Cerebellar atrophy in neuromyelitis optica spectrum disease (NMOSD) patients

Abstract

Neuromyelitis Optica (NMO) is an autoimmune neurodegenerative disease, which severely compromises the patients affected, mainly in the regions of the optic nerve and the spinal cord. It is a rare disease (with a predilection for women, especially after the third decade of life) in which the presence of anti-aquaporin 4 antibodies (anti-AQP4 or NMO-IgG) is responsible for causing the typical pattern of involvement, by various mechanisms. Being a disorder that occurs in inflammatory outbreaks, often the full manifestation characteristics of NMO is not observed initially. Thus, the term Neuromyelitis Optica Spectrum Diseases (NMOSD) is used to designate the variety of clinical conditions that can occur in patients, without fulfilling the criteria for NMO, but still with a similar etiology to this disease. The classic lesions caused by NMOSD are widely described. However, new studies show that, in addition to those, other areas of the CNS are altered, such as the cortex associated with the motor and visual systems (which interconnect with the classically affected areas), as well as the limbic system, which may indicate NMOSD directly affects other locations. Thereby, findings of cerebellar involvement in this group of patients may be expected, either by their connection to motor systems or even by direct attack of the disease. However, no studies analyzing specifically this region were found. Therefore, the project described below aims to compare the different cerebellar areas of individuals with NMOSD versus a control group, and we hypothesize that the affected group present significant cerebellar atrophies. For this project, clinical and magnetic resonance imaging (MRI) data from 60 patients will be used, which will be divided into the study group (with NMOSD) and the control group. After this step, the MR images will be processed according to specific techniques (such as the voxel-based morphometry, or VBM). Later the data can be compared between the two groups, using statistical analysis software, which will allow us to say if there are differences in cerebellar white and gray matter within individuals affected by NMOSD and individuals without any neurodegenerative diseases.