title: Clinical characteristics of disabling attacks at onset in patients with neuromyelitis optica spectrum disorder.
abstract: BACKGROUND
  Individual attacks of neuromyelitis optica (NMO) are generally severe enough to cause disability even after the onset attack. We aimed to elucidate the clinical characteristics of disabling attacks at the onset of NMO.
  
  
  METHODS
  We investigated the clinical characteristics at onset and at first relapse in patients with NMO or NMO spectrum disorder with seropositive for the anti-aquaporin-4 antibody. A disabling attack at onset (DAO) was defined as an onset attack in which, at best recovery (allowing up to one year), patients were unable to walk without assistance or were left functionally blind in at least one affected eye.
  
  
  RESULTS
  Fifty-seven patients were enrolled (53 females; onset age, 41.9±14.8years). Ten patients (17.5%) had a DAO; four had become unable to walk without assistance following myelitis, and six had severe visual impairment following optic neuritis despite rescue treatments. Attack severity at nadir was the only clinical factor predicting a DAO (odds ratio, 2.120; 95% CI, 1.162-3.869; P=0.014). The use of immunosuppressants delayed the interval to the first relapse (P=0.003).
  
  
  CONCLUSIONS
  Our study showed characteristics of NMO onset attacks that caused severe disability. However, no clinically modifiable factors predicted disabling attacks, except attack severity.
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
authors.forename: Jin Myoung
authors.initials: JM
authors.lastname: Seok
authors.affiliation: Department of Neurology, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, South Korea.
authors.forename: Eun Bin
authors.initials: EB
authors.lastname: Cho
authors.affiliation: Department of Neurology, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Chungbuk, South Korea.
authors.forename: Hye Lim
authors.initials: HL
authors.lastname: Lee
authors.affiliation: Department of Neurology, The Catholic University of Korea, College of Medicine, Bucheon St. Mary's Hospital, Bucheon, South Korea.
authors.forename: Hye-Jin
authors.initials: HJ
authors.lastname: Cho
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
authors.forename: Ju-Hong
authors.initials: JH
authors.lastname: Min
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
authors.forename: Kwang Ho
authors.initials: KH
authors.lastname: Lee
authors.affiliation: Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Neuroscience Center, Samsung Medical Center, Seoul, South Korea. Electronic address: bjkim@skku.edu.
authors.forename: Byoung Joon
authors.initials: BJ
authors.lastname: Kim
mesh_terms: D000293:Adolescent; D000328:Adult; D000906:Antibodies / Q000097:blood; D051401:Aquaporin 4 / Q000276:immunology; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009471:Neuromyelitis Optica / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology*; D012189:Retrospective Studies
chemical_list: D000906:Antibodies; D051401:Aquaporin 4; D007166:Immunosuppressive Agents
keywords: Disability; Disabling attack; Neuromyelitis optica; Neuromyelitis optica spectrum disorder; Onset attack