Carnero Contentti Edgar, Rojas Juan I, Alonso Ricardo, Yeaman Michael R, Weinshenker Brian G
Neuroimmunology Unit, Department of Neurosciences, Hospital Aleman, Buenos Aires, Argentina.
Centro de Enfermedades Neuroinmunológicas de Rosario (CENRos), Neuroimmunology Clinic, Instituto de Neurologia Cognitiva (INECO) Neurociencias Oroño, Rosario, Argentina.
Front Immunol. 2024 Dec 13;15:1515481. doi: 10.3389/fimmu.2024.1515481. eCollection 2024.
We evaluated comprehension and application of the 2015 neuromyelitis optica spectrum disorder (NMOSD) criteria core elements by neurologists in Latin America (LATAM) who routinely diagnose and care for NMOSD patients by (i) identifying typical/suggestive NMOSD syndromes, (ii) detecting typical MRI NMOSD lesions and meeting MRI dissemination in space (DIS) criteria, and (iii) evaluating historical symptoms suggestive of NMOSD.
We conducted an anonymous, voluntary, self-administered web- and case-based survey cross-sectional study from October 2023 to January 2024 of neurologists identified through the LACTRIMS database. Questions were presented first through iterative clinical cases or imaging, followed by questions directly evaluating comprehension of definitions. "Correct" responses were based on the 2015 criteria and adjudicated by the consensus of the experts leading the project.
A total of 106 neurologists (60.3% female; mean age: 46.6 ± 12.5 years) were included. Between 10.4% and 49.1% of neurologists inaccurately identified clinical or paraclinical aspects for DIS and 32.1% accurately identified the three non-cardinal (brainstem, diencephalic, and cerebral) syndromes for seronegative patients. Between 35.8% and 64.1% of neurologists identified the "optimal timing" of AQP4-IgG testing (e.g., during an attack or before receiving immunosuppressant treatments, among others); 56.6% considered live cell-based assay as the gold standard method for serological testing. Most neurologists accurately identified typical NMOSD MRI lesions, but periventricular, juxtacortical/cortical, fluffy infratentorial, corticospinal tract, and hypothalamic lesions were frequently misidentified.
Clinical scenarios were identified where the 2015 NMOSD criteria were susceptible to misinterpretation and misapplication by expert neurologists in LATAM. Implementing collaborative educational initiatives could improve NMOSD diagnosis and raise patient care standards.
我们评估了拉丁美洲（LATAM）的神经科医生对2015年视神经脊髓炎谱系障碍（NMOSD）标准核心要素的理解和应用情况，这些神经科医生日常负责诊断和治疗NMOSD患者，评估方式包括：（i）识别典型/疑似NMOSD综合征；（ii）检测典型的NMOSD磁共振成像（MRI）病变并满足MRI空间扩散（DIS）标准；（iii）评估提示NMOSD的既往症状。
我们于2023年10月至2024年1月开展了一项基于网络和病例的匿名、自愿、自我管理的横断面调查研究，调查对象是通过拉丁美洲多发性硬化和相关疾病研究组（LACTRIMS）数据库确定的神经科医生。问题首先通过迭代临床病例或影像学呈现，随后是直接评估对定义理解的问题。“正确”答案基于2015年标准，并由项目牵头专家的共识裁定。
共纳入106名神经科医生（女性占60.3%；平均年龄：46.6±l2.5岁）。10.4%至49.1%的神经科医生对DIS的临床或辅助检查方面识别不准确，32.1%的神经科医生准确识别了血清学阴性患者的三种非主要（脑干、间脑和大脑）综合征。35.8%至64.1%的神经科医生确定了水通道蛋白4免疫球蛋白（AQP4-IgG）检测的“最佳时机”（例如，在发作期间或接受免疫抑制治疗之前等）；56.6%的医生认为基于活细胞的检测方法是血清学检测的金标准方法。大多数神经科医生准确识别了典型的NMOSD MRI病变，但脑室周围、皮质旁/皮质、幕下絮状、皮质脊髓束和下丘脑病变经常被误认。
已确定在某些临床情况下，2015年NMOSD标准易被LATAM地区的专家神经科医生误解和误用。开展合作教育活动可改善NMOSD的诊断并提高患者护理标准。
