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Background: The diagnostic and pathophysiological relevance of antibodies to aquaporin-4 (AQP4-Ab) in patients with neuromyelitis optica spectrum disorders (NMOSD) has been intensively studied. However, little is known so far about the clinical impact of AQP4-Ab seropositivity.
Objective: To analyse systematically the clinical and paraclinical features associated with NMO spectrum disorders in Caucasians in a stratified fashion according to the patients' AQP4-Ab serostatus.
Methods: Retrospective study of 175 Caucasian patients (AQP4-Ab positive in 78.3%).
Results: Seropositive patients were found to be predominantly female (p < 0.0003), to more often have signs of co-existing autoimmunity (p < 0.00001), and to experience more severe clinical attacks. A visual acuity of <= 0.1 during acute optic neuritis (ON) attacks was more frequent among seropositives (p < 0.002). Similarly, motor symptoms were more common in seropositive patients, the median Medical Research Council scale (MRC) grade worse, and MRC grades <= 2 more frequent, in particular if patients met the 2006 revised criteria (p < 0.005, p < 0.006 and p < 0.01, respectively), the total spinal cord lesion load was higher (p < 0.006), and lesions >= 6 vertebral segments as well as entire spinal cord involvement more frequent (p < 0.003 and p < 0.043). By contrast, bilateral ON at onset was more common in seronegatives (p < 0.007), as was simultaneous ON and myelitis (p < 0.001); accordingly, the time to diagnosis of NMO was shorter in the seronegative group (p < 0.029). The course of disease was more often monophasic in seronegatives (p < 0.008). Seropositives and seronegatives did not differ significantly with regard to age at onset, time to relapse, annualized relapse rates, outcome from relapse (complete, partial, no recovery), annualized EDSS increase, mortality rate, supratentorial brain lesions, brainstem lesions, history of carcinoma, frequency of preceding infections, oligoclonal bands, or CSF pleocytosis. Both the time to relapse and the time to diagnosis was longer if the disease started with ON (p < 0.002 and p < 0.013). Motor symptoms or tetraparesis at first myelitis and > 1 myelitis attacks in the first year were identified as possible predictors of a worse outcome.
In der vorliegenden Studie wurde eine modifizierte Version des Eriksen Flanker Task verwendet, um ereigniskorrelierte Potentiale (ERPs) aufzuzeichnen und zu beurteilen, ob diese nach Richtigantworten, Falschantworten sowie Richtigantworten mit negativem Feedback ("PC-Fehlern") auftreten. Die bisher beschriebenen Fehlerpotentiale, d.h. die error-related negativity (negativer Peak nach Falschantworten) sowie die error positivity (positiver Peak nach Falschantworten), waren grundsätzlich nach Falschantworten zu beobachten, aber traten nur teilweise nach Richtigantworten mit negativem Feedback auf. Zudem trat eine späte Positivierung ausschließlich im letzteren Fall auf, welche eine bewußte Verarbeitung der unerwarteten Ereignisse widerspiegeln könnte. Diese Ergebnisse widersprechen der Vorstellung, dass die ERN/Ne die Aktivität eines generellen Fehlererkennungssystems des menschlichen Gehirns repräsentiert.