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An epidemiological study of neuromyelitis optica in Cuba

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Abstract

Introduction

Two population-based studies of neuromyelitis optica (NMO) in non-white populations provided prevalence rates of 0.32 and 3.1 per 100,000 population.

Objective

To estimate NMO prevalence in the multiethnic Cuban population by nation-wide case ascertainment.

Methods

The study was conducted from October 1, 2003 to November 30, 2004 . Ninety percent of general practitioners and all neurologists responded positively to the request for information on cases suspected of optic neuritis (ON), transverse myelitis (TM), multiple sclerosis, or NMO. Among the population of 11,177,743 there were 798 suspected cases, including 89 with possible NMO, relapsing ON (RON) and TM. Of the 89, 87 were examined by two of us (Cabrera JA, Lara R) who selected the NMO cases according to the 1999 Mayo Clinic criteria as well as those with relapsing TM and RON.

Results

58 cases provided a prevalence rate of 0.52 per 100,000 (95 % CI 0.39–0.67). The 7 males and 51 females gave rates of 0.13 (CI 0.05–0.26) and 0.91 (CI 0.68–1.20). The estimated average annual incidence rate was 0.053 per 100,000 (CI 0.040–0.068). Prevalence rates did not differ significantly among the three ethnic groups. Black NMO cases were significantly older, with more relapses and motor deficit, as well as more abnormalities in brainstem evoked potentials and in brain MRI (not meeting MS criteria). The predominant clinical form was relapsing over monophasic.

Conclusions:

This Cuban multiethnic population had a prevalence of NMO of 0.52 per 100,000 and an estimated average annual incidence rate of 0.053 per 100,000 with no differences by ethnicity. Black patients were older, with more relapses and motor impairment.

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References

  1. Wingerchuk DM, Hogancamp WF, O’Brien PC, Weinshenker BG (1999) The clinical course of neuromyelitis optica (Devic’s syndrome). Neurology 53:107–1114

    Google Scholar 

  2. Mandler RN, Davis LE, Jeffery DR, Kornfeld M (1993) Devic’s neuromyelitis optica: a clinicopathological study of 8 patients. Ann Neurol 34:162–168

    Article  PubMed  CAS  Google Scholar 

  3. Wingerchuck D, Weinshenker B (2003) Neuromyelitis optica: clinical predictors of a relapsing course and survival. Neurology 60:848–853

    Google Scholar 

  4. Mirsattari SM, Johnston JB, McKenna R, et al. (2001) Aboriginals with multiple sclerosis. HLA types and predominance of neuromyelitis optica. Neurology 56:317–323

    PubMed  CAS  Google Scholar 

  5. Rivera V, Cabrera JA (2001) Aboriginals with multiple sclerosis. HLA types and predominance of neuromyelitis optica. Neurology 57:937–938 (letter)

    PubMed  CAS  Google Scholar 

  6. Alvarenga R, Miranda-Santos CM, Puccioni-Sohler M, et al. (2002) Optic neuromyelitis syndrome in Brazilian patients. J Neurol Neurosurg Psychiatry 73:429–435

    Article  PubMed  Google Scholar 

  7. Domingues RB, Kuster GW, Lanes F, Callegaro D (2004) Recurrent neuromyelitis optica with diffuse central nervous system involvement. Arq Neuropsiquiatr 62(2-B):543–546

    PubMed  Google Scholar 

  8. Arruda WO, Scola RH, Teive HA, Werneck LC (2001) Multiple sclerosis: report of 200 cases from Curitiba, southern Brazil and comparison with other Brazilian series. Arq Neuropsiquiatr 59:165–170

    PubMed  CAS  Google Scholar 

  9. Cabrera-Gómez JA, Galarraga-Inza J, Coro Antich RM, Real-González Y, Cristófol-Corominas M, Gómez H, Romero-García K, Gil-Gil Mx, González-Quevedo A (2007) Down’s syndrome and neuromyelitis optica (Devic’s disease). An autopsy proven case. Mult Scler 13:433–436

    Article  PubMed  Google Scholar 

  10. Echevarria G, Troccolli G, D’Annuncio E, Gutierrez O (2001) Devic’s optic neuromyelitis: presentation as an inflammatory spinal tumour. Rev Neurol 33:41–44

    PubMed  CAS  Google Scholar 

  11. Borgesiturriza J, Gonzalez Alfonzo J, Von Schilling B (1963) Neuromyelitis optica: presentation of a case with anatomopathologic study. Gac Med Caracas 71:153–164

    PubMed  CAS  Google Scholar 

  12. Cartier L, Arellano R, Garcia L, Araya F, Campero M (1998) Optic neuromyelitis: a necrotizing disease of the central nervous system. Rev Med Chil 126:981–986

    PubMed  CAS  Google Scholar 

  13. Cabre P, Heinzlef O, Merle H, et al. (2001) Multiple sclerosis and neuromyelitis optica in Martinique. Neurology 56:507–514

    PubMed  CAS  Google Scholar 

  14. De Seze J, Stojkovic T, Ferriby D, Chatel M, et al. (2002) Devic’s neuromyelitis optica: clinical, laboratory, MRI and outcome profile. J Neurol Sci 197:57–61

    Article  PubMed  CAS  Google Scholar 

  15. Guimaraes J, Sa MJ (2006) Devic disease with abnormal brain magnetic resonance image findings: the first Portuguese case. Arch Neurol 63(3):390–396

    Article  Google Scholar 

  16. Ghezzi A, Bergamaschi R, Martinelli V, et al. (2004) Clinical characteristics, course and prognosis of relapsing Devic’s Neuromyelitis Optica. J Neurol 251:47–52

    Article  PubMed  Google Scholar 

  17. Eikelenboom MJ, Killestein J, Uitdehaag BM, Polman CH (2004) Opticospinal multiple sclerosis: a pathogenetically distinct form? Mult Scler 10(3):334–335

    Article  PubMed  CAS  Google Scholar 

  18. Saiz A, Zuliani L, Blanco Y, Tavolato B, Giometto B, Grauss F, for the Spanish- Italian NMO study group (2007) Revised diagnostic criteria for neuromyelitis optica (NMO): application in a series of suspected patients. J Neurol (Epub ahead of print)

  19. Rilling G, Fretz C, Ludin HP (1999) Recurrent retrobulbar neuritis and extensive myelitis: MS or optic neuromyelitis? Schweiz Rundsch Med Prax 88:2071–2076

    CAS  Google Scholar 

  20. Sebastian de la Cruz F, Lopez-Dolado E (1999) Neuromielitis optica: analisis de siete casos. Rev Neurol 28:476–482

    Google Scholar 

  21. O’Riordan JI, Gallagher HL, Thompson AJ, et al. (1996) Clinical, CSF, and MRI findings in Devic’s neuromyelitis optica. J Neurol Neurosurg Psychiatry 60(4):382–387

    Article  PubMed  CAS  Google Scholar 

  22. Doutlik S, Sblova O, Kryl R, Novak M (1975) Neuromyelitis optica as a parainfectious complication of varicella. Cesk Neurol Neurochir 38(4):238–242

    PubMed  CAS  Google Scholar 

  23. Khan MA, Mahar PS, Raghuraman VU (1990) Neuromielitis optica (Devic’s disease). Br J Clin Pract 44:667–668

    PubMed  CAS  Google Scholar 

  24. Antoine J-C, Camdessanche J-P, Absi L Lassabliere, Feasson L (2004) Devic disease and thymoma with anti-central nervous sytem and antithymus antibodies. Neurology 62:978–980

    PubMed  CAS  Google Scholar 

  25. Otmani H El, Rafai MA, Moutaouakil F, Moutawakkil B El, Boulaajaj FZ, Moudden M, Gam I, Slassi I (2005) Devic’s neuromyelitis optica in Morocco. A study of 9 cases. Rev Neurol (Paris) 161:1191–1196

    PubMed  Google Scholar 

  26. Modi G, Mochan A, Modi M, Saffer D (2001) Demyelinating disorder of the central nervous system occurring in black South Africans. J Neurol Neurosurg Psychiatry 70:500–505

    Article  PubMed  CAS  Google Scholar 

  27. Silber MH, Willcox PA, Bowen RM, Unger A (1990) Neuromyelitis optica (Devic’s syndrome) and pulmonary tuberculosis. Neurology 40:934

    PubMed  CAS  Google Scholar 

  28. Gunaydin B, Akcali D, Alkan M (2001) Epidural anaesthesia for Caesarean section in a patient with Devic’s Syndrome. Anaesthesia 56(6):565–567

    Article  PubMed  CAS  Google Scholar 

  29. Kuroiwa Y, Igata A, Itahara K, Koshijima S, Tsubaki T, Toyokura Y, et al. (1975) Nationwide survey of multiple sclerosis in Japan. Clinical analysis of 1084 cases. Neurology 25:845–851

    PubMed  CAS  Google Scholar 

  30. Kira J (2003) Multiple sclerosis in the Japanese population. Lancet Neurol 2(2):117–127

    Article  PubMed  Google Scholar 

  31. Tan CT, Chong HT (1999) Devic’s disease and multiple sclerosis in Asia. Neurol J Southeast Asia 4:57–59

    Google Scholar 

  32. Chon HT, Li PC, Ong B, et al. (2002) Severe spinal cord involvement is a universal feature of Asians with multiple sclerosis: A joint Asian study. Neurol J South East Asia 7:35–40

    Google Scholar 

  33. Singhal BS, Wadia NH (1975) Profile of multiple sclerosis in the Bombay region. On the basis of critical clinical appraisal. J Neurol Sci 26(2):259–270

    Article  PubMed  CAS  Google Scholar 

  34. Hidalgo PC (1998) The genetic constitution of the Cuban population. Rev Esp Antrop Biol 19:5–20

    Google Scholar 

  35. Lennon VA, Wingerchuk DM, Kryzer TJ, et al. (2004) A serum autoantibody marker of neuromyelitis optica: distinction from multiple sclerosis. Lancet 364:2106–2112

    Article  PubMed  CAS  Google Scholar 

  36. Barkhof F, Filippi M, Miller DH, Scheltens P, Campi A, Polman C, et al. (1997) Comparison of MRI criteria at first presentation to predict conversion to clinically definite multiple sclerosis. Brain 120:2059–2069

    Article  PubMed  Google Scholar 

  37. Kurtzke JF (1983) Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS). Neurology (Cleveland) 33:1444–1452

    PubMed  CAS  Google Scholar 

  38. Simon JH, Li D, Traboulsee A, Coyle PK, et al. (2006) Standardized MR Imaging Protocol for Multiple Sclerosis: Consortium of MS Centers Consensus Guidelines. Am J Neuroradiol 27(2):455–461

    PubMed  CAS  Google Scholar 

  39. Siegel S (1956) Nonparametric Statistics for the Behavioral Sciences. McGraw Hill, New York, pp 184–193

  40. Browne RH (1979) On visual assessment of the significance of a mean difference. Biometrics 35:657–665

    Article  Google Scholar 

  41. Nelson LM, McGuire VM (2004) Study design, measures of effect, and sources of bias. In: Nelson LM, Tanner CM, Van Den Eeden SK, McGuire VM (eds) Neuroepidemiology. From Principles to Practice. Oxford University Press, New York, pp 23–54 (Chapter 2)

  42. Cabrera-Gómez JA, Saiz-Hinarejos A, Graus F, González-Quevedo A, Rodríguez- Rojas R, Quevedo-Sotolongo L, et al. (2008) Brain magnetic resonance imaging findings in acute relapses of neuromyelitis optica spectrum disorders. Mult Scler 14:248–251

    Article  PubMed  Google Scholar 

  43. Cabrera-Gómez JA, Quevedo-Sotolongo L, González-Quevedo A, et al. (2007) Brain magnetic resonance imaging findings in relapsing neuromyelitis optica. Mult Scler 13:186–1921

    Article  PubMed  Google Scholar 

  44. Kurtzke JF (1975) A reassessment of the distribution of multiple sclerosis. Part one. Acta Neurol Scand 51:110–136

    Article  PubMed  CAS  Google Scholar 

  45. Wingerchuk DM, Lennon V, Pittock SJ, Luchinetti CF, Weinshenker BG (2006) Revised diagnostic criteria for neuromyelitis optica. Neurology 66: 1485–14894

    Article  PubMed  CAS  Google Scholar 

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Authors

Corresponding author

Correspondence to Jose A. Cabrera-Gómez MD, PhD, FAAN.

Additional information

Statistical analyses were performed by Alina González-Quevedo, with contributionsby John F. Kurtzke.

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Cabrera-Gómez, J.A., Kurtzke, J.F., González-Quevedo, A. et al. An epidemiological study of neuromyelitis optica in Cuba. J Neurol 256, 35–44 (2009). https://doi.org/10.1007/s00415-009-0009-0

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  • DOI: https://doi.org/10.1007/s00415-009-0009-0

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