title: Imaging Surrogates of Disease Activity in Neuromyelitis Optica Allow Distinction from Multiple Sclerosis.
abstract: Inflammatory demyelinating lesions of the central nervous system are a common feature of both neuromyelitis optica and multiple sclerosis. Despite this similarity, it is evident clinically that the accumulation of disability in patients with neuromyelitis optica is relapse related and that a progressive phase is very uncommon. This poses the question whether there is any pathological evidence of disease activity or neurodegeneration in neuromyelitis optica between relapses. To investigate this we conducted a longitudinal advanced MRI study of the brain and spinal cord in neuromyelitis optica patients, comparing to patients with multiple sclerosis and controls. We found both cross-sectional and longitudinal evidence of diffusely distributed neurodegenerative surrogates in the multiple sclerosis group (including thalamic atrophy, cervical cord atrophy and progressive widespread diffusion and myelin water imaging abnormalities in the normal appearing white matter) but not in those with neuromyelitis optica, where localised abnormalities in the optic radiations of those with severe visual impairment were noted. In addition, between relapses, there were no new silent brain lesions in the neuromyelitis optica group. These findings indicate that global central nervous system neurodegeneration is not a feature of neuromyelitis optica. The work also questions the theory that neurodegeneration in multiple sclerosis is a chronic sequela to prior inflammatory and demyelinating pathology, as this has not been found to be the case in neuromyelitis optica where the lesions are often more destructive.
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Neurology Department, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Lucy
authors.initials: L
authors.lastname: Matthews
authors.affiliation: Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Kolind
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Alix
authors.initials: A
authors.lastname: Brazier
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Neurology Department, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Leite
authors.affiliation: Clinical Research and Imaging Centre (CRiCBristol), University of Bristol, Bristol, United Kingdom.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Brooks
authors.affiliation: Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada.
authors.forename: Anthony
authors.initials: A
authors.lastname: Traboulsee
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Mark
authors.initials: M
authors.lastname: Jenkinson
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.
authors.forename: Heidi
authors.initials: H
authors.lastname: Johansen-Berg
authors.affiliation: Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom; Neurology Department, Oxford University Hospitals NHS Trust, Oxford, United Kingdom.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Palace
mesh_terms: D000328:Adult; D000368:Aged; D001284:Atrophy / Q000473:pathology; D001921:Brain / Q000473:pathology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000473:pathology*; D009471:Neuromyelitis Optica / Q000473:pathology*; D012720:Severity of Illness Index; D013116:Spinal Cord / Q000473:pathology*; D055815:Young Adult