Clinical Analysis Of Characteristic For 62 Cases Of Neuromyelitis Optica

Objective:According to collect the detail medical history, ophthalmic examinations, neurologic examinations, ophthalmic assist examinations, and imaging examinations of 62 neuromyelitis optica patients, referring to the international recognized diagnostic criteria, and the lab examinations of blood and cerebrospinal fluid, to analysis the course of the disease and reduce the clinical misdiagnosis and missed diagnosis. Followed up the patient for long term, and traced the recurrent and outcome of the disease, Observed the relationship between the diagnosis, treatment of the single-phase and multi-phase, and provided the help to the early diagnosis and prognosis.Methods:Retrospective analysis 62 neuromyelitis optica patients of General hospital PLA from the year 2000 to 2009,110 eyes. Collected and analysed the clinical materials including age, gender, initial symptom, optic neuritis sign, myelitis sign and previous treatment history. Asked the disease history in detail after the patient admitted to the hospital, and proceeded the examinations of visual acuity, visual field, fundus, VEP etc and other ophthalmic assist examinations. Proceeded the FFA, MRI, neurologic consultation and lumber puncture in needed. Proceeding routine blood analysis, ESR, blood sugar, liver function, renal function, humor level, rheumatoid factor, immunologic factor, blood NMo-IgG, cerebrospinal fluid biochemistry and routine analysis. Made the diagnosis by the diagnosis criteria established by Wingerchuk in 1999.Results:There are 15 males(24.2%)and 47 females(75.8) in this group, male to female ratio 1:3. Age of onset 3-69 years, mean (39.44±4.28),20-59 years old accounted for incidence of 74%, single eye involved 14 cases (23%), both eye involved 48 cases (77%), single-phase 15 cases (24.2%), multiple-phrase 47 cases (75.8%), the shortest duration was 30 days, and the longest was 20 years. It always indicated the single-phrase type may happened, when the Bilateral optic neuritis occur simultaneously or one after another quickly with myelitis. single-phase type had worse clinical manifestation than the recurrent type,but better prognosis. Multiple-phrase type starting as optic neuritis or myelitis only, and character of female, and onset in late age. The state of illness was light in movement disorder of myelitic and visual decrease of neuritis was its character (P value=0.057,0.122).All the NMO patients showed acute or subacute onset of unilateral or bilateral optic nerve damage, or symptoms of spinal cord damage without others damage. The incident rate of optic atrophy during the illness course of 1 to 3 months was 67.7%, and up to 90% after 3 months. The incident rate of optic atrophy was significant high in the 1-3 months group and> 3 month group than the<1 month group (P=0.013,P<0.05). There were 42 VEP abnormal in 43 patients, the abnormal rate was 98%. In 62 patients'MRI findings, spinal cord injury 35 cases (56.45%), thoracic 17 cases (27.42%), lumbar 3 cases (4.84%), no abnormalities 7 cases (11.29%). Thoracic and spinal cord injury was more than others, and the longer lesion find the more happen of the necrosis.Conclusions:The neurological symptoms and signs of NMO patients was limited in optic nerve and spinal cord, involved rate was 100%, had the sever clinical manifestations, trans-spinal cord injury, the pain and temperature sensation decrease significant in the first attack, bad prognosis, more in female, visual decrease was the first symptom on clinic, more involve both eyes, dramatic visual decrease, different degree visual field defect, pupil dilation, and RAPD(+). The incident rate of optic atrophy was significant high in the group of>3 months, and had difficult in diagnosis before the happen of myelitis. NMO always been misdiagnosis to the retrobulbur optic neuritis, optic neuritis, papillitis, and optic atrophy. Missed diagnosis rate was 93%. VEP was helpful in the ones had the symptom of myelitis only, MRI and NMO-IgG provide strong evidence and clinical value in the diagnosis and prognosis judgment. NMO could be separate into single-phrase and multi-phrase. Female, late age in onset, long interval between index events may be related to recurrence of disease progression.NMO may be divided into external cause (environmental factors) and the internal two categories, in view of its complexity, should be a large sample, multi-center study of long-term follow-up to the diagnosis and treatment of the NMO systematic evaluation.