Author Of 2 Presentations
P0251 - Early factors associated with later conversion to multiple sclerosis in patients presenting with isolated myelitis (ID 1848)
Abstract
Background
In patients presenting with ‘transverse myelitis’ without clinical or radiological evidence of inflammation/demyelination elsewhere in the central nervous system (i.e. isolated myelitis), it remains challenging to predict risk of later conversion to multiple sclerosis (MS).
Objectives
To identify early clinical and paraclinical factors that may help predict later conversion to MS in patients presenting with isolated myelitis.
Methods
In this retrospective cohort study, we examined a carefully defined population of patients who attended our specialized myelopathy clinic from 2010 to 2018. We included patients diagnosed with isolated myelitis who were followed clinically and radiologically for at least 1 year. We excluded patients with known MS (defined by the 2017 revised McDonald criteria), aquaporin-4 (AQP4)-IgG seropositivity, myelin oligodendrocyte glycoprotein (MOG)-IgG seropositivity, or other identified etiology of myelitis. Logistic regression was used to identify factors predictive of conversion to MS during follow-up.
Results
We included 100 patients (mean age 40.5 years [SD 12.6], 60% female). Over a median follow-up period of 4.3 years (range, 1.0-17.4 years), 25 patients (25%) converted to MS. Conversion to MS occurred in 25 of 77 patients (32%) with short-segment myelitis (longest cord lesion spanning <3 vertebral segments on MRI) as compared to zero of 23 patients with longitudinally-extensive myelitis (0%, p=0.002). Amongst patients with short-segment myelitis, factors identified as highly predictive of conversion to MS using multivariable logistic regression included positive cerebrospinal fluid (CSF)-restricted oligoclonal bands (adjusted odds ratio [OR] 9.18, 95% CI 2.06 to 41.02, p=0.004), younger age (adjusted OR 1.06 for each year younger, 95% CI 1.00 to 1.12, p=0.04) and longer follow-up period (adjusted OR 1.25 for each year longer, 95% CI 1.01 to 1.55, p=0.04). Conversion to MS occurred at a median of 2.77 years (range 0.20-4.39) after onset of myelitis.
Conclusions
Short-segment MRI cord lesion(s), positive CSF-restricted oligoclonal bands, younger age, and longer follow-up are all factors predictive of conversion to MS in patients presenting with isolated myelitis. Conversion to MS typically occurs within a few years after a bout of isolated myelitis, emphasizing the importance of close clinical and radiological follow-up after such an attack.
P0685 - AQP4-IgG and MOG-IgG related optic neuritis – prevalence, optical coherence tomography findings, visual outcomes: systematic review and meta-analysis (ID 860)
Abstract
Background
Optic neuritis (ON) is a cardinal manifestation of multiple sclerosis (MS), aquaporin-4 (AQP4)-IgG, and myelin oligodendrocyte glycoprotein (MOG)-IgG associated disease. However, the prevalence of AQP4-IgG seropositivity and MOG-IgG seropositivity in isolated ON is unclear, and studies comparing visual outcomes and optical coherence tomography (OCT)-derived structural retinal measures between MS-ON, AQP4-ON, and MOG-ON eyes are limited by small sample sizes.
Objectives
1) To assess the prevalence of AQP4-IgG and MOG-IgG seropositivity among patients presenting with isolated ON; 2) To compare visual outcomes and OCT measures between AQP4-ON, MOG-ON, and MS-ON eyes.
Methods
In this systematic review and meta-analysis, a total of 65 eligible studies were identified by Pubmed search. Statistical analyses were performed with random-effects models.
Results
In adults with isolated ON, AQP4-IgG seroprevalence was 4% in non-Asian and 27% in Asian populations, whereas MOG-IgG seroprevalence was 8% and 20% respectively. In children, AQP4-IgG seroprevalence was 0.4% in non-Asian and 15% in Asian populations, whereas MOG-IgG seroprevalence was 47% and 31% respectively. AQP4-ON eyes had lower peri-papillary retinal nerve fiber layer (pRNFL; -11.7μm, 95% CI: -15.2 to -8.3μm) and macular ganglion cell + inner plexiform layer (GCIPL; -9.0μm, 95% CI -12.5 to -5.4μm) thicknesses compared with MS-ON eyes, but these measures did not differ between AQP4-ON and MOG-ON eyes (pRNFL: -1.9μm, 95% CI: -9.1 to 5.4μm; GCIPL: -2.6μm, 95% CI: -8.9 to 3.8μm). Similar to AQP4-ON, pRNFL (-11.2μm, 95% CI -21.5 to -0.9μm) and GCIPL (-6.1μm, 95% CI -10.8 to -1.3μm thicknesses were lower in MOG-ON compared to MS-ON eyes. Visual outcomes were worse in AQP4-ON compared to both MOG-ON (mean logMAR difference: 0.60, 95% CI 0.39 to 0.81) and MS-ON eyes (mean logMAR difference: 0.68, 95% CI 0.40 to 0.96), but were similar in MOG-ON and MS-ON eyes (mean logMAR difference: 0.04, 95% CI: -0.05 to 0.14).
Conclusions
AQP4-IgG and MOG-IgG associated disease are important diagnostic considerations in adults presenting with isolated ON, especially in Asian populations. Furthermore, MOG-IgG seroprevalence is especially high in pediatric isolated ON, in both non-Asian and Asian populations. Despite a similar severity of GCIPL and pRNFL thinning in AQP4-ON and MOG-ON, AQP4-ON is associated with markedly worse visual outcomes.