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NMO-IgG and Devic's neuromyelitis optica: a French experience

Service de Neurologie A and EDMUS Co-ordinating Center, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel Lyon Bron cedex, F-69677, France, Inserm U 842, Lyon, F-69008, France, Université de Lyon, Lyon, F-69003; Université Lyon 1, Lyon, F-69003, France, romain.marignier{at}chu-lyon.fr

Jérôme De Sèze

Hôpital Civil de Strasbourg, Strasbourg, F-67000, France

Sandra Vukusic

Service de Neurologie A and EDMUS Co-ordinating Center, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel Lyon Bron cedex, F-69677, France, Inserm U 842, Lyon, F-69008, France, Université de Lyon, Lyon, F-69003; Université Lyon 1, Lyon, F-69003, France

Françoise Durand-Dubief

Service de Neurologie A and EDMUS Co-ordinating Center, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel Lyon Bron cedex, F-69677, France, Université de Lyon, Lyon, F-69003; Université Lyon 1, Lyon, F-69003, France

Hélène Zéphir

CHRU de Lille, Lille, F-59000, France

Patrick Vermersch

CHRU de Lille, Lille, F-59000, France

Philippe Cabre

CHU Fort de France, F-97200, France

Gaëlle Cavillon

Inserm U 842, Lyon, F-69008, France

Jérôme Honnorat

Inserm U 842, Lyon, F-69008, France, Université de Lyon, Lyon, F-69003; Université Lyon 1, Lyon, F-69003, France

Christian Confavreux

Service de Neurologie A and EDMUS Co-ordinating Center, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 59 boulevard Pinel Lyon Bron cedex, F-69677, France, Inserm U 842, Lyon, F-69008, France, Université de Lyon, Lyon, F-69003; Université Lyon 1, Lyon, F-69003, France

Background A serum autoantibody biomarker, NMO-IgG has been recently described in patients with Devic's neuromyelitis optica (DNMO) and so called `high-risk' patients for this disease. Our objectives were to replicate the test and to assess its usefulness.

Methods Indirect immunofluorescence with a substrate of adult rat cerebellum and midbrain was used to identify the distinctive NMO-IgG staining pattern. We tested masked sera from 26 patients with DNMO (group 1), 21 patients with idiopathic acute transverse myelitis (ATM) (group 2), 21 patients with bilateral and/or recurrent idiopathic optic neuritis (group 3), 52 patients with classical multiple sclerosis (MS) (group 4), 36 patients with HTLV-1 infection (group 5) and 7 patients with miscellaneous disorders (group 6).

Results We identified a vascular staining pattern typical of NMO-IgG. This particular staining was observed in 14/26 samples in group 1, 7/21 in group 2 (positive only in longitudinally extensive acute transverse myelitis: 7/13), 4/21 in group 3 (with bilateral loss of vision in all seropositive cases), 5/52 in group 4 (none of them suggestive of DNMO), 0/36 in group 5 and 0/7 in group 6. Sensitivity of the test was 54% considering detection of DNMO (group 1), and specificity was respectively 94% and 90% when considering groups 4, 5 and 6 altogether or group 4 of MS patients only.

Conclusion Detection of NMO-IgG is contributory to the distinction of DNMO and `DNMO high-risk' syndromes from MS. This test may allow earlier diagnosis and help therapeutic decisions. Multiple Sclerosis 2008; 14: 440—445. http://msj.sagepub.com

Key Words: Devic's disease • neuromyelitis optica • NMO-IgG • transverse myelitis

This version was published on May 1, 2008

Multiple Sclerosis, Vol. 14, No. 4, 440-445 (2008)
DOI: 10.1177/1352458507084595


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