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Background: Using an anti-aquaporin-4 (AQP4) antibody assay discovered in 2005, Japanese patients with neuromyelitis optica (NMO) can easily be differentially diagnosed from those with opticospinal multiple sclerosis (MS). Therefore, many patients with NMO and NMO spectrum disorders have been treated with oral corticosteroid (CS). The suppressive effects of relapses during CS treatment have been shown (Watanabe S et al. Mult Scler. 2007). However, the time course of relapses in NMO patients after CS treatment has not been known. Objectives: To elucidate the changes in relapses rates after CS treatment in patients with NMO and NMO spectrum disorders. Methods: We retrospectively reviewed the medical records of 91 consecutive patients with anti-AQP4 antibodies presenting at our MS center between 2005 and 2010. Those treated with oral CS for more than 2 years were enrolled. Patients who also received mitoxantrone (17 patients) or rituximab (5 patients) were excluded. We compared annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) scores before and after CS treatment. Results: Ten patients (8 NMO, 2 NMO spectrum), all female, were treated with oral CS for more than 2 years. The mean age at onset was 40.6 years (range 23-54 years). The average ARR during the 2 years before CS therapy was 2.45 (range 1-5), which rose to 3.40 during the 6 months just before CS induction. The average ARR was markedly decreased to 0.5 (range 0-2) after 2 years of CS therapy, and showed rapid reduction to 0.8 at only six months after CS induction. Suppression persisted for 2 years. EDSS scores were not affected by CS treatment. Conclusions: Most NMO patients showed rapid reduction of ARR after CS treatment.

Read More: Time course of relapses after treatment with oral corticosteroid in Japanese neuromyelitis optica patients