The TMA at the American Academy of Neurology Annual Meeting

One very important part of the TMA’s mission is to advance the scientific understanding of and therapy development for ADEM, MOG Antibody-Associated Disease, NMOSD, ON, and TM (including AFM). We do this by supporting the training of clinician-scientists and by supporting basic and clinical research about these disorders. Part of doing research involves disseminating or sharing research findings to the medical community, and this is often done through peer-reviewed publications, or by presentations at conferences. We are proud to announce that TMA supported research was presented at the 70th American Academy of Neurology Annual Meeting, which was held from April 21-27th in Los Angeles, California.

Dr. Olwen Murphy, a current James T. Lubin Fellow, and a team at The Johns Hopkins Hospital presented research on pediatric myelopathies. They conducted a retrospective review of 43 patients who were less than 21 years old who were referred to the Johns Hopkins TM Center with a diagnosis of TM between 2010-2017. They reviewed the temporal profile of symptoms, clinical presentation, cerebrospinal fluid analysis and spinal cord magnetic resonance imaging of the patients. They found that clinical, laboratory and imaging findings were consistent with inflammatory myelopathy in 29 patients (infectious [n=10], idiopathic [n=5], neuromyelitis optica [n=1], neuromyelitis optica spectrum disorder [n=1], clinically isolated syndrome [n=1], other [n=11]) and non-inflammatory myelopathy in 11 patients (SC ischemia [n=9], metabolic [n=2]). In 3 patients, the cause was unclear.

Maureen Mealy, also from the Johns Hopkins TM and NMO Centers, presented similar research that looked at 1000 patients who were referred to the Johns Hopkins TM Center between 2010 and 2017. They reviewed patients’ clinical/temporal profile, their neuroimaging, and laboratory findings to establish a final diagnosis. They found that 62% were confirmed to have an inflammatory cause for their myelopathy, of which 35% was idiopathic. They found 41% of patients had myelopathy attributable to an underlying disease such as multiple sclerosis or neuromyelitis optica spectrum disorder.

Dr. Murphy, Dr. Pardo, and Dr. Gailloud also presented research on a group of 100 patients with symptomatic low-flow spinal arteriovenous fistulas (SAVF). Low-flow SAVFs are the most common spinal vascular malformation and they can cause severe disability, including paraparesis, pain, bladder and sexual dysfunction. Most low-flow SAVFs can be treated, but they are frequently misdiagnosed, which can delay treatment. They identified clinical features that may help physicians identify this diagnosis, such as older age, male gender, history of intermittent cramping pain in the legs because of low blood flow during exercise, and risk factors for venous thrombosis.

Dr. Stacey L. Clardy at The University of Utah, one of the James T. Lubin Fellowship training sites, also presented research at AAN. Her team’s research aimed to determine the rate and characteristics of patients not meeting diagnostic criteria for neuromyelitis optica spectrum disorders who tested positive for autoantibodies to aquaporin 4 (AQP4). They found 48 patients in the University of Utah medical system who tested positive for AQP4, but only 20 of them met the clinical criteria for NMOSD. They argue that individuals should be tested for AQP4 multiple times to ensure patients do not receive false negative results.

Dr. Jonathan Galli, who will start his James T. Lubin Fellowship this summer, worked with Dr. Clardy on another research study that aims to characterize patients with NMOSD in the Department of Defense (DoD) population. They identified 131 patients within the DoD system who had the code for NMOSD documented in their medical record, 39 of whom were service members. Only 17 of this cohort of 39 met the criteria for NMOSD. Their clinical characteristics matched other reports of individuals with NMOSD, except for the distribution between men and women, but this may be because of the characteristics of the DoD population as a whole.

For more information on other research and clinical publications supported through the generosity of the TMA community, please visit https://tma.ong/2IsdzqW.

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