title: Optimizing the management of neuromyelitis optica and spectrum disorders in resource poor settings: Experience from the Mangalore demyelinating disease registry.
abstract: BACKGROUND
  In resource-poor settings, the management of neuromyelitis optica (NMO) and NMO spectrum (NMOS) disorders is limited because of delayed diagnosis and financial constraints.
  
  
  OBJECTIVE
  To device a cost-effective strategy for the management of NMO and related disorders in India.
  
  
  METHODS
  A cost-effective and disease-specific protocol was used for evaluating the course and treatment outcome of 70 consecutive patients.
  
  
  RESULTS
  Forty-five patients (65%) had a relapse from the onset and included NMO (n = 20), recurrent transverse myelitis (RTM; n = 10), and recurrent optic neuritis (ROPN; n = 15). In 38 (84.4%) patients presenting after multiple attacks, the diagnosis was made clinically. Only 7 patients with a relapsing course were seen at the onset and included ROPN (n = 5), NMO (n = 1), and RTM (n = 1). They had a second attack after a median interval of 1 ± 0.9 years, which was captured through our dedicated review process. Twenty-five patients had isolated longitudinally extensive transverse myelitis (LETM), of which 20 (80%) remained ambulant at follow-up of 3 ± 1.9 years. Twelve patients (17%) with median expanded disability status scale (EDSS) of 8.5 at entry had a fatal outcome. Serum NMO-IgG testing was done in selected patients, and it was positive in 7 of 18 patients (39%). Irrespective of the NMO-IgG status, the treatment compliant patients (44.4%) showed significant improvement in EDSS (P ≤ 0.001).
  
  
  CONCLUSIONS
  Early clinical diagnosis and treatment compliance were important for good outcome. Isolated LETM was most likely a post-infectious demyelinating disorder in our set-up. NMO and NMOS disorders contributed to 14.9% (45/303) of all demyelinating disorders in our registry.
authors: Department of Neurology, KS Hegde Medical Academy, Deralakatte, India.
authors: Lekha
authors: L
authors: Pandit
authors: Sharik
authors: S
authors: Mustafa
authors: Ramya
authors: R
authors: Kunder
authors: Rajesh
authors: R
authors: Shetty
authors: Zulkifly
authors: Z
authors: Misri
authors: Shivanand
authors: S
authors: Pai
authors: Rakshith
authors: R
authors: Shetty
keywords: Demyelinating disease registry; India; immunosuppression; neuromyelitis optica; neuromyleitis optica spectrum disorders