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<p><b>BACKGROUND</b>Although there were criteria for diagnosis of neuromyelitis optica (NMO) and multiple sclerosis (MS), it is still difficult to differentiate NMO from MS, due to the overlapping clinical manifestations. Therefore it is necessary to characterize clinical features of NMO and MS patients in the mainland of China, to simplify the process of disease diagnosis, and to identify criteria for the differential diagnosis of NMO and MS.</p><p><b>METHODS</b>A total of 138 Chinese Han patients from the mainland of China including 73 NMO, 60 MS and 5 MS-like patients with positive NMO-IgG were included in the study. Clinical records were reviewed retrospectively and the results of clinical examination, laboratory experiments, magnetic resonance imaging (MRI) and evoked potentials (EPs) were compared between NMO and MS patients. In addition, the relationship between the NMO-IgG serologic status and clinical characteristics were analyzed.</p><p><b>RESULTS</b>Compared with MS patients (1.3: 1.0), more female prevalence was observed in NMO patients (4.2: 1.0; P = 0.003). There were also statistically significant differences in visual EPs, oligoclonal bands, brainstem lesions in MRI and longitudinally extensive spinal cord lesions (LESCLs) between NMO and MS patients. Brainstem lesions observed in brain MRI were found in 17.9% of MS patients, over 3.7 times higher than in NMO patients (4.8%, P = 0.024). When stratified NMO patients by NMO-IgG, LESCLs were found in 42.1% of NMO-IgG-negative NMO patients, over 3.5 times higher than in NMO-IgG-positive patients (11.9%, P = 0.008). Statistical difference was also observed in CD4+/CD8+ ratios between NMO-IgG-positive and -negative NMO patients.</p><p><b>CONCLUSIONS</b>Comprehensive analysis of MRI, laboratory and EPs data can facilitate differential diagnosis of MS and NMO. In addition, the combination of LESCLs and brain MRI findings failing to satisfy MRI criteria for MS is highly sensitive and specific for NMO.</p>
Subject(s)
Adult , Female , Humans , Male , Middle Aged , China , Magnetic Resonance Imaging , Multiple Sclerosis , Diagnosis , Neuromyelitis Optica , Diagnosis , Retrospective StudiesABSTRACT
Objective To compare the clinic features of neuromyelitis optica (NMO) and multiple sclerosis(MS).To compare the positive rate of NMO-IgG in NMO,MS and other related diseases,and determine whether it can be considered as a biomarker for differential diagnosis.Methods Detected serum NMO-IgG in 34 NMO patients,22 MS patients,24 high risk syndrome,5 clinical isolated syndrome,and 35 patients with other neumlogical diseases.Compared the clinic features(onset age,severity,prognosis,MRI lesions,autoimmune antibodies,CSF)of 34 NMO patients and 22 MS patients.Results The onset age of NMO is older than that of MS.It is more severe and with worse prognosis than MS.Longitudinal spinal cord lesions are easily found in NMO.NMO-IgG positive rate in NMO and high risk syndrome patients are 58.8% (20/34)and 45.8%(11/24)respectively,which are higher than that in MS(1/22),clinical isolated syndrome(1/5)and other neurological diseases(1/35;x2=37.2,P<0.01).The positive rate may have a relationship with the length of spinal cord lesions.Condusions MS and NMO are probably different diseases.NMO-IgG positive rate in NMO is significandy higher than that in MS,it can be considered as a biomarker for differential diagnosis.
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Objective To study MRI characteristics of the gray matter lesions in multiple sclerosis (MS) patients, and to investigate the occult damage in normal appearing gray matter (NAGM) by quantitative analysis using diffusion tensor imaging (DTI). Methods Conventional brain MRI and DTI were performed in 34 clinically defined MS patients and 25 non-MS healthy volunteers. Main signs of the GMlesions detected by conventional MRI were analyzed, including the distribution, numbers, shape, size,signal intensity and enhanced pattern. The apparent diffusion coefficient (ADC) and fractional anisotropy (FA) values derived by DTI were measured in normal appearing deep gray matter for all participants and the differences between the two groups were compared. Results MRI examination revealed 83 lesions in cerebral gray matter, 18. 7% of the total 443 lesions. The GM lesions distributed over all brain lobes especially in frontal lobe, temporal lobe, and thalamus. Thirty-four, 60, 78, and 36 plaques were detected on T1WI, T,2WI, FLAIR, and reconstructed DWI images, respectively. Nine small lesions were identified on DWI more easily than on T2WI and FALIR. The ADC values of the head of caudatum (8. 0±0. 7) ×10-4mm2/s, t=-3.079, P<0.05), putamen (7.4±0.5)× 10-4mm2/s, t= -2.564, P<0.05),and thalamus (7.7± 0. 4) × 10-4mm<'2>/s, t = -2. 722, P < 0. 05) in MS group were significantly higher than those in healthy controls [ the ADC values of head of candatum (7.4 ± 0. 6) × 10-4 mm2/s, putamen(7.0±0.5) ×10-4 mm2/s,and thalamus(7.2±0.7)×10-4mm2/s]. Conclusions This study confirms the presence of GM damage in MS. It shows MRI characteristics of the macro-lesions, and combination of FLAIR and DWI can improve the detection of GM lesions. Occult micro-change in NAGM can be evaluated by using DTI quantitative analysis.
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Objective To study a monitoring instrument of multiple physiological parameters being capable of wireless long-distance transmission,low in power dissipation and price and small in size.Methods In combination of embedded technology and mobile communication technology,S3C2410 based on ARM9 core was used as main chip,ARM-Linux as embedded operation system and SIM300 as communication module connected to Internet,to complete wireless long-distance transmission of multiple physiological parameters.Results Tele-monitoring system of embedded multiple physiological parameters based on GPRS was realized.Conclusion The instrument is small,easily-expanded and reliable in the process of transmitting data,facilitating tele-monitoring and data sharing.