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Pujari SS, Kulkarni RV, Nadgir DB, Ojha PK, Nagendra S, Aglave V, Nadgir RD, Sant H, Palasdeokar N, Nirhale S, Bandishti S. Myelin Oligodendrocyte Glycoprotein (MOG)-IgG Associated Demyelinating Disease: Our Experience with this Distinct Syndrome. Ann Indian Acad Neurol 2020; 24:69-77. [PMID: 33911382 PMCID: PMC8061523 DOI: 10.4103/aian.aian_627_19] [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: 11/27/2019] [Revised: 12/10/2019] [Accepted: 12/25/2019] [Indexed: 11/04/2022] Open
Abstract
Background Discovery of serum myelin oligodendrocyte glycoprotein (MOG) antibody testing in demyelination segregated MOG-IgG disease from AQ-4-IgG positive NMOSD. Aims To study clinico-radiological manifestations, pattern of laboratory and electrophysiological investigations and response to treatment through follow up in MOG-IgG positive patients. Method Retrospective data of MOG-IgG positive patients was collected. Demographics, clinical manifestations at onset and at follow up and relapses, anti AQ-4-IgG status, imaging and all investigations were performed, treatment of relapses and further immunomodulatory therapy were captured. Results In our 30 patients, F: M ratio was 2.75:1 and adult: child ratio 4:1. Relapses at presentation were optic neuritis {ON}(60%), longitudinally extensive transverse myelitis {LETM}(20%), acute disseminated encephalomyelitis {ADEM}(13.4%), simultaneous ON with myelitis (3.3%) and diencephalic Syndrome (3.3%). Salient MRI features were ADEM-like lesions, middle cerebellar peduncle fluffy infiltrates, thalamic and pontine lesions and longitudinally extensive ON {LEON} as well as non-LEON. Totally, 50% patients had a relapsing course. Plasma exchange and intravenous immunoglobulin worked in patients who showed a poor response to intravenous methylprednisolone. Prednisolone, Azathioprine, Mycophenolate and Rituximab were effective attack preventing agents. Conclusions MOG-IgG related manifestations in our cohort were monophasic/recurrent/simultaneous ON, myelitis, recurrent ADEM, brainstem encephalitis and diencephalic Syndrome. MRI features suggestive of MOG-IgG disease were confluent ADEM-like lesions, middle cerebellar peduncle fluffy lesions, LETM, LEON and non-LEON. Where indicated, patients need to go on immunomodulation as it has a relapsing course and can accumulate significant disability. Because of its unique manifestations, it needs to be considered as a distinct entity. To the best of our knowledge, this is the largest series of MOG-IgG disease reported from India.
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Affiliation(s)
- Shripad S Pujari
- Department of Brain and Spine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India.,Department of Neurology, Noble Hospital, Pune, Maharashtra, India
| | - Rahul V Kulkarni
- Department of Brain and Spine, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Dattatraya B Nadgir
- Brain and Nerve Clinic, Neurology and Neuro- Opthalmology, Hubli, Karnataka, India
| | - Pawan K Ojha
- Department of Neurology, Grant Medical College and Sir J. J. group of Hospitals, Mumbai, Maharashtra, India
| | - Shashank Nagendra
- Department of Neurology, Grant Medical College and Sir J. J. group of Hospitals, Mumbai, Maharashtra, India
| | - Vikram Aglave
- Department of Neurology, Grant Medical College and Sir J. J. group of Hospitals, Mumbai, Maharashtra, India
| | - Rashmi D Nadgir
- Brain and Nerve Clinic, Neurology and Neuro- Opthalmology, Hubli, Karnataka, India
| | - Hemant Sant
- Department of Neurology, Sahyadri Speciality Hospital, Pune, Maharashtra, India
| | | | - Satish Nirhale
- Department of Neurology, D. Y. Patil Medical College and Hospital, Pimpri, Pune, Maharashtra, India
| | - Sunil Bandishti
- Department of Neurology, Ruby Hall Clinic, Pune, Maharashtra, India
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Tea F, Pilli D, Ramanathan S, Lopez JA, Merheb V, Lee FXZ, Zou A, Liyanage G, Bassett CB, Thomsen S, Reddel SW, Barnett MH, Brown DA, Dale RC, Brilot F. Effects of the Positive Threshold and Data Analysis on Human MOG Antibody Detection by Live Flow Cytometry. Front Immunol 2020; 11:119. [PMID: 32117270 PMCID: PMC7016080 DOI: 10.3389/fimmu.2020.00119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 01/16/2020] [Indexed: 12/12/2022] Open
Abstract
Human autoantibodies targeting myelin oligodendrocyte glycoprotein (MOG Ab) have become a useful clinical biomarker for the diagnosis of a spectrum of inflammatory demyelinating disorders. Live cell-based assays that detect MOG Ab against conformational MOG are currently the gold standard. Flow cytometry, in which serum binding to MOG-expressing cells and control cells are quantitively evaluated, is a widely used observer-independent, precise, and reliable detection method. However, there is currently no consensus on data analysis; for example, seropositive thresholds have been reported using varying standard deviations above a control cohort. Herein, we used a large cohort of 482 sera including samples from patients with monophasic or relapsing demyelination phenotypes consistent with MOG antibody-associated demyelination and other neurological diseases, as well as healthy controls, and applied a series of published analyses involving a background subtraction (delta) or a division (ratio). Loss of seropositivity and reduced detection sensitivity were observed when MOG ratio analyses or when 10 standard deviation (SD) or an arbitrary number was used to establish the threshold. Background binding and MOG ratio value were negatively correlated, in which patients seronegative by MOG ratio had high non-specific binding, a characteristic of serum that must be acknowledged. Most MOG Ab serostatuses were similar across analyses when optimal thresholds obtained by ROC analyses were used, demonstrating the robust nature and high discriminatory power of flow cytometry cell-based assays. With increased demand to identify MOG Ab-positive patients, a consensus on analysis is vital to improve patient diagnosis and for cross-study comparisons to ultimately define MOG Ab-associated disorders.
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Affiliation(s)
- Fiona Tea
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Deepti Pilli
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Joseph A Lopez
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Vera Merheb
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Fiona X Z Lee
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Alicia Zou
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia
| | - Ganesha Liyanage
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Chelsea B Bassett
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Selina Thomsen
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - David A Brown
- New South Wales Health Pathology, Institute of Clinical Pathology and Medical Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia.,Faculty of Medicine and Health, School of Medical Sciences, The University of Sydney, Sydney, NSW, Australia
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53
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Pedapati R, Bhatia R, Singh N, Bali P, Gupta P, Saxena R, Dash D, Singh MB, Goyal V, Srivastava MVP. Anti-myelin oligodendrocyte glycoprotein antibody associated disease spectrum - A north Indian tertiary care centre experience and review of literature. J Neuroimmunol 2020; 340:577143. [PMID: 31931436 DOI: 10.1016/j.jneuroim.2019.577143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION MOG antibody associated disease is a relatively new disorder for which the full clinical spectrum is being described and the literature is evolving. The current study outlines the observations on a cohort of patients diagnosed with this clinical entity. METHODS This is a retrospective review of prospectively followed up patients with MOG antibody positive neurological illness. Case records of patients following up in neuroimmunology clinic of All India Institute of Medical Sciences(AIIMS), New Delhi from January 2007 to July 2019 were reviewed for MOG antibody positivity and those patients with positive antibody result were included in this study. FINDINGS A total of 20 patients were tested positive for MOG-IgG antibody. 75% were females. Median (Range) age was 30.5 years (8-58). Median disease duration was 22 months (1-139). Most common symptom at presentation was decrease in vision (unilateral or bilateral) (80%). Most common syndrome at onset was unilateral optic neuritis (ON) (40%) followed by bilateral ON (35%), transverse myelitis (TM)(15%), ON plus TM (5%) and cerebral syndrome (5%). Median number of demyelinating episodes per person was 2.5. Out of 29 affected eyes, 26 had good outcome. Out of 7 patients with motor disability, 5 patients had good outcome. CONCLUSION MOG antibody associated disease presents predominantly as recurrent ON, but may also present as an opticospinal, cerebral or brainstem syndrome and recurrent myelitis. Many of the patients had relapses, but had good outcomes with treatment.
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Affiliation(s)
- Radhakrishna Pedapati
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Nishita Singh
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prerna Bali
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pranjal Gupta
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Neuro-Opthalmology services, Dr Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
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Tenembaum S, Yeh EA. Pediatric NMOSD: A Review and Position Statement on Approach to Work-Up and Diagnosis. Front Pediatr 2020; 8:339. [PMID: 32671002 PMCID: PMC7330096 DOI: 10.3389/fped.2020.00339] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/21/2020] [Indexed: 11/13/2022] Open
Abstract
Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system (CNS) primarily affecting the optic nerves and spinal cord, but also involving other regions of the CNS including the area postrema, periaqueductal gray matter, and hypothalamus. Knowledge related to pediatric manifestations of NMOSD has grown in recent years, particularly in light of newer information regarding the importance of not only antibodies to aquaporin 4 (AQP4-IgG) but also myelin oligodendrocyte glycoprotein (MOG-IgG) in children manifesting clinically with this syndrome. In this review, we describe the current state of the knowledge related to clinical manifestations, diagnosis, and chronic therapies for children with NMOSD, with emphasis on literature that has been published in the last 5 years. Following the review, we propose recommendations for the assessment/follow up clinical care, and treatment of this population.
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Affiliation(s)
- Silvia Tenembaum
- Department of Neurology, National Pediatric Hospital Dr. J. Garrahan, Buenos Aires, Argentina
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, SickKids Research Institute, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
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Giacomini T, Foiadelli T, Annovazzi P, Nosadini M, Gastaldi M, Franciotta D, Panarese C, Capris P, Camicione P, Lanteri P, De Grandis E, Prato G, Cordani R, Nobili L, Morana G, Rossi A, Pistorio A, Cellerino M, Uccelli A, Sartori S, Savasta S, Mancardi MM. Pediatric optic neuritis and anti MOG antibodies: a cohort of Italian patients. Mult Scler Relat Disord 2019; 39:101917. [PMID: 31896061 DOI: 10.1016/j.msard.2019.101917] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 12/16/2019] [Accepted: 12/23/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND recent studies reported that anti myelin oligodendrocyte glycoprotein (MOG) antibody (ab) related optic neuritis (ON) tend to have characteristics that differ from seronegative ones. The aim of our study was to investigate the clinical characteristics of pediatric anti-MOG ON by comparing anti MOG-ab-seropositive and seronegative patients with ON. METHODS in this retrospective Italian multicentre study, participants were identified by chart review of patients evaluated for acquired demyelinating syndromes of the central nervous system (over the period 2009-2019). We selected patients presenting with ON as their first demyelinating event. Inclusion criteria were age < 18 years at symptoms onset; presentation consistent with ON; negativity of anti-aquaporin 4 antibodies (AQP4). Only patients who were tested for MOG-IgG1-ab with a live cell-based assay were included. RESULTS 22 patients (10 MOG-ab-positive and 12 MOG-ab-negative) were included. Fundus oculi examination at onset showed disc swelling in 9/10 in the MOG-ab-positive cohort and 2/10 in the seronegative group (P = 0.002). Retinal Fiber Nerve Layer (RFNL) thickness measured by Spectral Domain Optical Coherence Tomography (S-OCT) was increased in the 5/5 MOG-ab-positive patients tested and was normal or reduced in the seronegative patients tested (4/4 patients) (P = 0.024). Visual acuity impairment at onset did not differ significantly between the two groups, but the MOG-ab-positive cohort showed better recovery at follow-up both regarding visual acuity (P = 0.025) and expanded disability status scale (EDSS) (P = 0.013). A final diagnosis of MS was frequent among seronegative patients (6/12, 50%), whereas none of the MOG-ab-positive group received a diagnosis of MS (P = 0.015). Clinical relapse frequency was low in both groups: 2/10 MOG-ab-positive and 2/12 seronegative cases relapsed, with a median follow up of 25 months. CONCLUSION optic disc swelling and increased RFNL at baseline are strongly associated with MOG-ab positivity. MOG-ab-positive patients with ON showed better recovery compared to the seronegative ones. The relapse rate was low and did not differ among the two groups.
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Affiliation(s)
- Thea Giacomini
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Thomas Foiadelli
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Pietro Annovazzi
- Multiple Sclerosis Center. ASST Valle Olona - Gallarate Hospital, Gallarate (VA), Italy
| | - Margherita Nosadini
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Claudio Panarese
- CSF Laboratory, Ospedale Policlinico San Martino-IRCCS, Genoa, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Paolo Capris
- Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paola Camicione
- Unit of Ophthalmology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Paola Lanteri
- Unit of Neurophisyology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Elisa De Grandis
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giulia Prato
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Ramona Cordani
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Lino Nobili
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy; Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Giovanni Morana
- Unit of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Andrea Rossi
- Unit of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Angela Pistorio
- Epidemiology and Biostatistics Unit, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Maria Cellerino
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Antonio Uccelli
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy; Ospedale Policlinico San Martino-IRCCS, Genoa, Italy
| | - Stefano Sartori
- Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Salvatore Savasta
- Pediatric Clinic, IRCCS Policlinico San Matteo Foundation, Pavia, Italy; Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy
| | - Maria Margherita Mancardi
- Unit of Child Neuropsychiatry, Clinical and Surgical Neurosciences Department, IRCCS Istituto Giannina Gaslini, Genova, Italy.
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Tajfirouz DA, Bhatti MT, Chen JJ. Clinical Characteristics and Treatment of MOG-IgG-Associated Optic Neuritis. Curr Neurol Neurosci Rep 2019; 19:100. [PMID: 31773369 DOI: 10.1007/s11910-019-1014-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
PURPOSE OF REVIEW Antibodies against myelin oligodendrocyte glycoprotein (MOG) are associated with a unique acquired central nervous system demyelinating disease-termed MOG-IgG-associated disorder (MOGAD)-which has a variety of clinical manifestations, including optic neuritis, transverse myelitis, acute disseminating encephalomyelitis, and brainstem encephalitis. In this review, we summarize the current knowledge of the clinical characteristics, neuroimaging, treatments, and outcomes of MOGAD, with a focus on optic neuritis. RECENT FINDINGS The recent development of a reproducible, live cell-based assay for MOG-IgG, has improved our ability to identify and study this disease. Based on contemporary studies, it has become increasingly evident that MOGAD is distinct from multiple sclerosis and aquaporin-4-positive neuromyelitis optica spectrum disorder with different clinical features and treatment outcomes. There is now sufficient evidence to separate MOGAD from other inflammatory central nervous system demyelinating disorders, which will allow focused research on understanding the pathophysiology of the disease. Prospective treatment trials are needed to determine the best course of treatment, and until then, treatment plans must be individualized to the clinical manifestations and severity of disease.
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Affiliation(s)
- Deena A Tajfirouz
- Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - M Tariq Bhatti
- Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.,Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA. .,Department of Ophthalmology, Mayo Clinic, 200 First Street, SW, Rochester, MN, 55905, USA.
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Abstract
PURPOSE OF REVIEW To summarize recent developments in the classification, investigation and management of pediatric optic neuritis (PON). RECENT FINDINGS A recent surge in interest surrounding antibodies to myelin oligodendrocyte glycoprotein antibody (MOG-Ab) has instigated a paradigm shift in our assessment of children with PON. This serological marker is associated with a broad spectrum of demyelinating syndromes that are clinically and radiologically distinct from multiple sclerosis (MS) and aquaporin-4 antibody positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). Optic neuritis is the most common presenting phenotype of MOG-Ab positive-associated disease (MOG+AD). MOG-Ab seropositivity is much more common in the pediatric population and it predicts a better prognosis than MS or AQP4+NMOSD, except in the subset that exhibit a recurrent phenotype. SUMMARY A better grasp of MOG+AD features and its natural history has facilitated more accurate risk stratification of children after a presenting episode of PON. Consequently, the initial investigation of PON has broadened to include serology, along with neuroimaging and cerebrospinal fluid analysis. Acute treatment of PON and chronic immunotherapy is also becoming better tailored to the suspected or confirmed diagnoses of MS, AQP4+NMOSD and MOG+AD.
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Affiliation(s)
- Jane H. Lock
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Nancy J. Newman
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Neurology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Valérie Biousse
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Neurology, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Jason H. Peragallo
- Departments of Ophthalmology, Emory University School of Medicine, Atlanta, Georgia, United States
- Departments of Ophthalmology, Pediatrics, Emory University School of Medicine, Atlanta, Georgia, United States
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58
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Cantó LN, Boscá SC, Vicente CA, Gil-Perontín S, Pérez-Miralles F, Villalba JC, Nuñez LC, Casanova Estruch B. Brain Atrophy in Relapsing Optic Neuritis Is Associated With Crion Phenotype. Front Neurol 2019; 10:1157. [PMID: 31736862 PMCID: PMC6838209 DOI: 10.3389/fneur.2019.01157] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 10/15/2019] [Indexed: 01/09/2023] Open
Abstract
Background and objective: Chronic relapsing inflammatory optic neuritis (CRION) is one of the more common phenotypes related to myelin oligodendrocyte glycoprotein antibodies (MOG-Abs). The absence of specific biomarkers makes distinguishing between CRION and relapsing inflammatory ON (RION) difficult. A recent work has suggested a widespread affectation of the central nervous system in CRION patients. In order to search for a potential CRION marker we have measured brain atrophy in a cohort of patients, stratified by phenotypes: CRION, RION, multiple sclerosis with a history of optic neuritis (MS-ON), and MOG-Abs status. Methods: A cross-sectional study was conducted in 31 patients (seven CRION, 11 RION, and 13 MS-ON). All patients were tested for MOG and aquaporin-4 antibodies (AQ4-Abs). Clinical data were collected. Brain atrophy was calculated by measuring the brain parenchyma fraction (BPF) with Neuroquant® software. Results: Four of seven CRION patients and one of 11 RION patients were positive for MOG-Abs (p = 0.046) and no MS-ON patients tested positive to MOG-Abs. All patients were negative to AQ4-Abs. The BPF was lower in patients with CRION than patients with RION (70.6 vs. 75.3%, p = 0.019) and similar to that in MS-ON patients. Conclusions: Brain atrophy in idiopathic inflammatory relapsing ON is present in patients with the CRION phenotype. Data from this study reflect that the optic nerve is a main target involved in these patients but not the only one. Our results should be further investigated in comprehensive and prospective studies.
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Affiliation(s)
- Laura Navarro Cantó
- Departament of Neurology, Hospital General Universitario de Elche, Alicante, Spain
| | - Sara Carratalá Boscá
- Neuroimunology and Multiple Sclerosis Research Group, Hospital Universitari i Politècnic La Fe de València, Valencia, Spain
| | | | - Sara Gil-Perontín
- Neuroimunology and Multiple Sclerosis Research Group, Hospital Universitari i Politècnic La Fe de València, Valencia, Spain
| | | | - Jessica Castillo Villalba
- Neuroimunology and Multiple Sclerosis Research Group, Hospital Universitari i Politècnic La Fe de València, Valencia, Spain
| | - Laura Cubas Nuñez
- Neuroimunology and Multiple Sclerosis Research Group, Hospital Universitari i Politècnic La Fe de València, Valencia, Spain
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Petzold A, Woodhall M, Khaleeli Z, Tobin WO, Pittock SJ, Weinshenker BG, Vincent A, Waters P, Plant GT. Aquaporin-4 and myelin oligodendrocyte glycoprotein antibodies in immune-mediated optic neuritis at long-term follow-up. J Neurol Neurosurg Psychiatry 2019; 90:1021-1026. [PMID: 31118222 DOI: 10.1136/jnnp-2019-320493] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 04/09/2019] [Accepted: 04/10/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To re-evaluate serum samples from our 2007 cohort of patients with single-episode isolated ON (SION), recurrent isolated ON (RION), chronic relapsing inflammatory optic neuropathy (CRION), multiple sclerosis-associated ON (MSON) and neuromyelitis optica (NMO). METHODS We re-screened 103/114 patients with available serum on live cell-based assays (CBA) for aquaporin-4 (AQP4)-M23-IgG and myelin-oligodendrocyte glycoprotein (MOG)-α1-IgG. Further testing included oligoclonal bands, serum levels of glial fibrillar acidic and neurofilament proteins and S100B. We show the impact of updated serology on these patients. RESULTS Reanalysis of our original cohort revealed that AQP4-IgG seropositivity increased from 56% to 75% for NMO, 5% to 22% for CRION, 6% to 7% for RION, 0% to 7% for MSON and 5% to 6% for SION. MOG-IgG1 was identified in 25% of RION, 25% of CRION, 10% of SION, 0% of MSON and 0% of NMO. As a result, patients have been reclassified incorporating their autoantibody status. Presenting visual acuity was significantly worse in patients who were AQP4-IgG seropositive (p=0.034), but there was no relationship between antibody seropositivity and either ON relapse rate or visual acuity outcome. CONCLUSIONS The number of patients with seronegative CRION and RION has decreased due to improved detection of autoantibodies over the past decade. It remains essential that the clinical phenotype guides both antibody testing and clinical management. Careful monitoring of the disease course is key when considering whether to treat with prophylactic immune suppression.
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Affiliation(s)
- Axel Petzold
- Neuroinflammation & Neuro-ophthalmology, UCL Institute of Neurology, The National Hospital for Neurology and Neurosurgery UCLH & Moorfields Eye Hospital, London, UK .,Expertise Centre Neuro-ophthalmology, Departments of Neurology and Ophthalmology, Amsterdam UMC-Locatie VUMC, Amsterdam, Noord-Holland, The Netherlands
| | - Mark Woodhall
- Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Z Khaleeli
- Neurology, The National Hospital for Neurology and Neurosurgery UCLH, St. Thomas Hospital & Moorfields Eye Hospital, London, UK
| | - W Oliver Tobin
- Departments of Neurology, Immunology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Departments of Neurology, Immunology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - B G Weinshenker
- Departments of Neurology, Immunology & Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Angela Vincent
- Nuffield Department of Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Patrick Waters
- Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gordon T Plant
- Neurology, The National Hospital for Neurology and Neurosurgery UCLH, St. Thomas Hospital & Moorfields Eye Hospital, London, UK
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60
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Çakar A, Ulusoy C, Gündüz T, Küçükali Cİ, Kürtüncü M. Clinical Features of the Patients with Neuromyelitis Optica Spectrum Disorder. ACTA ACUST UNITED AC 2019; 58:21-25. [PMID: 33795948 DOI: 10.29399/npa.23555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 01/01/2019] [Indexed: 01/01/2023]
Abstract
Introduction Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory, demyelinating syndrome of the central nervous system (CNS) that predominantly affects the spinal cord and optic nerves. Since it was first described, new information about the pathophysiology gained momentum with the discovery of an antibody against Aquaporin-4, a water channel protein that is predominantly found in the astrocytes. In our study, we evaluated the clinical features of NMOSD and clinically related CNS disorders. Method In our study, we recruited patients that were followed by Clinic for Multiple Sclerosis and Myelin Disorders at Istanbul University between 1979 and 2016. Results Thirty-five NMOSD, fifteen relapsing inflammatory optic neuropathy (RION) and ten opticospinal multiple sclerosis (OSMS) patients were recruited in our study. Forty-eight patients (%80) were female and twelve (%20) were male. Age, sex, follow-up period, annualized relapse rate, relapses in the first two years and progression index were similar between the groups. Cerebrospinal fluid (CSF) protein levels were higher in the NMOSD group. Concomitant autoimmune disorders were observed in six NMOSD patients and two OSMS patients. One patient with RION had nonspecific white matter lesions without gadolinium enhancement in the brain MRI. Conclusion Laboratory and imaging findings suggests that NMOSD is a distinct disorder than RION and OSMS. Further studies are needed to say specific comments about the existence of OSMS.
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Affiliation(s)
- Arman Çakar
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Canan Ulusoy
- Department of Neuroscience, Istanbul University Institute for Experimental Medical Research (DETAE), Istanbul, Turkey
| | - Tuncay Gündüz
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Turkey
| | - Cem İsmail Küçükali
- Department of Neuroscience, Istanbul University Institute for Experimental Medical Research (DETAE), Istanbul, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul University Faculty of Medicine, Istanbul, Turkey
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Kwon YN, Waters PJ, Kim M, Choi YS, Kim JW, Sung JJ, Park SH, Kim SM. Peripherally derived macrophages as major phagocytes in MOG encephalomyelitis. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:6/5/e600. [PMID: 31454776 PMCID: PMC6705630 DOI: 10.1212/nxi.0000000000000600] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 06/18/2019] [Indexed: 01/16/2023]
Affiliation(s)
- Young Nam Kwon
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Patrick J Waters
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Moonhang Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Youn Soo Choi
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Jin Wook Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Jung-Joon Sung
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea
| | - Sung-Hye Park
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
| | - Sung-Min Kim
- From the Department of Neurology (Y.N.K., J.-J.S., S.-M.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (Y.N.K.), Seoul National University Seoul Metropolitan Government Boramae Medical Center, Republic of Korea; Department of Medicine (Y.N.K.), Graduate School, Kyung Hee University, Republic of Korea; Neuroimmunology Group (P.J.W.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom; Biomedical Research Institute (M.K.), Seoul National University Hospital, Republic of Korea; Department of Medicine (Y.S.C.), Seoul National University, College of Medicine, Republic of Korea; Department of Neurosurgery (J.W.K.), Seoul National University Hospital, Republic of Korea; Department of Neurology (J.-J.S., S.-M.K.), Neuroscience Research Institute, Seoul National University, College of Medicine, Seoul, Republic of Korea; and Department of Pathology (S.-H.P.), Seoul National University, College of Medicine, Seoul, Republic of Korea.
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Abel A, McClelland C, Lee MS. Critical review: Typical and atypical optic neuritis. Surv Ophthalmol 2019; 64:770-779. [PMID: 31229520 DOI: 10.1016/j.survophthal.2019.06.001] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 05/22/2019] [Accepted: 06/07/2019] [Indexed: 10/26/2022]
Abstract
Typical optic neuritis is an idiopathic demyelinating condition that is often associated with multiple sclerosis. This has been well characterized and has an excellent prognosis. Atypical optic neuritis can result from an inflammatory, infectious, or autoimmune disorder. Differentiating the two types of optic neuritis is paramount and may be challenging early on in the clinical course. This review describes the recent literature describing the pathophysiology, clinical presentation, neuroimaging, and management of these disorders.
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Affiliation(s)
- Anne Abel
- Department of Ophthalmology, Hennepin Healthcare, Minneapolis, Minnesota, USA; Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Collin McClelland
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Michael S Lee
- Department of Ophthalmology and Visual Neurosciences, University of Minnesota, Minneapolis, Minnesota, USA; Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA; Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Clinical spectrum of central nervous system myelin oligodendrocyte glycoprotein autoimmunity in adults. Curr Opin Neurol 2019; 32:459-466. [DOI: 10.1097/wco.0000000000000681] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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