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“NMDA receptor spectrum disorder” in the differential diagnosis of demyelinating disorders of the CNS: optic neuritis and myelitis

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Abstract

Objective

The aim of this study was to investigate the frequency of anti-N-methyl-D-aspartate receptor (anti-NMDAR) antibody positivity in patients presenting with transverse myelitis (TM) and/or optic neuritis (ON), to describe their neurologic and radiological characteristics, and to compare these characteristics with those reported in previous studies.

Material and methods

This study included 179 patients (ON: 96, TM: 74, ON and TM: 9) who visited Isfahan Multiple Sclerosis Center from January 2017 to September 2019, for approximately 32 months. The respective neurological examinations were performed. Demographic data of the patients, as well as findings from radiological and serological investigations were obtained.

Results

Frequencies of anti-NMDAR seropositivity in patients with TM, ON, and concurrent TM and ON were approximately 3.4%, 1.4%, and 11.1%, respectively. None exhibited any psychiatric symptoms.

Conclusion

Based on the frequency of seropositivity for anti-NMDAR antibody in our patients, positivity for this antibody appears to be more frequent than previously anticipated in patients presenting with these conditions. We recommend that the anti-NMDAR antibody presence in CSF/serum be checked and considered in addition to the routine examinations performed upon confronting demyelinating conditions such as TM and ON. We suggest considering the term “NMDAR spectrum disorder” to more clearly distinguish the potentially overlapping conditions with different etiologies in patients with CNS disorders.

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Author information

Authors and Affiliations

  1. Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran

    Masoud Etemadifar & Fatemeh Sabeti

  2. Medical School, Isfahan University of Medical Sciences, Isfahan, Iran

    Amir Parsa Abhari, Fatemeh Hashemi, Ali Aghababaee, Reza Khorvash, Mohammad Hasan Khayati & Hosein Nouri

  3. Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

    Mazdak Ganjalikhani-Hakemi

  4. Department of Neurological Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran

    Mehri Salari

Authors
  1. Masoud Etemadifar
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  2. Amir Parsa Abhari
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  3. Fatemeh Sabeti
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  4. Mazdak Ganjalikhani-Hakemi
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  5. Mehri Salari
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  6. Fatemeh Hashemi
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  7. Ali Aghababaee
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  8. Reza Khorvash
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  9. Mohammad Hasan Khayati
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  10. Hosein Nouri
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Contributions

The main idea of the study was presented by Prof. Masoud Etemadifar. Ali Aghababaee and Fatemeh Hashemi performed the literature search and gathered the previously published data, Mohammad Hasan Khayati and Reza Khorvash assisted with the data collection and analysis, and Hosein Nouri and Amir Parsa Abhari prepared the manuscript, with the supervision of Prof. Etemadifar and critical revisions from Fatemeh Sabeti, Mazdak Ganjalikhani-Hakemi, and Mehri Salari, throughout the whole process of the study.

Corresponding author

Correspondence to Hosein Nouri.

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Etemadifar, M., Abhari, A.P., Sabeti, F. et al. “NMDA receptor spectrum disorder” in the differential diagnosis of demyelinating disorders of the CNS: optic neuritis and myelitis. Neurol Sci 42, 151–157 (2021). https://doi.org/10.1007/s10072-020-04518-y

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  • DOI: https://doi.org/10.1007/s10072-020-04518-y

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