DXM04
Spinal Movement Disorders in Transverse Myelitis, Nmosd, and Mogad
Movement disorders secondary to spinal cord demyelination are the most frequent movement disorders in MS. Retrospective studies suggest that spinal movement disorders especially tonic spasms are even more prevalent in NMOSD. However, there has been no prospective studies evaluating spinal movement disorders in NMOSD nor in MOGAD or idiopathic transverse myelitis (ITM).
Objectives:
To prospectively evaluate spinal movement disorders in patients with NMOSD, MOGAD, and ITM.
Methods:
Patients referred to a tertiary neuroimmunology clinic for evaluation of NMOSD, MOGAD, or ITM were evaluated by a neurologist trained in both neuroimmunology and movement disorders. All patients answered a movement disorders survey and underwent a movement disorder-focused exam. Movement disorders were compared among patients with NMOSD with AQP4-IgG, NMOSD without AQP4-IgG, MOGAD, and ITM. Patients with and without movement disorders were also compared to identify predictors of spinal movement disorders.
Results:
Eighty patients were evaluated from 2017 to 2021. Seventeen NMOSD/MOGAD patients without cord lesions were excluded. The remaining 62 patients were analyzed (71% females, average age 48+/-14 years). Of the total, 49% had ITM, 21% had NMOSD without AQP4-IgG, 19% had NMOSD with AQP4-IgG, and 11% had MOGAD. Movement disorders were present in 73% of all patients and were most frequent in NMOSD with AQP4-IgG (92%) and least frequent in MOGAD (57%). The most frequent spinal movement disorders were tonic spasms (57% of all patients), focal dystonia (25%), spinal tremor (17%), spontaneous clonus (11%), secondary RLS (9.5%), and spinal myoclonus (6%). NMOSD patients were more likely to have any tonic spasms (P=0.003), isometric tonic spasms (0.013), spinal myoclonus (0.04), and painful movement disorders (0.02). Univariate analysis showed that patients with spinal movement disorders had longer disease duration (P<0.001) and were more likely to have a relapsing course (P=0.04). Multivariate analysis showed that white race and AQP4-IgG sero-positivity are independent predictors of spinal movement disorders in patients with myelitis.
Conclusions:
Spinal movement disorders are highly prevalent in patients with myelitis. White race and AQP4-IgG sero-positivity are predictors of spinal movement disorders. Patients with NMOSD are more likely to have painful movement disorders, tonic spasms, and spinal myoclonus compared to patients with ITM and MOGAD.