The 2015 IPND Criteria Increases the Yield in Diagnosis of Neuromyelitis Optica Spectrum Disorder in Thai Patients Compared to the 2006 Diagnostic Criteria

Abstract

© 2020 Elsevier B.V. Background: The 2015 International Panel for Neuromyelitis Optica (NMO) Diagnosis (IPND) criteria was revised using systematic literature reviews and consensus from the experts. It facilitates NMOSD diagnosis and is applicable in an Asian population. Objective: To compare the utility of the 2015 IPND criteria and the 2006 NMO diagnostic criteria for the diagnosis of NMO/SD. Methods: We retrospectively reviewed the electronic medical records 5 of patients with NMOSD who attended Multiple Sclerosis and Related Disorders Clinic between January 2010 and December 2016. Two independent investigators applied the 2006 revised diagnostic criteria for NMO in patients who fulfilled the 2015 IPND criteria. Results: Of all 70 cases who had an NMOSD diagnosis according to 2015 criteria, 56 cases (80.0%) were positive for aquaporin-4 immunoglobulin (AQP4-IgG). Nineteen patients (27.1%) fulfilled the 2006 NMO diagnostic criteria. The 2015 IPND criteria identified 51 more NMOSD cases, increasing the diagnostic yield by 268%, compared to the 2006 criteria. The median time from onset to diagnosis by using the 2015 IPND criteria was shorter than those identified by the 2006 criteria (128 vs. 547 days, p=0.002). The 2015 IPND also provides for lesser attacks occurring before achieving diagnosis (1.7 vs. 2.7, p<0.001). In the absence of known AQP4-IgG serostatus, the 2015 criteria still indicated NMOSD patients by a 124% increase in detection rate (p<0.001); however, time to diagnosis was not statistically significant between the two criteria (258 vs. 604 days, p=0.081). Conclusions: Compared to the 2006 criteria, the 2015 IPND criteria increased diagnostic yield for NMOSD regardless of AQP4-IgG status and shortened the time from onset to diagnosis in patients with NMOSD with known AQP4-IgG serostatus.