title: Relapsing neuromyelitis optica: long term history and clinical predictors of death.
abstract: BACKGROUND
  Relapsing neuromyelitis optica (RNMO) is an uncommon but devastating inflammatory disorder of the central nervous system. Long term history in a wide series of RNMO is required for better knowledge of the course of the disease and identification of patients at high risk of death.
  
  
  METHODS
  Clinical features of patients with RNMO (88 women/eight men) obtained from the geographic Caribbean database (Cuba and French West Indies) were used to determine the progression of disability and to identify clinical predictors of death.
  
  
  RESULTS
  Median age at onset of RNMO was 29.5 years (range 11-74). Median duration of disease was 9.5 years (1-40). Median relapse rate was 0.7 attack/patient/year (0.1-3). 66 patients experienced severe visual loss in at least one eye and 46 in both eyes. Median time from onset to unilateral and bilateral severe visual loss was 3 and 15 years, respectively. Median times to reach Kurtzke Disability Status Scale 3, 6 and 8 from onset of RNMO were 1, 8 and 22 years. There were 24 deaths (25%); within 5 years in 63% of cases. A higher attack frequency during the first year of disease (p = 0.009), blindness (p = 0.04) and sphincter signs at onset (p = 0.02) and lack of recovery of first attack (p = 0.003) were independently associated with a shorter time to death.
  
  
  CONCLUSIONS
  RNMO is a very rapidly disabling disease affecting primarily young women. This study has identified clinical features that predict a poor outcome. These findings suggest that early and aggressive immunotherapy might be warranted in RNMO.
authors.affiliation: Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies. Philippe.Cabre@chu-fortdefrance.fr
authors.forename: P
authors.initials: P
authors.lastname: Cabre
authors.forename: A
authors.initials: A
authors.lastname: González-Quevedo
authors.forename: M
authors.initials: M
authors.lastname: Bonnan
authors.forename: A
authors.initials: A
authors.lastname: Saiz
authors.forename: S
authors.initials: S
authors.lastname: Olindo
authors.forename: F
authors.initials: F
authors.lastname: Graus
authors.forename: D
authors.initials: D
authors.lastname: Smadja
authors.forename: H
authors.initials: H
authors.lastname: Merle
authors.forename: L
authors.initials: L
authors.lastname: Thomas
authors.forename: J A
authors.initials: JA
authors.lastname: Cabrera-Gomez
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D015331:Cohort Studies; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000150:complications / Q000401:mortality* / Q000473:pathology*; D020127:Recovery of Function; D012044:Regression Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D055815:Young Adult