title: [Inflammation of the optic nerve: when it should be considered as neuromyelitis optica--the experience of the Department of Neurology at Hadassah Hospital].
abstract: BACKGROUND
  Inflammatory demyelinative diseases of the central nervous system are mostly idiopathic and represent the major cause of neurological disability in young adults. These diseases differ in terms of clinical symptoms, severity, pathological characteristics and epidemiology. However, there are also significant similarities between these diseases, which sometimes bring to a misleading diagnosis. Neuromyelitis optica (NMO) is a demyelinative disease in which the optic nerve and the spinal cord are predominantly affected. The detection of specific antibodies to aquaporin-4 (NMO-IgG) led to a modification of the diagnostic criteria for NMO.
  
  
  METHODS
  We performed a retrospective study on NMO-IgG positive patients referred to the Department of Neurology MS Center (2006-2011) with suspected NMO. Based on the presenting symptomatology of the patients, we identified the cases with optic neuritis and various parameters that may differentiate between NMO and MS. NMO-IgG were evaluated by ELISA.
  
  
  RESULTS
  A total of 50% of the 107 patients with NMO-IgG fulfilled the revised criteria of NMO; 38 patients had a single attack of optic neuritis or long lesion in the spinal cord and 15 patients presented with an opticospinal type of MS. The visual acuity following a single attack of optic neuritis remained significantly lower in NMO patients as compared to MS patients. Most of the NMO patients with NMO-IgG had additional attacks of optic neuritis within a short time from the initial event.
  
  
  CONCLUSIONS
  The finding of NMO-IgG in patients with optic neuritis foreshadows a bad prognosis and relapses. These patients are at high risk of experiencing a second event in the central nervous system and fulfilling the clinical criteria for NMO. Due to the difference in the severity of inflammation of the optic nerve between NMO and MS, it is highly recommended to seek a laboratory check-up for NMO-IgG in serum, immediately after the first event, in order to determine the necessity and the kind of treatment for the patient.
authors.affiliation: Department of Neurology, the Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew University Hospital, Jerusalem, Israel. adembinsky@yahoo.com
authors.forename: Adi
authors.initials: A
authors.lastname: Vaknin-Dembinsky
authors.forename: Netta
authors.initials: N
authors.lastname: Levin
authors.forename: Noa
authors.initials: N
authors.lastname: Raz
authors.forename: Oded
authors.initials: O
authors.lastname: Abramsky
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karussis
authors.forename: Livnat
authors.initials: L
authors.lastname: Brill
authors.forename: Panaiyota
authors.initials: P
authors.lastname: Petrou
authors.forename: Haim
authors.initials: H
authors.lastname: Ovadia
mesh_terms: D000293:Adolescent; D000328:Adult; D003937:Diagnosis, Differential; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006801:Humans; D007074:Immunoglobulin G / Q000276:immunology; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D009471:Neuromyelitis Optica / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D009902:Optic Neuritis / Q000175:diagnosis* / Q000276:immunology / Q000473:pathology; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors; D014792:Visual Acuity; D055815:Young Adult
chemical_list: D007074:Immunoglobulin G