Describe the diagnostic studies of optic neuromyelitis in the adult neurology services of the hospitals of the Costa Rican Social Security Fund from August 2011 to December 2015

Neuromyelitis optica is a demyelinating disease that mainly affects the optic nerve and the spinal cord, which generally produces recurrent outbreaks that cause severe disability. There are few epidemiological studies about this disease, with a single study in Central America in the country of Panama with cases provided by neurologists from that country. There are no epidemiological studies of optic naturalism published in Costa Rica at present. The list of patients with the diagnosis of Neuromyelitis optica, other demyelizing diseases and Unspecified demyelizing disease of the Central Nervous System were requested, during the period from August 2011 to December 2015 from the Statistics services of the Hospitals that have adult neurologists ; specifically: San Juan de Dios Hospital, Tony Facio Hospital, Heredia Hospital, Calderon Guardia Hospital, Mexico Hospital, Max Peralta Hospital, San Carlos Hospital, San Rafael de Alajuela Hospital, Escalante Pradilla Hospital and Monsenor Sanabria Hospital. Subsequently, those patients who met the criteria for optic neuromyelitis published in 2006 were included. The total number of patients with a diagnosis of optic neuromyelitis from August 2011 to December 2015 was 40, with an approximate frequency of 1.2 per 100,000 inhabitants. Of these 40 patients, 62% (25) of the patients were female and 38% (15) male, with a male / female ratio of 1: 1.6. The number of patients by province was as follows: Puntarenas 2, Limon 3, Guanacaste 1, San Jose 18, Alajuela 7, Cartago 6 and Heredia 3. While the diagnosis time after the first outbreak presented a median of 2 years. The number of seropositive patients for AQP-4 (Aquaporin 4) was 15, 8 patients were seronegative and 17 had not been tested. Most of the patients had recurrent type optic neuromyelitis (97.5%) and only one patient had a monophasic disease. Some patients with Neuromyelitis optica associated other diseases, such as Sjogren in one patient, intermittent Acute Porphyria in one patient, hypothyroidism in 3 patients, Thrombotic Thrombocytopenic Purpura in one case, and Systemic Lupus erythematosus and Anti phospholipid Syndrome in the same patient. The frequency of neuromyelitis optica in CCSS in people older than 13 years was higher than expected. Despite not having anti-AQP4 antibodies in the institution, the non-inclusion of patients from private hospitals, the underdiagnosis and the lack of a spectrum diagnosis of NMO (Neuromyelitis optica) due to the absence of antibodies. (author)