Hindawi Publishing Corporation
Multiple Sclerosis International
Volume 2013, Article ID 654501, 4 pages
http://dx.doi.org/10.1155/2013/654501
Research Article
Olfactory Dysfunction in Patients with Neuromyelitis Optica
Felix Schmidt,
1,2
Önder Göktas,
3
Sven Jarius,
4
Brigitte Wildemann,
4
Klemens Ruprecht,
1,2
Friedemann Paul,
1,2,5
and Lutz Harms
1,2
1
Department of Neurology, Charit´ e-Universit¨ atsmedizin Berlin, Charit´ eplatz 1, 10117 Berlin, Germany
2
Clinical and Experimental Multiple Sclerosis Research Center, Charit´ e-Universit¨ atsmedizin Berlin, Berlin, Germany
3
Department of Otolaryngology, Charit´ e-Universit¨ atsmedizin Berlin, Berlin, Germany
4
Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
5
NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Charit´ e-Universit¨ atsmedizin Berlin and Max
Delbrueck Center for Molecular Medicine, Berlin, Germany
Correspondence should be addressed to Felix Schmidt; felix.schmidt@charite.de
Received 9 June 2013; Revised 22 August 2013; Accepted 23 August 2013
Academic Editor: Wolfgang Bruck
Copyright © 2013 Felix Schmidt et al. his is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Background. Neuromyelitis optica (NMO) is a severely disabling autoimmune disorder of the CNS, which mainly afects the optic
nerves and spinal cord. However, recent studies have shown that extra-opticospinal are more common in NMO than previously
thought. Objective. To investigate olfactory function (OF) in patients with neuromyelitis optica (NMO) versus healthy controls
(HC). Methods. Psychophysical testing of the orthonasal OF was performed using the hreshold-Discrimination-Identiication test
(TDI ), measuring diferent qualities of olfaction, in 10 unselected NMO patients and 10 HC. Results. Five of 10 NMO patients (50%)
showed hyposmia, while all 10 HC were normosmic. Moreover, NMO patients had signiicantly lower mean TDI -scores compared
to HC, based on a poorer performance in both the Discrimination and the Identiication subtests. Conclusions. Our results suggest
that hyposmia might be part of the expanding clinical spectrum of NMO.
1. Introduction
Neuromyelitis optica (NMO, Devic’s syndrome) is an autoim-
mune central nervous system disorder that predominantly
afects the optic nerves and the spinal cord [1, 2]. Impaired
olfaction is increasingly recognized in neurodegenerative
diseases such as Parkinson’s and Alzheimer’s diseases and
has been reported in patients with multiple sclerosis (MS)
[3, 4]. As the clinical presentation of NMO may extend
beyond relapses of optic neuritis and myelitis [2, 5], we here
investigated whether olfactory function (OF) is altered in
NMO.
2. Patients and Methods
his pilot study was performed from July 2011 to October
2012. Ten patients with NMO according to the 2006 diagnos-
tic criteria [1] were prospectively recruited from the Charit´ e
outpatient clinics. Aquaporin-4 antibodies were tested using
a commercially available cell-based assay employing recom-
binant human target antigen (EUROIMMUN, Luebeck, Ger-
many) [6]. A healthy control group (HC) of 10 individuals
closely matched for gender and age (±3 years) was recruited
among the hospital staf. Exclusion criteria for both groups
were olfactory disorders (postinfectious, posttraumatic, and
sinunasal), infections of the upper respiratory tract, tumours
treated with radiation or chemotherapy, allergies, major
depression, and Parkinson’s or Alzheimer’s disease. All study
participants declared to be nonsmokers. Patients taking
drugs that could cause olfactory dysfunction as for exam-
ple amitriptyline and D-penicillamine were excluded from
the study. Furthermore, patients receiving corticosteroid
treatment during the testing period were excluded because
corticosteroids can have an efect on the OF. Olfaction
was evaluated using the tripartite hreshold-Discrimination-
Identiication test (TDI ), based on pen-like odour-dispensing
devices as recommended by the “Working Group Olfac-
tology and Gustology” of the German ENT Society [7].