Summary
Sixteen cerebrospinal fluid (CSF) specimens serially obtained during long-term follow-up of two patients with Devic's neuromyelitis optica (DNO) were compared with 65 CSF samples from patients with multiple sclerosis (MS). By statistical analysis, the CSF profile in DNO was found to differ from that observed in MS, mainly showing pleocytosis, blood-brain barrier damage, and absence of persistent immunoglobulin G synthesis within the central nervous system. Oligoclonal bands, detected with isoelectric focusing, were present in CSF of 92% of the patients with MS, and in three CSF specimens from one patient with DNO during the first 6 months after disease onset. The bands disappeared in two subsequent samples. This finding has never been described in MS. One patient with DNO had an apparent chronic-relapsing course probably due to steroid dependence. The clinical and CSF features of our cases favour the nosographic independence of DNO and MS.
References
Adams JM, Brown WJ, Eberle ED, Vortly A (1973) Neuromyelitis optica: severe demyelination occuring years after primary smallpox vaccination. Rev Roum Neurol 10:277–231
Aguilera AJ, Carlow TJ, Smith KJ, Simon TL (1985) Lymphocytoplasmapheresis in Devic's syndrome. Transfusion 25:54–56
Alexander EL, Malinow K, Lejewski JE, Jerdan MS, Provost TT, Alexander GE (1986) Primary Sjögren's syndrome with central nervous system disease mimicking multiple sclerosis. Ann Intern Med 104:323–330
April RS, Vansonnenberg E (1976) A case of neuromyelitis optica (Devic's syndrome) in systemic lupus erythematosus: clinicopathological report and review of the literature. Neurology 26:1066–1070
Barbizet J, Degos JD, Meyrignac C (1980) Neuromyélite optique aigué associée à une tuberculose pulmonaire aigué. Rev Neurol (Paris) 136:303–307
Chusid MJ, Williamson SJ, Murphy JV, Ramey LS (1979) Neuromyelitis optica (Devic's disease) following varicella infection. J Pediatr 95:737–738
Devic E (1894) Myélite subaigué compliquée de névrite optique. Bull Med Paris 8:1033–1034
Gault F (1894) De la neuromyélite optique aigué. Thesis, Lyon
Hassin GB (1937) Neuroptic myelitis versus multiple sclerosis: a pathologic study. Arch Neurol Psychiatry 37:1083–1099
Johnson RT (1982) Viral infections of the nervous system. Raven Press, New York, pp 78–83
Kinney EL, Beroff RL, Rao NS, Lay MF (1979) Devic's syndrome and systemic lupus erythematosus. A case report with necropsy. Arch Neurol 36:643–644
Kohut H, Richter RB (1945) Neuroptic myelitis: a clinicopathological study of two related cases. J Nerv Ment Dis 101:99–114
Kuroiwa Y (1985) Neuromelitis optica. In: Koestsier JC (ed) Handbook of clinical neurology. Elsevier, Amsterdam, pp 397–408
Leonardi A, Arata L, Farinelli M, Cocito L, Schenone A, Tabaton M, Mancardi GL (1987) Cerebrospinal fluid and neuropathological study in Devic's syndrome. J Neurol Sci 82:281–290
Leys D, Petit H, Block AM, Docx B, Basin B, Hache JC (1987) Neuromyélite optique de Devic. Rev Neurol (Paris) 143:722–728
Link H (1987) Cerebrospinal fluid in immunological CNS diseases. In: Aarly JA, Behan WMH, Behan PO (eds) Clinical neuroimmunology. Blackwell, Oxford, pp 446–466
McAlpine D, Lumdsen CE, Acheson ED (1965) Multiple sclerosis: a reappraisal. Churchill Livingstone, Edinburgh
Miller HG, Stanton JB, Gibbons JL (1957) Acute disseminated encephalomyelitis and related syndromes. Br Med J 1:668–672
Poser CM, Paty DW, Scheinberg L, McDonald WI, Floyd DA, Ebers GC, Johnson KP, Sibley WA, Silberberg DH, Tourtellotte WW (1983) New diagnostic criteria for multiple sclerosis: guidelines for research protocols. Ann Neurol 13:227–231
Schliep G, Felgenhauer K (1978) Serum-CSF protein gradient, the blood-CSF barrier and the local immuneresponse. J Neurol 218:77–96
Shibasaki H, Kuroda Y, Kuroiwa Y (1974) Clinical studies of multiple sclerosis in Japan: classical multiple sclerosis and Devic's disease. J Neurol Sci 23:215–222
Tibbling G, Link H, Ohman S (1977) Principles of albumin and IgG analysis in neurological disorders. I. Establishment of reference values. Scand J Clin Lab Invest 37:385–390
Willoughby EW, Lambert A (1983) A sensitive silver stain for proteins in agarose gel. Anal Biochem 130:353–358
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Piccolo, G., Franciotta, D.M., Camana, C. et al. Devic's neuromyelitis optica: long-term follow-up and serial CSF findings in two cases. J Neurol 237, 262–264 (1990). https://doi.org/10.1007/BF00314631
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00314631