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      A Case of Neuromyelitis Optica Misdiagnosed as Cervicogenic Headache

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          Abstract

          Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system associated with longitudinally extensive myelitis and optic neuritis. It is characterized by relapses that lead to blindness and paralysis sequelaes. But, this is rare disease; therefore high clinical suspicion for a correct diagnosis and proper examinations are not easy. However, early diagnosis is essential to prevent sequelae. We report the case of NMO with headache. A 30-year male patient who suffered headache visited our pain clinic because of aggravated pain despite treatment. The cause of the pain was revealed as NMO by more detailed previous history and examination.

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          The history of neuromyelitis optica

          The discovery of a novel serum autoantibody (termed NMO-IgG or AQP4-Ab) in a subset of patients in 2004 has revived interest in neuromyelitis optica (NMO). While the history of classical multiple sclerosis has been extensively studied, only little is known about the history of NMO. In the present article, we provide a comprehensive review of the early history of this rare but intriguing syndrome. We trace the origins of the concept of NMO in the 19th century medical literature and follow its evolution throughout the 20th and into the 21st century. Finally, we discuss recent proposals to revise the concept of NMO and explain why there is indeed a need for a more systematic and descriptive nomenclature.
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            Neuromyelitis optica: clinical predictors of a relapsing course and survival.

            The relapsing form of neuromyelitis optica (NMO) is characterized by recurrent optic neuritis and myelitis, usually leading to severe, permanent, relapse-related neurologic impairment (e.g., blindness, paraplegia) within 5 years. Aggressive therapy aimed at relapse prevention initiated soon after disease onset may be expected to have a relatively greater impact on early relapse-related disability in NMO than in typical MS. Early prediction of a relapsing course and subsequent disease severity would facilitate design and implementation of clinical trials of such therapies. A database of clinical and laboratory features of patients with NMO (n = 80) was used to develop potentially useful models predictive of a relapsing disease course and of subsequent disease severity as measured by survival. Predictors of a relapsing course were longer interattack interval between the first two clinical events (rate ratio [RR] = 2.16; per month increase), older age at onset (RR = 1.08; per year increase), female sex (RR = 10.0, female vs male), and less severe motor impairment with the sentinel myelitis event (RR = 0.48; per severity scale point increase). A history of other autoimmune disease (RR = 4.15; presence vs absence), higher attack frequency during the first 2 years of disease (RR = 1.21; per attack), and better motor recovery following the index myelitis event (RR = 1.84; per point increase) were associated with mortality due to relapsing NMO. These predictive models identify several clinical features, each available at diagnosis or early in the disease course, that predict relapsing disease and survival. These results may be useful to identify patients at high risk for severe, relapsing neuromyelitis optica in order to initiate early therapy for relapse prevention and to design clinical trials to study such interventions.
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              Neuropathic pain: mechanisms, therapeutic approach, and interpretation of clinical trials.

              Neuropathic pain (NP) is caused by a lesion of the somatosensory system and is characterized by a combination of positive symptoms (ongoing pain, paroxysmal pain, evoked pain) and negative phenomena (sensory deficit in the painful area). Examples of NP include painful diabetic and nondiabetic neuropathies, postherpetic neuralgia, traumatic nerve lesions, radiculopathies, and central pain (eg, spinal cord injury pain, poststroke pain). This review presents the mechanisms and therapeutic options for NP. Consensus recommendations for the treatment of NP or of some neuropathic conditions propose using antidepressants, antiepileptics, and topical lidocaine as first-line treatment and using tramadol and other opioids as second- or third-line treatment. Clinical advances in the management of NP include the implementation of comparative studies and combination therapy trials, the study of rarer and often neglected NP conditions, and the identification of responder profiles based on a detailed characterization of symptoms and signs using sensory examination and specific pain questionnaires. The management of patients with chronic NP is challenging because of the multiplicity of mechanisms involved in NP conditions. Evidence-based recommendations for the pharmacologic treatment of NP have recently been proposed.
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                Author and article information

                Journal
                Korean J Pain
                Korean J Pain
                KJP
                The Korean Journal of Pain
                The Korean Pain Society
                2005-9159
                2093-0569
                January 2014
                31 December 2013
                : 27
                : 1
                : 77-80
                Affiliations
                Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea.
                Author notes
                Correspondence to: Jong Yeun Yang. Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, 164 World Cup-ro, Yeongtong-gu, Suwon 443-380, Korea. Tel: +82-31-219-5689, Fax: +82-31-219-5579, yjyhy@ 123456hanmail.net
                Article
                10.3344/kjp.2014.27.1.77
                3903806
                24478906
                774bb573-e7ed-46b8-8f99-ddd6133f8ed9
                Copyright © The Korean Pain Society, 2014

                This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 30 June 2013
                : 25 October 2013
                : 25 October 2013
                Categories
                Case Report

                Anesthesiology & Pain management
                neuromyelitis optica,headache,optic neuritis,myelitis
                Anesthesiology & Pain management
                neuromyelitis optica, headache, optic neuritis, myelitis

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