Conus Medullaris Involvement in Demyelinating Disorders of the Cns: A Comparative Study Publisher Pubmed

Summary: Can conus medullaris involvement help differentiate CNS demyelinating disorders? Research suggests it is notably higher in anti-MOG patients. Further studies needed! #Neurology #Demyelination

Etemadifar M^{1, 2} ; Salari M³ ; Kargaran PK⁴ ; Sigari AA² ; Nouri H^{2, 5} ; Etemadifar F² ; Ebrahimi S² ; Sayahi N^{2, 6} ; Sedaghat N^{2, 5}
Source: Multiple Sclerosis and Related Disorders Published:2021

Abstract

Background: Differentiation of the demyelinating disorders of the CNS seems challenging in practice. Conus medullaris, the cone-shaped end of the spinal cord, is more involved in anti-MOG patients based on preliminary studies, a possibly helpful detail in its differentiation. Nevertheless, the evidence is still limited and the underlying cause is unclear and undiscussed in previous studies. Objective: To contribute to preliminary studies by comparing conus involvement among patients with MS, anti-AQP4, and anti-MOG diseases using larger sample size. Methods: More than a thousand MS, anti-AQP4, and anti-MOG patients were followed up for a maximum of five years, scanned for conus medullaris involvement. Data regarding each cohort were then analyzed and compared using statistical methods. Results: The rate of conus medullaris involvement was significantly higher in anti-MOG patietns (OR = 27.109, P < 0.001), followed by anti-AQP4 (OR = 4.944, P = 0.004), and MS patients (OR = reference). Survival analysis showed higher pace and cumulative incidence of conus attacks in anti-MOG patients. Conus-involved patients, showed no significant difference regarding age, sex, concurrent brain lesions, and their partial recovery. Predictive values show that the probability of being diagnosed with anti-MOG is roughly 13 times higher in conus-involved patients (25.93% vs. 1.97%), although this probability was still higher for MS, as it has a much higher incidence. Conclusion: Despite minor differences, the results were in line with previous studies, confirming the higher rate of conus medullaris involvement among anti-MOG patients. Potential underlying causes are proposed and remain to be investigated in future studies. © 2021 Elsevier B.V.