Contributions
Abstract: P341
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Myelin oligodendrocyte glycoprotein (MOG)-antibody disease has recently been recognised. Transverse myelitis at onset is a significant predictor of long-term disability, particularly sphincter dysfunction. Few data exist about the MRI features and their clinical association.
Methods: Adult MOG-antibody-positive patients, attending our specialist service, with onset myelitis and appropriate imaging were identified. MRI scans were reviewed and associated with clinical outcomes and CSF findings.
Results: Of the 22 patients included; 77.3% had LETM; 22.7% had short TM; 9.1% had isolated cervical cord lesions, 40.9% had involvement of the thoracic cord (18.2% thoracic without conus extension, 22.7% thoracic and conus). The remainder involved both cervical and thoracic cord. In total, 47.8% of patients had lesions involving the conus. 52.2% had >1 lesion at onset (range:2-6).
Median EDSS at nadir was 6 (range:1-9). Nadir EDSS scores correlated with total lesion length (r=0.3532,p=0.0119). Median EDSS at recovery was 1 (range:0-6). Lesion length did not correlate with recovery EDSS. One patient was left severely disabled (EDSS 6) and was the oldest (70 years at onset). Lesion number, GAD enhancement and swelling did not associate significantly with clinical outcomes, nor did CSF findings. All patients requiring long-term catheterisation had conus lesions and this proportion was significant when compared to those not requiring catheters (p=0.0373). The presence of brainstem lesions was significantly higher in patients whose residual EDSS was ≥3 (p=0.035).
16/22 had follow-up scans. 56.3% showed complete resolution (mean follow-up=29 months), 43.7% showed some resolution or were stable (mean follow-up=26 months). The mean improvement in EDSS was greater in those with complete resolution (p=0.0339).
Conclusion: MOG-antibody disease myelitis commonly presents as LETM, although short lesions are not uncommon. Patients may present with more than one lesion. Lesion length correlates with nadir EDSS but not with recovery EDSS as most patients recover well despite long lesions at onset. Brainstem lesions may contribute to residual disability. Long-term catheter requirement is significantly associated with conus involvement and MRI resolution associates with better recovery.
Disclosure: R. Mariano is undertaking graduate studies funded by the Rhodes Trust.
K. Kumar has no disclosures.
G. dP has received scholarships from the ECTRIMS, the World Federation of Neurology, and Novartis; funding for research from Biogen, Novartis and Roche; travel grants from Roche, Sanofi-Genzyme and Teva; and fees for editorial content from Bayer, Merck Serono and Roche.
S. Messina has received travel grants from Biogen, Novartis, Bayer, Merck, Almirall and honorarium for advisory work from Biogen.
M. Leite reported being involved in aquaporin 4 testing, receiving support from the National Health Service National Specialised Commissioning Group for Neuromyelitis Optica and the National Institute for Health Research Oxford Biomedical Research Centre, receiving speaking honoraria from Biogen Idec, and receiving travel grants from Novartis.
J. Palace is partly funded by highly specialised services to run a national congenital myasthenia service and a neuromyelitis service. She has received support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Chugai Pharma and Bayer Schering, Alexion, Roche, Genzyme, MedImmune, EuroImmun, MedDay, Abide and ARGENX, and grants from Merck Serono, Novartis, Biogen Idec, Teva, Abide and Bayer Schering. Her hospital trust received funds for her role as clinical lead for the RSS, and she has received grants from the MS society and Guthy Jackson Foundation for research studies.
Abstract: P341
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - MS Variants
Introduction: Myelin oligodendrocyte glycoprotein (MOG)-antibody disease has recently been recognised. Transverse myelitis at onset is a significant predictor of long-term disability, particularly sphincter dysfunction. Few data exist about the MRI features and their clinical association.
Methods: Adult MOG-antibody-positive patients, attending our specialist service, with onset myelitis and appropriate imaging were identified. MRI scans were reviewed and associated with clinical outcomes and CSF findings.
Results: Of the 22 patients included; 77.3% had LETM; 22.7% had short TM; 9.1% had isolated cervical cord lesions, 40.9% had involvement of the thoracic cord (18.2% thoracic without conus extension, 22.7% thoracic and conus). The remainder involved both cervical and thoracic cord. In total, 47.8% of patients had lesions involving the conus. 52.2% had >1 lesion at onset (range:2-6).
Median EDSS at nadir was 6 (range:1-9). Nadir EDSS scores correlated with total lesion length (r=0.3532,p=0.0119). Median EDSS at recovery was 1 (range:0-6). Lesion length did not correlate with recovery EDSS. One patient was left severely disabled (EDSS 6) and was the oldest (70 years at onset). Lesion number, GAD enhancement and swelling did not associate significantly with clinical outcomes, nor did CSF findings. All patients requiring long-term catheterisation had conus lesions and this proportion was significant when compared to those not requiring catheters (p=0.0373). The presence of brainstem lesions was significantly higher in patients whose residual EDSS was ≥3 (p=0.035).
16/22 had follow-up scans. 56.3% showed complete resolution (mean follow-up=29 months), 43.7% showed some resolution or were stable (mean follow-up=26 months). The mean improvement in EDSS was greater in those with complete resolution (p=0.0339).
Conclusion: MOG-antibody disease myelitis commonly presents as LETM, although short lesions are not uncommon. Patients may present with more than one lesion. Lesion length correlates with nadir EDSS but not with recovery EDSS as most patients recover well despite long lesions at onset. Brainstem lesions may contribute to residual disability. Long-term catheter requirement is significantly associated with conus involvement and MRI resolution associates with better recovery.
Disclosure: R. Mariano is undertaking graduate studies funded by the Rhodes Trust.
K. Kumar has no disclosures.
G. dP has received scholarships from the ECTRIMS, the World Federation of Neurology, and Novartis; funding for research from Biogen, Novartis and Roche; travel grants from Roche, Sanofi-Genzyme and Teva; and fees for editorial content from Bayer, Merck Serono and Roche.
S. Messina has received travel grants from Biogen, Novartis, Bayer, Merck, Almirall and honorarium for advisory work from Biogen.
M. Leite reported being involved in aquaporin 4 testing, receiving support from the National Health Service National Specialised Commissioning Group for Neuromyelitis Optica and the National Institute for Health Research Oxford Biomedical Research Centre, receiving speaking honoraria from Biogen Idec, and receiving travel grants from Novartis.
J. Palace is partly funded by highly specialised services to run a national congenital myasthenia service and a neuromyelitis service. She has received support for scientific meetings and honorariums for advisory work from Merck Serono, Biogen Idec, Novartis, Teva, Chugai Pharma and Bayer Schering, Alexion, Roche, Genzyme, MedImmune, EuroImmun, MedDay, Abide and ARGENX, and grants from Merck Serono, Novartis, Biogen Idec, Teva, Abide and Bayer Schering. Her hospital trust received funds for her role as clinical lead for the RSS, and she has received grants from the MS society and Guthy Jackson Foundation for research studies.