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Darakdjian M, Chaves H, Hernandez J, Cejas C. MRI pattern in acute optic neuritis: Comparing multiple sclerosis, NMO and MOGAD. Neuroradiol J 2023; 36:267-272. [PMID: 36062458 PMCID: PMC10268096 DOI: 10.1177/19714009221124308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Several MRI findings of optic neuritis (ON) have been described and correlated with specific underlying etiologies. Specifically, optic nerve enhancement is considered an accurate biomarker of acute ON. OBJECTIVE To identify differences in MRI patterns of optic nerve enhancement in certain demyelinating etiologies presenting with acute ON. METHODS Retrospective analysis of enhancement patterns on fat-suppressed T1-weighted images from patients presenting clinical and radiological acute ON, treated at our institution between January 2014 and June 2022. Location and extension of enhancing optic nerve segments, as well as presence of perineural enhancement were evaluated in three predetermined demyelinating conditions. Fisher's exact test and chi2 were calculated. RESULTS Fifty-six subjects met eligibility criteria. Mean age was 31 years (range 6-79) and 70% were females. Thirty-four (61%) patients were diagnosed with multiple sclerosis (MS), 8 (14%) with neuromyelitis optica (NMO), and 14 (25%) with anti-myelin oligodendrocyte glycoprotein disease (MOGAD). Bilateral involvement was more frequent in MOGAD, compared to MS and NMO (43 vs 3% and 12.5% respectively, p = 0.002). MS patients showed shorter optic nerve involvement, whereas MOGAD showed more extensive lesions (p = 0.006). Site of involvement was intraorbital in 63% MS, 89% NMO, 90% MOGAD (p = 0.051) and canalicular in 43% MS, 33% NMO and 75% MOGAD (p = 0.039). Intracranial or chiasmatic involvement and presence of perineural enhancement were not statistically different between entities. CONCLUSION In the setting of acute ON, patients presenting MOGAD were more likely to show bilateral, longitudinally extended and anterior (intraorbital and canalicular) optic nerve involvement compared to patients with MS or NMO.
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Taha FA, Few WE, Berman EL. Inappropriate Duration of Corticosteroids in Optic Neuritis in Suspected Myelin Oligodendrocyte Glycoprotein Antibody Disease Can Lead to Early Relapse. J Neuroophthalmol 2023:00041327-990000000-00351. [PMID: 37184953 DOI: 10.1097/wno.0000000000001883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Affiliation(s)
- Farris A Taha
- Department of Neurology (FAT), Medical University of South Carolina, Charleston, South Carolina; College of Medicine (WEF), Medical University of South Carolina, Charleston, South Carolina; and Department of Ophthalmology (ELB), Medical University of South Carolina, Charleston, South Carolina
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Al-Ani A, Chen JJ, Costello F. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): current understanding and challenges. J Neurol 2023:10.1007/s00415-023-11737-8. [PMID: 37154894 PMCID: PMC10165591 DOI: 10.1007/s00415-023-11737-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
New diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have recently been proposed, distinguishing this syndrome from other inflammatory diseases of the central nervous system. Seropositivity status for MOG-IgG autoantibodies is important for diagnosing MOGAD, but only in the context of robust clinical characterization and cautious interpretation of neuroimaging. Over the last several years, access to cell-based assay (CBA) techniques has improved diagnostic accuracy, yet the positive predictive value of serum MOG-IgG values varies with the prevalence of MOGAD in any given patient population. For this reason, possible alternative diagnoses need to be considered, and low MOG-IgG titers need to be carefully weighted. In this review, cardinal clinical features of MOGAD are discussed. Key challenges to the current understanding of MOGAD are also highlighted, including uncertainty regarding the specificity and pathogenicity of MOG autoantibodies, the need to identify immunopathologic targets for future therapies, the quest to validate biomarkers that facilitate diagnosis and detect disease activity, and the importance of deciphering which patients with MOGAD require long-term immunotherapy.
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Affiliation(s)
- Abdullah Al-Ani
- Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - Fiona Costello
- Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Sulaiman FN, Kamardin NF, Sultan Abdul Kader MI, Ch'ng H, Wan Abdul Halim WH. Myelin Oligodendrocyte Glycoprotein Optic Neuritis Presenting With Orbital Apex Syndrome. Cureus 2023; 15:e38975. [PMID: 37313108 PMCID: PMC10259875 DOI: 10.7759/cureus.38975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2023] [Indexed: 06/15/2023] Open
Abstract
A 36-year-old man presented with an acute onset of a right eye monocular altitudinal defect associated with pain on eye movement upon waking up from sleep. His right eye subsequently developed outward deviation and a total loss of vision. Clinical examination of the right eye revealed a visual acuity of no light perception (NLP) with the presence of relative afferent pupillary defect (RAPD) and involvement of cranial nerves II, III, IV, and VI. A marked optic disc swelling and peripapillary hemorrhages were seen in the right fundus. Contrast-enhanced computed tomography of the brain and orbit showed a unilateral enlargement and enhancement of the right intraorbital and intracanalicular segments of the optic nerve with surrounding fat stranding and orbital apex crowding. Magnetic resonance imaging showed T2/fluid-attenuated inversion recovery hyperintensity and enhancement of the optic nerve and the myelin sheath. Serum anti-myelin oligodendrocyte glycoprotein antibodies were detected. He was treated with corticosteroids, plasma exchange, and intravenous immunoglobulin. His vision improved slowly after treatment. This case report shows the diverse manifestations of myelin oligodendrocyte glycoprotein antibody disease, which includes the orbital apex syndrome.
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Affiliation(s)
- Farhana Nabila Sulaiman
- Department of Ophthalmology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Ophthalmology, Hospital Selayang, Selangor, MYS
| | | | - Mohamed Iliyas Sultan Abdul Kader
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, MYS
- Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Melaka, Melaka, MYS
| | - Hannie Ch'ng
- Department of Ophthalmology, Hospital Kuala Lumpur, Kuala Lumpur, MYS
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Lin CW, Chen WT, Lin YH, Hung K, Chen TC. Clinical characteristics and prognosis of optic neuritis in Taiwan - a hospital-based cohort study. Mult Scler Relat Disord 2023; 75:104739. [PMID: 37148579 DOI: 10.1016/j.msard.2023.104739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/27/2023] [Accepted: 04/28/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Optic neuritis (ON) is an inflammatory disease of optic nerve. The distinct etiologies of ON significantly influence its clinical manifestation, neuroimaging findings, and visual outcomes. However, the clinical characteristics might be influenced by the racial differences. The purpose of this study is to investigate the clinical characteristics of various types of ON at a Taiwanese tertiary center. METHODS This cohort study analyzed 163 patients who received treatment and continued following-up for ON between 2015 and 2022. We selected patients who had been tested for anti-aquaporin-4 antibody (AQP4-Ab) and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab). The participants were classified into four groups on the basis of their etiologies, specifically (1) multiple sclerosis (MS)-related, (2) AQP4-Ab-positive, (3) MOG-Ab-positive, or (4) idiopathic ON. The researchers recorded the patients' clinical characteristics, treatment course, magnetic resonance imaging and optical coherence tomography (OCT) findings, and visual outcomes. RESULTS MOG-Ab-positive group had higher percentages of disk swelling and pain with eye movement. Long optic nerve and perineural enhancement are the hallmarks of MOG-Ab-related ON. The ON relapse rate was higher in AQP4-Ab-positive group. Although members of AQP4-Ab-positive group received immediate steroid pulse therapy, these patients experienced the worst visual outcomes. Moreover, a thinner retinal nerve fiber layer (RNFL) was noted in AQP4-Ab-positive group. MS group had a higher incidence of extra-optic nerve lesions. Multivariate regression identified pretreatment visual acuity and RNFL thickness as the important factors affecting visual outcomes. CONCLUSIONS This cohort study identified the clinical features of different types of ON. Patients with AQP4-Ab-positive ON had poorer visual outcomes, which may be attributed to multiple relapses and profound nerve damage, as revealed by OCT findings. Patients with MOG-Ab-positive ON displayed long optic nerve enhancement but had more favorable prognoses. Thus, antibody-based classification facilitates treatment and prognosis in ON.
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Affiliation(s)
- Chao-Wen Lin
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, Taiwan
| | - Wei-Tse Chen
- Department of Medical Education, National Taiwan University Hospital, Taiwan
| | - Yen-Heng Lin
- Department of Medical Imaging, National Taiwan University Hospital, Taiwan
| | - Kuang Hung
- Department of Medical Imaging, National Taiwan University Hospital, Taiwan
| | - Ta-Ching Chen
- Department of Ophthalmology, National Taiwan University Hospital, No 7, Chung-Shan S. Rd., Taipei, Taiwan; Center of Frontier Medicine, National Taiwan University Hospital, Taiwan.
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Kim HJ, Lee EJ, Kim SY, Kim H, Kim KW, Kim S, Kim H, Seo D, Lee BJ, Lim HT, Kim KK, Lim YM. Serum proteins for monitoring and predicting visual function in patients with recent optic neuritis. Sci Rep 2023; 13:5609. [PMID: 37019946 PMCID: PMC10076295 DOI: 10.1038/s41598-023-32748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
It is unclear whether serum proteins can serve as biomarkers to reflect pathological changes and predict recovery in inflammation of optic nerve. We evaluated whether serum proteins could monitor and prognosticate optic neuritis (ON). We prospectively recruited consecutive patients with recent ON, classified as ON with anti-aquaporin-4 antibody (AQP4-ON), ON with anti-myelin oligodendrocyte glycoprotein antibody (MOG-ON), and double-seronegative ON (DSN-ON). Using ultrasensitive single-molecule array assays, we measured serum neurofilament light chain and glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF). We analyzed the markers according to disease group, state, severity, and prognosis. We enrolled 60 patients with recent ON (15 AQP4-ON; 14 MOG-ON; 31 DSN-ON). At baseline, AQP4-ON group had significantly higher serum GFAP levels than did other groups. In AQP4-ON group, serum GFAP levels were significantly higher in the attack state than in the remission state and correlated with poor visual acuity. As a prognostic indicator, serum BDNF levels were positively correlated with follow-up visual function in the AQP4-ON group (r = 0.726, p = 0.027). Serum GFAP reflected disease status and severity, while serum BDNF was identified as a prognostic biomarker in AQP4-ON. Serum biomarkers are potentially helpful for patients with ON, particularly those with AQP4-ON.
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Affiliation(s)
- Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Meidcal Center, Seoul, South Korea.
| | - Sang-Yeob Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Keon-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seungmi Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunji Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dayoung Seo
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Salunkhe M, Gupta P, Singh RK, Elavarasi A, Vibha D, Garg A, Bhatia R, Tripathi M. A comparative analysis of demographic, clinical and imaging features of myelin oligodendrocyte glycoprotein antibody positive, aquaporin 4 antibody positive, and double seronegative demyelinating disorders - An Indian tertiary care center prospective study. J Neurosci Rural Pract 2023; 14:313-319. [PMID: 37181191 PMCID: PMC10174118 DOI: 10.25259/jnrp_32_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 02/06/2023] [Indexed: 04/03/2023] Open
Abstract
Objectives The aim of the study was to study the demographical, clinical, radiological features, and outcome of anti-myelin oligodendrocyte glycoprotein (MOG) antibody spectrum disorder and compare these features with patients negative for anti-MOG antibody. MOG antibody-associated disease (MOGAD) and aquaporin-4 (AQP4) antibody-related diseases are immunologically distinct pathologies. Our aim was to compare the clinical and radiological features of MOG antibody-related diseases with AQP4 antibody-related diseases and seronegative demyelinating diseases (Non-multiple sclerosis). Materials and Methods This was a prospective and cohort study conducted at an apex tertiary care institute in the northern part of India from Jan 2019 to May 2021. We compared clinical, laboratory, and radiological findings of patients with MOGAD, AQP4 antibody-related diseases, and seronegative demyelinating disease. Results There were a total of 103 patients - 41 patients of MOGAD, 37 patients of AQP4 antibody-related diseases and 25 seronegative demyelinating disease. Bilateral optic neuritis was the most frequent phenotype in patients with MOGAD (18/41) whereas myelitis was the most common phenotype in the AQP4 (30/37) and seronegative groups (13/25). Cortical, juxtacortical lesions, anterior segment optic neuritis, optic sheath enhancement, and conus involvement in myelitis were radiological findings that separated MOGAD from AQP4 related diseases. Nadir Expanded Disability Status Scale (EDSS) and visual acuity were similar across the groups. Last follow-up EDSS was significantly better in the MOG antibody group as compared to AQP4 antibody group (1 [0-8] vs. 3.5 [0-8]; P = 0.03). Encephalitis, myelitis, and seizures were more common in the younger population (<18 vs. >18 years) in MOGAD (9 vs. 2, P = 0.001; 9 vs. 7, P = 0.03; 6 vs. 0, P = 0.001). Conclusion We identified several clinical and radiological features that can help physicians to distinguish MOGAD from AQP4-immunoglobulin G+neuromyelitis optica spectrum disorder. Differentiation is vital as treatment response might vary among both groups.
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Affiliation(s)
- Manish Salunkhe
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Pranjal Gupta
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Kumar Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Deepti Vibha
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Rode J, Pique J, Maarouf A, Ayrignac X, Bourre B, Ciron J, Cohen M, Collongues N, Deschamps R, Maillart E, Montcuquet A, Papeix C, Ruet A, Wiertlewski S, Zephir H, Marignier R, Audoin B. Time to steroids impacts visual outcome of optic neuritis in MOGAD. J Neurol Neurosurg Psychiatry 2023; 94:309-313. [PMID: 36600666 DOI: 10.1136/jnnp-2022-330360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/16/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND To characterise the response to treatment of inaugural optic neuritis (ON) in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS We searched the French MOGAD database for adults with inaugural ON with a detailed report of acute treatment modalities and measures of high-contrast best-corrected visual acuity (BCVA) at nadir and after 3 months. Predictors of visual outcomes were assessed by multivariable analysis. RESULTS Among 245 patients with at least one episode of ON, 82 fulfilled all criteria, and data on the peripapillary retinal nerve fibre layer (pRNFL) were available for 44. All patients received methylprednisolone (MP), combined with plasma exchange in 18. After 3 months, 75 of 82 (91%) patients retained full BCVA recovery, and median (range) pRNFL of the affected eye was 72 µm (40-102). Failure to regain 0.0 logarithmic minimum angle of resolution vision (Snellen 20/20) at 3 months was associated with time to first MP treatment ≥10 days (OR 16, 95% CI 1.14 to 213, p=0.01). pRNFL thickness after 3 months was related to better BCVA at nadir and time to first MP treatment <10 days (r2=19%, p=0.004 and r2=11%, p=0.03, respectively). CONCLUSIONS Time to MP affects functional but also structural visual outcomes of ON in MOGAD.
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Affiliation(s)
- Julie Rode
- Service de neurologie, Hôpital de la Timone, APHM, Marseille, France
| | - Julie Pique
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon/Bron, France
| | - Adil Maarouf
- Service de neurologie, Hôpital de la Timone, APHM, Marseille, France.,CRMBM UMR 7339, CNRS, Aix-Marseille University, Marseille, France
| | - Xavier Ayrignac
- INM, Inserm, Department of Neurology CHU Montpellier, University of Montpellier, Montpellier, France
| | | | - Jonathan Ciron
- Department of Neurology, Centre Hospitalier Universitaire de Toulouse, Toulouse, France
| | - Mikael Cohen
- Service de Neurologie, Hôpital Pasteur, Nice, France
| | | | - Romain Deschamps
- Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | | | - Caroline Papeix
- Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Aurelie Ruet
- Department of Neurology, CHU de Bordeaux, Bordeaux, France
| | | | - Helene Zephir
- Department of Neurology, Inserm U 1172, Centre hospitalier universitaire de Lille, Univ-Lille, Lille, France
| | - Romain Marignier
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon/Bron, France
| | - Bertrand Audoin
- Service de neurologie, Hôpital de la Timone, APHM, Marseille, France.,CRMBM UMR 7339, CNRS, Aix-Marseille University, Marseille, France
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Low RN, Low RJ, Akrami A. A review of cytokine-based pathophysiology of Long COVID symptoms. Front Med (Lausanne) 2023; 10:1011936. [PMID: 37064029 PMCID: PMC10103649 DOI: 10.3389/fmed.2023.1011936] [Citation(s) in RCA: 32] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 02/27/2023] [Indexed: 04/03/2023] Open
Abstract
The Long COVID/Post Acute Sequelae of COVID-19 (PASC) group includes patients with initial mild-to-moderate symptoms during the acute phase of the illness, in whom recovery is prolonged, or new symptoms are developed over months. Here, we propose a description of the pathophysiology of the Long COVID presentation based on inflammatory cytokine cascades and the p38 MAP kinase signaling pathways that regulate cytokine production. In this model, the SARS-CoV-2 viral infection is hypothesized to trigger a dysregulated peripheral immune system activation with subsequent cytokine release. Chronic low-grade inflammation leads to dysregulated brain microglia with an exaggerated release of central cytokines, producing neuroinflammation. Immunothrombosis linked to chronic inflammation with microclot formation leads to decreased tissue perfusion and ischemia. Intermittent fatigue, Post Exertional Malaise (PEM), CNS symptoms with "brain fog," arthralgias, paresthesias, dysautonomia, and GI and ophthalmic problems can consequently arise as result of the elevated peripheral and central cytokines. There are abundant similarities between symptoms in Long COVID and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). DNA polymorphisms and viral-induced epigenetic changes to cytokine gene expression may lead to chronic inflammation in Long COVID patients, predisposing some to develop autoimmunity, which may be the gateway to ME/CFS.
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Affiliation(s)
| | - Ryan J. Low
- Gatsby Computational Neuroscience Unit, University College London, London, United Kingdom
- Sainsbury Wellcome Centre, University College London, London, United Kingdom
| | - Athena Akrami
- Sainsbury Wellcome Centre, University College London, London, United Kingdom
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Bribiesca Contreras E, Gómez-Figueroa E, Flores-Rivera J, Correa-Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Piedra Andrade JS, Galleguillos L, Tkachuk V, Nadur D, Daccach Marques V, Soto de Castillo I, Casas M, Cohen L, Alonso R, Caride A, Lana-Peixoto M, Rojas JI. Clinical outcomes and prognostic factors in patients with optic neuritis related to NMOSD and MOGAD in distinct ethnic groups from Latin America. Mult Scler Relat Disord 2023; 72:104611. [PMID: 36907119 DOI: 10.1016/j.msard.2023.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Optic neuritis (ON) can be an initial manifestation of neuromyelitis optica spectrum disorder (NMOSD) associated with aquaporin 4-antibody (AQP4-Ab) or myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD). Additionally, both diseases may have overlapping paraclinical and radiological features. These diseases may have different outcomes and prognoses. We aimed to compare clinical outcomes and prognostic features of patients with NMOSD and MOGAD presenting ON as first attack, from different ethnic groups in Latin America. METHODS We conducted a retrospective observational multicenter study in patients from Argentina (n = 61), Chile (n = 18), Ecuador (n = 27), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 49) with MOGAD or NMOSD related ON. Predictors of disability outcomes at last follow-up, namely visual disability (Visual Functional System Score ≥4), motor disability (permanent inability to walk further than 100 m unaided) and wheelchair dependence based on EDSS score were evaluated. RESULTS After a mean disease duration of 42.7 (±40.2) months in NMOSD and 19.7 (±23.6) in MOGAD, 55% and 22% (p>0.001) experienced permanent severe visual disability (visual acuity from 20/100 to 20/200), 22% and 6% (p = 0.01) permanent motor disability and 11% and 0% (p = 0.04) had become wheelchair dependent, respectively. Older age at disease onset was a predictor of severe visual disability (OR=1,03 CI95%1.01-1.05, p = 0.03); older age at disease onset (OR=1,04 CI95%1.01-1.07, p = 0.01), higher number of relapses (OR=1,32 CI95%1.02-1.71, p = 0.03) and rituximab treatment (OR=0,36 CI95%0.14-0.90, p = 0.02) were predictors of permanent motor disability, whereas ON associated with myelitis at disease onset was a predictor of wheelchair dependency (OR=4,16, CI95%1.23-14.08, p = 0,02) in NMOSD patients. No differences were found when evaluating distinct ethnic groups (Mixed vs. Caucasian vs. Afro-descendant) CONCLUSIONS: NMOSD was associated with poorer clinical outcomes than MOGAD. Ethnicity was not associated with prognostic factors. Distinct predictors of permanent visual and motor disability and wheelchair dependency in NMOSD patients were found.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Enrique Gómez-Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | | | | | | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Débora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ibis Soto de Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Bolivarian Republic of Venezuela
| | - Magdalena Casas
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- Department of Neurology, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Hurtubise B, Frohman EM, Galetta S, Balcer LJ, Frohman TC, Lisak RP, Newsome SD, Graves JS, Zamvil SS, Amezcua L. MOG Antibody-Associated Disease and Thymic Hyperplasia: From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200077. [PMID: 36517233 PMCID: PMC9753285 DOI: 10.1212/nxi.0000000000200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described CNS inflammatory disorder that may manifest with optic neuritis, myelitis, seizures, and/or acute disseminated encephalomyelitis. While MOG-specific antibodies in patients with MOGAD are IgG1, a T-cell-dependent antibody isotype, immunologic mechanisms of this disease are not fully understood. Thymic hyperplasia can be associated with certain autoimmune diseases. In this report we describe a case of MOGAD associated with thymic hyperplasia in a young adult.
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Affiliation(s)
- Brigitte Hurtubise
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elliot M Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Teresa C Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Robert P Lisak
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Jennifer S Graves
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco.
| | - Lilyana Amezcua
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
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The Potential Pathogenicity of Myelin Oligodendrocyte Glycoprotein Antibodies in the Optic Pathway. J Neuroophthalmol 2023; 43:5-16. [PMID: 36729854 PMCID: PMC9924971 DOI: 10.1097/wno.0000000000001772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an acquired inflammatory demyelinating disease with optic neuritis (ON) as the most frequent clinical symptom. The hallmark of the disease is the presence of autoantibodies against MOG (MOG-IgG) in the serum of patients. Whereas the role of MOG in the experimental autoimmune encephalomyelitis animal model is well-established, the pathogenesis of the human disease and the role of human MOG-IgG is still not fully clear. EVIDENCE ACQUISITION PubMed was searched for the terms "MOGAD," "optic neuritis," "MOG antibodies," and "experimental autoimmune encephalomyelitis" alone or in combination, to find articles of interest for this review. Only articles written in English language were included and reference lists were searched for further relevant papers. RESULTS B and T cells play a role in the pathogenesis of human MOGAD. The distribution of lesions and their development toward the optic pathway is influenced by the genetic background in animal models. Moreover, MOGAD-associated ON is frequently bilateral and often relapsing with generally favorable visual outcome. Activated T-cell subsets create an inflammatory environment and B cells are necessary to produce autoantibodies directed against the MOG protein. Here, pathologic mechanisms of MOG-IgG are discussed, and histopathologic findings are presented. CONCLUSIONS MOGAD patients often present with ON and harbor antibodies against MOG. Furthermore, pathogenesis is most likely a synergy between encephalitogenic T and antibody producing B cells. However, to which extent MOG-IgG are pathogenic and the exact pathologic mechanism is still not well understood.
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Banwell B, Bennett JL, Marignier R, Kim HJ, Brilot F, Flanagan EP, Ramanathan S, Waters P, Tenembaum S, Graves JS, Chitnis T, Brandt AU, Hemingway C, Neuteboom R, Pandit L, Reindl M, Saiz A, Sato DK, Rostasy K, Paul F, Pittock SJ, Fujihara K, Palace J. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol 2023; 22:268-282. [PMID: 36706773 DOI: 10.1016/s1474-4422(22)00431-8] [Citation(s) in RCA: 296] [Impact Index Per Article: 296.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/07/2022] [Accepted: 10/13/2022] [Indexed: 01/26/2023]
Abstract
Serum antibodies directed against myelin oligodendrocyte glycoprotein (MOG) are found in patients with acquired CNS demyelinating syndromes that are distinct from multiple sclerosis and aquaporin-4-seropositive neuromyelitis optica spectrum disorder. Based on an extensive literature review and a structured consensus process, we propose diagnostic criteria for MOG antibody-associated disease (MOGAD) in which the presence of MOG-IgG is a core criterion. According to our proposed criteria, MOGAD is typically associated with acute disseminated encephalomyelitis, optic neuritis, or transverse myelitis, and is less commonly associated with cerebral cortical encephalitis, brainstem presentations, or cerebellar presentations. MOGAD can present as either a monophasic or relapsing disease course, and MOG-IgG cell-based assays are important for diagnostic accuracy. Diagnoses such as multiple sclerosis need to be excluded, but not all patients with multiple sclerosis should undergo screening for MOG-IgG. These proposed diagnostic criteria require validation but have the potential to improve identification of individuals with MOGAD, which is essential to define long-term clinical outcomes, refine inclusion criteria for clinical trials, and identify predictors of a relapsing versus a monophasic disease course.
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Affiliation(s)
- Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, USA.
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Romain Marignier
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon, France; Université Claude Bernard Lyon, Lyon, France
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia; School of Medical Sciences, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Eoin P Flanagan
- Departments of Neurology, Laboratory Medicine and Pathology and Center MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sudarshini Ramanathan
- Department of Neurology, Concord Hospital, Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, Australia; Brain and Mind Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Silvia Tenembaum
- Paediatric Neuroimmunology Clinic, Department of Neurology, National Paediatric Hospital Dr J P Garrahan, Ciudad de Buenos Aires, Argentina
| | - Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Tanuja Chitnis
- Department of Pediatric Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK; Institute of Neurology, UCL, London, UK
| | - Rinze Neuteboom
- Department of Neurology, MS Center ErasMS, Sophia Children's Hospital, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lekha Pandit
- Center for Advanced Neurological Research, Nitte University Mangalore, Mangalore, India
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Douglas Kazutoshi Sato
- School of Medicine and Institute for Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Kevin Rostasy
- Department of Paediatric Neurology, Children'sHospital Datteln, University Witten and Herdecke, Datteln, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sean J Pittock
- Departments of Neurology, Laboratory Medicine, and Pathology and Center MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Jacqueline Palace
- Department of Neurology John Radcliffe Hospital Oxford and Nuffield Department of Clinical Neurosciences Oxford University, Oxford, UK
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Bilateral Simultaneous Nonarteritic Anterior Ischemic Optic Neuropathy: Demographics, Risk Factors, and Visual Outcomes. J Neuroophthalmol 2023; 43:86-90. [PMID: 36166810 DOI: 10.1097/wno.0000000000001642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although nonarteritic anterior ischemic optic neuropathy is a well-known cause of vision loss, it typically presents unilaterally. Simultaneous, bilateral nonarteritic anterior ischemic optic neuropathy (sNAION) is rare and poorly studied in comparison. This study seeks to characterize the clinical features and risk factors of patients with sNAION compared with unilateral NAION (uNAION). METHODS In this retrospective case-control study, we reviewed 76 eyes (38 patients) with sNAION and 38 eyes (38 patients) with uNAION (controls) from 4 academic institutions examined between 2009 and 2020. Demographic information, medical history, medication use, symptom course, paraclinical evaluation, and visual outcomes were collected for all patients. RESULTS No significant differences were observed in demographics, comorbidities and their treatments, and medication usage between sNAION and uNAION patients. sNAION patients were more likely to undergo an investigative work-up with erythrocyte sedimentation rate measurement ( P = 0.0061), temporal artery biopsy ( P = 0.013), lumbar puncture ( P = 0.013), and MRI ( P < 0.0001). There were no significant differences between the 2 groups for visual acuity, mean visual field deviation, peripapillary retinal nerve fiber layer thickness, or ganglion cell-inner plexiform layer thickness at presentation, nor at final visit for those with ≥3 months of follow-up. The sNAION eyes with ≥3 months of follow-up had a smaller cup-to-disc ratio (CDR) at final visit ( P = 0.033). Ten patients presented with incipient NAION, of which 9 suffered vision loss by final visit. CONCLUSION Aside from CDR differences, the risk factor profile and visual outcomes of sNAION patients seem similar to those of uNAION patients, suggesting similar pathophysiology.
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Alqahtani Y, Oshi M, Kamal NM, Aljabri M, Abosabie S, Elhaj W, Abosabie SA. Pediatric myelin oligodendrocyte glycoprotein antibody associated disease-Asymmetric papilledema and elevated ICP are two of the chameleons: A case report. Medicine (Baltimore) 2023; 102:e32986. [PMID: 36827019 PMCID: PMC11309627 DOI: 10.1097/md.0000000000032986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody (MOGA) associated diseases are inflammatory immune-mediated demyelinating disorders with relapse potential involving the central nervous system. Multiple unusual clinical manifestations of those disorders were reported, making treatment decisions difficult. CASE PRESENTATION A healthy 12-year-old obese boy presented with headache and bilateral asymmetric papilledema. The patient had a negative medical history. His neurological and general examinations were unremarkable, his initial magnetic resonance imaging showed elevated intracranial pressure (ICP) only. A lumbar puncture revealed increased opening pressure and pleocytosis. The MOGA titer was 1:320. He needed acetazolamide and steroid therapy. After 2 months of medication, weight loss, exercise, the patient symptoms significantly improved, papilledema resolved, and visual function improved. CONCLUSION MOGA-associated disorders have a variety of clinical features, so a high index of suspicion is required for their diagnosis. Papilledema and an elevated ICP are 2 of the chameleons of MOGA-associated disorders. MOGA test may be useful in patients with elevated ICP and inflammatory cerebrospinal fluid profiles. An investigation of the possible association between those disorders and high ICP is warranted.
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Affiliation(s)
- Youssef Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Oshi
- Department of Pediatrics, Neurology Division, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Naglaa M. Kamal
- Pediatrics and Pediatric Hepatology, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammed Aljabri
- Department of Pediatrics, Neurology Division, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Salma Abosabie
- Faculty of Medicine, Julius-Maximilians-Universität Würzburg, Bavaria, Germany
| | - Waleed Elhaj
- Department of Pediatrics, Neurology Division, Alhada Armed Forces Hospital, Taif, Kingdom of Saudi Arabia
| | - Sara A Abosabie
- Faculty of Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
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Fernandes RD, de Souza Andrade T, Preti RC, Zacharias LC, Silva GD, Lucato LT, Apóstolos-Pereira SL, Callegaro D, Monteiro MLR. Paracentral Acute Middle Maculopathy Associated with Severe Anti-Mog (Myelin Oligodendrocyte Glycoprotein)-Positive Optic Neuritis. Neuroophthalmology 2023; 47:156-163. [PMID: 37398504 PMCID: PMC10312038 DOI: 10.1080/01658107.2023.2172434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Retinal complications in patients with inflammatory optic neuritis (ON) are generally related to post-infectious neuroretinitis and are considered uncommon in autoimmune/demyelinating ON, whether isolated or caused by multiple sclerosis (MS) or neuromyelitis optica spectrum disorder (NMOSD). More recently, however, cases with retinal complications have been reported in subjects positive for myelin oligodendrocyte glycoprotein (MOG) antibodies. We report a 53-year-old woman presenting with severe bilateral ON associated with a focal area of paracentral acute middle maculopathy (PAMM) in one eye. Visual loss recovered remarkably after high-dose intravenous corticosteroid treatment and plasmapheresis, but the PAMM lesion remained visible on both optical coherence tomography and angiography as an ischaemic lesion affecting the middle layers of the retina. The report emphasises the possible occurrence of retinal vascular complications in MOG-related optic neuritis, an important addition to the diagnosis of, and possible differentiation from, MS-related or NMOSD-related ON.
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Affiliation(s)
- Rodrigo Dahia Fernandes
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Thais de Souza Andrade
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Rony C. Preti
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | - Leandro C. Zacharias
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
| | | | - Leandro Tavares Lucato
- Neuroradiology Section, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Dagoberto Callegaro
- Department of Neurology, University of São Paulo Medical School, São Paulo, Brazil
| | - Mário Luiz R. Monteiro
- Division of Ophthalmology and the Laboratory of Investigation in Ophthalmology (LIM 33), University of São Paulo Medical School, São Paulo, Brazil
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Abstract
PURPOSE OF REVIEW The primary aim of this review is to describe the clinical course, salient imaging features, and relevant serological profiles of common optic neuritis (ON) subtypes. Key diagnostic challenges and treatment options will also be discussed. RECENT FINDINGS ON is a broad term that describes an inflammatory optic nerve injury arising from a variety of potential causes. ON can occur sporadically, however there is particular concern for co-associated central nervous system (CNS) inflammatory syndromes including multiple sclerosis (MS), neuromyelitis optic spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD). The ON subtypes that often herald MS, NMOSD, and MOGAD differ with respect to serological antibody profile and neuroimaging characteristics, yet there is significant overlap in their clinical presentations. A discerning history and thorough examination are critical to rendering the correct diagnosis. SUMMARY Optic neuritis subtypes vary with respect to their long-term prognosis and accordingly, require different acute treatment strategies. Moreover, delays in identifying MOGAD, and certainly NMOSD, can be highly detrimental because affected individuals are vulnerable to permanent vision loss and neurologic disability from relapses.
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Affiliation(s)
| | - Fiona Costello
- Department of Surgery, Section of Ophthalmology
- Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
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Tillema JM. Imaging of Central Nervous System Demyelinating Disorders. Continuum (Minneap Minn) 2023; 29:292-323. [PMID: 36795881 DOI: 10.1212/con.0000000000001246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE This article summarizes neuroimaging findings in demyelinating disease, the most common being multiple sclerosis. Revisions to criteria and treatment options have been ongoing, and MRI plays a pivotal role in diagnosis and disease monitoring. The common antibody-mediated demyelinating disorders with their respective classic imaging features are reviewed, as well as the differential diagnostic considerations on imaging. LATEST DEVELOPMENTS The clinical criteria of demyelinating disease rely heavily on imaging with MRI. With novel antibody detection, the range of clinical demyelinating syndromes has expanded, most recently with myelin oligodendrocyte glycoprotein-IgG antibodies. Imaging has improved our understanding of the pathophysiology of multiple sclerosis and disease progression, and further research is underway. The importance of increased detection of pathology outside of the classic lesions will have an important role as therapeutic options are expanding. ESSENTIAL POINTS MRI has a crucial role in the diagnostic criteria and differentiation among common demyelinating disorders and syndromes. This article reviews the typical imaging features and clinical scenarios that assist in accurate diagnosis, differentiation between demyelinating diseases and other white matter diseases, the importance of standardized MRI protocols in clinical practice, and novel imaging techniques.
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Pimentel Maldonado DA, Lisak R, Galetta S, Balcer L, Varkey T, Goodman A, Graves J, Racke M, Zamvil SS, Newsome S, Frohman EM, Frohman TC. Recurrent Optic Neuritis and Perineuritis Followed by an Unexpected Discovery. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2023; 10:10/1/e200051. [DOI: 10.1212/nxi.0000000000200051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 09/12/2022] [Indexed: 11/12/2022]
Abstract
We describe a woman with a history of relapsing acute optic neuritis and perineuritis. Testing failed to confirm a specific diagnosis; hence, she was diagnosed with seronegative neuromyelitis optica spectrum disorder and treated with the immunotherapy rituximab, later in conjunction with mycophenolate mofetil. She achieved a durable remission for 9 years until she presented with paresthesia affecting her left fifth digit, right proximal thigh, and left foot, while also reporting a 25-pound weight loss over the prior 3 months. New imaging demonstrated a longitudinally extensive and enhancing optic nerve, in conjunction with multifocal enhancing lesions within the spinal cord, in a skip-like distribution. The differential diagnosis is discussed.
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Belova AN, Sheiko GE, Rakhmanova EM, Boyko AN. [Clinical features and modern diagnostic criteria of the disease associated with myelin oligodendrocyte glycoprotein antibody disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:47-56. [PMID: 37994888 DOI: 10.17116/jnevro202312311147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Demyelinating disease of the central nervous system associated with antibodies to myelin oligodendrocyte glycoprotein (MOGAD) has been proposed to be distinguished from neuromyelitis optica spectrum disorders (NMOSD) into a separate nosological form. The basis for the recognition of nosological independence was the presence of clinical features of this disease and the detection of a specific biomarker in the blood serum of patients - IgG class antibodies to MOG. The article summarizes the current data on the clinical and radiological phenotypes of MOGAD in children and adults and the features of the course of the disease. The requirements for the laboratory diagnosis of the disease and diagnostic criteria for MOGAD proposed by an international group of experts in 2023 are given.
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Affiliation(s)
- A N Belova
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - G E Sheiko
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - E M Rakhmanova
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
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71
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Bennett JL, Costello F, Chen JJ, Petzold A, Biousse V, Newman NJ, Galetta SL. Optic neuritis and autoimmune optic neuropathies: advances in diagnosis and treatment. Lancet Neurol 2023; 22:89-100. [PMID: 36155661 DOI: 10.1016/s1474-4422(22)00187-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
Abstract
Optic neuritis is an inflammatory optic neuropathy that is commonly indicative of autoimmune neurological disorders including multiple sclerosis, myelin-oligodendrocyte glycoprotein antibody-associated disease, and neuromyelitis optica spectrum disorder. Early clinical recognition of optic neuritis is important in determining the potential aetiology, which has bearing on prognosis and treatment. Regaining high-contrast visual acuity is common in people with idiopathic optic neuritis and multiple sclerosis-associated optic neuritis; however, residual deficits in contrast sensitivity, binocular vision, and motion perception might impair vision-specific quality-of-life metrics. In contrast, recovery of visual acuity can be poorer and optic nerve atrophy more severe in individuals who are seropositive for antibodies to myelin oligodendrocyte glycoprotein, AQP4, and CRMP5 than in individuals with typical optic neuritis from idiopathic or multiple-sclerosis associated optic neuritis. Key clinical, imaging, and laboratory findings differentiate these disorders, allowing clinicians to focus their diagnostic studies and optimise acute and preventive treatments. Guided by early and accurate diagnosis of optic neuritis subtypes, the timely use of high-dose corticosteroids and, in some instances, plasmapheresis could prevent loss of high-contrast vision, improve contrast sensitivity, and preserve colour vision and visual fields. Advancements in our knowledge, diagnosis, and treatment of optic neuritis will ultimately improve our understanding of autoimmune neurological disorders, improve clinical trial design, and spearhead therapeutic innovation.
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Affiliation(s)
- Jeffrey L Bennett
- Department of Neurology and Department of Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, AB, Canada
| | - John J Chen
- Department of Ophthalmology and Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Axel Petzold
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, UK; Moorfields Eye Hospital, London, UK; Neuro-ophthalmology Expert Centre, Amsterdam, Netherlands
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven L Galetta
- Department of Neurology and Department of Opthalmology, NYU Langone Medical Center, New York, NY, USA
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72
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Sheremet NL, Eliseeva DD, Kalashnikova AK, Zakharova MN. [Typical and atypical optic neuritis]. Vestn Oftalmol 2023; 139:175-182. [PMID: 38235645 DOI: 10.17116/oftalma2023139061175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Optic neuritis (ON) is one of the most common neuro-ophthalmic causes of vision loss worldwide. Demyelinating ON can be idiopathic or be one of the symptoms of autoimmune demyelinating diseases of the central nervous system (CNS) such as multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Demographic, clinical and radiological signs of ON in these CNS diseases have differences. In this regard, typical and atypical ON are currently distinguished. Recognizing the clinical features that differentiate typical MS-associated ON from atypical ON in NMOSD and MOGAD is important for choosing the correct disease management and treatment strategy. This review summarizes the data from clinical, laboratory, instrumental methods of management used for the differential diagnosis of optic neuritis.
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Affiliation(s)
- N L Sheremet
- Kasnov Research Institute of Eye Diseases, Moscow, Russia
| | | | - A K Kalashnikova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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73
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Details and outcomes of a large cohort of MOG-IgG associated optic neuritis. Mult Scler Relat Disord 2022; 68:104237. [PMID: 36252317 DOI: 10.1016/j.msard.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of this study was to examine the temporal relationship of eye pain to visual loss and investigate whether timing of steroid treatment affects the rate and extent of visual recovery in optic neuritis (ON) from MOG-IgG associated disease (MOGAD) in a large cohort of MOGAD patients with ON. METHODS This is a multicenter, retrospective cohort study of consecutive MOGAD patients with ON attacks seen from 2017 to 2021 fulfilling the following criteria: (1) clinical history of ON; (2) MOG-IgG seropositivity. ON attacks were evaluated for presence/duration of eye pain, nadir of vision loss, time to intravenous methylprednisolone (IVMP) treatment, time to recovery, and final visual outcomes. RESULTS There were 107 patients with 140 attacks treated with IVMP and details on timing of treatment and outcomes. Eye pain was present in 125/140 (89%) attacks with pain onset a median of 3 days (range, 0 to 20) prior to vision loss. Among 46 ON attacks treated with IVMP within 2 days of onset of vision loss, median time to recovery was 4 days (range, 0 to 103) compared to 15 days (range, 0 to 365) in 94 ON attacks treated after 2 days (p = 0.004). Those treated within 2 days had less severe VA loss at time of treatment (median LogMAR VA 0.48, range, 0.1 to 3) compared to those treated after 2 days (median LogMAR VA 1.7, range, 0 to 3; p < 0.001), and were more likely to have a VA outcome of 20/40 or better (98% vs 83%, p = 0.01). After adjustment for the initial VA at time of treatment, the differences in final VA were no longer significantly different (p = 0.14). In addition, some patients were documented to recover without steroid treatment. CONCLUSION This study suggests that pain precedes vision loss in the majority of ON attacks and early steroids may lead to better outcomes in MOG-IgG ON, but some patients can recover without steroid treatment. Prospective randomized clinical trials are required to confirm these findings.
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74
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Song H, Yang M, Zhou H, Li Z, Wei S. MOG antibody prevalence in adult optic neuritis and clinical predictive factors for diagnosis: A Chinese cohort study. Mult Scler Relat Disord 2022; 68:104248. [PMID: 36544312 DOI: 10.1016/j.msard.2022.104248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Because AQP4/MOG antibody testing is not available in some parts of the world and there are often delays in obtaining results, it is particularly important to use clinical factors to predict the subtypes of adult optic neuritis (ON). METHODS This was a single-center retrospective cohort study. RESULTS The final analysis included 249 adult patients presenting with the first ON attack during January 2016 to January 2020. These included 109 (43.8%) AQP4-ON cases, 49 (19.7%) MOG-ON cases, and 91 (36.5%) Seronegative-ON cases. The proportion of optic disk swelling (ODS) and bilateral involvement in MOG-ON group was significantly higher than in the other two subgroups (P = 0.029, 0.001). The MOG-ON group had the best follow-up BCVA (P = 0.003). To predict adult AQP4-ON, unilateral involvement (sensitivity 0.88, NPV 0.77) was the most sensitivity predictors, while neurological history (specificity 0.96, PPV 0.65) and concomitant other autoimmune antibodies (specificity 0.76, PPV 0.65) were the most specific predictors. Using the parallel test 'unilateral or other autoimmune antibodies' increased sensitivity to 0.95, with an optimal NPV of 0.88. To predict adult MOG-ON, the most sensitive clinical characteristics were ODS (sensitivity 0.79, NPV 0.88), and follow-up VA ≤0.1logMAR (sensitivity 0.78, NPV 0.92), whereas the most specific values were prior neurological history or bilateral involvement, with specificities of 0.92 and 0.82, respectively. The sensitivity increased to 0.94, 0.97, and 0.97 when using the parallel clinical factors of 'bilateral or ODS or relapse', 'bilateral or ODS or follow-up VA ≤0.1logMAR', and 'ODS or follow-up VA ≤0.1logMAR', and the corresponding NPV (0.94, 0.97 vs 0.98). CONCLUSION The proportion of MOG-ON (19.7%) was less than that of AQP4-ON and Seronegative-ON. Moreover, MOG-ON had a better prognosis and was more likely to be associated with ODS or bilateral involvement. The use of parallel clinical parameters improved the sensitivity for the diagnosis of adult MOG-ON and AQP4-ON.
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Affiliation(s)
- Honglu Song
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China; Department of Ophthalmology, the 980th Hospital of the Chinese PLA Joint Logistics Support Force, Shijiazhuang, Hebei, China
| | - Mo Yang
- Department of Neuro-ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huanfen Zhou
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhaohui Li
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Shihui Wei
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China.
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75
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Abstract
PURPOSE OF REVIEW This review paper aims at discussing pathogenesis, etiology, clinical features, management, and prognosis of OPN. RECENT FINDINGS Optic perineuritis (OPN) is an inflammatory process primarily involving the optic nerve sheath. Clinically, OPN usually presents with unilateral, gradual decline of visual function, eye pain, and/or pain on eye movements, disc edema and various features of optic nerve dysfunction, including visual field defects. It can mimic typical optic neuritis. In most cases of OPN, the disease is isolated with no specific etiology being identified, however, it can also occur secondary to a wide range of underlying systemic diseases. OPN is clinically diagnosed and radiologically confirmed based on the finding of circumferential perineural enhancement of the optic nerve sheath on magnetic resonance imaging (MRI). SUMMARY Unlike optic nerve, OPN is not typically self-limited without treatment. High-dose oral corticosteroids are the mainstay of treatment in OPN. The initiation of therapy usually causes rapid and dramatic improvement in signs and symptoms. In general, OPN usually has a relatively good visual prognosis, which is influenced by delays between the onset of visual loss and the initiation of steroid therapy as well as the presence of underlying systemic diseases.
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Affiliation(s)
- George Saitakis
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary/Harvard Medical School, Boston, Massachusetts, USA
- Athens Eye Hospital, Athens, Greece
| | - Bart K Chwalisz
- Division of Neuro-Ophthalmology, Department of Ophthalmology, Massachusetts Eye & Ear Infirmary/Harvard Medical School, Boston, Massachusetts, USA
- Department of Neurology, Massachusetts General Hospital/ Harvard Medical School, Boston, Massachusetts, USA
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Orssaud C. Neuropathie optique héréditaire de Leber : le diagnostic différentiel. J Fr Ophtalmol 2022; 45:S9-S16. [DOI: 10.1016/s0181-5512(22)00445-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Chaudhuri JR, Bagul JJ, Swathi A, Singhal BS, Reddy NC, Vallam KK. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Presenting as Intracranial Hypertension: A Case Report. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/6/e200020. [PMID: 36261298 PMCID: PMC9581460 DOI: 10.1212/nxi.0000000000200020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Accepted: 06/27/2022] [Indexed: 11/14/2022]
Abstract
The production of autoantibodies against myelin oligodendrocyte glycoprotein (MOG) can cause a spectrum of autoimmune disorders, including optic neuritis, transverse myelitis, brainstem encephalitis, and acute disseminated encephalomyelitis. In this study, we present the case of a 19-year-old woman with an unusual clinical presentation of intracranial hypertension (IH) and bilateral papilledema. The patient presented with symptoms of increased intracranial pressure, which followed a relapsing, remitting course over several months. Serial CSF studies showed an increased opening pressure during clinical relapses. The CSF and serum tested positive for MOG immunoglobulin G antibodies. Contrast-enhanced MRI of the brain showed mild meningeal enhancement in the left parietal region with subtle underlying cortical hyperintensities, indicating possible fluid-attenuated inversion recovery variable unilateral enhancement of the leptomeninges. The patient responded well to immunosuppressive therapy using rituximab. The presentation of MOG antibody-associated disease (MOGAD) as IH without optic neuritis is rare. This report presents the first description of a relapsing remitting course presenting each time with only symptoms of raised intracranial pressure, without developing any typical clinical manifestations of MOGAD.
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Benard-Seguin E, Costello F. A Practical Approach to the Diagnosis and Management of Optic Neuritis. Ann Indian Acad Neurol 2022; 25:S48-S53. [PMID: 36589032 PMCID: PMC9795707 DOI: 10.4103/aian.aian_170_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/19/2022] [Indexed: 01/04/2023] Open
Abstract
Optic neuritis (ON), as an umbrella term, refers to a spectrum of inflammatory optic neuropathies arising from a myriad of potential causes. In its most common form, "typical" ON presents as a unilateral, painful subacute vision loss event in young Caucasian women. The Optic Neuritis Treatment Trial (ONTT) has historically guided our treatment of ON, and taught us important lessons about the clinical presentation, visual prognosis, and future risk of multiple sclerosis (MS) diagnosis associated with this condition. However, in the decades since the ONTT, several immune-mediated conditions such as neuromyelitis optica spectrum disorder (NMOSD), and myelin-oligodendrocyte glycoprotein IgG associated disease (MOGAD) have been discovered, complicating the clinical approach to ON. Unlike MS, other central nervous system (CNS) inflammatory conditions are associated with ON subtypes that are potentially blinding, and prone to recurrence. Owing to differences in the clinical presentation, serological biomarkers, radiological findings, and prognostic implications associated with MS ON, NMOSD ON, and MOGAD ON subtypes, it is imperative that clinicians be aware of the diagnostic approach and management options for these conditions.
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Affiliation(s)
| | - Fiona Costello
- Department of Surgery in Ophthalmology, University of Calgary, Calgary, AB, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada,Address for correspondence: Dr. Fiona Costello, 7007 14 St SW, Calgary, AB T2V 1P9, Calgary, Alberta, Canada. E-mail:
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Sguigna PV, Tardo LM, Blackburn KM, Horton LA, Conger DL, Hogan RN, McCreary MC, Greenberg BM. Application of the International Interocular Difference Thresholds into Practice: Localising the Patient Experience. Neuroophthalmology 2022; 46:375-382. [PMID: 36544583 PMCID: PMC9762821 DOI: 10.1080/01658107.2022.2109687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Demyelinating diseases of the central nervous system (CNS) often have neuro-ophthalmological manifestations, and retinal examination can be helpful in making the diagnosis. The latest iteration of optical coherence tomography (OCT)-based criteria for optic neuritis in multiple sclerosis has been developed in the research realm, but its application to clinical practice, and to the more uncommon demyelinating diseases requires further study. The ability to use OCT data to distinguish between various CNS demyelinating disorders could provide additional paraclinical tools to accurately diagnose patients. Furthermore, neuro-ophthalmological testing can define the extent of inflammatory damage in the CNS, independent of patient-reported history. New referrals for OCT at a tertiary multiple sclerosis and neuro-immunology referral centre (n = 167) were analysed retrospectively for the self-reporting of optic neuritis, serological test results, and diagnosis. Only approximately 30% of patients with a clinical history of unilateral optic neuritis solely had a unilateral optic neuropathy, nearly 40% of those subjects actually having evidence of bilateral optic neuropathies. Roughly 30% of patients reporting a history of bilateral optic neuritis did not have any evidence of structural disease, with 20% of these patients having a separate, intervenable diagnosis noted on macular scans. OCT is a useful adjunct diagnostic tool in the evaluation of demyelinating disease and has the ability to aid in a more accurate diagnosis for patients. Application of the international interocular difference thresholds to a clinical patient population generally reproduces the original results, emphasising their appropriateness. The analysis distinguishing the demyelinating diseases needs to be replicated in a blinded, multi-centre setting.
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Affiliation(s)
- Peter V. Sguigna
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Lauren M. Tardo
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Kyle M. Blackburn
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Lindsay A. Horton
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Darrel L. Conger
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - R. Nick Hogan
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Morgan C. McCreary
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Benjamin M. Greenberg
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
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The Prevalence, Demographics, Clinical Features, Neuroimaging, and Interethnic Differences of MOG Disease in Malaysia with Global Perspectives. Mult Scler Relat Disord 2022; 67:104168. [DOI: 10.1016/j.msard.2022.104168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/20/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022]
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81
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Shah SS, Morris P, Buciuc M, Tajfirouz D, Wingerchuk DM, Weinshenker BG, Eggenberger ER, Di Nome M, Pittock SJ, Flanagan EP, Bhatti MT, Chen JJ. Frequency of Asymptomatic Optic Nerve Enhancement in a Large Retrospective Cohort of Patients With Aquaporin-4+ NMOSD. Neurology 2022; 99:e851-e857. [PMID: 35697504 PMCID: PMC9484733 DOI: 10.1212/wnl.0000000000200838] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 04/22/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Asymptomatic or persistent optic nerve enhancement in aquaporin-4 (AQP4)-immunoglobulin G (IgG)-positive neuromyelitis optica spectrum disorder (NMOSD) is thought to be rare. Improved understanding may have important implications for assessment of treatment efficacy in clinical trials and in clinical practice. Our objective was to characterize NMOSD interattack optic nerve enhancement. METHODS This was a retrospective cohort study performed between 2000 and 2019 (median follow-up 5.5 [range 1-35] years) of patients with AQP4-IgG-positive optic neuritis (ON) evaluated at Mayo Clinic. MRI orbits were reviewed by a neuroradiologist, neuro-ophthalmologist, and neuroimmunologist blinded to the clinical history. Interattack optic nerve enhancement (>30 days after attack) was measured. The correlation between interattack enhancement and Snellen visual acuity (VA), converted to logarithm of the minimum angle of resolution (logMAR), at attack and at follow-up were assessed. RESULTS A total of 198 MRI scans in 100 patients with AQP4-IgG+ NMOSD were identified, with 107 interattack MRIs from 78 unique patients reviewed. Seven scans were performed before any ON (median 61 days before attack [range 21-271 days]) and 100 after ON (median 400 days after attack [33-4,623 days]). Optic nerve enhancement was present on 18/107 (16.8%) interattack scans (median 192.5 days from attack [33-2,943]) of patients with preceding ON. On 15 scans, enhancement occurred at the site of prior attacks; the lesion location was unchanged, but the lesion length was shorter. Two scans (1.8%) demonstrated new asymptomatic lesions (prior scan demonstrated no enhancement). In a third patient with subjective blurry vision, MRI showed enhancement preceding detectable eye abnormalities on examination noted 15 days later. There was no difference in VA at preceding attack nadir (logMAR VA 1.7 vs 2.1; p = 0.79) or long-term VA (logMAR VA 0.4 vs 0.2, p = 0.56) between those with and without interattack optic nerve enhancement. DISCUSSION Asymptomatic optic nerve enhancement occurred in 17% of patients with NMOSD predominantly at the site of prior ON attacks and may represent intermittent blood-brain barrier breakdown or subclinical ON. New asymptomatic enhancement was seen only in 2% of patients. Therapeutic clinical trials for NMOSD require blinded relapse adjudication when assessing treatment efficacy, and it is important to recognize that asymptomatic optic nerve enhancement can occur in patients with ON.
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Affiliation(s)
- Shailee S Shah
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Pearse Morris
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Marina Buciuc
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Deena Tajfirouz
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Dean M Wingerchuk
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Brian G Weinshenker
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Eric R Eggenberger
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Marie Di Nome
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - M Tariq Bhatti
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology (S.S.S., M.B., D.T., B.G.W., S.J.P., E.P.F., M.T.B., J.J.C.), and Center for Multiple Sclerosis and Autoimmune Neurology (S.S.S., M.B., D.M.W., B.G.W., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (S.S.S.), Vanderbilt University Medical Center, Nashville TN; Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Neurology (D.M.W.), Mayo Clinic, Scottsdale, AZ; Department of Ophthalmology (E.R.E.), Mayo Clinic, Jacksonville, FL; Department of Ophthalmology (M.D.N.), Mayo Clinic, Scottsdale, AZ; Department of Lab Medicine and Pathology (S.J.P., E.P.F.), and Department of Ophthalmology (M.T.B., J.J.C.), Mayo Clinic, Rochester, MN.
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Longbrake E. Myelin Oligodendrocyte Glycoprotein-Associated Disorders. Continuum (Minneap Minn) 2022; 28:1171-1193. [PMID: 35938661 PMCID: PMC9523511 DOI: 10.1212/con.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Anti-myelin oligodendrocyte glycoprotein (MOG) autoantibodies have become a recognized cause of a pathophysiologically distinct group of central nervous system (CNS) autoimmune diseases. MOG-associated disorders can easily be confused with other CNS diseases such as multiple sclerosis or neuromyelitis optica, but they have a distinct clinical phenotype and prognosis. RECENT FINDINGS Most patients with MOG-associated disorders exhibit optic neuritis, myelitis, or acute disseminated encephalomyelitis (ADEM) alone, sequentially, or in combination; the disease may be either monophasic or relapsing. Recent case reports have continued to expand the clinical spectrum of disease, and increasingly larger cohort studies have helped clarify its pathophysiology and natural history. SUMMARY Anti-MOG-associated disorders comprise a substantial subset of patients previously thought to have other seronegative CNS diseases. Accurate diagnosis is important because the relapse patterns and prognosis for MOG-associated disorders are unique. Immunotherapy appears to successfully mitigate the disease, although not all agents are equally effective. The emerging large-scale data describing the clinical spectrum and natural history of MOG-associated disorders will be foundational for future therapeutic trials.
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83
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Update on glial antibody-mediated optic neuritis. Jpn J Ophthalmol 2022; 66:405-412. [PMID: 35895155 DOI: 10.1007/s10384-022-00932-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 10/16/2022]
Abstract
Optic neuritis (ON) refers to inflammatory demyelinating lesions of the optic nerve, which can cause acute or subacute vision loss and is a major cause of vision loss in young adults. Much of our understanding of typical ON is from the Optic Neuritis Treatment Trial. Glial autoantibodies to aquaporin-4 immunoglobulin (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin (MOG-IgG) are recently established biomarkers of ON that have revolutionized our understanding of atypical ON. The detection of glial antibodies is helpful in the diagnosis, treatment, and follow-up of patients with different types of ON. AQP4-IgG and MOG-IgG screening is strongly recommended for patients with atypical ON. Research on the pathogenesis of NMOSD and MOGAD will promote the development and marketing of targeted immunotherapies. The application of new and efficient drugs, such as the selective complement C5 inhibitor, IL-6 receptor inhibitor, B cell-depleting agents, and drugs against other monoclonal antibodies, provides additional medical evidence. This review provides information on the diagnosis and management of glial antibody-mediated ON.
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Neuromyelitis Optica Spectrum Disorder: From Basic Research to Clinical Perspectives. Int J Mol Sci 2022; 23:ijms23147908. [PMID: 35887254 PMCID: PMC9323454 DOI: 10.3390/ijms23147908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system characterized by relapses and autoimmunity caused by antibodies against the astrocyte water channel protein aquaporin-4. Over the past decade, there have been significant advances in the biologic knowledge of NMOSD, which resulted in the IDENTIFICATION of variable disease phenotypes, biomarkers, and complex inflammatory cascades involved in disease pathogenesis. Ongoing clinical trials are looking at new treatments targeting NMOSD relapses. This review aims to provide an update on recent studies regarding issues related to NMOSD, including the pathophysiology of the disease, the potential use of serum and cerebrospinal fluid cytokines as disease biomarkers, the clinical utilization of ocular coherence tomography, and the comparison of different animal models of NMOSD.
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Lasrado A, Chattannavar G, Sachdeva V, Kekunnaya R. Optic chiasm, optic tract and deep white demyelination: an unusual distribution of myelin oligodendrocyte glycoprotein-associated demyelination (MOGAD), case report and review of literature. BMJ Case Rep 2022; 15:e249398. [PMID: 35798498 PMCID: PMC9263899 DOI: 10.1136/bcr-2022-249398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 11/04/2022] Open
Abstract
A preschool girl presented with sudden-onset bilateral painless loss of vision from 2 days prior. Child's examination showed light perception vision, sluggishly reacting pupils, otherwise normal anterior segment, healthy optic disc and retina in both eyes. MRI of brain and orbit with contrast revealed thickened left part of the optic chiasm with contrast enhancement extending proximally to bilateral optic tract and hyperintensities in the left thalamus and periventricular white mater. Considering the topographical distribution of lesions in the brain, neuromyelitis optica spectrum disorder was suspected. The child was started on intravenous methylprednisolone followed by tapering oral steroids. Serological testing was positive for myelin oligodendrocyte glycoprotein (MOG) and negative for aquaporin-4 antibodies. This case represents an unusual case of MOG associated demyelination disorder where the distribution of lesions showed chiasmal involvement along with optic tract, thalamus and deep white mater lesions.
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Affiliation(s)
- Adeline Lasrado
- Fellow LVPEI, Standard Chartered LVPEI Academy of Eye Care Education, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Goura Chattannavar
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender Sachdeva
- Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Vision Prognosis and Associated Factors of Optic Neuritis in Dependence of Glial Autoimmune Antibodies. Am J Ophthalmol 2022; 239:11-25. [PMID: 35081416 DOI: 10.1016/j.ajo.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the visual prognosis of optic neuritis (ON) in dependence of the glial autoimmune antibody status and associated factors. DESIGN Longitudinal observational cohort study. METHODS Patients with ON and measurements of serum concentrations of glial autoantibodies were consecutively and longitudinally examined with a minimal follow-up of 3 months. Patients with multiple sclerosis and double seronegative results were excluded. RESULTS The study included 529 patients (aquaporin-4 immunoglobulin [AQP4-IgG] seropositive, n = 291; myelin oligodendrocyte glycoprotein immunoglobulin [MOG-IgG] seropositive, n = 112; double-seronegative, n = 126) with 1022 ON episodes (AQP4-IgG seropositive, n = 550; MOG-IgG seropositive, n=254; double-seronegative, n = 218). Prevalence of severe vision loss (best-corrected visual acuity [BCVA] ≤20/200 at the end of follow-up) was higher (P < .001) in the AQP4-IgG group (236/550; 42.9%) than in the seronegative group (68/218; 31.2%) and in the MOG-IgG group (15/254; 5.9%). Prevalence of good vision recovery (BCVA≥20/40) was higher (P < .001) in the MOG-IgG group (229/254; 90.2%) than in the seronegative group (111/218; 50.9%) and in the AQP4-IgG group (236/550; 42.9%). In multivariable logistic analysis, higher prevalence of severe vision loss was associated with AQP4-IgG seropositivity (odds ratio [OR] 1.66; 95% CI 1.14, 2.43; P = .008), male sex (OR 1.97, 95% CI 1.33, 2.93; P < .001), age at ON onset >45 years (OR 1.93, 95% CI 1.35, 2.77; P < .001), nadir vision ≤20/200 (OR 14.11, 95% CI 6.54, 36.93; P < .001), and higher number of recurrences (OR 1.35, 95% CI 1.14, 1.61; P = .001). Higher prevalence of good vision outcome was associated with MOG-IgG seropositivity (OR 8.13, 95% CI 4.82, 14.2; P < .001), age at ON onset <18 years (OR 1.78, 95% CI 1.18, 2.71; P = .006), nadir visual acuity ≥20/40 (OR 4.03; 95% CI 1.45, 14.37; P = .015), and lower number of recurrences (OR 0.60; 95% CI 0.50, 0.72; P < .001). CONCLUSION Severe vision loss (prevalence in the AQP4-IgG group, MOG-IgG group, and seronegative group: 42.9%, 5.9%, and 31.2%, respectively) was associated with AQP4-IgG seropositivity, male gender, older age at onset, worse nadir vision, and higher number of recurrences.
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Sechi E, Cacciaguerra L, Chen JJ, Mariotto S, Fadda G, Dinoto A, Lopez-Chiriboga AS, Pittock SJ, Flanagan EP. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front Neurol 2022; 13:885218. [PMID: 35785363 PMCID: PMC9247462 DOI: 10.3389/fneur.2022.885218] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is the most recently defined inflammatory demyelinating disease of the central nervous system (CNS). Over the last decade, several studies have helped delineate the characteristic clinical-MRI phenotypes of the disease, allowing distinction from aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD) and multiple sclerosis (MS). The clinical manifestations of MOGAD are heterogeneous, ranging from isolated optic neuritis or myelitis to multifocal CNS demyelination often in the form of acute disseminated encephalomyelitis (ADEM), or cortical encephalitis. A relapsing course is observed in approximately 50% of patients. Characteristic MRI features have been described that increase the diagnostic suspicion (e.g., perineural optic nerve enhancement, spinal cord H-sign, T2-lesion resolution over time) and help discriminate from MS and AQP4+NMOSD, despite some overlap. The detection of MOG-IgG in the serum (and sometimes CSF) confirms the diagnosis in patients with compatible clinical-MRI phenotypes, but false positive results are occasionally encountered, especially with indiscriminate testing of large unselected populations. The type of cell-based assay used to evaluate for MOG-IgG (fixed vs. live) and antibody end-titer (low vs. high) can influence the likelihood of MOGAD diagnosis. International consensus diagnostic criteria for MOGAD are currently being compiled and will assist in clinical diagnosis and be useful for enrolment in clinical trials. Although randomized controlled trials are lacking, MOGAD acute attacks appear to be very responsive to high dose steroids and plasma exchange may be considered in refractory cases. Attack-prevention treatments also lack class-I data and empiric maintenance treatment is generally reserved for relapsing cases or patients with severe residual disability after the presenting attack. A variety of empiric steroid-sparing immunosuppressants can be considered and may be efficacious based on retrospective or prospective observational studies but prospective randomized placebo-controlled trials are needed to better guide treatment. In summary, this article will review our rapidly evolving understanding of MOGAD diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
| | - John J. Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Fadda
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Alessandro Dinoto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eoin P. Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eoin P. Flanagan
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Deschamps R, Shor N, Vignal C, Guillaume J, Boudot de la Motte M, Salviat F, Lecler A, Marignier R, Hage R, Coulette S, Bidot S, Gueguen A, Mauget-Faÿsse M, Bensa C, Vasseur V, Gout O, Lamirel C. A prospective longitudinal study on prognostic factors of visual recovery and structural change after a first episode of optic neuritis. Eur J Neurol 2022; 29:2781-2791. [PMID: 35617154 DOI: 10.1111/ene.15420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND To determine the role of OCT in predicting the final visual and structural outcome, and evaluate the correlation between functional eye outcome and retinal changes, in patients with first episode of optic neuritis (ON). METHODS In this prospective study, consecutive adult patients with acute ON underwent ophthalmological evaluation at baseline and 1 and 12 months, including OCT measurements of peripapillary retinal nerve fiber layer (pRNFL), macular ganglion cell and innerplexiform layer, and innernuclear layer thicknesses, high- and low-contrast visual acuity, visual field assessment, and baseline brain MRI. Univariate and multivariate linear regressions were used to assess predictive factors of outcome. Correlations between 12-month visual function and retinal structure were estimated by Spearman coefficients. Two groups of patients were analysed, with or without multiple sclerosis (MS). RESULTS Among 116 patients, 79 (68.1%) had MS, and 37 (31.9%) had ON not related to MS (including 19 idiopathic (i.e isolated) ON, and 13 and 5 with myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies, respectively). We found no independent predictive factor of visual and retinal outcome. Analysis of the relationship between the visual field test (mean deviation) and pRNFL thickness demonstrated a threshold of 75.4 μm and 66.4 μm, below which the mean deviation was worse, for patients with MS (p=0.007) and without MS (p<0.001), respectively. CONCLUSIONS We found that inner retinal layer measurements during the first month are not predictive of final outcome. The critical threshold of axonal integrity, below which visual function is damaged, is different between patients with and without MS.
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Affiliation(s)
- Romain Deschamps
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Natalia Shor
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France.,Department of Neuro-Radiology, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière - Sorbonne Université, Paris, France
| | - Catherine Vignal
- Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Jessica Guillaume
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Flore Salviat
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Augustin Lecler
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Romain Marignier
- Department of Neurology and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hospices civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon/Bron, France
| | - Rabih Hage
- Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Sarah Coulette
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Samuel Bidot
- Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Antoine Gueguen
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Martine Mauget-Faÿsse
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Vivien Vasseur
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Olivier Gout
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Cedric Lamirel
- Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France
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Bells S, Longoni G, Berenbaum T, de Medeiros CB, Narayanan S, Banwell BL, Arnold DL, Mabbott DJ, Ann Yeh E. Patterns of white and gray structural abnormality associated with paediatric demyelinating disorders. Neuroimage Clin 2022; 34:103001. [PMID: 35381508 PMCID: PMC8980471 DOI: 10.1016/j.nicl.2022.103001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 11/26/2022]
Abstract
A multi-modal approach was used to evaluate the visual pathway from anterior (retina) to posterior (visual cortex) in both paediatric MOGAD and MS patients. MS patients exhibited more widespread white matter abnormalities; MOGAD patients exhibited white matter changes primarily within the optic radiation. The pattern of cortical thinning differed in MS and MOGAD patients. Reduced RNFLT was associated with lower axonal density in MOGAD and tortuosity in MS.
The impact of multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein (MOG) - associated disorders (MOGAD) on brain structure in youth remains poorly understood. Reductions in cortical mantle thickness on structural MRI and abnormal diffusion-based white matter metrics (e.g., diffusion tensor parameters) have been well documented in MS but not in MOGAD. Characterizing structural abnormalities found in children with these disorders can help clarify the differences and similarities in their impact on neuroanatomy. Importantly, while MS and MOGAD affect the entire CNS, the visual pathway is of particular interest in both groups, as most patients have evidence for clinical or subclinical involvement of the anterior visual pathway. Thus, the visual pathway is of key interest in analyses of structural abnormalities in these disorders and may distinguish MOGAD from MS patients. In this study we collected MRI data on 18 MS patients, 14 MOGAD patients and 26 age- and sex-matched typically developing children (TDC). Full-brain group differences in fixel diffusion measures (fibre-bundle populations) and cortical thickness measures were tested using age and sex as covariates. Visual pathway analysis was performed by extracting mean diffusion measures within lesion free optic radiations, cortical thickness within the visual cortex, and retinal nerve fibre layer (RNFL) and ganglion cell layer thickness measures from optical coherence tomography (OCT). Fixel based analysis (FBA) revealed MS patients have widespread abnormal white matter within the corticospinal tract, inferior longitudinal fasciculus, and optic radiations, while within MOGAD patients, non-lesional impact on white matter was found primarily in the right optic radiation. Cortical thickness measures were reduced predominately in the temporal and parietal lobes in MS patients and in frontal, cingulate and visual cortices in MOGAD patients. Additionally, our findings of associations between reduced RNFLT and axonal density in MOGAD and TORT in MS patients in the optic radiations imply widespread axonal and myelin damage in the visual pathway, respectively. Overall, our approach of combining FBA, cortical thickness and OCT measures has helped evaluate similarities and differences in brain structure in MS and MOGAD patients in comparison to TDC.
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Affiliation(s)
- Sonya Bells
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada; Pediatric Neurology, Spectrum Health Helen Devos Children's Hospital, Grand Rapids, USA; Department of Pediatrics and Human Development, Michigan State University, East Lansing, USA
| | - Giulia Longoni
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada; Department of Neurology, Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Tara Berenbaum
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Cynthia B de Medeiros
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada
| | - Sridar Narayanan
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Brenda L Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA
| | - Douglas L Arnold
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and Hospital, McGill University, Montreal, Canada
| | - Donald J Mabbott
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada; Department of Psychology, University of Toronto, Toronto, Canada
| | - E Ann Yeh
- Neurosciences and Mental Health Program, Research Institute, Hospital for Sick Children, Toronto, Canada; Department of Neurology, Hospital for Sick Children, Toronto, Canada; Department of Paediatrics, University of Toronto, Toronto, Canada.
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Kang H, Qiu H, Hu X, Wei S, Tao Y. Differences in Neuropathic Pain and Radiological Features Between AQP4-ON, MOG-ON, and IDON. FRONTIERS IN PAIN RESEARCH 2022; 3:870211. [PMID: 35615385 PMCID: PMC9124930 DOI: 10.3389/fpain.2022.870211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to investigate pain and radiological features of different types of first-episode demyelinating optic neuritis (ON). Methods Eighty-three patients presenting with first-episode aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n = 28), myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n = 26) and idiopathic demyelinating optic neuritis (IDON, n = 29) were included in this retrospective case-control study. We assessed optic nerve lesions on magnetic resonance imaging (MRI), acute pain associated with onset of optic neuritis and clinical characteristics of those ON patients with different serum autoantibody status. Results 24 AQP4-ON patients (85.75%), 23 MOG-ON patients (88.5%) and 24 IDON patients (82.8%) suffered from ON-associated pain. MOG-ON had mostly retro-orbital pain; AQP4-ON and IDON had mostly neuropathic pain. In addition, pain was more severe in AQP4ON patients than in other ON patients. In MRI, bilateral involvement was more common in AQP4-ON than IDON (26.9 and 3.7%); radiological optic nerve head swelling was more common in MOG-ON than in AQP4-ON and IDON (68.0 vs. 23.1 vs. 25.9%). MRI lesion in peri-optic nerve sheath was more common in AQP4-ON (53.8 vs. 16.0 vs. 3.7%). In 70 patients with ON-associated pain, gadolinium enhancement of orbital optic nerve was most common in MOG-ON patients (82.4 vs. 55.0 vs. 33.3%, P = 0.018), and enhancement of optic chiasma was most common in AQP4-ON patients (40.0 vs. 5.9 vs. 6.7%, P = 0.015). Perineural and orbital enhancement was observed only in patients with MOG-ON (P < 0.001). The length of enhancement was longer in AQP4-ON patients than in MOG-ON and IDON patients. Conclusion Pain is a common symptom in patients with all types of demyelinating ON. AQP4-ON is frequently associated with severe ON-associated pain and longitudinally extensive optic nerve inflammatory lesions. Intra-orbital and peri-optic inflammation were more frequently observed in patients with MOG-ON, which was closely related to optic disc swelling and retro-orbital pain provoked by eye movements.
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Affiliation(s)
- Hao Kang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huaiyu Qiu
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Hu
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shihui Wei
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
- Shihui Wei
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Tao
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91
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Increased Plasma Lipocalin-2 Levels in Patients with Myelin Oligodendrocyte Glycoprotein-IgG–Positive Optic Neuritis. J Clin Med 2022; 11:jcm11092635. [PMID: 35566760 PMCID: PMC9105342 DOI: 10.3390/jcm11092635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 04/08/2022] [Accepted: 05/05/2022] [Indexed: 12/04/2022] Open
Abstract
This study aimed to evaluate the correlation between plasma lipocalin-2 (LCN2) levels and myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin G (IgG) seropositivity in patients with optic neuritis. Peripheral blood samples were collected from 19 patients with optic neuritis and 20 healthy controls. Plasma LCN2 and MOG-IgG levels were measured using enzyme-linked immunosorbent assay and a cell-based assay, respectively. The correlation between plasma LCN2 levels and MOG-IgG titers in patients with optic neuritis was analyzed. Receiver operating characteristic (ROC) curves were constructed to assess and compare the ability of plasma LCN2 and MOG-IgG levels for predicting optic neuritis recurrence. Patients with MOG-IgG–positive optic neuritis had significantly higher mean plasma LCN2 levels than controls and patients with MOG-IgG–negative optic neuritis (p = 0.037). Plasma LCN2 and MOG-IgG levels were significantly correlated in patients with optic neuritis (r = 0.553, p = 0.0141). There were no significant differences in the areas under the ROC curve (AUC) of plasma LCN2 (0.693, 95% confidence interval [CI] 0.443–0.880, p = 0.133) and MOG-IgG (0.641, 95% CI, 0.400–0.840, p = 0.298) levels (95% CI, −0.266–0.448, p = 0.618). Plasma LCN2 levels may aid differentiation of MOG-IgG–positive optic neuritis from MOG-IgG–negative optic neuritis.
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92
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Cooper SA, Leddy SG, Skipper NT, Barrett VJM, Plant GT. Optic neuritis with potential for poor outcome. Pract Neurol 2022; 22:190-200. [DOI: 10.1136/practneurol-2021-003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
Abstract
The Optic Neuritis Treatment Trial previously reported that corticosteroids accelerated visual recovery in optic neuritis (ON) without improving outcome. This finding related largely to multiple sclerosis (MS), and subsequently neurologists tended to await spontaneous recovery in ON. Since then, non-MS cases of ON have been identified with antibodies to aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG). These disorders can closely mimic multiple sclerosis-associated or idiopathic demyelinating optic neuritis (MS/IDON) initially but risk a worse visual outcome. Scrutinising the clinical features and neuroimaging often enables differentiation between MS/IDON and other causes of ON. Early treatment with high-dose corticosteroids is an important determinant of visual outcome in non-MS/IDON. Prompt use of plasma exchange may also save sight. In this review, we contrast the presentations of myelin oligodendrocyte glycoprotein associated optic neuritis (MOG-ON) and aquaporin 4 associated optic neuritis (AQP4-ON) with MS/IDON and provide an approach to acute management while awaiting results of antibody testing.
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93
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Chen JJ, Huda S, Hacohen Y, Levy M, Lotan I, Wilf-Yarkoni A, Stiebel-Kalish H, Hellmann MA, Sotirchos ES, Henderson AD, Pittock SJ, Bhatti MT, Eggenberger ER, Di Nome M, Kim HJ, Kim SH, Saiz A, Paul F, Dale RC, Ramanathan S, Palace J, Camera V, Leite MI, Lam BL, Bennett JL, Mariotto S, Hodge D, Audoin B, Maillart E, Deschamps R, Pique J, Flanagan EP, Marignier R. Association of Maintenance Intravenous Immunoglobulin With Prevention of Relapse in Adult Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. JAMA Neurol 2022; 79:518-525. [PMID: 35377395 PMCID: PMC8981066 DOI: 10.1001/jamaneurol.2022.0489] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Recent studies suggest that maintenance intravenous immunoglobulin (IVIG) may be an effective treatment to prevent relapses in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD); however, most of these studies had pediatric cohorts, and few studies have evaluated IVIG in adult patients. Objective To determine the association of maintenance IVIG with the prevention of disease relapse in a large adult cohort of patients with MOGAD. Design, Setting, and Participants This was a retrospective cohort study conducted from January 1, 2010, to October 31, 2021. Patients were recruited from 14 hospitals in 9 countries and were included in the analysis if they (1) had a history of 1 or more central nervous system demyelinating attacks consistent with MOGAD, (2) had MOG-IgG seropositivity tested by cell-based assay, and (3) were age 18 years or older when starting IVIG treatment. These patients were retrospectively evaluated for a history of maintenance IVIG treatment. Exposures Maintenance IVIG. Main Outcomes and Measures Relapse rates while receiving maintenance IVIG compared with before initiation of therapy. Results Of the 876 adult patients initially identified with MOGAD, 59 (median [range] age, 36 [18-69] years; 33 women [56%]) were treated with maintenance IVIG. IVIG was initiated as first-line immunotherapy in 15 patients (25%) and as second-line therapy in 37 patients (63%) owing to failure of prior immunotherapy and in 7 patients (12%) owing to intolerance to prior immunotherapy. The median (range) annualized relapse rate before IVIG treatment was 1.4 (0-6.1), compared with a median (range) annualized relapse rate while receiving IVIG of 0 (0-3) (t108 = 7.14; P < .001). Twenty patients (34%) had at least 1 relapse while receiving IVIG with a median (range) time to first relapse of 1 (0.03-4.8) years, and 17 patients (29%) were treated with concomitant maintenance immunotherapy. Only 5 of 29 patients (17%) who received 1 g/kg of IVIG every 4 weeks or more experienced disease relapse compared with 15 of 30 patients (50%) treated with lower or less frequent dosing (hazard ratio, 3.31; 95% CI, 1.19-9.09; P = .02). At final follow-up, 52 patients (88%) were still receiving maintenance IVIG with a median (range) duration of 1.7 (0.5-9.9) years of therapy. Seven of 59 patients (12%) discontinued IVIG therapy: 4 (57%) for inefficacy, 2 (29%) for adverse effects, and 1 (14%) for a trial not receiving therapy after a period of disease inactivity. Conclusions and Relevance Results of this retrospective, multicenter, cohort study of adult patients with MOGAD suggest that maintenance IVIG was associated with a reduction in disease relapse. Less frequent and lower dosing of IVIG may be associated with treatment failure. Future prospective randomized clinical trials are warranted to confirm these findings.
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Affiliation(s)
- John J Chen
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Saif Huda
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Yael Hacohen
- Department of Neurology, Great Ormond Street Hospital for Children, London, United Kingdom.,Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Itay Lotan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston.,Department of Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Wilf-Yarkoni
- Department of Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Stiebel-Kalish
- Department of Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Felsenstein Research Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Hellmann
- Department of Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland
| | - Amanda D Henderson
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland.,Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota
| | - M Tariq Bhatti
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota.,Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Eric R Eggenberger
- Department of Neurology, Mayo Clinic, Jacksonville, Florida.,Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida.,Department of Neuro-Ophthalmology, Mayo Clinic, Jacksonville, Florida
| | - Marie Di Nome
- Department of Ophthalmology, Mayo Clinic, Scottsdale, Arizona.,Department of Neurology, Mayo Clinic, Scottsdale, Arizona
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Albert Saiz
- Service of Neurology, Hospital Clinic, University of Barcelona, Barcelona, Spain.,Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin, Berlin, Germany.,Max Delbrueck Center for Molecular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Russell C Dale
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, Australia.,Department of Neurology, Children's Hospital at Westmead, Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, Australia.,Department of Neurology, Concord Hospital, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Valentina Camera
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Byron L Lam
- Bascom Palmer Eye Institute, University of Miami, Miami, Florida
| | - Jeffrey L Bennett
- Department of Neurology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Aurora.,Department of Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Aurora
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Dave Hodge
- Department of Quantitative Health Sciences, Mayo Clinic, Jacksonville, Florida
| | - Bertrand Audoin
- Department of Neurology, University Hospital of Marseille, Marseille, France.,Aix-Marseille University, Center for Magnetic Resonance in Biology and Medicine, French National Centre for Scientific Research, Marseille, France
| | - Elisabeth Maillart
- Department of Neurology, Pitie-Salpetriere Hospital, Assistance Publique-Hȏpitaux de Paris, Paris, France.,Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Paris, France
| | - Romain Deschamps
- Lyon Civil Hospices, Department of Neurology, Neurologic and Neurosurgical Hospital Pierre Wertheimer, Bron, France
| | - Julie Pique
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hȏpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota
| | - Romain Marignier
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hȏpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
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Moon Y, Lim BC, Chae JH, Jung JH. Clinical characteristics and clinical course of myelin oligodendrocyte glycoprotein antibody-seropositive pediatric optic neuritis. Mult Scler Relat Disord 2022; 60:103709. [DOI: 10.1016/j.msard.2022.103709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 02/02/2022] [Accepted: 02/19/2022] [Indexed: 10/19/2022]
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95
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Liou VD, Yoon MK, Maher M, Chwalisz BK. Orbital Inflammation in Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Case Report and Review of the Literature. J Neuroophthalmol 2022; 42:e56-e62. [PMID: 34999653 DOI: 10.1097/wno.0000000000001400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND To present 2 patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease with unilateral orbital inflammation, optic nerve head edema, and abnormalities of the optic nerve and nerve sheath on imaging. We review the most current literature on this important and uncommon clinical phenotype. METHODS A case report of 2 patients and a comprehensive review of the relevant literature on orbital inflammation in MOG antibody-associated disease (MOG-AD). RESULTS Two patients presented with decreased vision and unilateral orbital inflammation. Both had optic nerve head edema and abnormalities of the optic nerve and nerve sheath on imaging. The patients were treated with immunosuppressants and had improvement of vision changes as well as their orbital inflammatory signs. MOG antibody was positive in high titers in both patients. Only 3 other cases of orbital inflammation associated with MOG antibody have been described. In all cases, orbital signs responded rapidly to intravenous methylprednisolone, but the improvement in visual acuity was variable and less robust. CONCLUSION Orbital inflammation is a unique and underrecognized phenotype of MOG-AD with only a few reports in the literature. In patients who present with vision loss and orbital inflammation, MOG-AD should be considered in the differential.
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Affiliation(s)
- Victor D Liou
- Ophthalmic Plastic Surgery (VDL, MKY), Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts; Department of Radiology (MM), Massachusetts General Hospital/Harvard Medical School, Boston, Massachusetts; Neuro-ophthalmology (BKC), Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, Massachusetts; and Department of Neurology (BKC), Massachusetts General Hospital / Harvard Medical School, Boston, Massachusetts
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96
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Pineles SL, Henderson RJ, Repka MX, Heidary G, Liu GT, Waldman AT, Borchert MS, Khanna S, Graves JS, Collinge JE, Conley JA, Davis PL, Kraker RT, Cotter SA, Holmes JM. The Pediatric Optic Neuritis Prospective Outcomes Study – Two-Year Results. Ophthalmology 2022; 129:856-864. [PMID: 35364222 PMCID: PMC10357378 DOI: 10.1016/j.ophtha.2022.03.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/11/2022] [Accepted: 03/23/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Pediatric optic neuritis (ON) is a rare disease that has not been well characterized. The Pediatric ON Prospective Outcomes Study (PON1) was the first prospective study to our knowledge aiming to evaluate visual acuity (VA) outcomes, including VA, recurrence risk, and final diagnosis 2 years after enrollment. DESIGN Nonrandomized observational study at 23 pediatric ophthalmology or neuro-ophthalmology clinics in the United States and Canada. PARTICIPANTS A total of 28 (64%) of 44 children initially enrolled in PON1 (age 3-<16 years) who completed their 2-year study visit. METHODS Participants were treated at the investigator's discretion. MAIN OUTCOMES MEASURES Age-normal monocular high-contrast VA (HCVA). Secondary outcomes included low-contrast VA (LCVA), neuroimaging findings, and final diagnoses. RESULTS A total of 28 participants completed the 2-year outcome with a median enrollment age of 10.3 years (range, 5-15); 46% were female, and 68% had unilateral ON at presentation. Final 2-year diagnoses included isolated ON (n = 11, 39%), myelin oligodendrocyte glycoprotein-associated demyelination (n = 8, 29%), multiple sclerosis (MS) (n = 4,14%), neuromyelitis optica spectrum disease (NMOSD) (n = 3, 11%), and acute disseminated encephalomyelitis (n = 2, 7%). Two participants (7%; 95% confidence interval [CI], 1-24) had subsequent recurrent ON (plus 1 participant who did not complete the 2-year visit); all had MS. Two other participants (7%) had a new episode in their unaffected eye. Mean presenting HCVA was 0.81 logarithm of the minimum angle of resolution (logMAR) (∼20/125), improving to 0.14 logMAR (∼20/25-2) at 6 months, 0.12 logMAR (∼20/25-2) at 1 year, and 0.11 logMAR (20/25-1) at 2 years (95% CI, -0.08 to 0.3 [20/20+1-20/40-1]). Twenty-four participants (79%) had age-normal VA at 2 years (95% CI, 60-90); 21 participants (66%) had 20/20 vision or better. The 6 participants without age-normal VA had 2-year diagnoses of NMOSD (n = 2 participants, 3 eyes), MS (n = 2 participants, 2 eyes), and isolated ON (n = 2 participants, 3 eyes). Mean presenting LCVA was 1.45 logMAR (∼20/500-2), improving to 0.78 logMAR (∼20/125+2) at 6 months, 0.69 logMAR (∼20/100+1) at 1 year, and 0.68 logMAR (∼20/100+2) at 2 years (95% CI, 0.48-0.88 [20/50+1-20/150-1]). CONCLUSIONS Despite poor VA at presentation, most children had marked improvement in VA by 6 months that was maintained over 2 years. Associated neurologic autoimmune diagnoses were common. Additional episodes of ON occurred in 5 (18%) of the participants (3 relapses and 2 new episodes).
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97
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Tiong TYV, Kian C, Pillay R, Sitoh YY. Lessons Learnt from Two Interesting Cases of Malignant Optic Nerve Glioma. J Neuroradiol 2022; 49:444-446. [DOI: 10.1016/j.neurad.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
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98
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Kalashnikova AK, Sheremet NL, Andreeva NA, Zhorzholadze NV, Ronzina IA, Kaloshina AA. Optomyelitis associated with the presence of antibodies to myelin oligodendrocyte glycoprotein. Case report. CONSILIUM MEDICUM 2022. [DOI: 10.26442/20751753.2022.2.201391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Antibodies to myelin-oligodendrocyte glycoprotein (anti-MOG-IgG) is a specific biomarker that has been detected in peripheral blood from children with acute multiple encephalomyelitis (ADEM) as well as in adults with aquaporin-4 (AQP4), associated with seronegative opticoneuromyelitis spectrum disease (NMOSD), brainstem encephalitis, longitudinally disseminated transverse myelitis, and optic neuritis. Most experts now consider MOG-IgG-associated disorder (MOG-AD) an independent disease immunopathogenetically distinct from classical multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive optomyelitis. Isolated, bilateral, and less frequently unilateral OH, with simultaneous or sequential involvement of the eyes, is the most frequent clinical manifestation of MOG-AD. Because of the significant overlap in the clinical and radiological picture, MOG-AD is often misdiagnosed as MS. Timely diagnosis is critical to ensure appropriate treatment. This article describes a clinical case of anti-MOG-IgG encephalomyelitis with late-onset ON initially diagnosed as MS.
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99
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Dauby S, Dive D, Lutteri L, Andris C, Hansen I, Maquet P, Lommers E. Comparative study of AQP4-NMOSD, MOGAD and seronegative NMOSD: a single-center Belgian cohort. Acta Neurol Belg 2022; 122:135-144. [PMID: 34097296 PMCID: PMC8894224 DOI: 10.1007/s13760-021-01712-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 05/13/2021] [Indexed: 12/11/2022]
Abstract
Purpose To emphasize physio-pathological, clinical and prognosis differences between conditions causing serious and sometimes very similar clinical manifestations: anti-aquaporin-4 (AQP4) and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies related diseases, and seronegative NMOSD (neuromyelitis optica spectrum disorders).
Methods Based on Wingerchuk et al. (Neurology 85:177–189, 2015) criteria for NMOSD and on those more recently proposed by Jarius et al. (J Neuroinflammation 15:134, 2018) for MOGAD (MOG associated disorders), we retrospectively surveyed 10 AQP4-NMOSD, 8 MOGAD and 2 seronegative NMOSD, followed at the specialized neuroimmunology unit of the CHU Liège.
Results Female predominance was only observed in AQP4 group. Age at onset was 37.8 and 27.7 years old for AQP4-NMOSD and MOGAD respectively. In both groups, the first clinical event most often consisted of optic neuritis (ON), followed by isolated myelitis. Fifteen of our 20 patients encountered a relapsing course with 90% relapses in AQP4-NMOSD, 62.5% in MOGAD and 50% in seronegative group, and a mean period between first and second clinical event of 7.1 and 4.8 months for AQP4-NMOSD and MOGAD, respectively. In total we counted 54 ON, with more ON per patient in MOGAD. MOG-associated ON mainly affected the anterior part of the optic nerve with a papilledema in 79.2% of cases. Despite a fairly good visual outcome after MOG-associated ON, retinal nerve fibre layer (RNFL) thickness decreased, suggesting a fragility of the optic nerve toward further attacks.
Conclusion As observed in larger cohorts, our MOGAD and AQP4-NMOSD cases differ by clinical and prognostic features. A better understanding of these diseases should encourage prompt biological screening and hasten proper diagnosis and treatment.
Supplementary Information The online version contains supplementary material available at 10.1007/s13760-021-01712-3.
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100
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Chen JJ, Sotirchos ES, Henderson AD, Vasileiou ES, Flanagan EP, Bhatti MT, Jamali S, Eggenberger ER, Dinome M, Frohman LP, Arnold AC, Bonelli L, Seleme N, Mejia-Vergara AJ, Moss HE, Padungkiatsagul T, Stiebel-Kalish H, Lotan I, Hellmann MA, Hodge D, Oertel FC, Paul F, Saidha S, Calabresi PA, Pittock SJ. OCT retinal nerve fiber layer thickness differentiates acute optic neuritis from MOG antibody-associated disease and Multiple Sclerosis: RNFL thickening in acute optic neuritis from MOGAD vs MS. Mult Scler Relat Disord 2022; 58:103525. [PMID: 35038647 PMCID: PMC8882134 DOI: 10.1016/j.msard.2022.103525] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Optic neuritis (ON) is the most common manifestation of myelin oligodendrocyte glycoprotein antibody associated disorder (MOGAD) and multiple sclerosis (MS). Acute ON in MOGAD is thought to be associated with more severe optic disk edema than in other demyelinating diseases, but this has not been quantitatively confirmed. The goal of this study was to determine whether optical coherence tomography (OCT) can distinguish acute ON in MOGAD from MS, and establish the sensitivity of OCT as a confirmatory biomarker of ON in these entities. METHODS This was a multicenter cross-sectional study of MOGAD and MS patients with peripapillary retinal nerve fiber layer (pRNFL) thickness measured with OCT within two weeks of acute ON symptom. Cirrus HD-OCT (Carl Zeiss Meditec, Inc. Dublin, CA, USA) was used to measure the pRNFL during acute ON. Eyes with prior ON or disk pallor were excluded. A receiver operating characteristic (ROC) curve analysis was performed to assess the ability of pRNFL thickness to distinguish MOGAD from MS. RESULTS Sixty-four MOGAD and 50 MS patients met study inclusion criteria. Median age was 46.5 years (interquartile range [IQR]: 34.3-57.0) for the MOGAD group and 30.4 years (IQR: 25.7-38.4) for the MS group (p<0.001). Thirty-nine (61%) of MOGAD patients were female compared to 42 (84%) for MS (p = 0.007). The median pRNFL thickness was 164 µm (IQR: 116-212) in 96 acute MOGAD ON eyes compared to 103 µm (IQR: 93-113) in 51 acute MS ON eyes (p<0.001). The ROC area under the curve for pRNFL thickness was 0.81 (95% confidence interval 0.74-0.88) to discriminate MOGAD from MS. The pRNFL cutoff that maximized Youden's index was 118 µm, which provided a sensitivity of 74% and specificity of 82% for MOGAD. Among 31 MOGAD and 48 MS eyes with an unaffected contralateral eye or a prior baseline, the symptomatic eye had a median estimated pRNFL thickening of 45 µm (IQR: 17-105) and 7.5 µm (IQR: 1-18), respectively (p<0.001). All MOGAD affected eyes had a ≥ 5 µm pRNFL thickening, whereas 26 (54%) MS affected eyes had a ≥ 5 µm thickening. CONCLUSION OCT-derived pRNFL thickness in acute ON can help differentiate MOGAD from MS. This can aid with early diagnosis and guide disease-specific therapy in the acute setting before antibody testing returns, and help differentiate borderline cases. In addition, pRNFL thickening is a sensitive biomarker for confirming acute ON in MOGAD, which is clinically helpful and could be used for adjudication of attacks in future MOGAD clinical trials.
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Affiliation(s)
- John J. Chen
- Departments of Ophthalmology,Departments of Neurology, Mayo Clinic, Rochester, MN,Corresponding Author: John J. Chen, MD, PhD, Mayo Clinic, Department of Ophthalmology, 200 First Street, SW, Rochester, MN, USA 55905,
| | | | - Amanda D. Henderson
- Departments of Neurology,Departments of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Eoin P. Flanagan
- Departments of Neurology, Mayo Clinic, Rochester, MN,Departments of Laboratory Medicine and Pathology,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - M. Tariq Bhatti
- Departments of Ophthalmology,Departments of Neurology, Mayo Clinic, Rochester, MN
| | | | - Eric R. Eggenberger
- Departments of Neurology, Neurosurgery, and Neuro-Ophthalmology Mayo Clinic, Jacksonville, FL
| | - Marie Dinome
- Departments of Ophthalmology, Neurology, Mayo Clinic, Scottsdale, AZ
| | - Larry P. Frohman
- Departments of Ophthalmology & Visual Sciences and Neurology & Neurosciences, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Anthony C. Arnold
- Department of Ophthalmology, University of California Los Angeles, CA
| | - Laura Bonelli
- Department of Ophthalmology, University of California Los Angeles, CA
| | - Nicolas Seleme
- Department of Ophthalmology, University of California Los Angeles, CA
| | - Alvaro J. Mejia-Vergara
- Department of Ophthalmology, University of California Los Angeles, CA,Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, Colombia Department of Ophthalmology, Sanitas Eye Institute. Fundación Universitaria Sanita, Bogotá. Colombia
| | - Heather E. Moss
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA,Department of Ophthalmology, Stanford University, Palo Alto, CA
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Stanford University, Palo Alto, CA,Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hadas Stiebel-Kalish
- Felsenstein Research Center, Sackler School of Medicine, Tel Aviv University, Israel,Department of Ophthalmology and Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Itay Lotan
- Department of Ophthalmology and Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Mark A. Hellmann
- Department of Ophthalmology and Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Dave Hodge
- Department of Quantitative Health Sciences (D.O.H.), Mayo Clinic, Jacksonville, Florida, USA
| | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Peter A. Calabresi
- Departments of Neurology,Departments of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sean J. Pittock
- Departments of Neurology, Mayo Clinic, Rochester, MN,Departments of Laboratory Medicine and Pathology,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
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