Abstract Details

Title Is There a Prodrome to NMOSD? An Investigation of Neurologic Symptoms Preceding the First NMOSD Attack

Topic Autoimmune Neurology

Presentation(s) P11 - Poster Session 11 (5:30 PM-6:30 PM)

Poster/Presentation
Number 14-005

Objective To evaluate if patients with aquaporin-4 antibody positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) have prodromal neurologic symptoms preceding the first NMOSD attack.

Background It is unknown whether patients with AQP4+ NMOSD experience a prodrome, although there are cases reported of positive AQP4 serology up to 16 years before the first attack.

Design/Methods We retrospectively reviewed medical records of patients from four demyelinating disease centres across Canada who were enrolled in the Canadian NMOSD and other atypical demyelinating diseases cohort study (CANOPTICS). Participants had a diagnosis of AQP4+ NMOSD by 2015 criteria. We searched for neurologic symptoms occurring at least 30 days before the first attack. We excluded episodes where diagnosis was delayed, but in retrospect symptoms were attacks consistent with 2015 criteria. Findings were summarized descriptively.

Results Out of 116 patients with AQP4+ NMOSD, 18 (15.5%) had prodromal neurologic symptoms. Median age was 48.5 years (range 25-83) at first attack; 17 (94.4%) were female. Patients had a history of numbness (n=9), neuropathic pain (n=5), visual disturbance (n=4), tonic spasms (n=2), Lhermitte sign (n=2), severe headache (n=2), incoordination (n=2), weakness (n=1), psychosis (n=1), seizure (n=1), or tremor (n=1). Symptoms were constant (n=11) or intermittent (n=9), and 10 (55.6%) had more than one symptom. Five of 8 (62.5%) who underwent MRI had T2 hyperintense lesions that were not classic for NMOSD. Five (27.8%) had symptoms that persisted until their first attack, while 13 (72.2%) had complete resolution of symptoms with a median duration of 4 weeks (range 2 minutes-16 weeks). Within 1.5-245 months (median 16) patients experienced their first NMOSD attack with transverse myelitis (n=10), optic neuritis (n=5), area postrema syndrome (n=1), brainstem/cerebellar syndrome (n=1), or cerebral syndrome (n=1).

Conclusions Some patients may experience prodromal neurologic symptoms prior to the first NMOSD attack. Further systematic investigation of a possible NMOSD prodrome is warranted.

Authors/Disclosures
Sydney Lee, MD (Adult Neurology Program, University of Toronto) PRESENTER	Dr. Lee has nothing to disclose.
Ruth-Ann Marrie, MD, PhD (University of Manitoba)	The institution of Dr. Marrie has received research support from CIHR. The institution of Dr. Marrie has received research support from MS Canada. The institution of Dr. Marrie has received research support from National MS Society. The institution of Dr. Marrie has received research support from Crohn's and Colitis Canada. The institution of Dr. Marrie has received research support from US Department of Defense. The institution of Dr. Marrie has received research support from The Arthritis Society. The institution of Dr. Marrie has received research support from CMSC.
Giulia Fadda, MD (University of Ottawa)	Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amgen/Horizon Therapeutics. Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for roche. Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Fadda has received personal compensation in the range of $500-$4,999 for serving as a Speaker with Novartis.
Liesly Lee, MD (Sunnybrook Health Sciences Centre)	Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi-Aventis. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving as a Consultant for EMD Serono. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Lee has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis.
Alexandra Muccilli, MD (Saint Michael's Hospital - Multiple Sclerosis Clinic)	Dr. Muccilli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Muccilli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. Dr. Muccilli has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Muccilli 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.
Manav Vyas, MD (MV VYAS MEDICINE PROFESSIONAL CORPORATION)	The institution of Dr. Vyas has received research support from Heart and Stroke Foundation of Canada . The institution of Dr. Vyas has received research support from Canadian Institutes of Health Research . Dr. Vyas has received research support from Heart and Stroke Foundation of Canada .
Andrea Konig (St. Michael's Hospital)	No disclosure on file
Dalia Rotstein, MD	Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Novartis. Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen/Horizon . Dr. Rotstein 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 . Dr. Rotstein 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. Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanofi Aventis. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis . Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD Serono. Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Alexion . Dr. Rotstein has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Novartis. Dr. Rotstein has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Amgen. The institution of Dr. Rotstein has received research support from MS Canada. The institution of Dr. Rotstein has received research support from National MS Society. Dr. Rotstein has received research support from Li Ka Shing Knowledge Institute. The institution of Dr. Rotstein has received research support from University of Toronto Division of Neurology. The institution of Dr. Rotstein has received research support from Canada's Drug Agency. The institution of Dr. Rotstein has received research support from Amgen. The institution of Dr. Rotstein has received research support from Alexion. The institution of Dr. Rotstein has received research support from Guthy Jackson Foundation .

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