Preliminary findings of a ‘test bundle’ to accelerate the diagnosis of MS and NMOSD following optic neuritis

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2024-09-19 DOI:10.1016/j.msard.2024.105890

Jagannadha Avasarala , Christopher McLouth , Abusamra Khawla , Paul Wilkerson , Ellen Anderson-benge , Karen B. Lundgren , Saurav Das

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引用次数: 0

Abstract

No study has investigated the length of time it takes to diagnose multiple sclerosis (MS) or neuromyelitis optic spectrum disorder (NMOSD, aquaporin 4 antibody disease or myelin oligodendrocyte glycoprotein antibody disease, MOGAD) following the onset of de novo optic neuritis (ON). Minimizing the time between ON and downstream diagnoses needs urgency since early diagnosis equals early treatment. The time elapsed from ON to a subsequent diagnosis of MS/NMOSD was estimated through analysis of retrospective data collected from the Axon Registry (AR) of the American Academy of Neurology (AAN) and from the University of Kentucky (UK), Lexington. The time to diagnose MS/NMOSD was arbitrarily set as occurring < 6 months (early) or > 6 months (delayed) following ON. Data was collected between 2007 and 2021 (AR) and 2012 to 2022, for UK, respectively.

Of the 4015 ON patients from the AR dataset, 1069 (26.6 %) were diagnosed with MS, with 857 (80.2 %) diagnosed < 6 months (early) and 212 (19.8 %) diagnosed after > 6 months (delayed). Secondly, 420/4015 (10.4 %) were diagnosed with NMOSD (either MOGAD or AQP4 antibody disease), of which 340/420 (80.9 %) were diagnosed < 6 months (early) and 80/420 (19 %) diagnosed > 6 months (delayed). In the UK dataset, a total of 90/1464 individuals (6.14 %) were diagnosed with MS; of these, 69 patients (76.7 %) were diagnosed at < 6 months (early) and included a sub-group of 25 (27.8 %) diagnosed < 4 weeks; 21 (23.3 %) were diagnosed > 6 months (delayed) following ON. In either dataset (AR or UK, between 20 % - 23 % of MS diagnoses occurred > 6 months (delayed) after a diagnosis of ON. An accelerated diagnosis (4 weeks or less) of MS/NMOSD following ON in the UK data suggests that it is possible to minimize the time to a downstream diagnosis if a ‘test bundle’ of MRI of orbits, brain, C-spine, cerebrospinal fluid (CSF) analysis, and serum testing for NMOSD is used. Additional studies using prospective, larger datasets are required to confirm our findings.

查看原文本刊更多论文

加速诊断视神经炎后多发性硬化症和 NMOSD 的 "测试束 "的初步发现

目前还没有研究对新发视神经炎（ON）后诊断多发性硬化症（MS）或神经脊髓炎视谱系障碍（NMOSD、aquaporin 4 抗体病或髓鞘少突胶质细胞糖蛋白抗体病，MOGAD）所需的时间进行调查。由于早期诊断等于早期治疗，因此迫切需要尽量缩短视神经炎与下游诊断之间的时间。通过分析从美国神经病学会（AAN）轴突登记处（AR）和肯塔基大学（UK）莱克星顿分校收集的回顾性数据，我们估算出了从发病到随后确诊为 MS/NMOSD 所花费的时间。诊断多发性硬化症/NMOSD的时间被任意设定为发病后6个月（早期）或6个月（延迟）。AR数据集中的4015名ON患者中，1069人（26.6%）被诊断为多发性硬化症，其中857人（80.2%）被诊断为< 6个月（早期），212人（19.8%）被诊断为> 6个月后（延迟）。其次，420/4015（10.4%）人被诊断为 NMOSD（MOGAD 或 AQP4 抗体病），其中 340/420（80.9%）人在 6 个月后（早期）确诊，80/420（19%）人在 6 个月后（延迟）确诊。在英国的数据集中，共有 90/1464 人（6.14%）被确诊为多发性硬化症；其中 69 名患者（76.7%）在 6 个月（早期）时被确诊，包括 25 人（27.8%）在 4 周后被确诊，21 人（23.3%）在 6 个月（延迟）后被确诊。无论在哪个数据集（AR 或 UK）中，20%-23% 的 MS 诊断发生在 ON 诊断后 6 个月（延迟）。英国的数据表明，如果采用眼眶核磁共振成像、脑部、C-脊柱、脑脊液（CSF）分析和NMOSD血清检测等 "检测捆绑 "方法，有可能最大限度地缩短下游诊断的时间（4周或更短）。要证实我们的研究结果，还需要使用前瞻性的更大数据集进行更多研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Multiple sclerosis and related disorders CLINICAL NEUROLOGY-

CiteScore

5.80

自引率

20.00%

发文量

814

审稿时长

66 days

期刊介绍： Multiple Sclerosis is an area of ever expanding research and escalating publications. Multiple Sclerosis and Related Disorders is a wide ranging international journal supported by key researchers from all neuroscience domains that focus on MS and associated disease of the central nervous system. The primary aim of this new journal is the rapid publication of high quality original research in the field. Important secondary aims will be timely updates and editorials on important scientific and clinical care advances, controversies in the field, and invited opinion articles from current thought leaders on topical issues. One section of the journal will focus on teaching, written to enhance the practice of community and academic neurologists involved in the care of MS patients. Summaries of key articles written for a lay audience will be provided as an on-line resource. A team of four chief editors is supported by leading section editors who will commission and appraise original and review articles concerning: clinical neurology, neuroimaging, neuropathology, neuroepidemiology, therapeutics, genetics / transcriptomics, experimental models, neuroimmunology, biomarkers, neuropsychology, neurorehabilitation, measurement scales, teaching, neuroethics and lay communication.