Researchers have proposed a way to avoid patients with neuromyelitis optica being wrongly diagnosed as having multiple sclerosis (MS).
A team of researchers from UCL and University of Oxford and consultant neurologists from the National Hospital for Neurology and Neurosurgery used the imaging technique Magnetic Resonance Spectroscopy to study metabolic changes in diseases affecting the brain and the spinal cord and compare chemical compounds in MS patients and those with neuromyelitis optica (NMO).
The study, led by BRC-supported Dr Olga Ciccarelli and published in Annals of Neurology, showed concentration of the compound myo-inositol is reduced in the spinal cord lesions of patients with NMO, but increased in the lesions of MS patients.
These lesions look similar when using conventional types of spinal cord imaging.
NMO is a rare condition in which the immune system attacks the myelin cells in the spinal cord and optic nerves. It causes symptoms similar to those in MS but affects less than 1,000 people in the UK, whereas MS affects about 100,000 people in the UK.
Different medications are needed to treat the two conditions and it can be harmful to use drugs for MS to treat NMO patients.
However, differential diagnosis between these two conditions is often difficult. Clinicians combine patients’ symptoms and history with imaging characteristics and blood tests to diagnose patients.
Dr Ciccarelli, Reader in Neurology at the UCL Institute of Neurology and Consultant Neurologist at the National Hospital for Neurology and Neurosurgery said: “Sometimes the conventional tests are not sufficient to diagnose a patient with either NMO or MS, and the patient faces the uncertainty of when they will be told which disease they have and which treatment they can commence.
"The potential impact of this study is that myo-inositol may become a useful metabolite that distinguishes NMO from MS. This metabolite may also have value in future clinical trials which will test new treatments in patients with NMO”.
She continued: “BRC funding was essential to test the hypothesis that myo-inositol, which is linked to the astrocytes, is a useful diagnostic marker. We are looking forward to confirming these studies in larger patients groups and, if these results are confirmed, seeing this metabolite used in clinical practice to expedite the diagnosis, and improve management, of patients with NMO”.
