Significant Demographic and Clinical Differences Observed in Patterns Between NMOSD and MS

This article was originally published in NeurologyLive® and has been lightly edited.

In a systematic review and meta-analysis recently published in Cureus, findings showed different demographic, clinical, and lesion characteristics among adult patients with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). Overall, patients with NMOSD were more likely to be females with older age and higher Expanded Disability Status Scale (EDSS) score than patients with MS, among other findings.

Clinician Examining MRI of Patient With MS | image credit: New Africa - stock.adobe.com

Among the 23 articles included in the analysis, patients with NMOSD were associated with older age at presentation (mean difference [MD], 3.88; 95% CI, 1.80-5.97; P = .0003) and a higher EDSS (MD, 1.15; 95% CI, 0.58-1.72; P < .0001). Additionally, the risk of NMOSD was significantly higher in women than MS (OR, 2.21; 95% CI, 1.41-3.46; P = .0005). Notably, patients with NMOSD were associated with a lower risk of extrapyramidal symptoms (OR, 0.26; 95% CI, 0.11-0.60; P < .01), brainstem involvement symptoms (OR, 0.32; 95% CI, 0.16-0.64; P < .01), and developing brain lesions compared with MS (OR, 0.08; 95% CI, 0.03-0.18; P < .00001).

"Our findings showed that patients with NMOSD were more likely to be women of older age compared with patient living with MS. Moreover, patients with NMOSD were associated with higher EDSS than patients with MS. Regarding clinical symptoms, optic neuritis, myelitis, headache, sensory affection symptoms, and visual involvement are the most commonly reported symptoms in patients with NMOSD,” lead author Mohammed Alqwaifly, MD, associate professor of neurology, Unaizah College of Medicine and Medical Sciences, Qassim University, in Buraydah, Saudi Arabia, and colleagues wrote.

In this study, investigators conducted a computerized search on MEDLINE via PubMed, Web of Science, and ProQuest using relevant keywords to summarize the characteristics of adult patients with NMOSD compared with patients with MS. The researchers had 3 independent reviewers to perform 2-stage screening and data extraction. Authors then used a Review Manager 5.4 program (Cochrane Collaboration, Windows, London, UK) for the analysis and the Joanna Briggs Institute (JIB) tool to assess the quality of the included studies. Among the included studies, 9 were conducted in China, 5 in Korea, 2 in Japan, and 1 in India, France, Latin America, Malaysia, Taiwan, the UK, and the USA. Almost all of them were cross-sectional except for 2 cohort studies.

“Furthermore, patients with NMOSD were associated with a lower risk of developing brain lesions compared with patients with MS; however, spinal cord lesions, optic nerve lesions, deep gray matter lesions, deep white matter lesions, hypothalamus lesions, and medulla oblongata lesions were more common in patients with NMOSD patients than patients with MS. Regarding lesion morphology, patients with NMOSD had a lower risk of Dawson's finger-type lesions and S or U-shaped lesions,” Alqwaifly et al noted.

The limitations of the study included the significant heterogeneity in some analyses which authors noted could be explained by the varied data in terms of disease duration, EDSS, country of the study, race of the population, and the used method of magnetic resonance imaging (MRI). The investigators also noted that they could not perform a subgroup analysis because of the limited data. The analysis was also limited by the lack of available study data regarding the length of time required to reach specific disability levels using the EDSS. This analysis has also potential limitations related to confounding effects since the studies included had varied populations and study designs. In addition, authors noted the analysis could be impacted by the relative sizes and characteristics of the studies included, which could have potentially influenced the reliability of the results and thus should be cautioned for interpretation.

“It is crucial to enhance the tools and analyses used to differentiate between these diseases for early and accurate diagnosis. Similarities and differences between the 2 diseases may shed light on the various pathogenic processes. Patients with NMOSD may be screened for the disease using the serum anti-aquaporin-4 (AQP4) antibodies marker, while the same cannot be said for MS. Different tests for anti-AQP4 antibodies have varying degrees of sensitivity, and this variability, together with variations in the length of follow-up, may contribute to contradictory findings,” Alqwaifly et al noted.

Reference

Alqwaifly M, Althobaiti AH, AlAibani NS, et al. Patterns of Adult Neuromyelitis Optica Spectrum Disorder Patients Compared to Multiple Sclerosis: A Systematic Review and Meta-Analysis. Cureus. 2023;15(10):e47565. Published 2023 Oct 24. doi:10.7759/cureus.47565