Department of Neurology, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
Tohoku J Exp Med. 2011 Mar;223(3):211-4. doi: 10.1620/tjem.223.211.
Optic neuritis and myelitis are manifestations in both multiple sclerosis (MS) and neuromyelitis optica (NMO). But unlike MS, NMO is characterized by severe optic neuritis, longitudinally extensive and transverse myelitis, and the presence of aquaporin-4 antibody. Since patients with optic neuritis and myelitis have often been diagnosed with "optic-spinal MS (OSMS)" in Asia, it was obscure whether "OSMS" is synonymous with NMO or includes both NMO and MS. Interferon β (IFNβ)-1a and -1b are used as the first-line disease-modifying therapy for MS. However, some neurologists have been reluctant to use IFNβ to treat patients with optic-spinal symptoms, because IFNβ therapy is not efficacious in NMO. To evaluate the therapeutic effect of IFNβ in patients with "genuine" OSMS, we retrospectively evaluated Japanese MS patients who fulfilled the following six criteria: 1) Relapsing-remitting MS with optic-spinal presentation alone (no brain symptoms), 2) With or without asymptomatic brain MRI lesions, 3) Oligoclonal IgG band-positive, 4) aquaporin-4 antibody seronegativity, 5) No myelitis extending longitudinally over ≥ 3 vertebral segments, and 6) Duration of IFNβ-1b therapy ≥ 2 years. Among 157 patients with MS, six (four women and two men, age 43.8 ± 8.5 years old) met all the criteria. Their Expanded Disability Status Scale scores were lowered (4.1 ± 2.4 → 3.1 ± 2.8) (P = 0.033) and annualized relapse rate was decreased (0.59 ± 0.34 → 0.13 ± 0.15) (P = 0.027) after IFNβ-1b therapy. These results suggest that IFNβ is therapeutically effective in inhibiting functional worsening and reducing relapse rate in "genuine" OSMS.
视神经炎和脊髓炎是多发性硬化症（MS）和视神经脊髓炎（NMO）的共同表现。但与 MS 不同的是，NMO 以严重的视神经炎、纵向广泛和横向脊髓炎以及水通道蛋白 4 抗体的存在为特征。由于亚洲视神经炎和脊髓炎患者常被诊断为“视神经脊髓型 MS（OSMS）”，因此“OSMS”是否与 NMO 同义或包括 NMO 和 MS 并不清楚。干扰素 β（IFNβ）-1a 和 -1b 被用作 MS 的一线疾病修正治疗。然而，一些神经病学家不愿意用 IFNβ 来治疗有视神经脊髓症状的患者，因为 IFNβ 治疗对 NMO 无效。为了评估 IFNβ 在“真正的”OSMS 患者中的治疗效果，我们回顾性评估了符合以下六个标准的日本 MS 患者：1）单纯复发缓解型 MS 伴视神经脊髓表现（无脑部症状），2）有或无症状性脑 MRI 病变，3）寡克隆 IgG 带阳性，4）水通道蛋白 4 抗体阴性，5）无纵向延伸超过 3 个椎体节段的脊髓炎，以及 6）IFNβ-1b 治疗时间≥2 年。在 157 例 MS 患者中，有 6 例（4 名女性和 2 名男性，年龄 43.8±8.5 岁）符合所有标准。他们的扩展残疾状况量表评分降低（4.1±2.4→3.1±2.8）（P=0.033），年复发率降低（0.59±0.34→0.13±0.15）（P=0.027）。这些结果表明，IFNβ 在抑制“真正的”OSMS 患者的功能恶化和降低复发率方面具有治疗效果。
