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1. or more (>4) were categorized as the poor outcome group. == Results == In patients with NMOSD, the mean age was 44.5 12.8 years, and the mean three-month EDSS score was 4.3 1.9. A significantly higher all-limb muscle power score was found in the good EDSS group than in the poor EDSS group (p= 0.01). A tendency toward longer follow-up periods and lower anti-AQP4 antibody levels was found in the good outcome group. Serum anti-AQP4 antibodies were present in 86% of patients with NMOSD, and MOG autoantibodies were found in one anti-AQP4 antibody-negative patient (33.3%). In Propineb patients with NMOSD, more than 40% of spinal cord lesions were distributed at the middle cervical and upper thoracic levels. == Conclusions == Our findings suggest that EDSS scores and MRC scores at the nadir had significant associations with three-month EDSS scores. The topographic distributions of the spinal cord lesions might relate to different serum anti-AQP4 antibody status. However, further studies will be needed to corroborate this finding. Keywords:NMOSD, EDSS, Anti-AQP4, MRI == Introduction == Neuromyelitis optica spectrum disorder (NMOSD) is a group of chronic inflammatory and demyelinating disorders that are characterized by optic neuritis, transverse myelitis and extensive brain lesions in locations such as the brainstem, the area postrema and the diencephalic regions [1,2]. After the discovery of highly specific serum immunoglobulin G antibodies that target the water channel protein aquaporin-4 (AQP4-IgG), this serological marker was incorporated into the revised NMOSD diagnostic criteria and became the standard for clinical and research purposes [1]. NMOSD is different from multiple sclerosis (MS) in that the former causes greater disability due to severe optic nerve damage and longitudinally extensive transverse myelitis (LETM), fewer brain magnetic resonance imaging (MRI) lesions and the presence of anti-AQP4 antibody in the serum and cerebrospinal fluid (CSF) [3,4]. From a pathophysiological perspective, NMOSD is an autoimmune water channelopathy that predominantly affects astrocytes in the central nervous system (resulting in secondary demyelination) [5], while MS is a heterogeneous, multifactorial, immune-mediated disease that is Ctgf caused by complex geneenvironment interactions [6]. The prevalence of NMOSD in various studies ranges from 0.5 to 4 per 100,000 individuals, and the annual incidence is < 1/million individuals; therefore, it is categorized as a rare disease [79]. In Taiwan, the prevalence of NMOSD is unknown, but it affects a significantly higher proportion of middle-aged female than male patients, exhibits a high relapse rate, and results in greater functional disability than conventional multiple sclerosis [10]. The variability of disease severity in NMOSD has been documented; some patients have a disease course with frequent relapses and early motor disability, while others may have only a single attack without accumulating significant relapse-associated disability despite many years of disease [11]. The reasons for this heterogeneity are not clear and make it difficult to predict future outcomes. Recently, several studies, including one on a large international dataset, showed confounding factors Propineb for disease severity that included ethnic differences, onset age, sex, initial onset symptoms, recurrent episodes and serological features [1214]. In the current work, we Propineb explored the relationships connecting clinical features to disease severity and relapse episodes after the diagnosis of NMOSD. == Materials and methods == == Study design and patient population == We retrospectively analyzed the initial clinical presentations, neurological examinations, MRI features and serum anti-AQP4 antibody profiles of a total of 22 NMOSD patients with spinal cord lesions from 2002 to 2018. The study protocol was approved by the institutional review board of the Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (IRB number: 201800769B0). All methods Propineb were performed in accordance with the relevant guidelines and regulations. We recorded demographic characteristics; medical histories; and information on the clinical presentations, including the temporal profiles, initial symptoms and neurological examination results. The relevant MRI features, including the topography of the lesions at the initial assessment, were analyzed. The diagnosis of NMOSD was based on the international consensus criteria for that disorder [1]. Our study is a retrospective chart review analysis covering the period from 2002 to 2018..