Eslam Shosha1, Abdulla Al Asmi2, Eman Nasim3, Jihad Inshasi4, Fatima Abdulla5, Yaser Al Malik6, Ahmed Althobaiti7, Mohamed Alzawahmah8, Hind A Alnajashi9, Mohamed Binfalah10, Awad AlHarbi11, Ibtisam A Thubaiti12, Samar F Ahmed13, Jasem Al-Hashel14, Mortada Elyas2, Ramachandiran Nandhagopal2, Arunodaya Gujjar2, Talal Al Harbi3, Ghadah Al Towaijri15, Isa A Alsharooqi5, Ahmed AlMaawi5, Ali M Al Khathaami6, Naser Alotaibi6, Shahpar Nahrir7, Abdulrahman A Al Rasheed8, Mohammed Al Qahtani12, Sadaga Alawi8, Khalid Hundallah8, Mohammed Jumah15, Raed Alroughani16. 1. Departments of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia; Department of Clinical Neurological Sciences, University of Western Ontario, London, Ontario, Canada. Electronic address: dr.eslamshosha@hotmail.com. 2. Neurology Unit, Department of Medicine, Sultan Qaboos University and Hospital, Oman. 3. Departments of Neurology, King Fahad Specialist Hospital, Dammam, Saudi Arabia. 4. Neurology Department, Rashid Hospital and Dubai Medical College, Dubai, UAE. 5. Neuroscience Department, Salmaniya Medical Complex, Manama, Bahrain. 6. Neurology Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. 7. Department of Neurology, King Saud Medical City, Riyadh, Saudi Arabia. 8. Departments of Neurology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. 9. Neurology Division, Internal Medicine Department, King Abdulaziz University, Jeddah, Saudi Arabia; Neuroscience Department, International Medical Center, Jeddah, Saudi Arabia. 10. Department of Neurology, King Abdulla Medical City, Bahrain. 11. Neurology Division, Internal Medicine Department, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia. 12. Neurology Department, King Fahad Military Medical Complex, Dhahran, Saudi Arabia. 13. Department of Neurology, Ibn Sina Hospital, Kuwait; Faculty of Medicine, Minia University, Egypt. 14. Department of Neurology, Ibn Sina Hospital, Kuwait. 15. Neurology Department, King Fahad Medical City, Riyadh, Saudi Arabia. 16. Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait.
Abstract
OBJECTIVE: To describe the clinical and radiological characteristics of neuromyelitis optica spectrum disorders (NMOSD) patients from the Arabian Gulf relative to anti-aquaporin 4 antibody serostatus. METHODS: Retrospective multicentre study of hospital records of patients diagnosed with NMOSD based on 2015 International Panel on NMOSD Diagnosis (IPND) consensus criteria. RESULTS: One hundred forty four patients were evaluated, 64.3% were anti-AQP4 antibody positive. Mean age at onset and disease duration were 31±12 and 7 ± 6 years respectively. Patients were predominantly female (4.7:1). Overall; relapsing course (80%) was more common than monophasic (20%). Optic neuritis was the most frequent presentation (48.6%), regardless of serostatus. The proportion of patients (54.3%) with visual acuity of ≤ 0.1 was higher in the seropositive group (p = 0.018). Primary presenting symptoms of transverse myelitis (TM) were observed in 29% of patients, and were the most significant correlate of hospitalization (p<0.001). Relative to anti-APQ4 serostatus, there were no significant differences in terms of age of onset, course, relapse rates or efficacy outcomes except for oligoclonal bands (OCB), which were more often present in seronegative patients (40% vs.22.5%; p = 0.054). Irrespective of serostatus, several disease modifying therapies were instituted including steroids or immunosuppressives, mostly, rituximab and azathioprine in the cohort irrespective of serostatus. The use of rituximab resulted in reduction in disease activity. CONCLUSION: This is the first descriptive NMOSD cohort in the Arabian Gulf region. Seropositive patients were more prevalent with female predominance. Relapsing course was more common than monophasic. However, anti-AQP4 serostatus did not impact disease duration, relapse rate or therapeutic effectiveness. These findings offer new insights into natural history of NMOSD in patients of the Arabian Gulf and allow comparison with patient populations in different World regions.
OBJECTIVE: To describe the clinical and radiological characteristics of neuromyelitis optica spectrum disorders (NMOSD) patients from the Arabian Gulf relative to anti-aquaporin 4 antibody serostatus. METHODS: Retrospective multicentre study of hospital records of patients diagnosed with NMOSD based on 2015 International Panel on NMOSD Diagnosis (IPND) consensus criteria. RESULTS: One hundred forty four patients were evaluated, 64.3% were anti-AQP4 antibody positive. Mean age at onset and disease duration were 31±12 and 7 ± 6 years respectively. Patients were predominantly female (4.7:1). Overall; relapsing course (80%) was more common than monophasic (20%). Optic neuritis was the most frequent presentation (48.6%), regardless of serostatus. The proportion of patients (54.3%) with visual acuity of ≤ 0.1 was higher in the seropositive group (p = 0.018). Primary presenting symptoms of transverse myelitis (TM) were observed in 29% of patients, and were the most significant correlate of hospitalization (p<0.001). Relative to anti-APQ4 serostatus, there were no significant differences in terms of age of onset, course, relapse rates or efficacy outcomes except for oligoclonal bands (OCB), which were more often present in seronegative patients (40% vs.22.5%; p = 0.054). Irrespective of serostatus, several disease modifying therapies were instituted including steroids or immunosuppressives, mostly, rituximab and azathioprine in the cohort irrespective of serostatus. The use of rituximab resulted in reduction in disease activity. CONCLUSION: This is the first descriptive NMOSD cohort in the Arabian Gulf region. Seropositive patients were more prevalent with female predominance. Relapsing course was more common than monophasic. However, anti-AQP4 serostatus did not impact disease duration, relapse rate or therapeutic effectiveness. These findings offer new insights into natural history of NMOSD in patients of the Arabian Gulf and allow comparison with patient populations in different World regions.
Authors: Nirmeen A Kishk; Walaa Abdelfattah; Nevin M Shalaby; Hatem S Shehata; Amr Hassan; Mohamed I Hegazy; Noha T Abokrysha; Doaa Abdellatif; Shereen M Shawky; Sarah S Abdo; Noha Taha; Amr M Fouad; Alaa Elmazny; Amany H Ragab Journal: BMC Neurol Date: 2021-02-03 Impact factor: 2.474