RT Journal Article
SR Electronic
T1 Chronic neuropathic pain severity is determined by lesion level in aquaporin 4-antibody-positive myelitis
JF Journal of Neurology, Neurosurgery & Psychiatry
JO J Neurol Neurosurg Psychiatry
FD BMJ Publishing Group Ltd
SP 165
OP 169
DO 10.1136/jnnp-2016-314991
VO 88
IS 2
A1 George Tackley
A1 Domizia Vecchio
A1 Shahd Hamid
A1 Maciej Jurynczyk
A1 Yazhuo Kong
A1 Rosie Gore
A1 Kerry Mutch
A1 Mark Woodhall
A1 Patrick Waters
A1 Angela Vincent
A1 Maria Isabel Leite
A1 Irene Tracey
A1 Anu Jacob
A1 Jacqueline Palace
YR 2017
UL http://jnnp.bmj.com/content/88/2/165.abstract
AB Importance Chronic, intractable neuropathic pain is a common and debilitating consequence of neuromyelitis optica spectrum disorder (NMOSD) myelitis, with no satisfactory treatment; few studies have yet to explore its aetiology.Objective To establish if myelitis-associated chronic pain in NMOSD is related to the craniocaudal location of spinal cord lesions.Method (1) Retrospective cohort of 76 aquaporin 4-antibody (AQP4-Ab)-positive patients from Oxford and Liverpool's national NMOSD clinics, assessing current pain and craniocaudal location of cord lesion contemporary to pain onset. (2) Focused prospective study of 26 AQP4-Ab-positive Oxford patients, a subset of the retrospective cohort, assessing current craniocaudal lesion location and current pain.Results Patients with isolated thoracic cord myelitis at the time of pain onset were significantly more disabled and suffered more pain. Cervical and thoracic lesions that persisted from pain onset to ‘out of relapse’ follow-up (current MRI) had highly significant (p<0.01) opposing effects on pain scores (std. β=−0.46 and 0.48, respectively). Lesion length, total lesion burden and number of transverse myelitis relapses did not correlate with pain.Conclusions Persistent, caudally located (ie, thoracic) cord lesions in AQP4-Ab-positive patients associate with high postmyelitis chronic pain scores, irrespective of number of myelitis relapses, lesion length and lesion burden. Although disability correlated with pain in isolation, it became an insignificant predictor of pain when analysed alongside craniocaudal location of lesions.