- 作者列表："Papeix C","Beigneux Y","Maillart E","de Seze J","Lubetzki C","Vukusic S","Collongues N","Marignier R
BACKGROUND:Three different sets of criteria have been proposed for the diagnosis of neuromyelitis optica spectrum disorders (NMOSD). OBJECTIVE:To compare the specificity, sensitivity and diagnostic accuracy of the three different sets of NMOSD criteria, in patients presenting with inflammatory disorders of the central nervous system suggestive of NMOSD. METHODS:From 236 suspected NMOSD referred for serum AQP4-IgG testing between 2012 and 2014, the three sets of NMOSD criteria (1999, 2006 NMO criteria and 2015 International Panel for NMO Diagnosis criteria) were applied and compared to the final diagnosis. RESULTS:Seventy-six patients fulfilled at least one set of criteria and 28 patients fulfilled all NMOSD set of criteria. The final diagnosis was NMOSD in 66 cases, MS according to the MacDonald 2010 in 85 cases and another diagnosis in 85 cases. 2006 NMO criteria has the highest specificity (99%) and 2015 IPND NMOSD criteria, the highest sensitivity ( 97%). For the 1999, 2006 and 2015 IPND NMOSD criteria, the accuracy was respectively 82%, 87% and 97%. CONCLUSIONS:Our study highlights the limitations of the first set of criteria, that include optico-spinal form of MS. The accuracy of NMO/SD diagnostic criteria improved from 1999 to 2015. It confirms the increased performance of the last set of criteria which covers a larger spectrum of clinical presentation. This study raises some the concern to classify patients with seronegative transverse myelitis or optic neuritis, and MOG-antibody associated disease.
背景: 已经提出了三种不同的视神经脊髓炎谱系疾病 (NMOSD) 诊断标准。 目的: 比较三种不同的 NMOSD 标准在提示中枢神经系统炎症性疾病患者中的特异性、敏感性和诊断准确性。 方法: 从 2012 年至 236 年间接受血清 AQP4-IgG 检测的 2014 例疑似 NMOSD 患者中，获得 3 组 NMOSD 标准 (1999 、 2006 NMO 标准和 2015 NMO 诊断标准国际专家组) 应用并与最终诊断进行比较。 结果: 76 例患者符合至少一组标准，28 例患者符合所有 NMOSD 组标准。最终诊断为 NMOSD 66 例，MS 根据 MacDonald 2010 诊断 85 例，另诊断 85 例。2006 NMO 标准的特异性最高 (99%)，2015 IPND NMOSD 标准的敏感性最高 (97%)。对于 1999 、 2006 和 2015 IPND NMOSD 标准，准确度分别为 82% 、 87% 和 97%。 结论: 我们的研究强调了第一组标准的局限性，包括 MS 的视-脊髓形式。NMO/SD 诊断标准的准确性从 1999 年到 2015 年有所提高。它证实了最后一组标准的性能增加，涵盖了更广泛的临床表现。本研究提出了对血清阴性横贯性脊髓炎或视神经炎和 MOG 抗体相关疾病患者进行分类的一些担忧。
METHODS:Objective To clarify the existence of monophasic neuromyelitis optica spectrum disorders (NMOSD) and to identify predictive factors of long-term relapse-free form. Methods We retrospectively analyzed 289 Chinese patients with NMOSD. Selected subjects were divided into three groups based on the time interval between disease onset and the first relapse, if any. Clinical and imaging data were acquired from each patient’s medical record and evaluated as predictive factors for NMOSD. Results In total, none of the participating patients exhibited a monophasic form of NMOSD. Rather, 241 patients were selected for relapse tendency analysis; 143 (59.3%) patients relapsed within the first year, 66 (27.4%) during 1–5 years, and 32 (13.3%) beyond 5 years. Such onset symptoms as optic neuritis (ON) and non-longitudinally extensive transverse myelitis (LETM) were independent prognostic factors for a prolonged remission interval.
METHODS::Neuromyelitis optica spectrum disorders (NMOSD) are an inflammation of the central nervous system associated with autoantibodies to aquaporin-4. We have undertaken a clinic-based survey of NMOSD in the Australia and New Zealand populations with the aim of characterising the clinical features and establishing the value of recently revised diagnostic criteria. Cases of possible NMOSD and age and sex-matched controls with multiple sclerosis (MS) were referred from centres across Australia and New Zealand. Cases were classified as NMOSD if they met the 2015 IPND criteria and remained as suspected NMOSD if they did not. Clinical and paraclinical data were compared across the three groups. NMOSD was confirmed in 75 cases and 89 had suspected NMOSD. There were 101 controls with MS. Age at onset, relapse rates and EDSS scores were significantly higher in NMOSD than in MS. Lesions and symptoms referable to the optic nerve were more common in NMOSD whereas brainstem, cerebellar and cerebral lesions were more common in MS. Longitudinally extensive spinal cord lesions were seen in 48/71 (68%) of cases with NMOSD. Elevations of CSF, white cell count and protein were more common in NMOSD. We have confirmed a clinical pattern of NMOSD that has been seen in several geographical regions. We have demonstrated the clinical utility of the current diagnostic criteria. Distinct patterns of disease are evident in NMOSD and MS, but there remains a large number of patients with NMOSD-like features who do not meet the current diagnostic criteria for NMOSD and remain a diagnostic challenge.
METHODS:Spinal cord injury (SCI) is a traumatic lesion that causes disability with temporary or permanent sensory and/or motor deficits. The pharmacological approach still in use for the treatment of SCI involves the employment of corticosteroid drugs. However, SCI remains a very complex disorder that needs future studies to find effective pharmacological treatments. SCI actives a strong inflammatory response that induces a loss of neurons followed by a cascade of events that lead to further spinal cord damage. Many experimental studies demonstrate the therapeutic effect of stem cells in SCI due to their capacity to differentiate into neuronal cells and by releasing neurotrophic factors. Therefore, they appear to be a valid strategy to use in the field of regenerative medicine. The purpose of this paper is to provide an overview of clinical trials, recorded in clinical trial.gov during 2005−2019, aimed to evaluate the use of stem cell-based therapy in SCI. The results available thus far show the safety and efficacy of stem cell therapy in patients with SCI. However, future trials are needed to investigate the safety and efficacy of stem cell transplantation.