Is there a link between neuropathic pain and constipation in NMOSD and MOGAD? Results from an online patient survey and possible clinical implications

Advancements in the application of botulinum toxin type a in the treatment of anorectal disorders

Botulinum toxin type A (BoNT/A) has garnered significant attention in recent years due to its unique biological properties and neuromuscular blocking effects, particularly in the field of anorectal disorders. This review discusses the application of BoNT/A in treating various conditions such as anal sphincter spasms, hemorrhoids, anal fissures, and other related ailments. We analyze the latest research findings regarding its efficacy, safety, and clinical applications, highlighting both the current state of research and the challenges that persist in this area. This synthesis aims to provide valuable insights and guidance for future studies and clinical practices involving BoNT/A in the management of anorectal diseases.

Exploring core symptoms and symptom clusters among patients with neuromyelitis optica spectrum disorder: A network analysis

Objectives

To identify core symptoms and symptom clusters in patients with neuromyelitis optica spectrum disorder (NMOSD) by network analysis.

Methods

From October 10 to 30, 2023, 140 patients with NMOSD were selected to participate in this online questionnaire survey. The survey tools included a general information questionnaire and a self-made NMOSD symptoms scale, which included the prevalence, severity, and distress of 29 symptoms. Cluster analysis was used to identify symptom clusters, and network analysis was used to analyze the symptom network and node characteristics and central indicators including strength centrality (r s), closeness centrality (r c) and betweeness centrality (r b) were used to identify core symptoms and symptom clusters.

Results

The most common symptom was pain (65.7%), followed by paraesthesia (65.0%), fatigue (65.0%), easy awakening (63.6%). Regarding the burden level of symptoms, pain was the most burdensome symptom, followed by paraesthesia, easy awakening, fatigue, and difficulty falling asleep. Six clusters were identified: somatosensory, motor, visual, and memory symptom clusters, bladder and rectum symptom clusters, sleep symptoms clusters, and neuropsychological symptom clusters. Fatigue (r s = 12.39, r b = 68.00, r c = 0.02) was the most central and prominent bridge symptom, and motor symptom cluster (r s = 2.68, r c = 0.10) was the most central symptom cluster among the six clusters.

Conclusions

Our study demonstrated the necessity of symptom management targeting fatigue, pain, and motor symptom cluster in patients with NMOSD.

Quality of life in patients with myelin oligodendrocyte glycoprotein antibody associated disease compared to patients with AQP4-IgG positive neuromyelitis optica spectrum disorders: A Korean multicenter study

BACKGROUND

Little is known about the quality of life (QOL) of patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). We compared QOL and associated factors in patients with MOGAD and aquaporin4 IgG (AQP4-IgG) positive neuromyelitis optica spectrum disorder (NMOSD).

METHODS

This multicenter questionnaire study compared the QOL of 41 patients with MOGAD and 78 with AQP4-IgG positive NMOSD. Patients who were positive for AQP4-IgG or MOG antibodies were included. WHO Quality of Life Scale Brief Version was used to assess QOL in physical, psychological, social, and environmental domains. QOL, sleep quality, pain, fatigue, and depression were compared between the two groups. The factors associated with QOL in each group and the entire cohort were analyzed.

RESULTS

The proportion of patients with poor QOL was not significantly different between MOGAD (51.22 %) and AQP4-IgG positive NMOSD (58.97 %, p = 0.054). In the MOGAD group, the pain score (β=-1.032, p = 0.001) and depression score (β=-0.694, p = 0.007) were negatively associated with physical and psychological QOL, respectively. Sleep quality was negatively associated with physical (β=-1.506, p = 0.034) and psychological (β =-2.064, p = 0.033) QOL. When the entire cohort was analyzed, a positive MOG antibody was independently associated with worse psychological QOL (β=-8.998, p = 0.013) compared to positive AQP4-Ab after adjustment for sleep quality, depression, fatigue, and pain.

CONCLUSIONS

The overall QOL of the patients of MOGAD was comparable to that of AQP4-IgG positive NMOSD. Patients with MOGAD were experiencing sleep disorder, fatigue, and depression at similar degrees to those of patients with AQP4-IgG positive NMOSD. Further consideration of sleep quality and psychological QOL is required to improve QOL in patients with MOGAD.

Significant up-regulation of lncRNAs in neuromyelitis optica spectrum disorder

Neuromyelitis optica spectrum disorder (NMOSD) is an immune-related demyelinating defect. Long non-coding RNAs (lncRNAs) might influence the pathobiology and progression of NMOSD. The current study assessed expression level of NEAT1, PANDAR, MEG3 and TUG1 lncRNAs in the peripheral blood of NMOSD patients compared with healthy individuals. All mentioned lncRNAs were shown to be over-expressed in total NMOSD cases, male NMOSD cases and female NMOSD cases compared with the matching control subgroups. MEG3 had the most robust over-expression in patients subgroups compared with normal subjects. There was no noteworthy difference in the expression of any of lncRNAs between female and male patients. MEG3 had an ideal performance in the differentiation of NMOSD cases from healthy persons (Sensitivity and specificity values = 100%). Other lncRNAs could also efficiently separate NMOSD cases from control subjects (AUC values = 0.97, 0.89 and 0.88 for PANDAR, NEAT1 and TUG1, respectively). Cumulatively, NEAT1, PANDAR, MEG3 and TUG1 lncRNAs can be considered as appropriate disease markers for NMOSD.

Pain in neuromyelitis optic spectrum disorder

BACKGROUND

Pain is a common symptom of neuromyelitis optica spectrum disorder (NMOSD), but there are relatively few studies on NMOSD pain.

METHODS

We retrospectively reviewed the medical records of 145 patients with NMOSD admitted to our hospital between July 2016 and June 2019.

RESULTS

The clinical characteristics of pain and factors related to NMOSD were analyzed, revealing that the incidence of pain in NMOSD is high and can be used for disease localization.

CONCLUSION

Different types of pain occur at different stages of the disease, and serum aquaporin-4 antibody (AQP4-ab) positivity is an independent risk factor for NMOSD pain. Hormones and biological immune agents may also be effective in some cases.