Contributions
Abstract: P309
Type: Poster
Abstract Category: Clinical aspects of MS - 2 MS Variants
Introduction: We have recently undertaken a clinical survey of NMOSD across Australia and New Zealand; here we focussed on a detailed analysis of relapse histories with the aim of better defining the clinical features of this condition.
Methods: We performed a clinical survey of NMOSD through 23 demyelinating disease clinics. Identification of cases was based on clinical criteria using features identified as being of high risk for NMOSD. Demographic and clinical information, including relapse histories, were recorded using a standardised questionnaire. NMOSD cases were defined using the 2015 Wingerchuk criteria.
Results: Of 177 cases of suspected NMOSD, 11 (6%) were excluded. NMOSD was confirmed in 75/166 (45%) cases. AQP4 antibodies were positive in 67/75 (89%) cases. Information for 328 relapses was available for analysis in the 75 cases. The most common types of relapse were transverse myelitis (48%) and optic neuritis (40%). Brainstem (9%), including area postrema (3%), and cerebral (1%) relapses were less common. Multifocal relapses were quite uncommon with optic neuritis and transverse myelitis being the most common combination (2%). Optic neuritis relapses were more common in cases with Asian ancestry (46/87 (53%) vs 85/241 (35%); p< 0.01). There was no significant difference in the pattern of relapses according to gender or serostatus. Analysis of month of relapse did not show any statistically significant variance from the expected distribution and there was no clear seasonal pattern. Area postrema syndromes were more common as a first relapse (9%) compared to overall and analysis of relapse by age suggested a predominance of optic neuritis prior to the age of 30 years with transverse myelitis being more common later. In 193/328 (59%) attacks IV steroids were given and 41/328 (13%) were treated with plasma exchange. Recovery data was available for 271 attacks and was full in 80 (30%), partial in 167 (62%) and nil in 24 (9%).
Conclusions: This cohort of NMOSD patients represents approximately 50% of the known cases in Australia and New Zealand. These data indicate that optic neuritis and transverse myelitis are the most common types of relapse and that simultaneous multifocal attacks are relatively uncommon. Attacks of optic neuritis predominate over spinal attacks under the age of 30 years, but this pattern is reversed thereafter. Optic neuritis may be more common in cases with Asian ancestry. Recovery is incomplete in the majority of relapses.
Disclosure: SAB is PI for a clinical trial sponsored by Alexion Pharmaceuticals.
ANZ NMO Collaborators: Wajih Bukhari, Elham Khalili, Laura Clarke, Kerri M Prain, Patrick Waters, Mark Woodhall, Cullen O'Gorman, Roger Silvestrini, Christine S Bundell, David Abernethy, Sandeep Bhuta, Stefan Blum, Mike Boggild, Karyn Boundy,Bruce J Brew, Matthew Brown, Wallace Brownlee, Helmut Butzkueven, William M Carroll, Celia Chen, Alan Coulthard, Russell C Dale, Chandi Das, Keith Dear, Marzena J Fabis-Pedrini, David Fulcher, David Gillis, Simon Hawke, Robert Heard, Andrew P D Henderson, Saman Heshmat, Suzanne Hodgkinson, Sofia Jimenez-Sanchez, Trevor J Kilpatrick, John King, Chris Kneebone, Andrew J Kornberg, Jeannette Lechner-Scott, Ming-Wei Lin, Christopher Lynch, Richard A L Macdonnell, Deborah F Mason, Pamela A McCombe, Michael P Pender, Jennifer Pereira, John D Pollard, Stephen W Reddell, Cameron Shaw, Judith Spies, James Stankovich, Ian Sutton, Steve Vucic, Michael Walsh, Richard C Wong, Eppie M Yiu, Michael H Barnett, Allan G Kermode, Mark P Marriott, John Parratt, Mark Slee, Bruce V Taylor, Ernest Willoughby, Robert J Wilson, Angela Vincent, Simon A Broadley.
This project was undertaken by the Australia and New Zealand Neuromyelitis Optica (ANZ NMO) Collaboration and was supported by funding from Multiple Sclerosis Research Australia, the Brain Foundation, Griffith University and the Gold Coast Hospital Foundation. The work in Oxford was supported by the National Health Service National Specialised Commissioning Group for Neuromyelitis Optica and the National Institute for Health Research Oxford Biomedical Research Centre. We are grateful to the study participants and would like to thank the support of the members of the Australian and New Zealand Association of Neurologists and Multiple Sclerosis Nurses Australia who assisted with data collection.
Abstract: P309
Type: Poster
Abstract Category: Clinical aspects of MS - 2 MS Variants
Introduction: We have recently undertaken a clinical survey of NMOSD across Australia and New Zealand; here we focussed on a detailed analysis of relapse histories with the aim of better defining the clinical features of this condition.
Methods: We performed a clinical survey of NMOSD through 23 demyelinating disease clinics. Identification of cases was based on clinical criteria using features identified as being of high risk for NMOSD. Demographic and clinical information, including relapse histories, were recorded using a standardised questionnaire. NMOSD cases were defined using the 2015 Wingerchuk criteria.
Results: Of 177 cases of suspected NMOSD, 11 (6%) were excluded. NMOSD was confirmed in 75/166 (45%) cases. AQP4 antibodies were positive in 67/75 (89%) cases. Information for 328 relapses was available for analysis in the 75 cases. The most common types of relapse were transverse myelitis (48%) and optic neuritis (40%). Brainstem (9%), including area postrema (3%), and cerebral (1%) relapses were less common. Multifocal relapses were quite uncommon with optic neuritis and transverse myelitis being the most common combination (2%). Optic neuritis relapses were more common in cases with Asian ancestry (46/87 (53%) vs 85/241 (35%); p< 0.01). There was no significant difference in the pattern of relapses according to gender or serostatus. Analysis of month of relapse did not show any statistically significant variance from the expected distribution and there was no clear seasonal pattern. Area postrema syndromes were more common as a first relapse (9%) compared to overall and analysis of relapse by age suggested a predominance of optic neuritis prior to the age of 30 years with transverse myelitis being more common later. In 193/328 (59%) attacks IV steroids were given and 41/328 (13%) were treated with plasma exchange. Recovery data was available for 271 attacks and was full in 80 (30%), partial in 167 (62%) and nil in 24 (9%).
Conclusions: This cohort of NMOSD patients represents approximately 50% of the known cases in Australia and New Zealand. These data indicate that optic neuritis and transverse myelitis are the most common types of relapse and that simultaneous multifocal attacks are relatively uncommon. Attacks of optic neuritis predominate over spinal attacks under the age of 30 years, but this pattern is reversed thereafter. Optic neuritis may be more common in cases with Asian ancestry. Recovery is incomplete in the majority of relapses.
Disclosure: SAB is PI for a clinical trial sponsored by Alexion Pharmaceuticals.
ANZ NMO Collaborators: Wajih Bukhari, Elham Khalili, Laura Clarke, Kerri M Prain, Patrick Waters, Mark Woodhall, Cullen O'Gorman, Roger Silvestrini, Christine S Bundell, David Abernethy, Sandeep Bhuta, Stefan Blum, Mike Boggild, Karyn Boundy,Bruce J Brew, Matthew Brown, Wallace Brownlee, Helmut Butzkueven, William M Carroll, Celia Chen, Alan Coulthard, Russell C Dale, Chandi Das, Keith Dear, Marzena J Fabis-Pedrini, David Fulcher, David Gillis, Simon Hawke, Robert Heard, Andrew P D Henderson, Saman Heshmat, Suzanne Hodgkinson, Sofia Jimenez-Sanchez, Trevor J Kilpatrick, John King, Chris Kneebone, Andrew J Kornberg, Jeannette Lechner-Scott, Ming-Wei Lin, Christopher Lynch, Richard A L Macdonnell, Deborah F Mason, Pamela A McCombe, Michael P Pender, Jennifer Pereira, John D Pollard, Stephen W Reddell, Cameron Shaw, Judith Spies, James Stankovich, Ian Sutton, Steve Vucic, Michael Walsh, Richard C Wong, Eppie M Yiu, Michael H Barnett, Allan G Kermode, Mark P Marriott, John Parratt, Mark Slee, Bruce V Taylor, Ernest Willoughby, Robert J Wilson, Angela Vincent, Simon A Broadley.
This project was undertaken by the Australia and New Zealand Neuromyelitis Optica (ANZ NMO) Collaboration and was supported by funding from Multiple Sclerosis Research Australia, the Brain Foundation, Griffith University and the Gold Coast Hospital Foundation. The work in Oxford was supported by the National Health Service National Specialised Commissioning Group for Neuromyelitis Optica and the National Institute for Health Research Oxford Biomedical Research Centre. We are grateful to the study participants and would like to thank the support of the members of the Australian and New Zealand Association of Neurologists and Multiple Sclerosis Nurses Australia who assisted with data collection.