Neurology-Different nerve demyelinating diseases have huge differences in the evolution of the disease

Myelin-oligonucleotide-glycoprotein (MOG-IgG related disease (MOGAD), aquaporin-4-IgG positive neuromyelitis spectrum disorder (AQP4-IgG-NMOSD) and multiple sclerosis (MS) are central nervous system (CNS) Different inflammatory demyelinating diseases
.
Although there are some overlapping manifestations, previous studies have highlighted the main differences between these disease entities, especially regarding the severity of the attack and the clinical course

AQP4-IgG-NMOSD and MOGAD are characterized by severe attacks, usually leading to severe acute disability (such as paraplegia, encephalopathy, blindness), and often accompanied by brain (maximum diameter> 3 cm) or spinal cord (≥3 consecutive vertebrae) Segment) large MRI T2 lesions, and MS attacks are usually of lesser clinical severity and accompanied by smaller lesions of the brain/spine MRI, although some patients may develop tumorous MS lesions
.

However, in the long term, the course of these diseases generally does not reflect the severity of the initial attack
.
Patients with MOGAD often have better results than patients with AQP4-IgG-NMOSD, although there are similar severe attacks at the lowest point, and secondary progressive disability is basically unique to MS, although the onset of disease is more severe in this case.

In this way, Elia Sechi and others of Mayo Clinic explored the time evolution of demyelinating lesions on MRI in patients with MOGAD, AQP4-IgGNMOSD, and MS after a clinical attack on the brain or spinal cord
.

They retrospectively identified patients with MOGAD, AQP4-IgG-NMOSD or MS at the Mayo Clinic, as well as 1) brain or myelitis onset; 2) MRI with onset within 6 weeks; 3) follow-up MRI for more than 6 months , There is no interval recurrence in this area
.
Two neurologists identify the symptomatic or largest T2 lesion (first lesion) for each patient

There is a difference between age in MOGAD), AQP4-IgG-NMOSD and MS (P<0.
01), women are in the AQP4-IgG-NMOSD (41/51[80%]) and MS (51/67[76%]) groups There is a difference in MOGAD (17/38 [45%]), but not in patients with MOGAD (17/38 [45%])

Compared with AQP4-IgG-NMOSD, MOGAD's index T2 lesions have a higher frequency of complete remission
.

The size reduction of MOGAD and AQP4-IgG-NMOSD in sagittal spine MRI follow-up was similar (p=0.
4), which was greater than that of MS (23[0-152]) (p<0.

The important significance of this study lies in the discovery: MOGAD MRI T2 lesions are easier to completely dissipate than AQP4-IgG-NMOSD and MS
.
This is of significance for the diagnosis, monitoring of disease activity and clinical trial design, and also provides enlightenment for the pathogenesis of central nervous system demyelinating diseases

Original source:
Sechi E, Krecke KN, Messina SA, Buciuc M, Pittock SJ, Chen JJ, Weinshenker BG, Lopez-Chiriboga AS, Lucchinetti CF, Zalewski NL, Tillema JM, Kunchok A, Monaco S, Morris PP, Fryer JP, Nguyen A, Greenwood T, Syc-Mazurek SB, Keegan BM, Flanagan EP.
Comparison of MRI Lesion Evolution in Different Central Nervous System Demyelinating Disorders.
Neurology.
2021 Jul 14:10.
1212/WNL.
0000000000012467.
doi: 10.
1212/WNL.
0000000000012467.
Epub ahead of print.
PMID: 34261784.