Development of a clinical score to estimate the probability of neuromyelitis optica in patients presenting with optic neuritis

IF 2.9 3区医学 Q2 CLINICAL NEUROLOGY

Multiple sclerosis and related disorders Pub Date : 2025-05-13 DOI:10.1016/j.msard.2025.106523

Sara Terrim , Guilherme Diogo Silva , Fernando Cavalcanti de Sá e Benevides Falcão , Paula Baleeiro Rodrigues Silva , Graziella Aguiar Santos Faria , Flavio Vieira Marques Filho , Ana Claudia Piccolo , Luiz Roberto Comerlatti , Mateus Boaventura de Oliveira , Tarso Adoni , Douglas Kazutoshi Sato , Samira Luisa Apóstolos-Pereira , Dagoberto Callegaro

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引用次数: 0

Abstract

Background

Neuromyelitis Optica Spectrum Disorder (NMOSD) represents a significant etiology of optic neuritis (ON), primarily due to its severity and risk of sequelae. Early diagnosis is crucial to establish prompt treatment and avoid disability. However, its recognition in acute-phase ON can pose challenges. We aimed to develop a prognostic model for early suspicion of neuromyelitis optica (NMOSD) in patients presenting with ON.

Methods

Patients admitted to our emergency department between 2015 and 2020 with diagnosis of ON were enrolled in our study. We performed univariable analysis in our sample to identify variables associated with a final diagnosis of NMOSD. Based on our findings and previous literature, we selected four variables to develop a prognostic model to predict the risk of a diagnosis of NMOSD independent of anti-AQP4 status.

Results

We enrolled 63 participants with optic neuritis (45 women [71 %]; median age 34 years [interquartile range 29–47 years]), of which 18 were diagnosed with NMOSD (12 anti-AQP4 positive and 6 anti-AQP4 negative) and 45 with other demyelinating disease. Our final prognostic model included female gender, bilateral ON, absence of pain, and chiasmal involvement detected in orbit MRI into an NMOON risk score. This score aims to stratify patients into low, intermediate, and high-risk categories for NMOSD among those presenting with ON symptoms.

Conclusion

An easily accessible score with clinical and radiological information may early predict the risk of NMOSD to help in diagnostic and therapeutic decisions.

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临床评分的发展，以估计视神经炎患者视神经脊髓炎的可能性

视神经脊髓炎视谱障碍（NMOSD）是视神经炎（ON）的重要病因，主要是由于其严重程度和后遗症的风险。早期诊断对于建立及时治疗和避免致残至关重要。然而，急性期ON的识别可能会带来挑战。我们的目的是建立一个早期怀疑视神经脊髓炎（NMOSD）的预后模型。方法选取2015年至2020年在急诊科就诊并诊断为ON的患者。我们对样本进行了单变量分析，以确定与NMOSD最终诊断相关的变量。基于我们的研究结果和先前的文献，我们选择了四个变量来建立一个预测NMOSD诊断风险的预后模型，该模型独立于抗aqp4状态。结果我们招募了63名视神经炎患者(45名女性[71%]；中位年龄34岁[四分位数范围29-47岁])，其中NMOSD 18例（抗aqp4阳性12例，抗aqp4阴性6例），其他脱髓鞘疾病45例。我们最终的预后模型包括女性、双侧ON、无疼痛和眼眶MRI检测到的交叉受累，并将其纳入NMOON风险评分。该评分旨在将出现ON症状的NMOSD患者分为低、中、高风险三类。结论结合临床和影像学信息的评分方法可早期预测NMOSD的发病风险，有助于制定诊断和治疗方案。

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.