Neuromyelitis Optica spectrum disorder, formerly known as Devic’s disease, is characterized by an autoimmune-mediated pathology of the central nervous system. This pathology generates an inflammatory process directed against the channels of the protein Aquaporin 4, located mainly in the membrane of astrocytes. Aquaporin-4 is a protein related to water transport, which plays a crucial role in brain inflammation through mechanisms that involve the release of cytokines and astrocytic inflammation. These pathological changes cause demyelination and secondary axonal damage, with diverse clinical manifestations in the brain, spinal cord, and optic nerve sheaths. The detection of antibodies against the protein Aquaporin 4, the analysis of oligoclonal bands in the cerebrospinal fluid, and radiological findings by magnetic resonance imaging of the brain and spinal cord must be carefully evaluated to reach an accurate diagnosis in challenging clinical cases. This report reviews the differential etiologies of this disease and the challenge of comprehensive analysis of the corresponding diagnostic tests.
oligoclonal bands
Reto Diagnóstico en Enfermedad del Espectro de Neuromielitis Óptica Asociado a Bandas Oligoclonales Tipo 2 Positivas: Reporte de Caso. Diagnostic Challenge in Neuromyelitis Optica Spectrum Disease Associated with Type 2 Positive Oligoclonal Bands: Case Report
Factores Pronósticos de la Esclerosis Múltiple Prognostic Factors In Multiple Sclerosis.
Multiple sclerosis is an inflammatory and degenerative disease of the central nervous system which affects young adults. The prevalence of multiple sclerosis in the world is heterogeneous and is low in Ecuador. The diagnosis is based on the McDonald 2017 criteria. Once the diagnosis has been made, it is necessary that any negative factors which will impact the type of treatment used be identified. At this time, factors such as epidemiological, clinical, biomolecular, and magnetic resonance images, which will allow us to identify if the case is aggressive or benign, are studied. The number of lesions shown in a brain MRI, the presence of lesions in the brain stem and spinal cord are factors which have been demonstrated to have an impact on the progression of disability. The presence of oligoclonal bands in the cerebrospinal fluid has a fundamental role in the conversion of an isolated clinical syndrome to multiple sclerosis. Low levels of vitamin D have been associated with a negative prognosis, however how important vitamin D is in the prognosis of MS in countries such as Ecuador is still an area to be studied.
