Diagnostic utility of NMO/AQP4-IgG in evaluating CNS inflammatory disease in Thai patients

Metha Apiwattanakul, Thanin Asawavichienjinda, Teeratorn Pulkes, Tasanee Tantirittisak, Thiravat Hemachudha, Erika S. Horta, Sarah M. Jenkins, Sean J. Pittock

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Epidemiological studies in Thailand have reported that inflammatory demyelinating diseases (IDDs) commonly affect the optic nerve and spinal cord. We investigated the diagnostic utility of aquaporin (AQP)-4-IgG testing in 31 consecutive patients evaluated for CNS IDDs in 3 academic Thai hospital neurology clinics between February 2008 and January 2009. Patients were classified into 3 clinical diagnostic groups: Neuromyelitis optica (NMO, n = 10) multiple sclerosis (MS, n = 5) and unclassified IDD (n = 16). All sera were tested blindly by cell binding (Euroimmun) assay (CBA). Sera were also tested by indirect immunofluorescence assay (IFA) and ELISA (RSR/Kronus). After initial screening by CBA, AQP4-IgG was detected in 6 NMO patients (60%); 3 of the 4 seronegative cases were receiving immunosuppressants. AQP4-IgG was detected in 13 unclassified IDD cases (81%), but in no MS cases. Cell binding assay and ELISA were more sensitive than IFA (p = 0.0004). The 81% seropositivity rate in unclassified patients suggests that AQP4 autoimmunity accounts for a significant proportion of Thai CNS inflammatory demyelinating disease, especially those with optic neuritis or transverse myelitis, with or without abnormal brain MRI, in whom a specific diagnosis or clear-cut treatment approach is unclear.

Original languageEnglish (US)
Pages (from-to)118-120
Number of pages3
JournalJournal of the neurological sciences
Issue number1-2
StatePublished - Sep 15 2012


  • Aquaporin-4
  • Assays
  • Autoantibodies
  • Autoimmune diseases
  • Demyelinating disease
  • Devic's syndrome
  • Diagnosis
  • Multiple sclerosis
  • Neuromyelitis optica
  • Sensitivity

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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