title: A clinical and radiological profile of neuromyelitis optica and spectrum disorders in an Indian cohort.
abstract: BACKGROUND
  There is insufficient data on the clinical and radiological features of neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD) from India.
  
  
  OBJECTIVE
  The objective of the following study is to examine the clinico-radiological features of NMO and NMOSD in an Indian cohort.
  
  
  METHODS
  This retrospective study included 44 consecutive patients who (1) satisfied the 2006 Wingerchuk criteria for NMO (16 seropositive and 7 seronegative); or (2) had isolated or recurrent optic neuritis (ON) with seropositivity (n = 4); or (3) had isolated or recurrent myelitis with seropositivity (n = 17).
  
  
  RESULTS
  The female:male ratio was 7.8:1 with median age of onset 26.5 (range 8-72). Annualized relapse rate (ARR) was comparable across all groups (F [3, 40] = 0.938 and P = 0.431). Various presentations other than ON and myelitis were noted. All 40 patients with myelitis had spinal cord lesions involving ≥3 vertebral segments during the course of the disease. Cervicomedullary involvement was seen in 32.5% (13/40) patients. Brain magnetic resonance imaging was available for 40 patients; eight of these (20%) had brain lesions in locations described in multiple sclerosis (MS), 27.5% (11/40) had lesions at sites unusual for MS and 52.5% (21/40) had normal brain imaging.
  
  
  CONCLUSIONS
  NMO and NMOSD patients in this cohort have comparable ARR regardless of clinical presentation, supporting the emerging trend of treating all patients with immunotherapeutic agents at an early stage. Varied presentations seen in NMO and NMOSD highlight the need for a high index of suspicion for NMO in demyelinating episodes not classical for MS.
authors.affiliation: Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
authors.forename: Kavita Sohan
authors.initials: KS
authors.lastname: Barhate
authors.affiliation: Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
authors.forename: Malti
authors.initials: M
authors.lastname: Ganeshan
authors.affiliation: Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India.
authors.forename: Bhim Sen
authors.initials: BS
authors.lastname: Singhal
keywords: Myelitis; neuromyelitis optica; neuromyelitis optica spectrum disorders; optic neuritis
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