Prevalence and pattern of craniofacial pain and headache in Danish patients with neuromyelitis optica spectrum disorder

There is a dearth of knowledge about the pattern of pain and somatosensory alterations that co-exist with neuromyelitis optica spectrum disorder (NMOSD). Understanding the presence and underlying mechanisms will assist in better pain management in these patients. This study sought to identify prevalence and pattern of headache, craniofacial pain and abnormalities in somatosensory function within a group of NMOSD patients in Denmark. Six patients (two males, four females; mean age 41.2 ± 8.6 years) participated in a telephone interview. Eight questionnaires were used to assess pain, illness perception, fatigue, anxiety and depression. Pain occurred in several regions, including the head, face, neck, back and legs. Two patients experienced frequent headaches and one had headaches following neck pain. Pain occurred frequently over a 3-month period, ranging from mild to severe and described as ‘burning’ (66.7%), ‘exhausting’ (83.3%) and ‘sharp’ (50%). Correlations were found between pain severity and patients’ ‘ability to walk’ (r=0.889), ‘general activity’ (r=0.901), ‘mood’ (r=0.603), ‘normal work’ (r=0.664), ‘relations with other people’ (r=0.774) and ‘sleep’ (r=0.586). Somatosensory abnormality was only reported in legs. While fatigue had a great impact on patients’ daily life, patients did not report that for anxiety and depression. This study demonstrated that headaches and craniofacial pain occur frequently in NMOSD. Patients’ function, mobility, mood and sleep were all affected by pain. These findings highlight the value of further investigation on headaches, craniofacial and overall pain in NMOSD.</p

Multicentre comparison of a diagnostic assay: Aquaporin-4 antibodies in neuromyelitis optica

Objective Antibodies to cell surface central nervous system proteins help to diagnose conditions which often respond to immunotherapies. The assessment of antibody assays needs to reflect their clinical utility. We report the results of a multicentre study of aquaporin (AQP) 4 antibody (AQP4-Ab) assays in neuromyelitis optica spectrum disorders (NMOSD). Methods Coded samples from patients with neuromyelitis optica (NMO) or NMOSD (101) and controls (92) were tested at 15 European diagnostic centres using 21 assays including live (n=3) or fixed cell-based assays (n=10), flow cytometry (n=4), immunohistochemistry (n=3) and ELISA (n=1). Results Results of tests on 92 controls identified 12assays as highly specific (0-1 false-positive results). 32 samples from 50 (64%) NMO sera and 34 from 51 (67%) NMOSD sera were positive on at least two of the 12 highly specific assays, leaving 35 patients with seronegative NMO/spectrum disorder (SD). On the basis of a combination of clinical phenotype and the highly specific assays, 66 AQP4-Ab seropositive samples were used to establish the sensitivities (51.5-100%) of all 21 assays. The specificities (85.8-100%) were based on 92 control samples and 35 seronegative NMO/SD patient samples. Conclusions The cell-based assays were most sensitive and specific overall, but immunohistochemistry or flow cytometry could be equally accurate in specialist centres. Since patients with AQP4-Ab negative NMO/SD require different management, the use of both appropriate control samples and defined seronegative NMOSD samples is essential to evaluate these assays in a clinically meaningful way. The process described here can be applied to the evaluation of other antibody assays in the newly evolving field of autoimmune neurology

Correction: Langeskov-Christensen, M., <i>et al</i>. Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis—A Cross-Sectional Investigation. <i>Journal of Clinical Medicine</i> 2018, <i>7</i>, 272

The authors wish to make the following corrections to this paper [...

Aerobic Capacity Is Not Associated with Most Cognitive Domains in Patients with Multiple Sclerosis—A Cross-Sectional Investigation

(1) Background: Cognitive impairment is highly prevalent in multiple sclerosis (MS). Staying physically fit may be associated with preservation of cognitive performance in persons with MS (pwMS); (2) Objective: To investigate the association between aerobic capacity and the cognitive domains of information processing, learning and memory, and verbal fluency as well as single and composite z-scores of the Brief Repeatable Battery of Neuropsychological tests (BRBNT) in pwMS; (3) Methods: All subjects first performed the BRBNT and then a maximal oxygen consumption (VO2-max) test on a bicycle ergometer as a measure of aerobic capacity. Simple and multiple (adjusting for age, sex, and education level) regression analyses were performed to evaluate the relationship between aerobic capacity and cognitive performance in different domains. Published international norms were used to compute z-scores for each individual and composite BRBNT score. Furthermore, cognitive impairment was defined as one or more z-scores ≤−1.5 standard deviation (SD) of healthy controls; (4) Results: Eighty-four subjects were included (44.9 ± 9 years, 16.3 ± 2 education years, Expanded Disability Status Scale (EDSS): 2.6 ± 1.4, MS-type (relapsing-remitting, primary progressive, or secondary progressive): 73/6/5, disease duration: 9.9 ± 7 years, VO2-max: 28.4 ± 7.0 mL O2/min/kg). No significant associations between aerobic capacity and cognitive performance in the individual BRBNT tests were found, except that a weak relationship was found between aerobic capacity and the composite processing speed z-score (R2 = 0.06, p = 0.02). The average global BRBNT z-score (−0.2 ± 0.66) was not associated with aerobic capacity. Comparison of the cognitively impaired group (34.5%) with the nonimpaired group (65.5%) showed lower aerobic capacity in the impaired group (25.9 ± 1 vs. 29.7 ± 1 mLO2/min/kg, p = 0.02); (5) Conclusions: Limited support was found for an association between performance in most cognitive domains and aerobic capacity in the present MS group with a third of patients showing signs of cognitive impairments