Comorbidity Analysis Of Multiple Sclerosis And Neuromyelitis Optica In Chongqing Area

ObjectiveThe most common demyelinating diseases in central nervous system are multiple sclerosis (MS) and neuromyelitis optica (NMO), of which are also autoimmune-induced chronic diseases. As the increasing incidence of comorbidity in MS and NMO patients, more studies were focus on the association between chronic diseases and comorbidity. But few researches were mentioned in China. Our aim was to investigate comorbidity of MS and NMO patients in Chongqing area, to describe the impact of comorbidity on MS and NMO clinical characters.MethodsAccording to the 2010 version McDonald diagnostic criteria for MS and 2006 version Wingerchuk NMO diagnostic criteria, and we collected 230 MS cases and 42 NMO cases in Chongqing area. The patients’general clinical statistics, MRI characteristics, comorbidity types and numbers were collected, and effect of comorbidity on MS and NMO clinical features.Results1) 59.6% of MS patients have comorbidities, and the most common comorbidities are hypertension, hyperlipidemia, type 2 diabetes mellitus (DM), cerebrovascular disease, water electrolyte balance disorders, anemia, and infectious diseases.2) MS and other autoimmune diseases (AIDs) may have common pathogenesis and risk factors. Compared with no comorbidity group, MS patients with other AIDs have later diagnostic age (p< 0.05).3) Compared with no comorbidity group, MS patients with vascular, musculoskeletal, digestive and mental disorders have later onset age, older diagnostic age, and longer duration of clinical course and more times of relapse (p< 0.05).4) During the treatment, the most common comorbidities were infectious diseases, such as viral hepatitis and tuberculosis; and also some diseases related to corticosteroids, mainly electrolyte imbalance, bone marrow inhibition, drug-induced liver damage, osteoporosis.5) Clinical diagnosis of NMO is mainly rely on clinical symptoms and head, spinal cord MRI, but less AQP4 antibody detection. Brain MRI were normal (59.5%) in NMO patient, while in MS patient 73.0% have brain demyelinating lesions; spinal MRI shows that NMO patient usually involving≥3 vertebral segments, and MS only have 15.4% involving >3 segments.6) 69% of NMO patients have comorbidities, compared to NMO cases without comorbidity, their onset and diagnose age delayed, duration of clinical course extended and relapse time increased as the number of comorbidities grown.7) 61.9% of NMO patients developed to difficulty walking, even paralysis of lateral lower limbs in the latter peroid of the course. There are 7 cases of patients had paralysis, blind, constipation and urine retention at the same time, and these 7 cases had the longest duration compared to cases had the symptoms alone, (p< 0.05).Conclusion1) MS and NMO are two different diseases with different clinical characters. AQP4 is helpful to differentiate these two diseases.2) Comorbidity is frequently in MS and may affect the clinical features of MS. High attention should pay to the impact of complications on MS, to avoid delays in diagnosis and treatment in MS. In the course of treatment should pay attention to the amount of corticosteroids, so as to avoid diseases related to medicine side effects.3) MS and other AIDs often exist in one patient. If one certain kind of AIDs has been diagnosed, other AIDs should pay attention to, in order to avoid misdiagnosis and under diagnosis.4) NMO cases has more sever symptoms, more adverse prognosis and worse quality of life than MS cases. Presence of comorbidity may influence clinical features of NMO, causing delayed diagnosis, untimely diagnosis and under treatment, and longer duration of clinical courses.5) When MS and NMO patients have new symptoms, brain and spinal MRI should be done immediately, in order to detect lesion changes in the course of MS and NMO.