Divergent Comorbidity Profiles in Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis: A Large Single-Centre Cohort from Turkey

Abstract

Background Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are immune-mediated demyelinating disorders with overlapping clinical features. Comorbidities may influence diagnostic accuracy, therapeutic decisions, and long-term prognosis. Comparative data on comorbidity profiles in NMOSD versus MS are scarce, particularly from Middle Eastern and Mediterranean cohorts. Objective To compare the prevalence and distribution of systemic, metabolic, cardiovascular, and neuropsychiatric comorbidities in patients with NMOSD and MS. Methods We retrospectively analysed 144 patients with NMOSD and 2892 with MS followed at a neuroimmunology clinic between 2015 and 2023. Demographic, clinical, and comorbidity data were systematically extracted from electronic records. Results Comorbidity profiles differed significantly between groups. NMOSD patients more frequently had systemic lupus erythematosus (3.5% vs 0.1%, p < 0.01), diabetes mellitus (12.5% vs 4.5%, p < 0.01), and dyslipidemia (7.6% vs 3.5%, p = 0.012). A trend toward higher prevalence of Behçet's disease was observed (1.4% vs 0.2%, p = 0.052). In contrast, depression/anxiety (20.1% vs 12.5%, p = 0.025), restless legs syndrome (5.6% vs 1.4%, p = 0.029) were significantly more common in MS. Conclusion NMOSD and MS differ substantially in their comorbidity signatures