Introduction: Devic’s neuromyelitis optica is an autoimmune and central nervous system demyelinating disease. It mainly affects the spinal chord and optic nerves. Considered for a long time as a special form of Multiple Sclerosis (MS), it is distinguished clinically by its rarity and poor prognostic, biologically by NMO (IgG) antibody, radiologically by extended myelitis. Treatment include mega dose of methylprednisolone during relapses and immunosuppressive drug in prevention of recurrences. Observation: Devic’s disease manifests itself in outbreaks of neuritis optic or myelitis. We report the case of a patient who had no particular antecedents. She presented a spastic tetraparesis, accompanied by a decreasing left visual acuity (4/10th); the all evolving by thrust since one year. Spinal chord lesions on MRI, second stage brain damages appearance affecting the white substance and the discovery in the patient serum of anti-aquaporin 4 antibodies (anti-AQP4 Ab) allowed the diagnosis of Devic’s disease. Conclusion: Diagnosis of Devic’s neuromyelitis optica that was initially based on clinical examination and radiological assessment is currently confirmed by the discovery in the patient serum of the NMO immunoglobulin G directed against Aquaporin 4.
References
[1]
Lennon, V.A., et al. (2005) IgG marker of Optic-Spinal Multiple Sclerosis Binds to the Aquaporin-4 Waterchannel. The Journal of Experimental Medicine, 202, 473-477. https://doi.org/10.1084/jem.20050304
[2]
Lucchinetti, C., et al. (2000) Heterogeneity of Multiple Sclerosis Lesions: Implications for the Pathogenesis of Demyelination. Annals of Neurology, 47, 707-717. https://doi.org/10.1002/1531-8249(200006)47:6<707::AID-ANA3>3.0.CO;2-Q
[3]
Yu, C.S., Lin, F.C., Li, K.C., Jiang, T.Z., Zhu, C.Z., Qin, W., et al. (2006) Diffusion Tensor Imaging in the Assessment of Normal-Appearing Brain Tissue Damage in Relapsing Neuromyelitis Optica. American Journal of Neuroradiology, 27, 1009-1015.
[4]
Papeix, C. (2006) Maladie de Devic. La Presse Médicale, 35, 1703-1706. https://doi.org/10.1016/S0755-4982(06)74884-9
[5]
Wingerchuk, D.M. (2006) Neuromyelitis Optica. International MS Journal, 13, 42-50.
[6]
Poser, C.M. and Brinar, V.V. (2004) The Nature of Multiple Sclerosis. Clinical Neurology and Neurosurgery, 106, 159-171. https://doi.org/10.1016/j.clineuro.2004.02.005
[7]
Rocca, M.A., Agosta, F., Mezzapeza, D.M., Martinelli, V., Salvi, F., Ghezzi, A., et al. (2004) Magnetization Transfer and Diffusion Tensor MRI Show Gray Matter Damage in Neuromyelitis Optica. Neurology, 62, 476-478. https://doi.org/10.1212/01.WNL.0000106946.08741.41
[8]
Lalive, P.H., et al. (2006) Identification of New Serum Autoantibodies in Neuromyelitis Optica Using Protein Microarrays. Neurology, 67, 176-177. https://doi.org/10.1212/01.wnl.0000223346.09426.34
[9]
Pittock, S.J., et al. (2006) Brain Abnormalities in Neuromyelitis Optica. Archives of Neurology, 63, 390-396. https://doi.org/10.1001/archneur.63.3.390
[10]
Pescovitz, M.D. (2006) Rituximab, an Anti-cd20 Monoclonal Antibody: History and Mechanism of Action. American Journal of Transplantation, 6, 859-866. https://doi.org/10.1111/j.1600-6143.2006.01288.x
[11]
Mandler, R.N., Ahmed, W. and Dencoff, J.E. (1998) Devic’s Neuromyelitis Optica : A Prospective Study of Seven Patients Treated with Prednisone and Azathioprine. Neurology, 51, 1219-1220. https://doi.org/10.1212/WNL.51.4.1219
[12]
Nakashima, I., et al. (2006) Clinical and MRI Features of Japanese Patients with Multiple Sclerosis Positive for NMO-IgG. Journal of Neurology, Neurosurgery, and Psychiatry, 77, 1073-1075. https://doi.org/10.1136/jnnp.2005.080390
[13]
Weinstock-Guttman, B., et al. (2006) Study of Mitoxantrone for the Treatment of Recurrent Neuromyelitis Optica (Devic Disease). Archives of Neurology, 63, 957-963. https://doi.org/10.1001/archneur.63.7.957
[14]
Pittock, S.J., et al. (2006) Neuromyelitis Optica Brain Lesions Localized at Sites of High Aquaporin 4 Expression. Archives of Neurology, 63, 964-968. https://doi.org/10.1001/archneur.63.7.964
[15]
Kira, J. (2003) Multiple Sclerosis in the Japanese Population. The Lancet Neurology, 2, 117-127. https://doi.org/10.1016/S1474-4422(03)00308-9
[16]
Wingerchuk, D.M. and Weinshenker, B.G. (2005) Neuromyelitis Optica. Current Treatment Options in Neurology, 7, 173-182. https://doi.org/10.1007/s11940-005-0010-6
[17]
Wingerchuk, D.M., Lennon, V.A., Pittock, S.J., Lucchinetti, C.F. and Weinshenker, B.G. (2006) Revised Diagnostic Criteria for Neuromyelitis Optica. Journal of Neurology, 66, 1485-1489. https://doi.org/10.1212/01.wnl.0000216139.44259.74
[18]
Weinshenker, B.G., Wingerchuk, D.M., Lindo, L. and Lennon, V. (2005) NMO IgG Predicts Relapse in Patients with Longitudinally Extensive Idiopathic Transverse Myelitis. Journal of Neurology, 64, 128.
[19]
Papeix, C.L.C., Moreau, T., Tourbah, A. and Gout, O. (2003) Spinal Cord Magnetic Resonance Characteristics in Devic’s Neuromyelitis Optica. Multiple Sclerosis, 110.
[20]
Watanabe, S., Nakashima, I., Misu, T., Shiga, Y., Fugihara, K. and Itoyama, Y. (2007) Therapeutic Efficacy of Plasma Exchange in NMO-IgG Positive Patients with Neuromyelitis Optica. Multiple Sclerosis, 13, 128-132. https://doi.org/10.1177/1352458506071174
