title: AQP4 antibody-positive Thai cases: clinical features and diagnostic problems.
abstract: OBJECTIVE
  To evaluate the prevalence of aquaporin-4 (AQP4) antibody in Thai patients with idiopathic inflammatory demyelinating CNS diseases (IIDCDs) and to analyze the significance of the autoantibody to distinguish neuromyelitis optica (NMO) and other NMO spectrum disorders (ONMOSDs) from other IIDCDs, especially multiple sclerosis (MS).
  
  
  METHODS
  We retrospectively evaluated 135 consecutive patients with IIDCDs seen at the MS clinic at Siriraj Hospital, Bangkok, Thailand, and classified them into NMO, ONMOSDs, optic-spinal MS (OSMS), classic MS (CMS), and clinically isolated syndrome (CIS) groups in this order with accepted diagnostic criteria. The patients' coded sera were tested separately for AQP4 antibody. Then the relations between the clinical diagnosis and the AQP4 antibody serologic status were analyzed.
  
  
  RESULTS
  Among the 135 patients, 53 (39.3%) were AQP4 antibody-positive. Although the AQP4 antibody-positive group had features of NMO, such as female predominance, long cord lesions (>3 vertebral bodies), and CSF pleocytosis, only 18 patients (33% of 54) fully met Wingerchuk 2006 criteria except for AQP4 antibody-seropositive status. We also detected some AQP4 antibody-positive patients in the OSMS (4 of 7), CMS (11 of 46), and CIS (1 of 16) groups. These patients had been misdiagnosed with MS because they often had brain lesions and never underwent spinal cord MRI examination or lacked long cord lesions.
  
  
  CONCLUSIONS
  AQP4 antibody was highly prevalent (almost 40%) in Thai patients with IIDCDs. Moreover, only one-third of AQP4 antibody-positive patients fully met Wingerchuk 2006 criteria, and many were misdiagnosed with MS. A sensitive AQP4 antibody assay is required in this region because the therapy for NMO is different from that for MS.
authors.affiliation: Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. sinpy@mahidol.ac.th
authors.forename: S
authors.initials: S
authors.lastname: Siritho
authors.forename: I
authors.initials: I
authors.lastname: Nakashima
authors.forename: T
authors.initials: T
authors.lastname: Takahashi
authors.forename: K
authors.initials: K
authors.lastname: Fujihara
authors.forename: N
authors.initials: N
authors.lastname: Prayoonwiwat
mesh_terms: D000293:Adolescent; D000328:Adult; D051401:Aquaporin 4 / Q000097:blood / Q000276:immunology*; D044466:Asian People / Q000208:ethnology; D001323:Autoantibodies / Q000096:biosynthesis* / Q000097:blood; D015415:Biomarkers / Q000097:blood; D020278:Demyelinating Autoimmune Diseases, CNS / Q000175:diagnosis / Q000208:ethnology / Q000276:immunology; D005260:Female; D057809:HEK293 Cells; D006801:Humans; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000175:diagnosis* / Q000208:ethnology / Q000276:immunology*; D015995:Prevalence; D012189:Retrospective Studies; D013785:Thailand / Q000208:ethnology; D055815:Young Adult
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies; D015415:Biomarkers