title: Is pruritus an indicator of aquaporin-positive neuromyelitis optica?
abstract: Recently, pruritus has been recognised as an important association with neuromyelitis optica spectrum disorders (NMOSD).
  
  
  
  To determine the clinical and radiological characteristics of patients with NMOSD and pruritus.
  
  
  
  Among 57 consecutive patients with NMOSD, 15 (26.3% women) reported pruritus. All had aquaporin-4 (AQP4) antibodies. The mean age was 34.5 ± 9.1 years, age at onset was 31.3 ± 11.0 years and the duration of illness was 3.9 ± 3.1 years. Pruritus preceded the neurological disturbances in all the patients. Predominant patients experienced pruritus in the cervical dermatome (66.7%) followed by cervicothoracic region (13.3%), trigeminal nerve (13.3%) and lumbar region (6.7%). Lesions extending from cervicomedullary junction up to the thoracic segment was the most common site of affection (40%) followed by cervicothoracic (26.7%), cervicomedullary junction to cervical cord (13.3%), cervical cord (6.7%) and thoracic segment (6.7%).
  
  
  
  This report is one of the largest series reporting the close association of pruritus with onset of neurological symptoms in NMOSD. It highlights the importance of recognising this rare symptom which may help in making a correct diagnosis in a patient with suspected demyelinating disorder. In a patient with NMOSD, early treatment with immunomodulation during pruritus may prevent or minimise occurrence of neurological dysfunction.
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Manjunath
authors.initials: M
authors.lastname: Netravathi
authors.affiliation: Department of Neuroimaging & Interventional Radiology (NIIR), National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Jitender
authors.initials: J
authors.lastname: Saini
authors.affiliation: Department of Neuropathology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Mahadevan
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Bollampalli
authors.initials: B
authors.lastname: Hari-Krishna
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Ravi
authors.initials: R
authors.lastname: Yadav
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Pramod Kumar
authors.initials: PK
authors.lastname: Pal
authors.affiliation: Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
authors.forename: Parthasarathy
authors.initials: P
authors.lastname: Satishchandra
mesh_terms: D000328:Adult; D051401:Aquaporin 4 / Q000276:immunology*; D001323:Autoantibodies / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D011537:Pruritus / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology
chemical_list: C496030:AQP4 protein, human; D051401:Aquaporin 4; D001323:Autoantibodies
keywords: NMO; NMOSD; itch; neuromyelitis optica; pruritus