Is there a prodrome to NMOSD? An investigation of neurologic symptoms preceding the first NMOSD attack

• Published in: Multiple sclerosis Vol. 30; no. 11-12; pp. 1423 - 1435
• Main Authors: Lee, Sydney, Marrie, Ruth Ann, Fadda, Giulia, Freedman, Mark S, Lee, Liesly, Muccilli, Alexandra, Vyas, Manav V, Konig, Andrea, Rotstein, Dalia L.
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.10.2024
• Subjects: Neuromyelitis optica spectrum disorder; neuroinflammatory diseases; demyelinating diseases; prodrome
• ISSN: 1352-4585; 1477-0970
• DOI: 10.1177/13524585241275491

Background: It is unknown whether people with aquaporin-4 antibody positive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD) experience a prodrome, although a few cases report AQP4 + serology up to 16 years before the first attack. Objectives: To evaluate whether individuals with AQP4-IgG + NMOSD have prodromal neurologic symptoms preceding the first attack. Methods: We reviewed medical records of participants meeting the 2015 diagnostic criteria for AQP4-IgG + NMOSD from four demyelinating disease centres in the Canadian NMOSD cohort study CANOPTICS. We searched for neurologic symptoms occurring at least 30 days before the first attack. Results: Of 116 participants with NMOSD, 17 (14.7%) had prodromal neurologic symptoms. The median age was 48 years (range 25–83) at first attack; 16 (94.1%) were female. Participants presented with numbness/tingling (n = 9), neuropathic pain (n = 5), visual disturbance (n = 4), tonic spasms (n = 2), Lhermitte sign (n = 2), severe headache (n = 2), incoordination (n = 2), weakness (n = 1), psychosis (n = 1) or seizure (n = 1). Of eight who underwent magnetic resonance imaging (MRI) brain, orbits and/or spinal cord, five had T2 lesions. Within 1.5–245 months (median 14) from the onset of prodromal neurologic symptoms, participants experienced their first NMOSD attack. Conclusions: One in seven people with NMOSD experienced neurologic symptoms before their first attack. Further investigation of a possible NMOSD prodrome is warranted.