title: Longitudinally extensive transverse myelitis in neuromyelitis optica: a prospective study of 13 Caucasian patients and literature review.
abstract: Neuromyelitis optica (NMO) is a homogenous disease that can be diagnosed by an association of clinical, neuroimaging and serological aspects. We analysed our 4 years NMO series with longitudinally extensive transverse myelitis (LETM) during the disease course. We included consecutive adult Caucasian patients who were diagnosed with definite NMO, or cases of NMO-IgG seropositive LETM considered as limited forms of NMO. Patients included were negative for other diseases (autoimmune, infectious, etc.). We report the Expanded Disability Status Scale (EDSS), brain and spine MRI, CSF, NMO-IgG, treatment, motor and visual outcome. Thirteen cases fulfilled the inclusion criteria, and the mean follow-up period was 3.74 ± 1.8 years. The initial motor deficit was severe with the mean value of motor functional parameter of 4.46 ± 1 and improved at discharge to 2.53 ± 1.4 (p < 0.001). With treatment, the outcome after LETM attack was good in 10 patients, with a significant improvement of the EDSS mainly upon motor deficit, while visual function had a very slight amelioration. The CSF analysis was normal in 8 cases; spinal MRI showed evidence of LETM in all patients while brain MRI was normal in 7. NMO-IgG is a biomarker for NMO that is of diagnostic value in cases of isolated LETM. LETM has a better outcome than ON in NMO Caucasians. Spinal MRI is essential for NMO diagnosis in the presence of LETM and the absence of multiple brain MRI lesions. Maintenance immunosuppressive therapy reduces the frequency of attacks.
authors.affiliation: First Neurological Clinic, Multiple Sclerosis Centre, Emergency County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania. iipascu@redatronic.ro.|Mureş County Clinical Emergency Hospital, Neurology Clinic I, Gh. Marinescu 50, 540136, Târgu Mureş, Mureş County, Romania. iipascu@redatronic.ro.
authors.forename: Rodica
authors.initials: R
authors.lastname: Bălaşa
authors.affiliation: First Neurological Clinic, Multiple Sclerosis Centre, Emergency County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Smaranda
authors.initials: S
authors.lastname: Maier
authors.affiliation: First Neurological Clinic, Multiple Sclerosis Centre, Emergency County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Zoltan
authors.initials: Z
authors.lastname: Bajko
authors.affiliation: First Neurological Clinic, Multiple Sclerosis Centre, Emergency County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Anca
authors.initials: A
authors.lastname: Motataianu
authors.affiliation: First Neurological Clinic, Multiple Sclerosis Centre, Emergency County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Crişan
authors.affiliation: Neurosurgical Clinic, Emergency County Hospital, University of Medicine and Pharmacy, Targu Mures, Romania.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bălaşa
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology; D004569:Electroencephalography; D005074:Evoked Potentials, Visual; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009188:Myelitis, Transverse / Q000209:etiology* / Q000473:pathology; D009471:Neuromyelitis Optica / Q000150:complications*; D012189:Retrospective Studies; D013116:Spinal Cord / Q000473:pathology; D044465:White People; D055815:Young Adult
keywords: Azathioprine; Devic disease; Longitudinal extensive transverse myelitis; Neuromyelitis optica