Jun-Soon Kim

Utility of aquaporin-4 antibody assay in patients with neuromyelitis optica spectrum disorders.

Objective: Our aim was to evaluate the utility of aquaporin-4 antibodies (AQP4-Ab) in patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: The clinical and radiological characteristics of 78 patients with NMOSD and 22 with multiple sclerosis (MS), who were tested for AQP4-Ab by a cell-based assay, were assessed. Results: The mean time interval between symptom onset and development of optic neuritis and myelitis was 39.9 months in neuromyelitis optica (NMO). About 40% of patients with limited NMO would have fulfilled the diagnostic criteria for MS in the absence of the antibody assay results. In patients with longitudinally extensive transverse myelitis, positive AQP4-Ab assay results were associated with the poor response to acute steroid treatment and asymptomatic visual evoked potential abnormality. Presence of either painful tonic spasm associated with myelitis or severe disability at onset had high specificity and relatively high sensitivity in differentiating NMOSD with AQP4-Ab from MS. Conclusions: The AQP4-Ab assay can facilitate the early diagnosis of NMO and prevent limited NMO from being misdiagnosed as MS. It can predict the poor response to first-line acute-phase treatment and probably detect the subclinical optic nerve involvement in subgroups of NMOSD. Lastly, it will contribute to the upcoming revision of the current diagnostic criteria for NMO.

A case of chronic progressive myelopathy

Acute myelitis and optic neuritis are the main clinical features of patients with neuromyelitis optica (NMO), which usually appears as a relapsing—remitting course of disease that worsens over days and improves over weeks. We present a patient with chronic progressive myelitis over a 4-month period without remission as having a limited form of NMO that improved after plasmapheresis. Plasmapheresis may benefit patients with chronic progressive myelitis, which may be a manifestation of NMO, as well as those with a relapsing—remitting course of NMO.

Impact of Both Ends of the Hemoglobin Range on Clinical Outcomes in Acute Ischemic Stroke

Background and Purpose— Although both ends of the hemoglobin range may negatively influence clinical outcomes in acute ischemic stroke, most studies have examined the linear relationship or focused on the lower end of the range. Furthermore, it is unclear whether hemoglobin concentrations at different time points during hospitalization correlate with clinical outcomes in the same manner. Methods— We identified 2681 consecutive patients with acute ischemic stroke from a prospective stroke registry database and grouped them into hemoglobin concentration quintiles using the following 5 indices: initial, nadir, time-averaged, discharge hemoglobin, and hemoglobin drop. To examine the effect of both ends of hemoglobin range, the third quintile was selected as a reference category except for hemoglobin drop, for which the first quintile was used. As outcome variables, 3-month modified Rankin Scale as an ordinal scale and 3-month mortality were used. Results— With respect to higher modified Rankin Scale scores, the adjusted odds ratios and 95% confidence intervals of the first quintiles of initial, nadir, time-averaged, and discharge hemoglobin were 1.74 (1.31−2.31), 2.64 (2.09−3.33), 1.81 (1.42−2.30), and 1.65 (1.29−2.13), respectively. The opposite ends of these hemoglobin indices were not significantly associated. The adjusted odds ratio of the fifth quintile of hemoglobin drop (greatest hemoglobin drop) was 2.09 (1.51−2.89). The mortality analysis showed similar results except for initial hemoglobin. Conclusions— In acute ischemic stroke, poor outcome was related to the lower but not the higher end of the hemoglobin range, regardless of when and how hemoglobin concentrations were measured.

T91. Factors predicting the successful generation of baseline motor evoked potentials in patients undergoing spine surgery

Introduction The purpose of this study was to search for clinical factors predicting the successful generation of baseline muscle motor evoked potentials (mMEPs) in patients undergoing spine surgery and to determine the relationship with postoperative functional outcome. Methods From July 2014 to June 2015, a total of 345 patients underwent spine surgery with intraoperative mMEPs monitoring and were consecutively included in this study. Their demographic features, clinical parameters, and mMEPs recording results were reviewed retrospectively. Results Two hundred and fifty-three (73%) patients showed the successful generation of baseline mMEPs at all recording muscles, and 92 (27%) patients failed to record baseline mMEPs at one or more limb muscles. When we compared the preoperative clinical parameters of the two groups, the latter group (“Failure group”) significantly had a higher male ratio, lower MRC grades, higher Nurick grades, more often cervical/cervicothoracic segment involvement, higher proportion of the presence of spine surgery history, motor deficits, sensory symptoms, bladder/bowel dysfunction, T2-weighted high signal intensity (HSI) of cord at spine MRI compared to the former group (“Success group”) and were older. Among these factors, male sex, cervical/cervicothoracic lesion location the presence of T2-weighted HSI of cord, preoperative Nurick grade, and MRC grade showed a significant contribution for predicting the successful generation of mMEPs. When analyzing predictors for postoperative poor functional outcomes, the success rate of mMEPs recording and lesion etiology were significantly related factors for the aggravation of the Nurick grades before and after surgery. Conclusion Various clinical parameters including lesion location, abnormal cord signal on MRI, preoperative motor power, and functional status were revealed to have a significant relationship with the successful generation of baseline mMEPs. Additionally, the successful generation of mMEPs was one of the indicators for predicting the long-term functional outcome.