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Profil clinique des neuropathies optiques chez 48 patients marocains atteints de spectre de neuromyélite optique (NMOSD)

Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system demyelinating disease typically manifesting with severe relapses of optic neuritis, longitudinally extensive myelitis and/or brainstem syndromes, often leading to severe disability. Some patients are seropositive for antibodies against aquaporin-4 (AQP4), others are positive for anti-myelin oligodendrocyte glycoprotein (MOG), while a few are negative for both biomarkers. The disease is complex, with severe functional disability, and only now are specific therapeutic clinical trials being carried out. The present study adds to the literature through detailed clinical data from 48 medical records of Moroccan patients.

Monocentric, retrospective assessment of medical records from the neurology department in Ibn Rochd Hospital in Casablanca, through a descriptive and analytical study extending from 2001 to September 2019.

NMOSD was more prevalent in females (1:3), with a median age of 35,5 years (±13,5). Concomitant autoimmune disease was found in 19% of patients. The mean visual acuity of the worse eye on the logMar scale was 1,3 (±1,130) which is the equivalent of 1/20 on the Monoyer scale. A relative afferent pupillary defect was noted in 21% of patients at first examination, and the eye fundus exam showed papillitis in 2,1%, grade I papillary edema in 4,2%, grade II edema in 1%, grade IV edema in 9,4%, a pale papilla in 21%, and was normal in 48% of patients. Positivity for anti-AQP4 antibodies was identified in 40% of the patients tested, while 2% presented anti-MOG antibodies. Anti-AQP4 antibodies were not associated to worse disease course (p<0,05). The last medical record showed that seven patients had died (14,6%) on a median of 11 months. Seventy percent of the patients received cyclophosphamide as a first-line therapy. The median visual acuity improvement was -0,33 on the logMAR scale, which represents a median visual acuity of 1/10 on the Monoyer scale after treatment.

NMOSD is a potentially devastating condition with no proven therapy to control clinical relapses. Unlike multiple sclerosis (MS), which may be progressive, NMOSD does not tend to accumulate disability between relapses. However, even one or two relapses may render the patient blind or wheelchair-bound for life.

The relatively high mortality rates of NMOSD makes it essential to know this condition and evoke this diagnosis when presented with a severe optic neuritis in middle-aged female patients.

Early diagnosis cannot be stressed enough, since therapeutic options for the condition must be instituted immediately.

The present study adds to the reports from other countries presenting original data on Moroccan patients diagnosed with NMOSD according to the 2015 criteria, and provides an insight of the current diagnostic conduct when presented with NMOSD.