A clinico-neurophysiological study of urogenital dysfunction in MOG-antibody transverse myelitis

Abstract

ObjectiveTo assess the clinical, urodynamic and neurophysiologic features of patients with persisting bladder, bowel and sexual dysfunction following transverse myelitis in MOG-antibody disease.MethodsPatients with a history of MOG-antibody disease related transverse myelitis seen prospectively in a tertiary centre Uro-Neurology service between 2017 and 2019 were included. They received cross-sectional clinical assessment, completed standardised questionnaires on bladder, bowel and sexual symptoms and underwent urodynamic and pelvic neurophysiologic investigations.ResultsTwelve patients (9 males) were included with a total of 17 episodes of transverse myelitis. Mean age at first attack was 26 years (SD 9) and median follow-up duration was 50 months (IQR 32–87). Acute urinary retention requiring bladder catheterisation occurred in 14 episodes and was the first symptom in 10 episodes. Patients with lesions affecting the conus medullaris required catheterisation for significantly longer durations than those without a conus lesion (median difference 15.5 days, p = 0.007). At follow-up, all patients had recovered full ambulatory function, but persisting bladder and bowel dysfunction had moderate or severe impacts on quality of life in 55% and 36% respectively and 82% had sexual dysfunction. Pelvic neurophysiology demonstrated abnormal residual conus function in 6 patients. Urodynamic findings predominantly showed detrusor overactivity and/or detrusor-sphincter dyssynergia, indicative of a supraconal pattern of lower urinary tract dysfunction.ConclusionsPersisting urogenital and bowel dysfunction is common despite motor recovery. Although a proportion of patients had neurophysiologic evidence of residual conus abnormalities at follow-up, predominant urodyamic findings suggest that ongoing lower urinary tract dysfunction results from supraconal injury.

Assessment of patients with lower urinary tract symptoms where an undiagnosed neurological disease is suspected: A report from an International Continence Society consensus working group

“…Transverse myelitis due to other inflammatory causes can occasionally present as urinary retention with few neurological signs because of predilection for conus involvement, particularly when associated with antibodies against Myelin oligodendrocyte glycoprotein (MOG antibody transverse myelitis); persisting urogenital and bowel dysfunction is common despite motor recovery at followup 15 …”

Sacral Tarlov cysts: Neurophysiology abnormalities and correlation with pelvic sensory and visceral symptoms

“…Data were collected directly on the machine, and the position of the markers was checked if the values were outside the limits. Technical aspects have been described in a previous study [17] and are reported in Figure 1 and Data S1. Abnormal findings were defined as follows: EAS EMG was abnormal only if it satisfied the criteria for 'probable' or 'definite' abnormality, that is, if no less than two or three of the studied parameters were abnormal [18].…”

Low mortality rate in a large cohort of myelin oligodendrocyte glycoprotein antibody disease (MOGAD)

“…1 While the long-term outcomes in MOGAD are generally favorable, permanent disability may occur due to visual, sphincter, and/or erectile impairment. 2,3 Mortality rates in MOGAD have not been previously reported. In this analysis, we calculated the mortality rate in a large MOGAD cohort and compared it to data reported in the literature for other demyelinating diseases.…”

“…While the long‐term outcomes in MOGAD are generally favorable, permanent disability may occur due to visual, sphincter, and/or erectile impairment 2,3 . Mortality rates in MOGAD have not been previously reported.…”