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Correspondence |

Is It Too Early to Predict the Failure of Natalizumab in NMO?—Reply

Ingo Kleiter, MD; Kerstin Hellwig, MD; Achim Berthele, MD; Tania Kümpfel, MD; Ralf A. Linker, MD; Hans-Peter Hartung, MD; Friedemann Paul, MD; Orhan Aktas, MD ; for the Neuromyelitis Optica Study Group (NEMOS)
Arch Neurol. 2012;69(8):1085-1086. doi:10.1001/archneurol.2012.1316.
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We appreciate Drs Govindarajan and Salgado describing a NMO IgG antibody–positive patient who had a 6-year course of clinical stability under natalizumab before becoming progressive. While such a long period with a good treatment response to natalizumab is noteworthy, several aspects of this patient are untypical for neuromyelitis optica (NMO). Only 13.7% of patients are older than 60 years at disease onset,1 8% have an elevated IgG index, and 16.4% show oligoclonal bands.2 Disease progression without relapses is uncommon in NMO,3 and it remains unclear whether optic neuritis was present, completing the full picture of NMO. In a patient with untypical clinical presentation, the verification of aquaporin 4 antibodies is of particular importance to make the diagnosis of NMO. Diagnostic tests applied to measure aquaporin 4 antibodies vary considerably regarding sensitivity and specificity, and immunohistochemical methods to detect NMO IgG additionally depend on the experience of the examiner.4

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August 1, 2012
Raghav Govindarajan, MD; Efrain Salgado, MD
Arch Neurol. 2012;69(8):1085-1086. doi:10.1001/archneurol.2012.1138.
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