Effects of Age and Sex on Aquaporin-4 Autoimmunity | Epilepsy and Seizures | JAMA Neurology | JAMA Network
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Original Contribution
Aug 2012

Effects of Age and Sex on Aquaporin-4 Autoimmunity

Author Affiliations

Author Affiliations: Departments of Laboratory Medicine and Pathology (Drs Quek, McKeon, Lennon, Iorio, Jiao, and Pittock), Neurology (Drs McKeon, Lennon, Costanzi, Weinshenker, Lucchinetti, and Pittock), Immunology (Dr Lennon), and Health Sciences Research (Dr Mandrekar), Mayo Clinic College of Medicine, Rochester, Minnesota; Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, Arizona (Dr Wingerchuk); and Department of Neurology, Mayo Clinic College of Medicine, Jacksonville, Florida (Dr Shuster).

Arch Neurol. 2012;69(8):1039-1043. doi:10.1001/archneurol.2012.249

Objective To determine the sex and age distribution of aquaporin-4 (AQP4) autoimmunity using data derived from clinical service laboratory testing of 56 464 patient samples.

Design Observational analysis.

Setting Mayo Clinic Neuroimmunology Laboratory.

Patients Between October 1, 2005, and January 4, 2011, 56 464 patients were tested for AQP4-IgG; 2960 (5.2%) patients were seropositive.

Main Outcome Measure Seropositivity for AQP4-IgG.

Results Patients seropositive for AQP4-IgG were older than seronegative patients (mean [SD] age, 46 [16] vs 42 [15] years, respectively; P < .001). More females than males were tested (37 662 vs 16 810, respectively; P < .001). Among 2743 seropositive patients, 146 (5.3%) were pediatric (aged ≤18 years) and 333 (12.1%) were elderly (aged ≥65 years). The sex distribution of seropositive patients was 2465 females and 306 males (absolute female:male ratio, 8.1:1; P < .001). After adjusting for the number of females tested, an excess of females persisted (adjusted female:male ratio, 3.6:1). Female predominance for AQP4-IgG was more striking in adults (absolute female:male ratio, 8.4:1; adjusted female:male ratio, 3.5:1) than in pediatric patients (absolute female:male ratio, 4.3:1; adjusted female:male ratio, 2.9:1) (P < .001). Elderly women were more likely to be seropositive than individuals in other age categories (13.1% vs 6.0%, respectively; P < .001). The proportion of AQP4-IgG–seropositive individuals (detection rate), defined by decade of age, increased exponentially in women after age 50 years.

Conclusions Seropositivity for AQP4-IgG occurs predominantly in females, particularly in individuals older than 18 years. Among seropositive patients, 1 in 6 is in the extremes of age. The detection rate of AQP4-IgG increased in women after age 50 years.