Abstract Details

Title The Frequency of Longitudinally Extensive Transverse Myelitis in Multiple Sclerosis in the Era of Glial Biomarkers; A Population-Based Study

Topic Multiple Sclerosis

Presentation(s) P4 - Poster Session 4 (5:30 PM-6:30 PM)

Poster/Presentation
Number 15-055

Objective

To determine the frequency of longitudinally extensive transverse myelitis (LETM) in multiple sclerosis (MS) patients at the time of their myelitis attack.

Background

A wide range of frequencies for LETM in MS was previously reported. These studies have only occasionally assessed for aquaporin-4-IgG (AQP4-IgG) but never for myelin oligodendrocyte glycoprotein-IgG (MOG-IgG). Both of these glial biomarkers commonly associate with LETM.

Design/Methods

We identified patients using a population-based sero-epidemiology biorepository of Olmsted County residents on 12/31/2011 with inflammatory demyelinating disease (IDD). Inclusion criteria were: 1) Myelitis episode with new spinal MRI lesion (≤6 weeks from onset); 2) MS diagnosis by 2010 McDonald criteria; 3) Seronegative for AQP4-IgG and MOG-IgG. We determined the characteristics of these patients including the frequency of LETM.

Results Sixty-six patients with one or more myelitis episode were included. Eighty-seven myelitis attacks accompanied by a new MRI spinal cord lesion were identified. The median age at myelitis attack was 41 years (range, 16-65) and 50 patients (76%) were female. One of the attacks (1.1%) was associated with a LETM lesion on MRI, and despite meeting MS criteria, this patient had atypical features (lacked oligoclonal bands, central lesion, and resolution of all lesions in follow-up). Two MS patients (2.3% of attacks) had multiple short lesions that resembled LETM on sagittal images but axial images confirmed multiple non-contiguous short lesions rather than a true LETM. Most cord lesions were cervical (82%), peripherally located (89%) and gadolinium-enhancing (56%).

Conclusions LETM is rare in MS and its presence should prompt evaluation for AQP4-IgG, MOG-IgG or other etiologies. Careful scrutiny of axial images is important when a sagittal image suggests a longitudinally-extensive lesion as the coalescence of multiple short MS lesions can be mistaken for LETM.

Authors/Disclosures
Solmaz Asnafi, MD (JFK Medical Center) PRESENTER	No disclosure on file
	No disclosure on file
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology)	Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Brian G. Weinshenker, MD, FAAN (University of Virginia Health System)	Dr. Weinshenker has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CANbridge Pharmaceuticals. Dr. Weinshenker has received personal compensation in the range of $0-$499 for serving as a Consultant for CALIBR. Dr. Weinshenker has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Group (Chugai, Genentech, Roche). Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharmaceuticals. Dr. Weinshenker has received research support from Guthy Jackson Charitable Foundation. Dr. Weinshenker has received intellectual property interests from a discovery or technology relating to health care.
Jacqueline Palace (John Radcliff Hospital Oxford Univeristy Hospitals Trust)	Dr. Palace has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Merck Serono, Medimmune, Argenx, Janssen, AMgen, UCB, Roche, Novartis, Amplo, Alexion, . Dr. Palace has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Argenx, Sanofi. Dr. Palace has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Roche, UCB, Alexion, Amgen. Dr. Palace has or had stock in Astra Zenica. The institution of Dr. Palace has received research support from Roche, AMPLO, Alexion, UCB,. argenx, amgen. Dr. Palace has received intellectual property interests from a discovery or technology relating to health care.
Silvia Messina (AOU Policlinico Vittorio Emanuele)	No disclosure on file
Elia Sechi, MD (University of Sassari)	Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Alexion. Dr. Sechi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Argenx.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic)	The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Merck. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology that is relevant to AAN interests or activities.

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