Value of anti-aquaporin 4 antibody in conversion of brainstem clinically isolated syndrome / 中华神经医学杂志

ABSTRACT

Objective Brainstem clinically isolated syndrome (BCIS) may herald multiple sclerosis (MS) or neuromyelitis (NMO),or it may occur as an isolated syndrome.However,the role of anti-aquaporin 4 antibodies in the conversion of BCIS to NMO remains uncertain.Methods Thirty-one BCIS patients hospitalized in our hospital from July 2006 to December 2010 were chosen in our study;their clinical data were retrospectively analyzed;according to the presence of anti-AQP4 antibodies,they divided into two groups:anti-AQP4(+)BCIS group (n=14) and anti-AQP4(-)BCIS group (n=l 7).The differences of clinical manifestations,imaging features and cerebrospinal fluid level between the two groups were compared and the conversion of patients from the two groups was analyzed.Results Nine (64.29％) anti-AQP4 (+)BCIS patients converted to NMO,while only two (11.76％) anti-AQP4 (-)BCIS patients progressed to NMO,over a mean follow-up period of 36.10± 18.94 months;significant difference of conversion rate was noted between the two groups (P＜0.05).Anti-AQP4(+)BCIS patients demonstrated a higher immunogamm globulin (IgG) index (0.68±0.43 vs.0.47±0.19,P=0.018) and Kurtzke Expanded Disability Status Scale (EDSS) scores at the last visit of follow-up 0.64±0.92 vs.2.71±0.81,P=0.000) than anti-AQP4 (-)BCIS patients.Gastroenterology-related brainstem symptoms occurred more frequently in anti-AQP4(+)BCIS patients than that in anti-AQP4(-)BCIS patients (71.43％ vs.23.53％,P=0.001).In brainstem MR imaging,the anti-AQP4(+)BCIS patients were observed having medulla-predominant involvement in the sagittal view (78.57％) and dorsal-predominant involvement in the axial view (78.57％),which were significantly different as compared with those in the anti-AQP4(-) BCIS patients (35.29％ and 41.17％,P＜0.05).Conclusion anti-AQP4(+)BCIS may represent an early,isolated syndrome of NMO spectrum disorder.