TY - JOUR
T1 - Diagnostic utility of NMO/AQP4-IgG in evaluating CNS inflammatory disease in Thai patients
AU - Apiwattanakul, Metha
AU - Asawavichienjinda, Thanin
AU - Pulkes, Teeratorn
AU - Tantirittisak, Tasanee
AU - Hemachudha, Thiravat
AU - Horta, Erika S.
AU - Jenkins, Sarah M.
AU - Pittock, Sean J.
N1 - Funding Information:
Dr Sean Pittock's research is supported in part by the Guthy-Jackson Charitable Foundation and NIH ( NS065829-01 ). Dr Terratorn Pulkes is supported by the Thailand Fund ( RSA5480019 ).
PY - 2012/9/15
Y1 - 2012/9/15
N2 - Epidemiological studies in Thailand have reported that inflammatory demyelinating diseases (IDDs) commonly affect the optic nerve and spinal cord. We investigated the diagnostic utility of aquaporin (AQP)-4-IgG testing in 31 consecutive patients evaluated for CNS IDDs in 3 academic Thai hospital neurology clinics between February 2008 and January 2009. Patients were classified into 3 clinical diagnostic groups: Neuromyelitis optica (NMO, n = 10) multiple sclerosis (MS, n = 5) and unclassified IDD (n = 16). All sera were tested blindly by cell binding (Euroimmun) assay (CBA). Sera were also tested by indirect immunofluorescence assay (IFA) and ELISA (RSR/Kronus). After initial screening by CBA, AQP4-IgG was detected in 6 NMO patients (60%); 3 of the 4 seronegative cases were receiving immunosuppressants. AQP4-IgG was detected in 13 unclassified IDD cases (81%), but in no MS cases. Cell binding assay and ELISA were more sensitive than IFA (p = 0.0004). The 81% seropositivity rate in unclassified patients suggests that AQP4 autoimmunity accounts for a significant proportion of Thai CNS inflammatory demyelinating disease, especially those with optic neuritis or transverse myelitis, with or without abnormal brain MRI, in whom a specific diagnosis or clear-cut treatment approach is unclear.
AB - Epidemiological studies in Thailand have reported that inflammatory demyelinating diseases (IDDs) commonly affect the optic nerve and spinal cord. We investigated the diagnostic utility of aquaporin (AQP)-4-IgG testing in 31 consecutive patients evaluated for CNS IDDs in 3 academic Thai hospital neurology clinics between February 2008 and January 2009. Patients were classified into 3 clinical diagnostic groups: Neuromyelitis optica (NMO, n = 10) multiple sclerosis (MS, n = 5) and unclassified IDD (n = 16). All sera were tested blindly by cell binding (Euroimmun) assay (CBA). Sera were also tested by indirect immunofluorescence assay (IFA) and ELISA (RSR/Kronus). After initial screening by CBA, AQP4-IgG was detected in 6 NMO patients (60%); 3 of the 4 seronegative cases were receiving immunosuppressants. AQP4-IgG was detected in 13 unclassified IDD cases (81%), but in no MS cases. Cell binding assay and ELISA were more sensitive than IFA (p = 0.0004). The 81% seropositivity rate in unclassified patients suggests that AQP4 autoimmunity accounts for a significant proportion of Thai CNS inflammatory demyelinating disease, especially those with optic neuritis or transverse myelitis, with or without abnormal brain MRI, in whom a specific diagnosis or clear-cut treatment approach is unclear.
KW - Aquaporin-4
KW - Assays
KW - Autoantibodies
KW - Autoimmune diseases
KW - Demyelinating disease
KW - Devic's syndrome
KW - Diagnosis
KW - Multiple sclerosis
KW - Neuromyelitis optica
KW - Sensitivity
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U2 - 10.1016/j.jns.2012.07.014
DO - 10.1016/j.jns.2012.07.014
M3 - Article
C2 - 22831763
AN - SCOPUS:84864620668
SN - 0022-510X
VL - 320
SP - 118
EP - 120
JO - Journal of the neurological sciences
JF - Journal of the neurological sciences
IS - 1-2
ER -