Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA.
Mult Scler Relat Disord. 2022 Jul;63:103825. doi: 10.1016/j.msard.2022.103825. Epub 2022 Apr 26.
Neuropathic pain (NP) and constipation are common among people with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and have a negative impact on quality-of-life measures. The possible association between the two symptoms has not been explored.
Patients with NMOSD and MOGAD, who were members of a closed international Facebook group, were recruited to complete an anonymous survey on REDCap. Participants were queried regarding demographic and disease-related characteristics, the presence and severity of NP and constipation, and whether they believe there is a relationship between the two symptoms.
Of the 317 participants who completed the survey, 213 (67.2%) reported a diagnosis of aquaporin-4 (AQP-4) positive NMOSD, 93 (29.4%) - MOGAD, and 11 (3.4%) - double-seronegative NMOSD. The mean age was 43.9 ± 16.4 years; 259 were female (81.7%). 206 participants (65%) reported NP, of whom 133 (64.6%) were being treated for it with one or more medications. 167 participants (52.7%) reported constipation, of whom 67 (40.2%) received one or more medications. 137 of 206 participants with NP (66%) also had constipation. Both symptoms were significantly more common among patients with a history of myelitis. Among patients with NP and constipation, 47 participants (34.3%) thought there was a relationship between the two conditions, with the majority reporting increased severity of NP when constipation severity was increased and, conversely, alleviation of NP when constipation lessened.
NP and constipation were seen in the majority of NMOSD and MOGAD patients with a history of myelitis. Interestingly, one-third of patients with both symptoms reported a link between them, with the majority reporting that NP severity was increased with worse constipation. The possible association opens a possibility of a new approach to managing NP, which tends to be poorly responsive to symptomatic therapies and is associated with worse quality of life in NMOSD and MOGAD. Further studies are warranted to confirm our results.
神经病理性疼痛（NP）和便秘在视神经脊髓炎谱系疾病（NMOSD）和髓鞘少突胶质细胞糖蛋白抗体病（MOGAD）患者中较为常见，对生活质量评估指标有负面影响。这两种症状之间可能存在关联，但尚未得到探究。
本研究招募了一个封闭的国际 Facebook 群组中的 NMOSD 和 MOGAD 患者，让他们完成 REDCap 上的匿名调查。参与者被询问了人口统计学和疾病相关特征、NP 和便秘的存在和严重程度，以及他们是否认为这两种症状之间存在关联。
在完成调查的 317 名参与者中，213 名（67.2%）报告诊断为水通道蛋白-4（AQP-4）阳性 NMOSD，93 名（29.4%）-MOGAD，11 名（3.4%）-双阴性 NMOSD。平均年龄为 43.9±16.4 岁，259 名为女性（81.7%）。206 名参与者（65%）报告有 NP，其中 133 名（64.6%）正在使用一种或多种药物进行治疗。167 名参与者（52.7%）报告有便秘，其中 67 名（40.2%）服用了一种或多种药物。206 名有 NP 的参与者中有 137 名（66%）也有便秘。这两种症状在有脊髓炎病史的患者中更为常见。在有 NP 和便秘的患者中，47 名参与者（34.3%）认为这两种情况之间存在关联，大多数参与者报告说便秘严重程度增加时 NP 严重程度也增加，反之，便秘减轻时 NP 也减轻。
有脊髓炎病史的 NMOSD 和 MOGAD 患者中，大多数患者存在 NP 和便秘。有趣的是，三分之一有这两种症状的患者报告两者之间存在关联，大多数患者报告说便秘加重时 NP 严重程度增加。这一可能的关联为管理 NP 提供了一种新的思路，NMOSD 和 MOGAD 患者的 NP 往往对对症治疗反应不佳，且与生活质量较差相关。需要进一步的研究来证实我们的结果。
