Abstract Details

Title Clinical Characteristics of Subacute vs. Acute Presentations of Neuromyelitis Optica Spectrum Disorder

Topic Multiple Sclerosis

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 20-012

Objective

To elucidate whether subacute initial presentations of neuromyelitis optica spectrum disorder (NMOSD) exhibit different clinical characteristics than acute presentations.

Background

NMOSD is a demyelinating auto-immune disease involving blood-brain barrier disruption and repeated immune infiltration of the central nervous system. Patients experience symptoms ranging from vision loss to extremity weakness. Existing studies on NMOSD have largely focused on acute presentations while subacute presentations and their management remain underexplored.

Design/Methods

A multi-center retrospective cohort study of patients in southern New Jersey diagnosed with NMOSD was undertaken. Subacute NMOSD presentations were defined as symptoms lasting more than 7 days and acute presentations as less than 7 days. Data was collected on patients’ ages, sex, symptoms, CSF findings, anti-AQP-4 positivity, initial treatment, and relapse after initial presentation.

Results From 43 NMOSD patients, 34 patients with acuity data were included of whom 15 had subacute presentations. Subacute patients had a younger median age than acute patients (36 years, IQR: 31.5-39 vs. 37 years, IQR: 29-46.5) with a lower proportion of males (13.3% vs. 42.1%). The most common subacute presenting symptom was sensory loss (53.3%). Lower extremity weakness (52.6%) and visual symptoms (52.6%) were most common for acute patients. Inflammatory CSF findings, defined as WBC count >5 cells/μL or protein >50 mg/dL, were less common in subacute (60.0% vs. 63.2%) patients. Anti-AQP-4 positivity was more common in subacute patients (53.3% vs. 26.3%). Steroids alone were the most common initial treatment for subacute (53.3%) and acute (47.4%) patients. Combined steroid and plasmapheresis treatment was less common in subacute patients (33.3% vs. 42.1%). Relapse was more common in subacute than acute patients (60.0% vs. 42.1%).

Conclusions While subacute NMOSD presentations may trend toward greater association with female sex, sensory symptoms, non-inflammatory CSF findings, anti-AQP-4 positivity, and relapse than acute presentations, additional studies with larger sample sizes are needed to validate these trends.

Authors/Disclosures
Humza Qureshi PRESENTER	Mr. Qureshi has nothing to disclose.
Ashutosh K. Gupta	Mr. Gupta has nothing to disclose.
Aswathi Sajeendran, MD	Dr. Sajeendran has nothing to disclose.
Anjali Patel	Miss Patel has nothing to disclose.
Donald A. Barone, DO (Cooper Neurologic Institute)	Dr. Barone has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Vanda. Dr. Barone has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Serono.
Cris S. Constantinescu, MD, PhD (Cooper Neurological Institute)	Dr. Constantinescu has received publishing royalties from a publication relating to health care.
Olga R. Thon, MD (Cooper Neurological Institute)	Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech. Dr. Thon has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Horizon. Dr. Thon has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Horizon.
Judy Diep, MD	Dr. Diep has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for TG Therapeutics .

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