cervicomedullary junction up to the thoracic segment was the most common site of affection (40%) followed by cervicothoracic (26.7%), cervicomedullary junction to cervical cord (13.3%), cervical cord (6.7%) and thoracic segment (6.7%). CONCLUSION: This report is one of the largest series reporting the close association of pruritus with onset of neurological symptoms in NMOSD. It highlights the importance of recognising this rare symptom which may help in making a correct diagnosis in a patient with suspected demyelinating disorder. In a patient with NMOSD, early treatment with immunomodulation during pruritus may prevent or minimise occurrence of neurological dysfunction.
BACKGROUND: Recently, pruritus has been recognised as an important association with neuromyelitis optica spectrum disorders (NMOSD). OBJECTIVE: To determine the clinical and radiological characteristics of patients with NMOSD and pruritus. METHODS AND RESULTS: Among 57 consecutive patients with NMOSD, 15 (26.3% women) reported pruritus. All had aquaporin-4 (AQP4) antibodies. The mean age was 34.5 ± 9.1 years, age at onset was 31.3 ± 11.0 years and the duration of illness was 3.9 ± 3.1 years. Pruritus preceded the neurological disturbances in all the patients. Predominant patients experienced pruritus in the cervical dermatome (66.7%) followed by cervicothoracic region (13.3%), trigeminal nerve (13.3%) and lumbar region (6.7%). Lesions extending from cervicomedullary junction up to the thoracic segment was the most common site of affection (40%) followed by cervicothoracic (26.7%), cervicomedullary junction to cervical cord (13.3%), cervical cord (6.7%) and thoracic segment (6.7%). CONCLUSION: This report is one of the largest series reporting the close association of pruritus with onset of neurological symptoms in NMOSD. It highlights the importance of recognising this rare symptom which may help in making a correct diagnosis in a patient with suspected demyelinating disorder. In a patient with NMOSD, early treatment with immunomodulation during pruritus may prevent or minimise occurrence of neurological dysfunction.
Authors: Andrea Salazar-Camelo; Naveen George; Hesham Abboud; Sarah M Planchon; Marcelo Matiello; Maureen A Mealy; Andrew Goodman Journal: J Neurol Date: 2021-09-05 Impact factor: 4.849