Clinical And Imaging Study In Optical Spinal Type Multiple Sclerosis

Background: Among Asian population, optical spinal type MS could be classified as three clinical subtypes: Opticospinal MS (OSMS), Neuromyelitis optica (NMO), SMS (Spinal MS). There presents many differences with the western Conventional MS in natural history, clinical presentation, imaging features and prognosis. These differences imply that there might be some pathogenesis distinguish from eastern MS to western MS, and NMO is particularly the central issue of latest researches. Today we have no related epidemiologic study. DTI technology has been the important researching method upon the study in the function of write matter in CNS. However, with regard to spinal lesions due to technological limitation, there is lack of reports domestically and internationally.Objective:Summarize the clinical characters of patients with optical spinal type MS who was diagnosed in the General Hospital of PLA, use contrastively research and conclude the characteristics of each subtype;Evaluate the sensitivity and specificity of McDonald diagnostic criteria applies to optic spinal type MS;Analysis the clinical course of the cases from CIS to MS, draw estimation to disease course and prognosis.the research will further discuss the DTI results of the demyelinating lesions located in the cervical spinal, expected to provide assist to early diagnosis, distinguish diagnosis and prognosis.Methods:Retrospectively analysis 158 optical spinal type MS cases that had been in hospital during 1990 to 2007, apply the method of epidemiology, and research on the natural course of the diseases, clinical features and prognosis.Meanwhile contrastively research the differences among each subtype, apply 2*2 diagnosis and filtration experiment to appraise the accordability that McDonald method functions to Asian types.Summarize the epidemiology characteristic of CIS, research its infectivecourse of disease and the main reasons of prognosis.Compare the groups of enhancement and non-enhancement, normal-appearing and normal control, analyze each DTI datas in cervical spinal, combine the results, conduct research by comparing the pathological and physiological change, and evaluate the diagnostic value of DTI.Results:The prevalence of optical spinal type MS increases yearly. The age of patients mostly ranges from 20-50. The ratio of male and female is 1:2.67. 25.95% of patients have premium factors before first attack. Sensory disfunction rate is 53.1% in the first on set, Eyesight letdown 47.7%. Bladder disfunction 27.22%. There are 52.53% OSMS in clinical sub type. 84.18% is RRMS course. The spinal lesions mostly located in cervical and thoracic vertebra, acute lesions often presents partially enhancement. CSF mostly represents normal or slightly increases, protein and lgG slightly increases, positive rate of OB is low. Positive rate of electric physiological check is high. Steroid and IVIg treatment was effective during acute lesions period. Compared with PPMS, SPMS and PPMS had shorter disease course. It develops more rapid, appear longer segment lesions, poor medicament curative effect, higher EDSS value, P<0.05.Compare with OSMS, NMO has below features:SPMS rate is higher.the age of first onset is older and the relapse is more frequent.Aesthema disturbance occurs more frequently at first on set, and often follow with Lhermitte sign.During whole course, optic nerve and spinal cord damage 100% involved, aesthema disturbance and weakness of upper limb is more frequently than in OSMS, particularly in bladder disturbance.MRI lesions mostly located in cervical and thoracic vertebra, it also have specialties such as long segment, significant occupy effect and necrosis.Medicative effect is poor, state of illness develop rapidly, EDSS value is higher, prognosis is bad, P<0.05.For optical spinal type MS, the sensitivity and specificity of McDonalddiagnostic criteria is 60.2% and 97.1%.The occurring rate of optic nerve and spinal symptom is high in this CIS group. Among it, ON to OSMS, compare to ON to NMO, S to OSMS and S to SMS, the course is longer, P<0.05. The position and length of the lesions in first onset are not relevant to prognosis.DTI research shows, the ADC level of enhancement lesions, non-enhancement lesions, normal appearing region around lesions and normal control group debases in turn. Non-enhancement lesions has higher ADC level than normal control group. Enhancement lesions has lower FA level and RA level than non-enhancement lesions and normal control group, P<0.05.Conclusions:Optical spinal type MS have differences with CMS in terms of natural history, clinical features and other various aspects. The prevalence rate is increasing year after year and the ratio of female patients obviously increased. In clinic, it represents dysfunction of limb aesthesia, vision disturbance and bladder dysfunction. MRI lesions mostly located in cervical and thoracic vertebra, acute lesions often presents partially enhancement. It also have specialties such as long segment, significant occupy effect and necrosis. Its positive rate of OB is lower, EDSS value is higher, prognosis is bad.McDonald diagnostic criteria represent high level of sensitivity and low level of specificity. Almost 40% patient was leave out. It is not applicable to the optical spinal type MS.The optic nerve and spinal symptom rate is high in this CIS group. Those patients, whose onset with ON, had mild clinical symptoms, with long relapse interval, without or short of cerebral lesion, indicates benign prognosis.DTI shows highly according with the pathological and physiological change. DTI is a valuable tool in diagnosis and differential diagnosis. It can help in judge the range and degree of the lesion and make prognosis.