Elderly-Onset Neuromyelitis Optica Spectrum Disorder with Pre-Existing Prednisone Allergy

Hollen, Christopher; Suhaib, Omer; Farrow, Aaron; Sidorov, Evgeny

doi:10.1159/000485120

Cited by 5 publications

(3 citation statements)

References 8 publications

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“…(36.53 ± 16.26 years). Although mean age of the first presentation of optic neuritis in NMOSD group was younger than MS and idiopathic group, the oldest patient in the NMOSD group was 75 years old in our study, and there were several studies that reported NMOSD in elderly up to 90 years old [ 26 , 27 ]. For elderlies with optic neuritis, NMOSD should be taken into account, especially for elderlies with poor vision at the beginning.…”

Section: Discussionmentioning

confidence: 50%

Clinical Characteristics, Treatment Outcomes and Predictive Factors in Optic Neuritis

Hansapinyo¹,

Vivattanaseth²

2018

TOOPHTJ

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Background:The causes, clinical presentations and treatment outcomes of optic neuritis are distinct among different populations. Early diagnosis based on clinical presentations plays an important role in treating optic neuritis patients.Objective: The study aimed to determine clinical characteristics, treatment outcomes and predictive factors of treatment outcomes in optic neuritis patients with and without demyelinating disease.Methods:A retrospective descriptive study of optic neuritis patients carried out between January 2009 and December 2016 was done. Univariate analysis and multivariate logistic regression analysis were used to evaluate the predictive factors of treatment outcomes.Results:Among 150 patients with optic neuritis, 58 patients were diagnosed with Neuromyelitis Optica Spectrum Disease (NMOSD), 23 patients were diagnosed with Multiple Sclerosis (MS) and 69 patients were idiopathic. The age at presentation in the NMOSD group was significantly younger than the MS group and the idiopathic group. The female:male ratio was significantly lower in the idiopathic group than in the NMOSD group. The initial Best Corrected Visual Activity (BCVA) of 20/20-20/60 (p = 0.001) and the idiopathic group (p =0.030) was associated with good visual outcomes. Initial BCVA of < 20/200 (p = 0.009) and the NMOSD group (p < 0.001) was associated with poor visual outcomes.Conclusion:NMOSD is a more common cause of optic neuritis than MS in Thai population. Female patients with poor initial VA, poor response to steroids treatment, and presenting recurrent attacks are highly suspicious for NMOSD. Optic neuritis without associated demyelinating disease has a better visual outcome and lower recurrence rate.

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Section: Discussionmentioning

confidence: 50%

Clinical Characteristics, Treatment Outcomes and Predictive Factors in Optic Neuritis

Hansapinyo¹,

Vivattanaseth²

2018

TOOPHTJ

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“…Our cohort was similar to several previous studies in terms of AQP4 serostatus, female predominance, age at first episode of ON in each affected eye, laterality. 1,10,[15][16][17][18][19][20][21][22][23][24] Most of the affected eyes (37 eyes, 58.6%) in our study presented with BCVA at nadir < 20/400. This result was fairly similar to several other studies, which provides additional evidences that NMOSD-ON is typically severe.…”

Section: Discussionmentioning

confidence: 53%

<p>Prognostic Factors for Visual Outcomes Following the First Episode of NMOSD-Related Optic Neuritis in Affected Eyes</p>

Thongmee¹,

Padungkiatsagul²,

Jindahra³

et al. 2020

OPTH

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Objective: We aim to identify prognostic factors for visual outcomes following a first episode of neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) in affected eyes. Materials and Methods: This was a single-center, retrospective study. The study included 50 individuals who were diagnosed with NMOSD-ON (63 affected eyes) in a tertiary institution over a 12-year period. Data regarding any second, or higher, episodes of NMOSD-ON in each eye were not taken into consideration. Medical records of included individuals were reviewed. Demographic data, clinical and magnetic resonance imaging characteristics, and treatment outcomes were collected. Main outcome measures of the study were prognostic factors for good visual outcome (best-corrected visual acuity (BCVA) ≥ 20/200) following an initial episode of NMOSD-ON in affected eyes. Results: Sixty-three affected eyes of 50 individuals (3 men and 47 women) were included. BCVA at nadir that was better than counting fingers (CF) (odds ratio 10.43, 95% confidence interval 1.04, 104.45, p = 0.046) and time from NMOSD-ON onset to intravenous methylprednisolone (IVMP), less than 21 days (odds ratio 10.73, 95% confidence interval 1.91, 60.01, p = 0.007), were significantly associated with good visual outcomes. Conclusion: BCVA at nadir that was better than CF and treatment with IVMP within 21 days of symptom onset were important prognostic factors of good visual outcomes following a first episode of NMOSD-ON in affected eyes.

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“…Chronic use of corticosteroids may be particularly difficult among individuals with diabetes, hypertension, gastrointestinal diseases, or osteoporosis. Pulses of methylprednisolone or dexamethasone, or plasma exchange, may be an option for elderly people, particularly those who do not have good tolerance for chronic use of corticosteroids [23]. Use of azathioprine has been correlated with higher risks of toxicity, infection, and malignancies [24].…”

Section: Discussionmentioning

confidence: 99%

Late Onset of Neuromyelitis Optica Spectrum Disorders

et al. 2019

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IntroductionNeuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. NMOSD starting after the age of 50 years is considered a “late onset” (LO-NMOSD) and seems to be particularly aggressive. The objective of this paper is to present a series of 37 Brazilian patients with LO-NMOSD.MethodsRetrospective data collection from medical records of patients with LO-NMOSD seen at 14 Brazilian specialized units.ResultsThe ratio of women to men in the sample was 4.3 to 1. The patients were followed up for a median period of 4 years. Sex, age at disease onset, and ethnic background were not associated with the number of relapses or disability outcomes. Extensive longitudinal myelitis affected 86% of patients, while optic neuritis affected 70%, and brainstem syndromes were present in only 16% of these patients. Six patients are currently using some type of support for walking or are wheelchair-bound. Three have died. Therapeutic options for NMOSD were particularly complicated for these elderly patients, since medications for controlling NMOSD are, in essence, immunosuppressive. Long-term use of corticosteroids can be an issue when the patients have high blood pressure, diabetes mellitus, or dyslipidemia (conditions often seen in elderly individuals).ConclusionThis series of LO-NMOSD cases highlights the importance of prompt diagnosis and treatment for these patients.

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Elderly-Onset Neuromyelitis Optica Spectrum Disorder with Pre-Existing Prednisone Allergy

Cited by 5 publications

References 8 publications

Clinical Characteristics, Treatment Outcomes and Predictive Factors in Optic Neuritis

Clinical Characteristics, Treatment Outcomes and Predictive Factors in Optic Neuritis

<p>Prognostic Factors for Visual Outcomes Following the First Episode of NMOSD-Related Optic Neuritis in Affected Eyes</p>

Late Onset of Neuromyelitis Optica Spectrum Disorders

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