Abstract: Environmental Risk Factors Associated With Pediatric Neuromyelitis Optica (The 27th Annual Meeting of the CMSC and the 5th Cooperative Meeting of the CMSC-ACTRIMS)

Thursday, May 30, 2013

Sirisha Grandhe, BA , Neurology, University of California, San Francisco, Bakersfield, CA

Jennifer Graves, MD, PhD , Neurology, University of California, San Francisco, San Francisco, CA

Ellen M Mowry, MD , Neurology, University of California, San Francisco, San Francisco, CA

Lauren Krupp, MD , Neurology, Stony Brook University Medical Center, East Setauket, NY

Tanuja Chitnis, MD , Neurology, Massachusetts General Hospital, Boston, MA

Eluen A Yeh, MD , Division of Neurology, Hospital for Sick Children, Toronto, ON, Canada

Nancy Kuntz, MD , Neurology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL

Jayne Ness, MD , Neurology, Children's Hospital Alabama, Birmingham, AL

Jamie C McDonald, BS , Neurology, Stony Brook University Medical Center, Stony Brook, NY

Anita L Belman, MD , Neurology, Stony Brook University Medical Center, East Setauket, NY

Maria Milazzo, NP , Neurology, Stony Brook University Medical Center, Stony Brook, NY

Mark Gorman, MD , Neurology, Boston Children's Hospital, Boston, MA

Bianca Weinstock-Guttman, MD , Neurology, University of Buffalo, Buffalo, NY

Moses Rodriguez, MD , Neurology, Mayo Clinic, Rochester, MN

Marc Patterson, MD , Neurology, Mayo Clinic, Rochester, MN

Emmanuelle Waubant, MD, PhD , Neurology, University of California, San Francisco, San Francisco, CA

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Background:

Neuromyelitis optica (NMO) is now identified as a distinct entity although it had long been considered a variant of multiple sclerosis (MS) due to substantial clinical and radiological phenotype similarities. Whether the environmental risk factors of pediatric MS also predict NMO remains to be investigated.

Objectives:

We assessed whether environmental risk factors for MS, such as mode of delivery, length of breast feeding, and exposure to smoking, increase the risk of developing pediatric NMO.

Methods:

Pediatric MS and control data were provided by the 6 pediatric MS centers part of the US Network. An environmental questionnaire about past exposures such as mode of delivery, length of breast feeding, and exposure to smoking, was completed by the families of NMO and MS patients and neurological controls seen at the pediatric MS centers.

Results: 29 pediatric NMO, 215 pediatric MS, and 160 pediatric neurological controls had information documented for relevant environmental exposures from initial visit. Approximately 34% of pediatric NMO patients were positive for aquaporin-4 (AQP4) IgG. The rate of birth by C-section was higher in AQP4 IgG-positive pediatric NMO patients (56%) compared with NMO AQP4 IgG-negative (31%), pediatric MS (27%) and healthy controls (30%). Pediatric NMO patients who are AQP4-positive have been breastfed less often (33%) than AQP4 IgG-negative NMO (64%), pediatric MS (63%) and healthy controls (68%). Exposure to smoking was also less frequent in AQP4-positive NMO patients (0%) compared to AQP4-negative NMO (24%), pediatric MS (26%), and healthy controls (17%).

Conclusions:

Birth by C-section, low rate of breastfeeding, and low exposure to smoking may be associated with a higher risk of developing pediatric NMO, especially in AQP4-positive patients. Larger case-control studies are needed to confirm these findings.

SC16 Environmental Risk Factors Associated With Pediatric Neuromyelitis Optica