Terézia Mazúrová, Ema Kantorová, Egon Kurča, Štefan Sivák
Introduction: Sclerosis multiplex (SM) a neuromyelitis optica (NMO)/neuromyelitis optica spectrum disorders (NMOSD) are autoimmune demyelinating inflammatory diseases afflicting the central nervous system. Long time NMO has been considered as just a variant of SM, nowadays it is perceived as an independent disease with its own diagnostic criteria and so it might be distinguished from SM with clinical, laboratory and imaging methods. The differentiation those two diagnosis is needed from the view their various therapy and prognosis. Our work aimed to find difference in the results of the first examinations and chosen parameters in patients with SM and NMO/NMOSD with the attack of optic neuritis, which would help to detect which disease it is in the particular case with the higher probability, in the shortest possible time.
Methodology: The investigated collection consisted of 10 patients with the SM diagnosis and 10 patients with NMO/NMOSD, who were and are treated in the Centre for SM in the University Hospital Martin and who had as the symptoms optic neuritis. In these two groups we compared: the age of the patient, in which the disease manifested, its symptoms, EDSS score, MRI of the brain and spinal cord, visually evoked potentials, examination of the vision, presence of anti AQP-4-IgG, presence of oligoclonal bands in the cerebrospinal fluid. To evaluate the difference between the groups of variables in both groups we use statistical methods.
Results: We found statistically significant differences in the observed groups when comparing the age of the disease onset, EDSS score and MRI of the brain and spinal cord. We found out that the average age of the disease onset was in the SM group 27.8 years, in NMO/NMOSD group it was by 9 years later, on average, at the age of 36.7 years. p = 0.009174 The assessment of the EDSS score showed that its average value was in patients with SM 2.1, in patients with NMO 4.2 (p = 0.046409). On average the patients with SM reached a higher MRI score (2.2) than the patients with NMO/NMOSD (1.6) according to by us created score system to detect the number of locations (0-3), in which lesions were located (p = 0.059724). The presence of antibodies against AQP4-IgG was detected in six NMO patients and in none of patients with SM. Positivity of oligoclonal bands in cerebrospinal fluid was detected in nine SM patients and in one patient with NMO. When we evaluated the examination of VEPs we used scoring system, the score in observed groups was different, however, without statistical significance. Comparison of examinations of visual acuity id not show a significant difference in the observed groups.
Conclusion: From the results and findings there results the possibility of SM and NMO/NMOSD distinguishing already at the beginning of diagnostics based on the different age of patients at the disease onset, EDSS score and brain and spinal cord imaging with MRI.