AI Article Synopsis
- This study addresses the difficulty in differentiating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS), particularly in borderline cases due to the absence of clear biomarkers.
- Researchers sought to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome using MRI and an unsupervised algorithm.
- Four subgroups were identified: "MS-like," "spinal MS-like," "classic NMO-like," and "NMO-like with brain involvement," each with unique features and potential implications for tailored treatment approaches.
Article Abstract
Background: Separating antibody-negative neuromyelitis optica spectrum disorders (NMOSD) from multiple sclerosis (MS) in borderline cases is extremely challenging due to lack of biomarkers. Elucidating different pathologies within the likely heterogenous antibody-negative NMOSD/MS overlap syndrome is, therefore, a major unmet need which would help avoid disability from inappropriate treatment.
Objective: In this study we aimed to identify distinct subgroups within the antibody-negative NMOSD/MS overlap syndrome.
Methods: Twenty-five relapsing antibody-negative patients with NMOSD features underwent a prospective brain and spinal cord MRI. Subgroups were identified by an unsupervised algorithm based on pre-selected NMOSD/MS discriminators.
Results: Four subgroups were identified. Patients from Group 1 termed "MS-like" (n = 6) often had central vein sign and cortical lesions (83% and 67%, respectively). All patients from Group 2 ("spinal MS-like", 8) had short-segment myelitis and no MS-like brain lesions. Group 3 ("classic NMO-like", 6) had high percentage of bilateral optic neuritis and longitudinally extensive transverse myelitis (LETM, 80% and 60%, respectively) and normal brain appearance (100%). Group 4 ("NMO-like with brain involvement", 5) typically had a history of NMOSD-like brain lesions and LETM. When compared with other groups, Group 4 had significantly decreased fractional anisotropy in non-lesioned tracts (0.46 vs. 0.49, p = 0.003) and decreased thalamus volume (0.84 vs. 0.98, p = 0.04).
Conclusions: NMOSD/MS cohort contains distinct subgroups likely corresponding to different pathologies and requiring tailored treatment. We propose that non-conventional MRI might help optimise diagnosis in these challenging patients.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8738499 | PMC |
| http://dx.doi.org/10.1007/s00415-021-10619-1 | DOI Listing |
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