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Monoclonal Antibody-Based Treatments for Neuromyelitis Optica Spectrum Disorders: From Bench to Bedside. Neurosci Bull 2020; 36:1213-1224. [PMID: 32533450 DOI: 10.1007/s12264-020-00525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/10/2020] [Indexed: 12/20/2022] Open
Abstract
Neuromyelitis optica (NMO)/NMO spectrum disorder (NMOSD) is a chronic, recurrent, antibody-mediated, inflammatory demyelinating disease of the central nervous system, characterized by optic neuritis and transverse myelitis. The binding of NMO-IgG with astrocytic aquaporin-4 (AQP4) functions directly in the pathogenesis of >60% of NMOSD patients, and causes astrocyte loss, secondary inflammatory infiltration, demyelination, and neuron death, potentially leading to paralysis and blindness. Current treatment options, including immunosuppressive agents, plasma exchange, and B-cell depletion, are based on small retrospective case series and open-label studies. It is noteworthy that monoclonal antibody (mAb) therapy is a better option for autoimmune diseases due to its high efficacy and tolerability. Although the pathophysiological mechanisms of NMOSD remain unknown, increasingly, therapeutic studies have focused on mAbs, which target B cell depletion, complement and inflammation cascade inactivation, blood-brain-barrier protection, and blockade of NMO-IgG-AQP4 binding. Here, we review the targets, characteristics, mechanisms of action, development, and potential efficacy of mAb trials in NMOSD, including preclinical and experimental investigations.
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102
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Katsuse K, Shimizu G, Saito Sato N, Hatano K, Yagi S, Kimura T, Irie K, Ichi S, Takahashi T, Hashida H. Epilepsia Partialis Continua as an Early Sign of Anti-Myelin Oligodendrocyte Glycoprotein Antibody-positive Encephalitis. Intern Med 2020; 59:1445-1449. [PMID: 32132331 PMCID: PMC7332626 DOI: 10.2169/internalmedicine.3076-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies have been associated with steroid-responsive cortical encephalitis and comorbid generalized epilepsy. A 44-year-old woman developed repeated epilepsia partialis continua (EPC) without generalized seizures and was anti-MOG antibody-positive. Radiological abnormalities were detected in the bilateral medial frontoparietal cortices, but there were no cerebrospinal fluid abnormalities. She achieved remission with anti-epileptic drugs alone. However, encephalitis recurred four months later when pleocytosis appeared, and steroid therapy was effective. Altogether, EPC without typical cerebrospinal fluid features can be an early sign of anti-MOG antibody-positive encephalitis. Thus, patients with EPC of unknown etiology need to be screened for anti-MOG antibodies.
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Affiliation(s)
- Kazuto Katsuse
- Department of Neurology, Japanese Red Cross Medical Center, Japan
| | - Genki Shimizu
- Department of Neurology, Japanese Red Cross Medical Center, Japan
| | - Naoko Saito Sato
- Department of Neurology, Japanese Red Cross Medical Center, Japan
| | - Keiko Hatano
- Department of Neurology, Japanese Red Cross Medical Center, Japan
| | - Shintaro Yagi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Japan
| | - Toshikazu Kimura
- Department of Neurosurgery, Japanese Red Cross Medical Center, Japan
| | - Koreaki Irie
- Department of Neurosurgery, Japanese Red Cross Medical Center, Japan
| | - Shunsuke Ichi
- Department of Neurosurgery, Japanese Red Cross Medical Center, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
- Department of Neurology, National Hospital Organization Yonezawa Hospital, Japan
| | - Hideji Hashida
- Department of Neurology, Japanese Red Cross Medical Center, Japan
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103
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Foiadelli T, Gastaldi M, Scaranzin S, Franciotta D, Savasta S. Seizures and myelin oligodendrocyte glycoprotein (MOG) antibodies: Two paradigmatic cases and a review of the literature. Mult Scler Relat Disord 2020; 41:102011. [DOI: 10.1016/j.msard.2020.102011] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/13/2022]
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Abstract
Neuromyelitis optica (NMO) is a rare and chronic disabling autoimmune astrocytopathy of the central nervous system. Current advances regarding aquaporin-4 antibody function facilitate the understanding of clinical manifestations and imaging findings beyond optic neuritis and transverse myelitis. The current definition of NMO spectrum disorder (NMOSD) includes both aquaporin-4-IgG seropositive and seronegative patients who present with characteristic findings. This review will briefly summarize the pathophysiology and the latest NMOSD diagnostic criteria and focus on the NMOSD imaging findings and its differential diagnosis.
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Affiliation(s)
- Sheng-Che Hung
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC; Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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105
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Li H, Yang L, Wu Z, Zhou L, Bao Y, Geng D, Quan C, Li Y. Brain MRI features of Chinese Han patients with MOG-antibody disease. Mult Scler Relat Disord 2020; 43:102167. [PMID: 32447248 DOI: 10.1016/j.msard.2020.102167] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 04/15/2020] [Accepted: 04/27/2020] [Indexed: 10/24/2022]
Abstract
Background The spectrum of imaging features of patients with MOG antibody disease (MOGAD) remains unclear. We aimed to determine the brain MRI features of MOGAD in a Chinese Han cohort and to assess differences in brain MRI features between MOGAD and neuromyelitis optica spectrum disorders (NMOSDs). Methods We retrospectively reviewed the MRI images of 43 patients with MOGAD. As a routine diagnostic approach, all patients underwent serum aquaporin 4 IgG (AQP4-IgG) and MOG-IgG detection via cell-based assays. The topographies and features of brain lesions were independently assessed by two raters. As a comparison, topographies and features of brain lesions were also assessed using neuroimaging characteristics of NMOSDs recommended by the international panel for NMO diagnosis (IPND) in 2015. Results Thirty-five (81.4%) patients were found to have brain lesions. These brain lesions were classified into the following three patterns according to their distributions: (I) lesions involving midline structures and deep gray matte; (II) supratentorial white matter lesions; and (III) cortical gray matter lesions. There were 17 patients whose brain lesions did not fulfill the neuroimaging characteristics of NMOSDs recommended by the 2015 IPND, in which 11 patients had cortical gray matter lesions and/or juxtacortical white matter lesions, four patients had middle cerebral peduncles lesions, and two patients had gray matter lesions and juxtacortical white matter lesions, as well as middle cerebral peduncles lesions. Conclusion MOGAD in this Chinese Han cohort exhibited distinct brain MRI features, especially in terms of cortical gray matter lesions, juxtacortical white matter lesions, and middle cerebral peduncles lesions, which may help to further identify and diagnose patients with MOGAD while they are waiting for serological antibody results.
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Affiliation(s)
- Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Liqin Yang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Zhengyu Wu
- Department of Geriatrics, Huashan Hospital, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Yifang Bao
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Daoying Geng
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China; Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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106
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Dos Passos GR, Elsone L, Luppe S, Kitley J, Messina S, Rodríguez Cruz PM, Harding K, Mutch K, Leite MI, Robertson N, Jacob A, Palace J. Seasonal distribution of attacks in aquaporin-4 antibody disease and myelin-oligodendrocyte antibody disease. J Neurol Sci 2020; 415:116881. [PMID: 32428758 DOI: 10.1016/j.jns.2020.116881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/19/2020] [Accepted: 05/01/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Seasonal variation in incidence and exacerbations has been reported for neuroinflammatory conditions such as multiple sclerosis and acute disseminated encephalomyelitis (ADEM). It is unknown whether seasonality also influences aquaporin-4 antibody (AQP4-Ab) disease and myelin-oligodendrocyte antibody (MOG-Ab) disease. OBJECTIVE We examined the seasonal distribution of attacks in AQP4-Ab disease and MOG-Ab disease. METHODS Observational study using data prospectively recorded from three cohorts in the United Kingdom. RESULTS There was no clear seasonal variation in AQP4-Ab or MOG-Ab attacks for either the onset attack nor subsequent relapses. In both groups, the proportion of attacks manifesting with each of the main phenotypes (optic neuritis, transverse myelitis, ADEM/ADEM-like) appeared stable across the year. This study is the first to examine seasonal distribution of MOG-Ab attacks and the largest in AQP4-Ab disease so far. CONCLUSION Lack of seasonal distribution in AQP4-Ab and MOG-Ab disease may argue against environment factors playing a role in the aetiopathogenesis of these conditions.
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Affiliation(s)
- Giordani Rodrigues Dos Passos
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Liene Elsone
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Sebastian Luppe
- Department of Neurology, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom
| | - Joanna Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Pedro María Rodríguez Cruz
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Katharine Harding
- Department of Neurology, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom
| | - Kerry Mutch
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Neil Robertson
- Department of Neurology, University Hospital of Wales, Cardiff University, Cardiff, United Kingdom
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom.
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The pathology of central nervous system inflammatory demyelinating disease accompanying myelin oligodendrocyte glycoprotein autoantibody. Acta Neuropathol 2020; 139:875-892. [PMID: 32048003 PMCID: PMC7181560 DOI: 10.1007/s00401-020-02132-y] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 01/13/2020] [Accepted: 01/29/2020] [Indexed: 12/18/2022]
Abstract
We sought to define the pathological features of myelin oligodendrocyte glycoprotein (MOG) antibody associated disorders (MOGAD) in an archival autopsy/biopsy cohort. We histopathologically analyzed 2 autopsies and 22 brain biopsies from patients with CNS inflammatory demyelinating diseases seropositive for MOG-antibody by live-cell-based-assay with full length MOG in its conformational form. MOGAD autopsies (ages 52 and 67) demonstrate the full spectrum of histopathological features observed within the 22 brain biopsies (median age, 10 years; range, 1–66; 56% female). Clinical, radiologic, and laboratory characteristics and course (78% relapsing) are consistent with MOGAD. MOGAD pathology is dominated by coexistence of both perivenous and confluent white matter demyelination, with an over-representation of intracortical demyelinated lesions compared to typical MS. Radially expanding confluent slowly expanding smoldering lesions in the white matter as seen in MS, are not present. A CD4+ T-cell dominated inflammatory reaction with granulocytic infiltration predominates. Complement deposition is present in all active white matter lesions, but a preferential loss of MOG is not observed. AQP4 is preserved, with absence of dystrophic astrocytes, and variable oligodendrocyte and axonal destruction. MOGAD is pathologically distinguished from AQP4-IgG seropositive NMOSD, but shares some overlapping features with both MS and ADEM, suggesting a transitional pathology. Complement deposition in the absence of selective MOG protein loss suggest humoral mechanisms are involved, however argue against endocytic internalization of the MOG antigen. Parallels with MOG-EAE suggest MOG may be an amplification factor that augments CNS demyelination, possibly via complement mediated destruction of myelin or ADCC phagocytosis.
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108
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Wegener-Panzer A, Cleaveland R, Wendel EM, Baumann M, Bertolini A, Häusler M, Knierim E, Reiter-Fink E, Breu M, Sönmez Ö, Della Marina A, Peters R, Lechner C, Piepkorn M, Roll C, Höftberger R, Leypoldt F, Reindl M, Rostásy K. Clinical and imaging features of children with autoimmune encephalitis and MOG antibodies. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2020; 7:7/4/e731. [PMID: 32358225 PMCID: PMC7217659 DOI: 10.1212/nxi.0000000000000731] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 03/25/2020] [Indexed: 12/14/2022]
Abstract
Objective To describe the presentations, radiologic features, and outcomes of children with autoimmune encephalitis associated with myelin oligodendrocyte glycoprotein antibodies (MOG abs). Methods Identification of children fulfilling the diagnostic criteria for possible autoimmune encephalitis (AE) and testing positive for serum MOG abs. Chart review and comprehensive analysis of serum MOG abs using live cell assays and rat brain immunohistochemistry. Results Ten children (4 girls, 6 boys) with AE and serum MOG abs were identified. The median age at onset was 8.0 years (range: 4–16 years). Children presented with a combination of encephalopathy (10/10), headache (7/10), focal neurologic signs (7/10), or seizures (6/10). CSF pleocytosis was common (9/10, median 80 white cell count/μL, range: 21–256). Imaging showed cortical and deep gray matter involvement in all in addition to juxtacortical signal alterations in 6/10 children. No involvement of other white matter structures or contrast enhancement was noted. MOG abs were detected in all children (median titer 1:640; range: 1:320–1:10,540). Nine children had a favorable outcome at discharge (modified Rankin scale of < 2). Five of 10 children had up to 3 additional demyelinating relapses associated with persisting MOG abs. One child had NMDA receptor (NMDAR) abs at initial presentation. A second child had a third demyelinating episode with MOG abs with overlapping NMDAR encephalitis. Discussion AE associated with serum MOG abs represents a distinct form of autoantibody-mediated encephalitis in children. We therefore recommend including MOG abs testing in the workup of children with suspected AE.
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Affiliation(s)
- Andreas Wegener-Panzer
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Robert Cleaveland
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Eva-Maria Wendel
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Matthias Baumann
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Annikki Bertolini
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Martin Häusler
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Ellen Knierim
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Edith Reiter-Fink
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Markus Breu
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Özcan Sönmez
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Adela Della Marina
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Renate Peters
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Christian Lechner
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Martin Piepkorn
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Claudia Roll
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Romana Höftberger
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Frank Leypoldt
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Markus Reindl
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria
| | - Kevin Rostásy
- From the Department of Radiology (A.W.-P., R.C.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (E.-M.W.), Olgahospital, Klinikum Stuttgart, Germany; Division of Pediatric Neurology (M. Baumann, C.L.), Department of Pediatrics I, Medical University of Innsbruck, Austria; Department of Pediatric Neurology (A.B., K.R.), Children's Hospital Datteln, University Witten/Herdecke; Department of Pediatrics (M.H.), Division of Neuropediatrics and Social Pediatrics, Medical University RWTH Aachen, Germany; Charité-Universitätsmedizin Berlin (E.K.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Germany; Department of Neuropediatrics (E.K.), Berlin, Germany; Department of Pediatrics and Adolescent Medicine (E.R.-F., M. Breu), Medical University of Vienna; St. Anna Children´s Hospital (E.R.-F.), Vienna, Austria; Klinik für Kinder und Jugendmedizin (Ö.S.), Evangelisches Krankenhaus Hamm, Germany; Department of Neuropediatrics (A.D.M.), Developmental Neurology and Social Pediatrics, Children's Hospital, University of Duisburg-Essen, Germany; Department of Pediatrics (R.P.), Christliches Kinderhospital Osnabrück, Germany; Department of Pediatric Neurology (M.P.), Children's Hospital Auf der Bult, Hannover Germany; Department of Neonatology (C.R.), Pediatric Intensive Care, Sleep Medicine, Children's Hospital Datteln, University Witten/Herdecke, Germany; Institute of Neurology (R.H.), Medical University of Vienna, Austria; Neuroimmunology (F.L.), Institute of Clinical Chemistry and Department of Neurology, Christian-Albrechts-University Kiel and Medical University Hospital Schleswig-Holstein, Germany; and Clinical Department of Neurology (M.R.), Medical University of Innsbruck, Austria.
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109
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Breaking boundaries between demyelinating disorders and autoimmune encephalitis. Lancet Neurol 2020; 19:199-200. [DOI: 10.1016/s1474-4422(20)30032-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 12/26/2022]
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Fujimori J. [Anti-myelin oligodendrocyte glycoprotein antibody associated encephalitis]. Rinsho Shinkeigaku 2020; 60:117-119. [PMID: 31956198 DOI: 10.5692/clinicalneurol.cn-001379] [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: 11/05/2022]
Abstract
The recent development of a cell-based assay that can detect specific autoantibodies revealed the clinical features of diseases associated with the anti-myelin oligodendrocyte glycoprotein (MOG) antibody. The anti-MOG antibody associated diseases may include inflammatory demyelinating central nervous system diseases such as neuromyelitis optica spectrum disorders, optic neuritis, myelitis, atypical multiple sclerosis, and encephalitis. Among them, anti-MOG antibody associated cortical encephalitis may develop seizure as one of the primary symptoms, present unique lateral or bilateral medial frontal cortical lesions on brain MRI FLAIR images. In acute phase, steroid pulse therapy and anti-epileptic drugs are required. In chronic phase, immunosuppressive drugs are often required to prevent relapses.
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Affiliation(s)
- Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University
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111
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Armangue T, Olivé-Cirera G, Martínez-Hernandez E, Sepulveda M, Ruiz-Garcia R, Muñoz-Batista M, Ariño H, González-Álvarez V, Felipe-Rucián A, Jesús Martínez-González M, Cantarín-Extremera V, Concepción Miranda-Herrero M, Monge-Galindo L, Tomás-Vila M, Miravet E, Málaga I, Arrambide G, Auger C, Tintoré M, Montalban X, Vanderver A, Graus F, Saiz A, Dalmau J. Associations of paediatric demyelinating and encephalitic syndromes with myelin oligodendrocyte glycoprotein antibodies: a multicentre observational study. Lancet Neurol 2020; 19:234-246. [PMID: 32057303 DOI: 10.1016/s1474-4422(19)30488-0] [Citation(s) in RCA: 179] [Impact Index Per Article: 44.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 12/18/2019] [Accepted: 12/19/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Investigations of myelin oligodendrocyte glycoprotein (MOG) antibodies are usually focused on demyelinating syndromes, but the entire spectrum of MOG antibody-associated syndromes in children is unknown. In this study, we aimed to determine the frequency and distribution of paediatric demyelinating and encephalitic syndromes with MOG antibodies, their response to treatment, and the phenotypes associated with poor prognosis. METHODS In this prospective observational study, children with demyelinating syndromes and with encephalitis other than acute disseminated encephalomyelitis (ADEM) recruited from 40 secondary and tertiary centres in Spain were investigated for MOG antibodies. All MOG antibody-positive cases were included in our study, which assessed syndromes, treatment and response to treatment (ie, number of relapses), outcomes (measured with the modified Rankin scale [mRS]), and phenotypes associated with poor prognosis. We used Fisher's exact and Wilcoxon rank sum tests to analyse clinical features, and survival Cox regression to analyse time to antibody negativity. FINDINGS Between June 1, 2013, and Dec 31, 2018, 239 children with demyelinating syndromes (cohort A) and 296 with encephalitis other than ADEM (cohort B) were recruited. 116 patients had MOG antibodies, including 94 (39%) from cohort A and 22 (7%) from cohort B; 57 (49%) were female, with a median age of 6·2 years (IQR 3·7-10·0). Presenting syndromes in these 116 patients included ADEM (46 [68%]), encephalitis other than ADEM (22 [19%]), optic neuritis (20 [17%]), myelitis (13 [11%]), neuromyelitis optica spectrum disorders (six [5%]), and other disorders (nine [8%]). Among the patients with autoimmune encephalitis in cohort B (n=64), MOG antibodies were more common than all neuronal antibodies combined (22 [34%] vs 21 [33%]). After a median follow-up of 42 months (IQR 22-67), 33 (28%) of the 116 patients had relapses, including 17 (17%) of 100 diagnosed at first episode. Steroids, intravenous immunoglobulin, or plasma exchange were used in 100 (86%) patients at diagnosis, and 32 (97%) of 33 at relapses. Rituximab was mainly used at relapses (11 [33%]). 99 (85%) of 116 patients had substantial recovery (mRS <2) and 17 (15%) moderate to severe deficits (mRS >2; one died). Phenotypes of poor prognosis included ADEM-like relapses progressing to leukodystrophy-like features, and extensive cortical encephalitis evolving to atrophy. Time to antibody negativity was longer in patients with relapses (HR 0·18, 95% CI 0·05-0·59). INTERPRETATION The spectrum of paediatric MOG antibody-associated syndromes is wider than previously reported and includes demyelinating syndromes and encephalitis. Recognition of these disorders has important clinical and prognostic implications. FUNDING Mutua Madrileña Foundation; ISCIII-Subdirección General de Evaluación y Fomento de la Investigación Sanitaria; Fondo Europeo de Desarrollo Regional; Pediatrics Spanish Society; Departament de Salut, Generalitat de Catalunya; Marato TV3 Foundation; Red Española de Esclerosis Múltiple; La Caixa Foundation; and Fundació CELLEX.
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Affiliation(s)
- Thaís Armangue
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Pediatric Neuroimmunology Unit, Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain.
| | - Gemma Olivé-Cirera
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Neurology Section, Pediatric Service, Hospital Parc Taulí, Sabadell, Barcelona, Spain
| | - Eugenia Martínez-Hernandez
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Maria Sepulveda
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Raquel Ruiz-Garcia
- Immunology Department, Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain
| | - Marta Muñoz-Batista
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Helena Ariño
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Veronica González-Álvarez
- Pediatric Neuroimmunology Unit, Neurology Department, Sant Joan de Déu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Ana Felipe-Rucián
- Neurology Section, Pediatric Service, Vall d'Hebron Hospital Barcelona, Spain
| | | | | | | | | | - Miguel Tomás-Vila
- Neurology Section, Pediatric Service, Hospital La Fe, Valencia, Spain
| | - Elena Miravet
- Pediatric Neurology Unit, Pediatric Service, Hospital Son Espases Palma de Mallorca, Spain
| | - Ignacio Málaga
- Child Neurology Unit, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Georgina Arrambide
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology and Magnetic Resonance Unit, Department of Radiology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Xavier Montalban
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca, Universitat Autònoma de Barcelona, Barcelona, Spain; Division of Neurology, University of Toronto, St Michael's Hospital, Toronto, ON, Canada
| | - Adeline Vanderver
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Francesc Graus
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Albert Saiz
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA; Catalan Institute for Research and Advanced Studies, Barcelona, Spain.
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Abstract
Anti-myelin oligodendrocyte glycoprotein (MOG) antibodies (MOG-Abs) were first detected by immunoblot and enzyme-linked immunosorbent assay nearly 30 years ago, but their association with multiple sclerosis (MS) was not specific. Use of cell-based assays with native MOG as the substrate enabled identification of a group of MOG-Ab-positive patients with demyelinating phenotypes. Initially, MOG-Abs were reported in children with acute disseminated encephalomyelitis (ADEM). Further studies identified MOG-Abs in adults and children with ADEM, seizures, encephalitis, anti-aquaporin-4-antibody (AQP4-Ab)-seronegative neuromyelitis optica spectrum disorder (NMOSD) and related syndromes (optic neuritis, myelitis and brainstem encephalitis), but rarely in MS. This shift in our understanding of the diagnostic assays has re-invigorated the examination of MOG-Abs and their role in autoimmune and demyelinating disorders of the CNS. The clinical phenotypes, disease courses and responses to treatment that are associated with MOG-Abs are currently being defined. MOG-Ab-associated disease is different to AQP4-Ab-positive NMOSD and MS. This Review provides an overview of the current knowledge of MOG, the metrics of MOG-Ab assays and the clinical associations identified. We collate the data on antibody pathogenicity and the mechanisms that are thought to underlie this. We also highlight differences between MOG-Ab-associated disease, NMOSD and MS, and describe our current understanding on how best to treat MOG-Ab-associated disease.
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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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114
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Abstract
OBJECTIVES To elucidate etiologies, treatment, functional and neurocognitive outcomes of children with new-onset refractory status epilepticus. DESIGN A single-center retrospective study. SETTING A tertiary care children's hospital. PATIENTS All patients between 1 month and 21 years old admitted with new-onset refractory status epilepticus between January 2004 and July 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Clinical presentation, laboratory data, imaging studies, and treatments were collected during hospitalization. Outcomes were assessed at hospital discharge and follow-up in the outpatient neurology clinic based on functional and neurocognitive outcomes as well as development of epilepsy. A total of 674 unique patients presented with status epilepticus of which 40 had new-onset refractory status epilepticus. Patients were classified into either refractory status epilepticus or super-refractory status epilepticus. The etiology of most children with new-onset refractory status epilepticus remained cryptogenic. The most common identified etiology was viral (20%). None of the patients had a contributory positive neuronal antibody test. Several treatments were tried including immunotherapy which was used in half of the patients. Five patients died (12.5%) during the acute phase of their disease, with four lost to follow-up. Twenty out of the remaining 31 patients (65%) developed epilepsy and 18 (58%) had persistent neurocognitive impairment. There was no statistical significant difference in various outcome measures and various etiologies, patients' characteristics, and treatments. CONCLUSIONS In this single-center cohort, more than half of the children with new-onset refractory status epilepticus did not have an identifiable etiology. Unlike adult patients, the presence of positive neuronal antibody syndrome was rare. There was no difference in outcome between those with or without an identifiable etiology. As expected, patients with super-refractory status epilepticus had worse functional and neurocognitive outcomes. More standardized diagnostic and treatment algorithms are needed along with prospective multicenter studies.
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Wright SK, Wood AG. Neurodevelopmental outcomes in paediatric immune-mediated and autoimmune epileptic encephalopathy. Eur J Paediatr Neurol 2020; 24:53-57. [PMID: 31879225 DOI: 10.1016/j.ejpn.2019.12.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 12/06/2019] [Indexed: 12/23/2022]
Abstract
Recognition of paediatric autoimmune/immune-mediated encephalitis and epileptic encephalopathy (e.g. NMDAR-Ab encephalitis) has rapidly increased over the last ten years. While we are succeeding in the diagnosis and identification and even early treatment of these encephalitidies, with studies describing >80% are making a "good" recovery, we are now recognising that a "good" medical outcome does not cover the cognitive, social and behavioural sequelae that can occur, particularly in paediatric patients. Basic measures of medical outcome, for example the modified Rankin Scale (MRS) or the Paediatric Cerebral Performance Category (PCPC), offer the advantage of being quick to use, but do not reveal the more complex difficulties that can impact the future of affected children. This article reviews the current literature on neurodevelopmental outcomes in children affected with autoimmune and immune-mediated encephalitis/epileptic encephalopathy and provides guidance on post-onset surveillance aimed at identifying those most likely to experience ongoing long-term difficulties.
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Affiliation(s)
- Sukhvir K Wright
- School of Life and Health Sciences & Aston Neuroscience Institute, Aston University, Birmingham, UK; Department of Neurology, Birmingham Children's Hospital, Birmingham, UK.
| | - Amanda G Wood
- School of Life and Health Sciences & Aston Neuroscience Institute, Aston University, Birmingham, UK; School of Psychology, Faculty of Health, Melbourne Burwood Campus, Deakin University, Geelong, Victoria, Australia
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Jarius S, Wildemann B. The history of neuromyelitis optica. Part 2: 'Spinal amaurosis', or how it all began. J Neuroinflammation 2019; 16:280. [PMID: 31883522 PMCID: PMC6935230 DOI: 10.1186/s12974-019-1594-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 09/23/2019] [Indexed: 01/08/2023] Open
Abstract
Neuromyelitis optica (NMO) was long considered a clinical variant of multiple sclerosis (MS). However, the discovery of a novel and pathogenic anti-astrocytic serum autoantibody targeting aquaporin-4 (termed NMO-IgG or AQP4-Ab), the most abundant water channel protein in the central nervous system, led to the recognition of NMO as a distinct disease entity in its own right and generated strong and persisting interest in the condition. NMO is now studied as a prototypic autoimmune disorder, which differs from MS in terms of immunopathogenesis, clinicoradiological presentation, optimum treatment, and prognosis. While the history of classic MS has been extensively studied, relatively little is known about the history of NMO. In Part 1 of this series we focused on the late 19th century, when the term 'neuromyelitis optica' was first coined, traced the term's origins and followed its meandering evolution throughout the 20th and into the 21st century. Here, in Part 2, we demonstrate that the peculiar concurrence of acute optic nerve and spinal cord affliction characteristic for NMO caught the attention of physicians much earlier than previously thought by re-presenting a number of very early cases of possible NMO that date back to the late 18th and early 19th century. In addition, we comprehensively discuss the pioneering concept of 'spinal amaurosis', which was introduced into the medical literature by ophthalmologists in the first half of the 19th century.
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Affiliation(s)
- S. Jarius
- Department of Neurology, Molecular Neuroimmunology Group, University of Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
| | - B. Wildemann
- Department of Neurology, Molecular Neuroimmunology Group, University of Heidelberg, Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120 Heidelberg, Germany
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Quantitative brain lesion distribution may distinguish MOG-ab and AQP4-ab neuromyelitis optica spectrum disorders. Eur Radiol 2019; 30:1470-1479. [PMID: 31748853 DOI: 10.1007/s00330-019-06506-z] [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: 04/24/2019] [Revised: 08/26/2019] [Accepted: 10/10/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Antibodies to myelin oligodendrocyte glycoprotein (MOG-ab) and antibodies to aquaporin-4 (AQP4-ab) have been suggested to play roles in commonly separated subsets of patients with neuromyelitis optica spectrum disorder (NMOSD) phenotypes. The aim of this study is to quantitatively delineate and compare the brain lesion distributions of AQP4-ab-positive and MOG-ab-positive patients. METHODS Fifty-seven and twenty-eight clinical MRI scans were collected from fifty-two AQP4-ab-positive and twenty-four MOG-ab-positive patients, respectively. T2 lesions were segmented manually on each axial FLAIR image. Probabilistic lesion distribution maps were created for each group after spatial normalization. Lobe-wise and voxel-wise quantitative comparisons of the two distributions were performed. A classification model based on the lesion distribution features was constructed to differentiate the two patient groups. RESULTS Infratentorial and supratentorial brain lesions were found in both AQP4-ab-positive and MOG-ab-positive patients, with large inter-group overlap mainly in deep white matter (WM). In comparison with those in the AQP4 group, the brain lesions of the MOG-ab-positive patients had a larger size, dispersed distribution, and higher probabilities in the cerebellum, pons, midbrain, and GM and juxtacortical WM in temporal, sublobar, frontal, and parietal lobes. The area under the receiver operating characteristic curve of the lesion-distribution-based classification model was 0.951. CONCLUSIONS MOG-ab-positive and AQP4-ab-positive groups showed similar but quantitatively different brain lesion distributions. These results may help clinicians in considering MOG versus AQP4 in initial diagnosis, and add rationale for sending corresponding serologic testing. KEY POINTS • Brain lesion distributions of AQP-ab-positive and MOG-ab-positive NMOSD patients • Larger size, dispersed distribution, higher lesion probabilities in the cerebellum, pons, midbrain, and GM and juxtacortical WM in the MOG group • The lesion-distribution-based classification model differentiates the two groups with AUC = 0.951.
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Suzuki T, Maekawa K, Matsuo K, Yamasaki M, Shibata M, Takahashi T, Naito Y. Aseptic Meningitis as an Initial Manifestation of Anti-myelin Oligodendrocyte Glycoprotein Antibody-associated Disease. Intern Med 2019; 58:3319-3321. [PMID: 31327827 PMCID: PMC6911747 DOI: 10.2169/internalmedicine.2845-19] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Antibody against myelin oligodendrocyte glycoprotein (MOG-IgG) associated encephalitis is an important syndrome associated with MOG-IgG. However, there have been no reports of MOG-IgG-associated optic neuritis or demyelination following meningitis without encephalitic symptoms. A 55-year-old woman presented to our hospital with headache, nausea, fever, and nuchal rigidity that had persisted for more than a month. She was hospitalized due to aseptic meningitis and recovered with conservative therapy. However, she was re-admitted due to left optic neuritis and demyelinating lesions. We diagnosed MOG-IgG-associated neuromyelitis optica spectrum disorder (NMOSD). She responded to treatment with intravenous methylprednisolone and oral prednisolone. Aseptic meningitis may be an initial manifestation of MOG-IgG-positive NMOSD.
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Affiliation(s)
| | - Kota Maekawa
- Department of Neurology, Ise Red Cross Hospital, Japan
- Department of Neuroendovascular Therapy, Ise Red Cross Hospital, Japan
| | - Ko Matsuo
- Department of Neurology, Ise Red Cross Hospital, Japan
| | | | - Masunari Shibata
- Department of Neuroendovascular Therapy, Ise Red Cross Hospital, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
- Department of Neurology, National Hospital Organization Yonezawa Hospital, Japan
| | - Yutaka Naito
- Department of Neurology, Ise Red Cross Hospital, Japan
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119
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B cells in autoimmune and neurodegenerative central nervous system diseases. Nat Rev Neurosci 2019; 20:728-745. [DOI: 10.1038/s41583-019-0233-2] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2019] [Indexed: 12/16/2022]
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120
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MOG-IgG-associated demyelination: focus on atypical features, brain histopathology and concomitant autoimmunity. J Neurol 2019; 267:359-368. [DOI: 10.1007/s00415-019-09586-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/11/2019] [Accepted: 10/14/2019] [Indexed: 01/22/2023]
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Wandinger KP, Leypoldt F, Junker R. Autoantibody-Mediated Encephalitis. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:666-673. [PMID: 30381132 DOI: 10.3238/arztebl.2018.0666] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 12/19/2017] [Accepted: 06/04/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Acute and subacute disturbances of wakefulness and cognitive function are common neurological manifestations in the hospital and in outpatient care. An important element of the differential diagnosis was described only a few years ago: autoimmune encephalitis, a condition whose diagnosis and treatment pose an interdisciplinary challenge. METHODS This review is based on pertinent publications from the years 2005-2017 that were retrieved by a selective search in PubMed, and on the authors' personal experience and case reports. RESULTS The incidence of autoimmune encephalitis in Germany is estimated at 8-15 cases per million persons per year. In some patients with psychotic manifestations or impaired consciousness of acute or subacute onset, an autoimmune patho - genesis can be demonstrated by the laboratory detection of autoantibodies against neuronal target antigens (e.g., glutamate receptors). Testing of this type should be performed in patients with inflammatory changes in the cerebrospinal fluid or on magnetic resonance imaging (MRI), or those who have had an otherwise unexplained first epileptic seizure or status epilepticus. The cumulative sensitivity of testing for all potentially causative antineuronal antibodies in patients with clinically defined autoimmune encephalitis is estimated at 60-80 %. Figures on cumulative specificity are currently unavailable. CONCLUSION The detection of antineuronal antibodies in patients with the corresponding appropriate symptoms implies the diagnosis of autoimmune encephalitis. Observational studies have shown that rapidly initiated immunosuppressive treatment improves these patients' outcomes. Further studies are needed to determine the positive predictive value of antineuronal antibody detection and to develop further treatment options under randomized and controlled conditions.
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Yılmaz Ü, Edizer S, Songür ÇY, Güzin Y, Durak FS. Atypical presentation of MOG-related disease: Slowly progressive behavioral and personality changes following a seizure. Mult Scler Relat Disord 2019; 36:101394. [PMID: 31525625 DOI: 10.1016/j.msard.2019.101394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 08/18/2019] [Accepted: 09/08/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Myelin Oligodendrocyte Glycoprotein (MOG) antibodies-related disease is mainly presented with acute disseminated encephalomyelitis (ADEM), recurrent optic neuritis, and neuromyelitis optica spectrum disorders (NMOSDs), however the complete clinical spectrum has not yet been defined. We describe an unusual presentation of MOG- related disease. A previously well 10-year-old girl admitted with a focal onset seizure. Neurological examination, electroencephalography, and brain magnetic resonance imaging (MRI) were normal. Following seizure episode she developed gradually increased behavioral and personality changes during a period of 2.5 months. Neurological examination was unremarkable except for drowsiness and minimal ataxia on tandem walking. Repeated brain MRI revealed hazy and poorly demarcated lesions with gadolinium enhancement in the basal ganglia, supratentorial white matter, cerebral peduncles, cerebellum, and servical spinal cord. Cerebrospinal fluid analyses (CSF) revealed 10 lymphocytes /µL, normal protein concentration and IgG index, and negative oligoclonal bands. Auto-antibodies against N-methyl-d-aspartate receptor and CASPR2 in CSF, and antibodies against aquaporin 4 in serum were negative. Analysis with a cell-based assay identified high serum titer of MOG antibodies (1:320). Following IVIG therapy, the patient showed complete clinical recovery within a week with no further relaps for the following 6-month period. CONCLUSION Slowly progressive behavioral and personality changes following a seizure may be a manifestation of MOG-related disease in children.
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Affiliation(s)
- Ünsal Yılmaz
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey.
| | - Selvinaz Edizer
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Çisel Yazan Songür
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Child and Adolescent Psychiatry, Izmir, Turkey
| | - Yiğithan Güzin
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Fatma Sibel Durak
- University of Health Sciences, Dr. Behçet Uz Children's Education and Research Hospital, Department of Child and Adolescent Psychiatry, Izmir, Turkey
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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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Chen C, Liu C, Fang L, Zou Y, Ruan H, Wang Y, Cui C, Sun X, Peng L, Qiu W. Different magnetic resonance imaging features between MOG antibody- and AQP4 antibody-mediated disease: A Chinese cohort study. J Neurol Sci 2019; 405:116430. [PMID: 31465985 DOI: 10.1016/j.jns.2019.116430] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/16/2019] [Accepted: 08/17/2019] [Indexed: 01/02/2023]
Abstract
Few studies have compared radiological features obtained on magnetic resonance imaging (MRI) between myelin oligodendrocyte glycoprotein antibody (MOG-ab)- and aquaporin 4 antibody (AQP4-ab)-positive patients. In this study, 77 MOG-ab and 92 AQP4-ab patients were enrolled. The results demonstrated that the brain MRI-based incidence of subcortical white matter lesions was higher in MOG-ab patients (p < .000) than in AQP4-ab patients and that the former therefore had a higher incidence of periventricular lesions (p = .003). The posterior limb of the internal capsule was more prone to lesions in MOG-ab patients (p = .019). Large lesions and U- or S-shaped lesions were also more frequent in MOG-ab (p < .000 and p = .013, respectively). Half of the MOG-ab patients had spinal cord involvement, and 36.5% presented with longitudinally extensive transverse myelitis (LETM). However, among the MOG-ab and AQP4-ab patients with spinal attack, there was no significant difference in the proportion with LETM (p = .057). In conclusion, a higher proportion of MOG-ab patients than AQP4-ab patients had brain lesions in white matter. Among MOG-ab patients who had an attack in the spinal cord, 65.5% also had LETM during the disease course. Conus medullaris lesions were rare in Chinese MOG-ab patients.
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Affiliation(s)
- Chen Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Chunxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Ling Fang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Yan Zou
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Hengfang Ruan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Chunping Cui
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510000, China.
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Chang VTW, Chang HM. Review: Recent advances in the understanding of the pathophysiology of neuromyelitis optica spectrum disorder. Neuropathol Appl Neurobiol 2019; 46:199-218. [PMID: 31353503 DOI: 10.1111/nan.12574] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 07/17/2019] [Accepted: 07/24/2019] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica is an autoimmune inflammatory disorder of the central nervous system that preferentially targets the spinal cord and optic nerve. Following the discovery of circulating antibodies against the astrocytic aquaporin 4 (AQP4) water channel protein, recent studies have expanded our knowledge of the unique complexities of the pathogenesis of neuromyelitis optica and its relationship with the immune response. This review describes and summarizes the recent advances in our understanding of the molecular mechanisms underlying neuromyelitis optica disease pathology and examines their potential as therapeutic targets. Additionally, we update the most recent research by proposing major unanswered questions regarding how peripheral AQP4 antibodies are produced and their entry into the central nervous system, the causes of AQP4-IgG-seronegative disease, why peripheral AQP4-expressing organs are spared from damage, and the impact of this disease on pregnancy.
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Affiliation(s)
- V T W Chang
- St George's, University of London, London, UK
| | - H-M Chang
- Department of Obstetrics and Gynaecology, University of British Columbia and BC Children's Hospital Research Institute, Vancouver, BC, Canada
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126
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Mao L, Yang L, Kessi M, He F, Zhang C, Wu L, Yin F, Peng J. Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Diseases in Children in Central South China: Clinical Features, Treatments, Influencing Factors, and Outcomes. Front Neurol 2019; 10:868. [PMID: 31440204 PMCID: PMC6694759 DOI: 10.3389/fneur.2019.00868] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 07/26/2019] [Indexed: 12/02/2022] Open
Abstract
Background and purpose: The clinical and radiological features of myelin oligodendrocyte glycoprotein antibody (MOG-Ab) diseases vary among the patients and studies. In addition, the clinical significance of MOG-Ab for the diagnosis, treatment, and prognosis is not yet established. Therefore, we aimed to evaluate the clinical, radiological, treatments and outcome features of MOG-Ab diseases in Central Southern part of China. Methods: A retrospective study of children with MOG-Ab disease was carried out from January 2015 to October 2018. Demographics, clinical features, treatments, and outcomes were reviewed. Some of the clinical information was compared including the annualized relapse rates (ARRs) before and after treatment with disease-modifying drugs (DMDs). Results: Twenty-five patients with MOG-Ab disease were recruited. The onset age ranged from 3 to 12.4 years old. 13 were females and 12 were males. The median follow-up period was 15 months (range 7–63). Most of the cases that aged ≤9 years presented with fever (47.4%), encephalopathy (47.4%), and lesions on white matter and/or deep gray matter (52.6%). While most of those aged above 9 years presented with optic neuritis (ON) (66.7%), and lesions on spinal cord and/or optic nerve (50%). Until the last follow-up, 10 (40%) cases had multiphasic courses while 15 (60%) had a monophasic course, and the mean follow-up time was statistically significant (10.67 vs. 31 months, p = 0.0001). DMDs such as rituximab (RTX) or/and azathioprine (AZP) or mycophenolate mofetil (MMF) were used at least once in 56% of the cases. The ARR before and after treatment was 2.4 and 0 respectively (p < 0.05). The median Expanded Disability Status Scale scores of our study were 0 (range 0–2). 96% (24/25) of the cases had a full recovery. Conclusions: MOG-Ab disease among Chinese children share the same clinical characteristics with Caucasians. However, the Chinese children seem to have a better prognosis than Caucasians. There is an age-dependent phenotypes, as brain involvement is more frequently seen in children younger or equal to 9 years while ON and neuromyelitis optica spectrum disorders are commonly seen in children older than 9 years. DMDs, such as AZA, MMF or RTX, can reduce the ARR.
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Affiliation(s)
- Leilei Mao
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Lifen Yang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Miriam Kessi
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Fang He
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Ciliu Zhang
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Liwen Wu
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China
| | - Fei Yin
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
| | - Jing Peng
- Department of Pediatrics, Xiangya Hospital, Central South University, Changsha, China.,Hunan Intellectual and Developmental Disabilities Research Center, Changsha, China
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127
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Oertel FC, Outteryck O, Knier B, Zimmermann H, Borisow N, Bellmann-Strobl J, Blaschek A, Jarius S, Reindl M, Ruprecht K, Meinl E, Hohlfeld R, Paul F, Brandt AU, Kümpfel T, Havla J. Optical coherence tomography in myelin-oligodendrocyte-glycoprotein antibody-seropositive patients: a longitudinal study. J Neuroinflammation 2019; 16:154. [PMID: 31345223 PMCID: PMC6657100 DOI: 10.1186/s12974-019-1521-5] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 06/13/2019] [Indexed: 12/19/2022] Open
Abstract
Background Serum antibodies against myelin-oligodendrocyte-glycoprotein (MOG-IgG) are detectable in a proportion of patients with acute or relapsing neuroinflammation. It is unclear, if neuro-axonal damage occurs only in an attack-dependent manner or also progressively. Therefore, this study aimed to investigate longitudinally intra-retinal layer changes in eyes without new optic neuritis (ON) in MOG-IgG-seropositive patients. Methods We included 38 eyes of 24 patients without ON during follow-up (F/U) [median years (IQR)] 1.9 (1.0–2.2) and 56 eyes of 28 age- and sex-matched healthy controls (HC). The patient group’s eyes included 18 eyes without (EyeON-) and 20 eyes with history of ON (EyeON+). Using spectral domain optical coherence tomography (OCT), we acquired peripapillary retinal nerve fiber layer thickness (pRNFL) and volumes of combined ganglion cell and inner plexiform layer (GCIP), inner nuclear layer (INL), and macular volume (MV). High-contrast visual acuity (VA) was assessed at baseline. Results At baseline in EyeON-, pRNFL (94.3 ± 15.9 μm, p = 0.36), INL (0.26 ± 0.03 mm3, p = 0.11), and MV (2.34 ± 0.11 mm3, p = 0.29) were not reduced compared to HC; GCIP showed thinning (0.57 ± 0.07 mm3; p = 0.008), and VA was reduced (logMAR 0.05 ± 0.15 vs. − 0.09 ± 0.14, p = 0.008) in comparison to HC. Longitudinally, we observed pRNFL thinning in models including all patient eyes (annual reduction − 2.20 ± 4.29 μm vs. − 0.35 ± 1.17 μm, p = 0.009) in comparison to HC. Twelve EyeON- with other than ipsilateral ON attacks ≤ 6 months before baseline showed thicker pRNFL at baseline and more severe pRNFL thinning in comparison to 6 EyeON- without other clinical relapses. Conclusions We observed pRNFL thinning in patients with MOG-IgG during F/U, which was not accompanied by progressive GCIP reduction. This effect could be caused by a small number of EyeON- with other than ipsilateral ON attacks within 6 months before baseline. One possible interpretation could be a reduction of the swelling, which could mean that MOG-IgG patients show immune-related swelling in the CNS also outside of an attack’s target area. Electronic supplementary material The online version of this article (10.1186/s12974-019-1521-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Frederike C Oertel
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Robert-Rössle-Straße 10, 13125, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Olivier Outteryck
- Department of Neurology and Neuroradiology, Roger Salengro Hospital, University of Lille, INSERM 1171, Avenue du Professeur Emile Laine, 59037, Lille, France
| | - Benjamin Knier
- Department of Neurology, Klinikum Rechts der Isar, Technische Universität München, Ismaninger Straße 22, 81675, Munich, Germany
| | - Hanna Zimmermann
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Robert-Rössle-Straße 10, 13125, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Nadja Borisow
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Robert-Rössle-Straße 10, 13125, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Robert-Rössle-Straße 10, 13125, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Astrid Blaschek
- Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner's Children's Hospital, University of Munich, Lindwurmstraße 4, 80337, Munich, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Edgar Meinl
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - Reinhard Hohlfeld
- Munich Cluster for Systems Neurology, Feodor-Lynen-Str 17, 81377, Munich, Germany.,Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Robert-Rössle-Straße 10, 13125, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin, Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - Alexander U Brandt
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Robert-Rössle-Straße 10, 13125, Berlin, Germany. .,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Department of Neurology, University of California Irvine, 30, 101 The City Dr S, Orange, CA, 92868, USA.
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Marchioninistr. 15, 81377, Munich, Germany.,Data Integration for Future Medicine consortium (DIFUTURE), Ludwig-Maximilians University, Marchioninistr. 15, Munich, 81377, Germany
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128
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Vogrig A, Joubert B, André‐Obadia N, Gigli GL, Rheims S, Honnorat J. Seizure specificities in patients with antibody‐mediated autoimmune encephalitis. Epilepsia 2019; 60:1508-1525. [DOI: 10.1111/epi.16282] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Alberto Vogrig
- French Reference Center for Paraneoplastic Neurological Syndromes Hospital for Neurology and Neurosurgery Pierre Wertheimer Lyon University Hospital Lyon France
- SynatAc Team NeuroMyoGene InstituteINSERM U1217/CNRSUMR5310 Lyon France
- University Claude Bernard Lyon 1, University of Lyon Lyon France
- Clinical Neurology Unit Santa Maria della Misericordia University Hospital Udine Italy
| | - Bastien Joubert
- French Reference Center for Paraneoplastic Neurological Syndromes Hospital for Neurology and Neurosurgery Pierre Wertheimer Lyon University Hospital Lyon France
- SynatAc Team NeuroMyoGene InstituteINSERM U1217/CNRSUMR5310 Lyon France
- University Claude Bernard Lyon 1, University of Lyon Lyon France
| | - Nathalie André‐Obadia
- Department of Functional Neurology and Epileptology Hospital for Neurology and Neurosurgery Pierre Wertheimer Lyon University Hospital Lyon France
- Lyon's Neurosciences Research Center INSERM U1028/CNRSUMR 5292University of Lyon Lyon France
| | - Gian Luigi Gigli
- Clinical Neurology Unit Santa Maria della Misericordia University Hospital Udine Italy
- Department of Medicine (DAME) University of Udine Medical School Udine Italy
- Department of Mathematics, Informatics and Physics (DMIF) University of Udine Udine Italy
| | - Sylvain Rheims
- Department of Functional Neurology and Epileptology Hospital for Neurology and Neurosurgery Pierre Wertheimer Lyon University Hospital Lyon France
- Lyon's Neurosciences Research Center INSERM U1028/CNRSUMR 5292University of Lyon Lyon France
| | - Jérome Honnorat
- French Reference Center for Paraneoplastic Neurological Syndromes Hospital for Neurology and Neurosurgery Pierre Wertheimer Lyon University Hospital Lyon France
- SynatAc Team NeuroMyoGene InstituteINSERM U1217/CNRSUMR5310 Lyon France
- University Claude Bernard Lyon 1, University of Lyon Lyon France
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129
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Cobo-Calvo A, Sepúlveda M, Rollot F, Armangué T, Ruiz A, Maillart E, Papeix C, Audoin B, Zephir H, Biotti D, Ciron J, Durand-Dubief F, Collongues N, Ayrignac X, Labauge P, Thouvenot E, Bourre B, Montcuquet A, Cohen M, Deschamps R, Solà-Valls N, Llufriu S, De Seze J, Blanco Y, Vukusic S, Saiz A, Marignier R. Evaluation of treatment response in adults with relapsing MOG-Ab-associated disease. J Neuroinflammation 2019; 16:134. [PMID: 31266527 PMCID: PMC6607517 DOI: 10.1186/s12974-019-1525-1] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 06/19/2019] [Indexed: 12/21/2022] Open
Abstract
Background Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) are related to several acquired demyelinating syndromes in adults, but the therapeutic approach is currently unclear. We aimed to describe the response to different therapeutic strategies in adult patients with relapsing MOG-Ab-associated disease. Methods This is a retrospective study conducted in France and Spain including 125 relapsing MOG-Ab patients aged ≥ 18 years. First, we performed a survival analysis to investigate the relapse risk between treated and non-treated patients, performing a propensity score method based on the inverse probability of treatment weighting. Second, we assessed the annualised relapse rates (ARR), Expanded Disability Status Scale (EDSS) and visual acuity pre-treatment and on/end-treatment. Results Median age at onset was 34.1 years (range 18.0–67.1), the female to male ratio was 1.2:1, and 96% were Caucasian. At 5 years, 84% (95% confidence interval [CI], 77.1–89.8) patients relapsed. At the last follow-up, 66 (52.8%) received maintenance therapy. Patients initiating immunosuppressants (azathioprine, mycophenolate mophetil [MMF], rituximab) were at lower risk of new relapse in comparison to non-treated patients (HR, 0.41; 95CI%, 0.20–0.82; p = 0.011). Mean ARR (standard deviation) was reduced from 1.05(1.20) to 0.43(0.79) with azathioprine (n = 11; p = 0.041), from 1.20(1.11) to 0.23(0.60) with MMF (n = 11; p = 0.033), and from 1.08(0.98) to 0.43(0.89) with rituximab (n = 26; p = 0.012). Other immunosuppressants (methotrexate/mitoxantrone/cyclophosphamide; n = 5), or multiple sclerosis disease-modifying drugs (MS-DMD; n = 9), were not associated with significantly reduced ARR. Higher rates of freedom of EDSS progression were observed with azathioprine, MMF or rituximab. Conclusion In adults with relapsing MOG-Ab-associated disease, immunosuppressant therapy (azathioprine, MMF and rituximab) is associated with reduced risk of relapse and better disability outcomes. Such an effect was not found in the few patients treated with MS-DMD. Electronic supplementary material The online version of this article (10.1186/s12974-019-1525-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alvaro Cobo-Calvo
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, 59 boulevard Pinel, 69677 Bron cedex, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Lyon, France
| | - María Sepúlveda
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Fabien Rollot
- Faculté de Médecine Lyon-Est, Université Claude Bernard Lyon 1, Lyon, France.,Observatoire Francais de la Sclérose En Plaques (OFSEP), Hôpital Pierre-Wertheimer, Bron, France
| | - Thais Armangué
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Pediatric Neuroimmunology Unit, Department of Neurology, Sant Joan de Deu Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Anne Ruiz
- Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, 59 boulevard Pinel, 69677 Bron cedex, Lyon, France
| | - Elisabeth Maillart
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Caroline Papeix
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Bertrand Audoin
- Aix Marseille University, APHM, Hôpital de La Timone, Pôle de Neurosciences Cliniques, Service de Neurologie, Marseille, France
| | - Helene Zephir
- Pôle des Neurosciences et de l'Appareil Locomoteur, CHU de Lille, Université de Lille, LIRIC, UMR 995, Lille, France
| | - Damien Biotti
- Department of Neurology, Hôpital Pierre-Paul Riquet, University Hospital of Toulouse, Toulouse, France
| | - Jonathan Ciron
- Department of Neurology, Hôpital Pierre-Paul Riquet, University Hospital of Toulouse, Toulouse, France
| | - Francoise Durand-Dubief
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France
| | - Nicolas Collongues
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France
| | - Xavier Ayrignac
- Multiple Sclerosis Clinic, Montpellier University Hospital, Montpellier, France
| | - Pierre Labauge
- Multiple Sclerosis Clinic, Montpellier University Hospital, Montpellier, France
| | - Eric Thouvenot
- Department of Neurology, Hôpital Carémeau, Nimes University Hospital, Nimes, France
| | - Bertrand Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | | | - Mikael Cohen
- Université Côte d'Azur, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Service de Neurologie, Nice, France
| | - Romain Deschamps
- Department of Neurology, Fondation A. De Rothschild, Paris, France
| | - Nuria Solà-Valls
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sara Llufriu
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Jerome De Seze
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France
| | - Yolanda Blanco
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Lyon, France
| | - Albert Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France. .,Lyon Neuroscience Research Center, U1028 INSERM, UMR5292 CNRS, FLUID Team, 59 boulevard Pinel, 69677 Bron cedex, Lyon, France. .,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Lyon, France.
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130
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Fujimori J, Takahashi T, Matsumoto Y, Fujihara K, Takai Y, Misu T, Nakashima I. Two Japanese cases of anti-MOG antibody-associated encephalitis that mimicked neuro-Behçet's disease. J Neuroimmunol 2019; 334:577002. [PMID: 31279093 DOI: 10.1016/j.jneuroim.2019.577002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 06/17/2019] [Accepted: 06/27/2019] [Indexed: 11/17/2022]
Abstract
Recently, we documented two Japanese cases of myelin-oligodendrocyte glycoprotein (MOG) antibody-associated relapsing encephalitis among patients who had been diagnosed with probable neuro-Behçet's disease (NBD). They presented partial systemic BD symptoms, brainstem lesions, and the human leukocyte antigen (HLA) B51 allele and responded well to steroid therapy. Our cases suggest that we need to differentiate anti-MOG antibody-associated encephalitis from probable NBD because both disorders can present with brainstem or cerebral lesions, CSF pleocytosis, and elevated levels of CSF IL-6 and respond to steroid treatment. Furthermore, oral ulceration, skin lesions, and HLA-B51 might be observed nonspecifically in patients with anti-MOG antibody-associated encephalitis.
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Affiliation(s)
- Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Yuki Matsumoto
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, School of Medicine and Multiple Sclerosis, Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuro Misu
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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131
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MRI features of demyelinating disease associated with anti-MOG antibodies in adults. J Neuroradiol 2019; 46:312-318. [PMID: 31228536 DOI: 10.1016/j.neurad.2019.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 11/20/2022]
Abstract
The spectrum of Myelin Oligodendrocytes Glycoprotein (MOG) antibody disease constitutes a recently described challenging entity, referring to a relatively new spectrum of autoimmune disorders with antibodies against MOG predominantly involving the optic nerve and spinal cord. The purpose of this article is to describe MRI features of MOG-AD involvement in the optic nerves, spinal cord and the brain of adults.
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132
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Oertel FC, Schließeit J, Brandt AU, Paul F. Cognitive Impairment in Neuromyelitis Optica Spectrum Disorders: A Review of Clinical and Neuroradiological Features. Front Neurol 2019; 10:608. [PMID: 31258505 PMCID: PMC6587817 DOI: 10.3389/fneur.2019.00608] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 05/22/2019] [Indexed: 12/21/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are mostly relapsing autoimmune inflammatory disorders of the central nervous system (CNS) with optic neuritis, myelitis, and brainstem syndromes as clinical hallmarks. With a reported prevalence of up to 70%, cognitive impairment is frequent, but often unrecognized and an insufficiently treated burden of the disease. The most common cognitive dysfunctions are decline in attention and memory performance. Magnetic resonance imaging can be used to access structural correlates of neuropsychological disorders. Cognitive impairment is not only a highly underestimated symptom in patients with NMOSD, but potentially also a clinical correlate of attack-independent changes in NMOSD, which are currently under debate. This article reviews cognitive impairment in NMOSD and discusses associations between structural changes of the CNS and cognitive deficits.
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Affiliation(s)
- Frederike Cosima Oertel
- NeuroCure Clinical Research Center, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jana Schließeit
- NeuroCure Clinical Research Center, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, Netherlands
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California, Irvine, Irvine, CA, United States
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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133
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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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134
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de Mol CL, Wong Y, van Pelt ED, Wokke B, Siepman T, Neuteboom RF, Hamann D, Hintzen RQ. The clinical spectrum and incidence of anti-MOG-associated acquired demyelinating syndromes in children and adults. Mult Scler 2019; 26:806-814. [PMID: 31094288 PMCID: PMC7294530 DOI: 10.1177/1352458519845112] [Citation(s) in RCA: 133] [Impact Index Per Article: 26.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Objectives: The aim of this study was to assess the Dutch nationwide incidence of myelin oligodendrocyte glycoprotein (MOG)-IgG-associated acquired demyelinating syndromes (ADS) and to describe the clinical and serological characteristics of these patients. Methods: All serum samples for routine diagnostics from February 2014 to December 2017 were sent to the single central reference laboratory for the full-length MOG-IgG cell-based assay (CBA) in the Netherlands. Clinical data from patients known in our National ADS centre were available. Results: A total of 1414 samples of 1277 patients were received; of these, 92 patients (7%) were MOG-IgG-seropositive. The mean incidence was 0.16/100,000 people, with higher seropositivity in children (0.31/100,000) than in adults (0.13/100,000). In MOG-IgG-positive patients at the National ADS centre (61/92, 66%), the most common presenting phenotype is acute disseminated encephalomyelitis (ADEM, 56%) in children and optic neuritis (ON, 44%) in adults. Relapsing disease occurred in 9/34 (26%) children and 11/27 (41%) adults during median follow-up of 27.5 months. Patients were tested MOG-IgG-positive >200 months after the initial attack, suggesting an extended time to first relapse (TTFR). Longitudinal analysis of MOG-IgG (25/61, 41%) showed that 67% of the monophasic patients remain seropositive and 60% in relapsing patients. Majority of seronegative patients had no relapses (89%). Conclusion: This nationwide study shows that the overall incidence of MOG-IgG-seropositive disorders is 0.16 per 100,000 people. The distribution over the clinical phenotypes differs between adults and children. Seropositivity can be maintained over years even without clinical activity, while seronegative patients generally had no relapses.
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Affiliation(s)
- C L de Mol
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Yym Wong
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - E D van Pelt
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Bha Wokke
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - Tam Siepman
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
| | - R F Neuteboom
- Department of Paediatric Neurology, Erasmus MC, Rotterdam, The Netherlands
| | - D Hamann
- Department of Immunopathology and Blood Coagulation, Sanquin Diagnostic Services, Amsterdam, The Netherlands
| | - R Q Hintzen
- Department of Neurology, MS Centre ErasMS, Erasmus MC, Rotterdam, The Netherlands
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135
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Ramanathan S, O'grady GL, Malone S, Spooner CG, Brown DA, Gill D, Brilot F, Dale RC. Isolated seizures during the first episode of relapsing myelin oligodendrocyte glycoprotein antibody-associated demyelination in children. Dev Med Child Neurol 2019; 61:610-614. [PMID: 30221764 DOI: 10.1111/dmcn.14032] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/01/2018] [Indexed: 11/27/2022]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibodies have a strong association with acute disseminated encephalomyelitis (ADEM) in children, and bilateral and recurrent optic neuritis in children and adults. Recent reports suggest that seizures and encephalopathy may occur in children and adults with MOG antibody-associated disease. We describe the clinical, laboratory, and radiological course of four MOG antibody-positive children who first presented with isolated seizures without fulfilling clinical or radiological criteria for ADEM or other central nervous system demyelination syndromes, who months to years later developed more typical demyelination. This case series highlights a novel observation that isolated seizures in the absence of ADEM may be the index presentation for MOG antibody-associated disease, which should therefore be considered a form of autoimmune epilepsy. It would be reasonable to test for MOG antibodies in children with seizures accompanied by subtle inflammatory changes on magnetic resonance imaging or cerebrospinal fluid analyses, particularly if followed by demyelination, given the clinical and therapeutic implications of an expedited diagnosis in minimizing long-term disability. WHAT THIS PAPER ADDS: Isolated seizures in the absence of acute disseminated encephalomyelitis may be the index presentation for myelin oligodendrocyte glycoprotein antibody-associated demyelination.
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Affiliation(s)
- Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Gina L O'grady
- Paediatric Neuroservices, Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Stephen Malone
- Department of Neurosciences, Lady Cilento Children's Hospital, South Brisbane, QLD, Australia
| | - Claire G Spooner
- Paediatric Neuroservices, Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - David A Brown
- New South Wales Health Pathology, ICPMR, Westmead, NSW, Australia.,Westmead Institute for Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Deepak Gill
- TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, NSW, Australia.,Epilepsy and Movement Disorders Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Applied Medical Sciences, University of Sydney, Sydney, Australia
| | - Russell C Dale
- Brain Autoimmunity Group, Kids Neuroscience Centre at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,TY Nelson Department of Neurology and Neurosurgery, Children's Hospital at Westmead, Sydney, NSW, Australia.,Epilepsy and Movement Disorders Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, NSW, Australia.,Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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136
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Fang L, Kang X, Wang Z, Wang S, Wang J, Zhou Y, Chen C, Sun X, Yan Y, Kermode AG, Peng L, Qiu W. Myelin Oligodendrocyte Glycoprotein-IgG Contributes to Oligodendrocytopathy in the Presence of Complement, Distinct from Astrocytopathy Induced by AQP4-IgG. Neurosci Bull 2019; 35:853-866. [PMID: 31041694 DOI: 10.1007/s12264-019-00375-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 01/18/2019] [Indexed: 12/14/2022] Open
Abstract
Immunoglobulin G against myelin oligodendrocyte glycoprotein (MOG-IgG) is detectable in neuromyelitis optica spectrum disorder (NMOSD) without aquaporin-4 IgG (AQP4-IgG), but its pathogenicity remains unclear. In this study, we explored the pathogenic mechanisms of MOG-IgG in vitro and in vivo and compared them with those of AQP4-IgG. MOG-IgG-positive serum induced complement activation and cell death in human embryonic kidney (HEK)-293T cells transfected with human MOG. In C57BL/6 mice and Sprague-Dawley rats, MOG-IgG only caused lesions in the presence of complement. Interestingly, AQP4-IgG induced astroglial damage, while MOG-IgG mainly caused myelin loss. MOG-IgG also induced astrocyte damage in mouse brains in the presence of complement. Importantly, we also observed ultrastructural changes induced by MOG-IgG and AQP4-IgG. These findings suggest that MOG-IgG directly mediates cell death by activating complement in vitro and producing NMOSD-like lesions in vivo. AQP4-IgG directly targets astrocytes, while MOG-IgG mainly damages oligodendrocytes.
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Affiliation(s)
- Ling Fang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Xinmei Kang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Zhen Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest China, College of Life Sciences, Shaanxi Normal University, Xi'an, 710119, China
| | - Shisi Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Jingqi Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Yifan Zhou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Chen Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
| | - Yaping Yan
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest China, College of Life Sciences, Shaanxi Normal University, Xi'an, 710119, China
| | - Allan G Kermode
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China
- Department of Neurology, Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Sir Charles Gairdner Hospital, University of Western Australia, Perth, WA, 6009, Australia
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China.
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510000, China.
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137
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Zhong X, Zhou Y, Chang Y, Wang J, Shu Y, Sun X, Peng L, Lau AY, Kermode AG, Qiu W. Seizure and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Encephalomyelitis in a Retrospective Cohort of Chinese Patients. Front Neurol 2019; 10:415. [PMID: 31080435 PMCID: PMC6497765 DOI: 10.3389/fneur.2019.00415] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 04/04/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Myelin oligodendrocyte glycoprotein (MOG) antibody associated encephalomyelitis is increasingly being considered a distinct disease entity, with seizures and encephalopathy commonly reported. We investigated the clinical features of MOG-IgG positive patients presenting with seizures and/or encephalopathy in a single cohort. Methods: Consecutive patients with suspected idiopathic inflammatory demyelinating diseases were recruited from a tertiary University hospital in Guangdong province, China. Subjects with MOG-IgG seropositivity were analyzed according to whether they presented with or without seizure and/or encephalopathy. Results: Overall, 58 subjects seropositive for MOG-IgG were analyzed, including 23 (40%) subjects presenting with seizures and/or encephalopathy. Meningeal irritation (P = 0.030), fever (P = 0.001), headache (P = 0.001), nausea, and vomiting (P = 0.004) were more commonly found in subjects who had seizures and/or encephalopathy, either at presentation or during the disease course. Nonetheless, there was less optic nerve (4/23, 17.4%, P = 0.003) and spinal cord (6/16, 37.5%, P = 0.037) involvement as compared to subjects without seizures or encephalopathy. Most MOG encephalomyelitis subjects had cortical/subcortical lesions: 65.2% (15/23) in the seizures and/or encephalopathy group and 50.0% (13/26) in the without seizures or encephalopathy group. Cerebrospinal fluid (CSF) leukocytes were elevated in both groups. Subgroup analysis showed that 30% (7/23) MOG-IgG positive subjects with seizures and/or encephalopathy had been misdiagnosed for central nervous system infection on the basis of meningoencephalitis symptoms and elevated CSF leukocytes (P = 0.002). Conclusions: Seizures and encephalopathy are not rare in MOG encephalomyelitis, and are commonly associated with cortical and subcortical brain lesions. MOG-encephalomyelitis often presents with clinical meningoencephalitis symptoms and abnormal CSF findings mimicking central nervous system infection in pediatric and young adult patients.
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Affiliation(s)
- Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yifan Zhou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanyu Chang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingqi Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Shu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Alexander Y Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China
| | - Allan G Kermode
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perth, WA, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, WA, Australia.,Institute of Immunology and Infectious Diseases, Murdoch University, Perth, WA, Australia
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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138
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Cobo-Calvo A, Ruiz A, Marignier R. Myelin oligodendrocyte glycoprotein antibody associated disease: about the importance of diagnostic assays and selection of the target population in retrospective studies. Eur J Neurol 2019; 26:e58-e59. [PMID: 30980491 DOI: 10.1111/ene.13896] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/20/2018] [Indexed: 11/28/2022]
Affiliation(s)
- A Cobo-Calvo
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Lyon's Neuroscience Research Center, U1028 INSERM, UMR5292, CNRS, FLUID Team, Lyon, France
| | - A Ruiz
- Lyon's Neuroscience Research Center, U1028 INSERM, UMR5292, CNRS, FLUID Team, Lyon, France
| | - R Marignier
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Lyon's Neuroscience Research Center, U1028 INSERM, UMR5292, CNRS, FLUID Team, Lyon, France
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139
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Salama S, Khan M, Pardo S, Izbudak I, Levy M. MOG antibody-associated encephalomyelitis/encephalitis. Mult Scler 2019; 25:1427-1433. [PMID: 30907249 DOI: 10.1177/1352458519837705] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody disease is a rare autoimmune disorder with antibodies against the MOG predominantly involving the optic nerve and spinal cord leading to vision loss and paralysis. When MOG antibody disease involves the brain, the phenotype is similar to acute disseminated encephalomyelitis (ADEM). In this review, we discuss MOG-positive cases presenting with encephalitis, encephalopathy, or ADEM-like presentation based on recently published series.
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Affiliation(s)
- Sara Salama
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA/Department of Neurology, University of Alexandria, Alexandria, Egypt
| | - Majid Khan
- Department of Neuroradiology, Johns Hopkins University, Baltimore, MD, USA
| | - Santiago Pardo
- Department of Neurology,Johns Hopkins University,Baltimore, MD,USA
| | - Izlem Izbudak
- Department of Neuroradiology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA/Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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140
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Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon antibody-mediated disease of the central nervous system. Long segments of spinal cord inflammation (myelitis), severe optic neuritis, and/or bouts of intractable vomiting and hiccoughs (area postrema syndrome) are classic presentations of the disease and may alert the clinician to the diagnosis. Untreated, approximately 50% of NMOSD patients will be wheelchair users and blind, and a third will have died within 5 years of their first attack. Unlike multiple sclerosis, a progressive clinical course is very unusual and the accrual of disability is related to relapses. Approximately 75% of patients have antibodies against aquaporin-4, a water channel expressed on astrocytes. Relapses are treated aggressively to prevent residual disability with high-dose steroids and often plasma exchange. Relapse prevention is crucial and achieved with long-term immunosuppression. In this article we review the pathogenesis, clinical features, diagnosis and management of NMOSD.
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Affiliation(s)
- Saif Huda
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Dan Whittam
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | | | - Anu Jacob
- Walton Centre NHS Foundation Trust, Liverpool, UK
- Walton Centre NHS Foundation Trust, Liverpool, UK
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141
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Salama S, Pardo S, Levy M. Clinical characteristics of myelin oligodendrocyte glycoprotein antibody neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2019; 30:231-235. [PMID: 30825703 DOI: 10.1016/j.msard.2019.02.023] [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: 11/01/2018] [Revised: 02/19/2019] [Accepted: 02/21/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Serological antibodies against myelin oligodendrocyte glycoprotein (MOG) are associated with a relapsing autoimmune demyelinating disease of the central nervous system. Initially identified in the context of acute disseminated encephalomyelitis, persistent seropositivity of MOG antibodies is now recognized as a variant of neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVES The aim of the study is to describe the epidemiological and clinical features of MOG antibody positive cases and compare our findings with those previously published. METHODS This is a retrospective descriptive study of 23 patients with MOG antibody disease who were cared for at Johns Hopkins Hospital over the period from 2015 to 2018. MOG testing was done at Johns Hopkins using the cell based assay (CBA). We describe their epidemiological and clinical features. RESULTS Twenty-three patients were included in the study with a female to male ratio of 2.3:1. The mean age of the cohort was 42.6 years, while the mean age at onset was 37 years. The most frequent initial presentation was optic neuritis, followed by ADEM-like encephalopathic clinical picture and transverse myelitis. Five patients showed a monophasic disease course while the rest experienced a relapsing phenotype. Nine patients (39%) experienced immediate relapses on withdrawal of steroids. CONCLUSIONS Our cohort showed clinical characteristics comparable with previously published reports of MOG antibody disease worldwide. Unique features of MOG antibody disease are: high frequency of optic neuritis attacks, good long term neurological recovery and sensitivity to steroid use and withdrawal.
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Affiliation(s)
- Sara Salama
- Department of Neurology, University of Alexandria, Alexandria, Egypt; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Santiago Pardo
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA
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142
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Rossor T, Benetou C, Wright S, Duignan S, Lascelles K, Robinson R, Das K, Ciccarelli O, Wassmer E, Hemingway C, Lim M, Hacohen Y. Early predictors of epilepsy and subsequent relapse in children with acute disseminated encephalomyelitis. Mult Scler 2019; 26:333-342. [DOI: 10.1177/1352458518823486] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective: To identify predictors of epilepsy and clinical relapses in children presenting with acute disseminated encephalomyelitis (ADEM). Methods: Children presenting with ADEM between 2005 and 2017 and tested clinically for MOG-Ab were identified from three tertiary paediatric neurology centres in the United Kingdom. Patients were followed up for a median of 6 years (range, 1–16 years). Results: A total of 74 children were studied (38 females; median age at first presentation: 4.5 years (range, 1.4–16 years)). MOG-Ab was positive in 50/74 (67.6%) of cases, and 27 (54%) of MOG-Ab positive children presented with a neurological relapse over time. MOG-Ab was more frequently positive in the relapsing group than in the monophasic group (27/31 vs 23/43; odds ratio 5.9 (95% CI: 1.8–19.7); p = 0.002). 16/74 (22%) children had seizures during the acute presentation with ADEM and 12/74 (16.2%) patients were diagnosed with post-ADEM epilepsy. The diagnosis of post-ADEM epilepsy was more frequently observed in children with relapsing disease than monophasic disease (10/31 vs 2/43; odds ratio 9.8 (95% confidence interval (CI): 2.0–48.7); p = 0.003), in children who had positive intrathecal oligoclonal bands than those with negative bands (4/7 vs 4/30; odds ratio 8.7 (95% CI: 1.4–54.0); p = 0.027) and in children who had positive MOG-Ab than negative MOG-Ab cases (11/12 vs 39/62; odds ratio 6.5 (95% CI:0.8–53.6); p = 0.051). Conclusion: A higher relapse rate and a greater risk of post-ADEM epilepsy in children with MOG-Ab-associated disease may indicate a chronic disease with immune-mediated seizures in these children.
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Affiliation(s)
- Thomas Rossor
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Christina Benetou
- Children’s Neurosciences, Evelina London Children’s Hospital @ Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, London, UK
| | - Sukhvir Wright
- Department of Neurology, Birmingham Children’s Hospital, Birmingham, UK
| | - Sophie Duignan
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Karine Lascelles
- Children’s Neurosciences, Evelina London Children’s Hospital @ Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, London, UK
| | - Robert Robinson
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Krishna Das
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | | | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ming Lim
- Children’s Neurosciences, Evelina London Children’s Hospital @ Guy’s and St. Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, London, UK; Faculty of Life Sciences & Medicine, King’s College London, London, UK
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK; Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
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143
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Geis C, Planagumà J, Carreño M, Graus F, Dalmau J. Autoimmune seizures and epilepsy. J Clin Invest 2019; 129:926-940. [PMID: 30714986 DOI: 10.1172/jci125178] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
The rapid expansion in the number of encephalitis disorders associated with autoantibodies against neuronal proteins has led to an incremental increase in use of the term "autoimmune epilepsy," yet has occurred with limited attention to the physiopathology of each disease and genuine propensity to develop epilepsy. Indeed, most autoimmune encephalitides present with seizures, but the probability of evolving to epilepsy is relatively small. The risk of epilepsy is higher for disorders in which the antigens are intracellular (often T cell-mediated) compared with disorders in which the antigens are on the cell surface (antibody-mediated). Most autoantibodies against neuronal surface antigens show robust effects on the target proteins, resulting in hyperexcitability and impairment of synaptic function and plasticity. Here, we trace the evolution of the concept of autoimmune epilepsy and examine common inflammatory pathways that might lead to epilepsy. Then, we focus on several antibody-mediated encephalitis disorders that associate with seizures and review the synaptic alterations caused by patients' antibodies, with emphasis on those that have been modeled in animals (e.g., antibodies against NMDA, AMPA receptors, LGI1 protein) or in cultured neurons (e.g., antibodies against the GABAb receptor).
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Affiliation(s)
- Christian Geis
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jesus Planagumà
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and
| | - Mar Carreño
- Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Francesc Graus
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and.,Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Josep Dalmau
- Institut D'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and.,Hospital Clinic, University of Barcelona, Barcelona, Spain.,Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Cobo-Calvo A, Ayrignac X, Kerschen P, Horellou P, Cotton F, Labauge P, Vukusic S, Deiva K, Serguera C, Marignier R. Cranial nerve involvement in patients with MOG antibody-associated disease. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e543. [PMID: 30800725 PMCID: PMC6384017 DOI: 10.1212/nxi.0000000000000543] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/07/2018] [Indexed: 12/16/2022]
Abstract
Objective To describe clinical and radiologic features of cranial nerve (CN) involvement in patients with myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) and to assess the potential underlying mechanism of CN involvement using a nonhuman primate (NHP) model. Methods Epidemiologic, clinical, and radiologic features from a national cohort of 273 MOG-IgG–positive patients were retrospectively reviewed for CN involvement between January 2014 and January 2018. MOG-IgG binding was evaluated in CNS, CN, and peripheral nerve tissues from NHP. Results We identified 3 MOG-IgG–positive patients with radiologic and/or clinical CN involvement. Two patients displayed either trigeminal or vestibulocochlear nerve lesions at the root level, and the remaining patient had an oculomotor nerve involvement at the root exit and at the cisternal level. Additional CNS involvement was found in all 3 patients. None of the 3 patients' sera recognized MOG expression in CN of NHP. Conclusion Craneal nerve involvement can coexist in patients with MOG antibody disease, although the underlying pathophysiology remains elusive.
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Affiliation(s)
- Alvaro Cobo-Calvo
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Xavier Ayrignac
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Philippe Kerschen
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Philippe Horellou
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Francois Cotton
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Pierre Labauge
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Sandra Vukusic
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Kumaran Deiva
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Ché Serguera
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
| | - Romain Marignier
- Service de neurologie (A.C.-C., S.V., R.M.), sclérose en plaques, pathologies de la myéline et neuroinflammation and Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, France; Lyon Neuroscience Research Center (A.C.-C., R.M.), U1028 INSERM, UMR5292 CNRS, FLUID Team, Lyon, France; Service de sclérose en plaques (X.A., P.L.), Hôpital Universitaire de Montpellier, France; Service de Neurologie (P.K.), Centre hospitalier de Luxembourg; Inserm (P.H.), U 1184, Center for Immunology of Viral Infections and Autoimmune Diseases, Université Paris-Sud 11, CEA, DSV/iMETI, Division of Immuno-Virology, IDMIT, Faculté de médecine, Le Kremlin-Bicêtre Cedex, France; Service de Radiologie (F.C.), Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France; Université Claude Bernard Lyon 1 (F.C., S.V., R.M.), F-69100 Villeurbanne, France; Lyon's Neuroscience Research Center (S.V.), Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR5292, Lyon, France; Service de neurologie pédiatrique (K.D.), Centre de référence pour les maladies inflammatoires rares du cerveau et de la moelle, Le Kremlin-Bicêtre, France; and INSERM US27 MIRCen (C.S.), CEA, Fontenay-aux-Roses, France
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Abstract
Purpose of review The purpose of this review is to summarize current understanding regarding the treatment of myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated demyelination in children. Emphasis is placed on the unique obstacles we face when predicting the risk of relapse and the important implications of such challenges when planning treatment protocols. Recent findings MOG-Abs are consistently identified in a range of acquired demyelinating syndromes (ADS) in adults and children with a clinical phenotype distinct of MS and AQP4-Ab neuromyelitis optica spectrum disorder. Although initially thought to be associated with a benign disease, recent reports of children who are treatment-resistant and developed progressive disability over time raise important questions about how children with relapsing MOG-Ab disease should be managed. Summary MOG-Abs are common in children with ADS with both monophasic and relapsing disease courses. Treatment of patients with MOG-Ab-associated demyelination includes management of acute relapses and chronic immunotherapy for those with relapsing disease. Emerging consensus supports distinction of treatment strategies from those typically used for relapsing remitting MS, and several groups debate whether to follow treatment protocols akin to those for AQP4-Ab NMOSD. A key challenge remains predicting the severity of the disease at onset. Collaborative international consensus to derive shared clinical evaluative platforms standardized biological and neuroimaging protocols which can be used clinically, and partnered research programs are required to advance personalized treatment for children with MOG-Ab-associated demyelination.
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146
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Salama S, Khan M, Levy M, Izbudak I. Radiological characteristics of myelin oligodendrocyte glycoprotein antibody disease. Mult Scler Relat Disord 2019; 29:15-22. [PMID: 30658259 DOI: 10.1016/j.msard.2019.01.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/02/2019] [Accepted: 01/07/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND MOG antibody disease is an autoimmune disease of the central nervous system (CNS) characterized by the presence of a serological antibody against myelin oligodendrocyte glycoprotein (MOG). MRI is instrumental in distinguishing neuromyelitis optica spectrum disorder (NMOSD) from multiple sclerosis (MS), but MRI features of MOG disease appear to overlap with NMOSD and MS. OBJECTIVES In this study we aim to characterize the radiological features of MOG antibody disease and compare the findings with those previously described. METHODS This is a retrospective study of 26 MOG positive patients. We aim to describe their brain, spinal and orbital MRI features and compare our findings with those previously reported in the literature. RESULTS The majority of the abnormal findings was located on orbital MRIs, with more involvement of the anterior structures and bilateral involvement of the optic nerves. Brain abnormalities were distinct from both NMOSD and MS lesions. Spinal cord was the least affected. CONCLUSIONS This is a dedicated radiological study aiming to characterize the features of MOG antibody disease which might aid in the proper investigation of cases presenting with acquired demyelinating disorders.
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Affiliation(s)
- Sara Salama
- Department of Neurology, University of Alexandria, Alexandria, Egypt; Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Majid Khan
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Levy
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA; Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Izlem Izbudak
- Department of Radiology, Johns Hopkins University, Baltimore, MD, USA
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147
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Katsuse K, Kurihara M, Sugiyama Y, Kodama S, Takahashi M, Momose T, Yumoto M, Kaneko K, Takahashi T, Kubota A, Hayashi T, Toda T. Aphasic status epilepticus preceding tumefactive left hemisphere lesion in anti-MOG antibody associated disease. Mult Scler Relat Disord 2019; 27:91-94. [DOI: 10.1016/j.msard.2018.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 10/11/2018] [Accepted: 10/14/2018] [Indexed: 11/16/2022]
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148
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Oertel FC, Zimmermann HG, Brandt AU, Paul F. Novel uses of retinal imaging with optical coherence tomography in multiple sclerosis. Expert Rev Neurother 2018; 19:31-43. [PMID: 30587061 DOI: 10.1080/14737175.2019.1559051] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Introduction: Multiple Sclerosis (MS) is the most common chronic autoimmune neuroinflammatory condition in young adults. It is often accompanied by optic neuritis (ON) and retinal neuro-axonal damage causing visual disturbances. Optical coherence tomography (OCT) is a sensitive non-invasive method for quantifying intraretinal layer volumes. Recently, OCT not only showed to be a reliable marker for ON-associated damage, but also proved its high prognostic value for functional outcome and disability accrual in patients with MS. Consequently, OCT is discussed as a potential marker for monitoring disease severity and therapeutic response in individual patients. Areas covered: This article summarizes our current understanding of structural retinal changes in MS and describes the future potential of OCT for differential diagnosis, monitoring of the disease course and for clinical trials. Expert commentary: Today, OCT is used in clinical practice in specialized MS centers. Standardized parameters across devices are urgently needed for supporting clinical utility. Novel parameters are desirable to increase sensitivity and specificity in terms of MS.
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Affiliation(s)
- Frederike C Oertel
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Hanna G Zimmermann
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
| | - Alexander U Brandt
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,b Department of Neurology , University of California Irvine , Irvine , CA , USA
| | - Friedemann Paul
- a NeuroCure Clinical Research Center , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,c Department of Neurology , Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany.,d Experimental and Clinical Research Center , Max-Delbrück-Centrum für Molekulare Medizin and Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health , Berlin , Germany
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149
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Bhattacharyya S. Autoantibodies in neuropsychiatric lupus: still looking. Rheumatology (Oxford) 2018; 58:746-747. [DOI: 10.1093/rheumatology/key354] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Shamik Bhattacharyya
- Department of Neurology, Brigham and Women’s Hospital
- Department of Neurology, Harvard Medical School, Boston, MA, USA
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150
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Wynford-Thomas R, Jacob A, Tomassini V. Neurological update: MOG antibody disease. J Neurol 2018; 266:1280-1286. [PMID: 30569382 PMCID: PMC6469662 DOI: 10.1007/s00415-018-9122-2] [Citation(s) in RCA: 140] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/25/2022]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOG-AD) is now recognised as a nosological entity with specific clinical and paraclinical features to aid early diagnosis. Although no age group is exempt, median age of onset is within the fourth decade of life, with optic neuritis being the most frequent presenting phenotype. Disease course can be either monophasic or relapsing, with subsequent relapses most commonly involving the optic nerve. Residual disability develops in 50-80% of patients, with transverse myelitis at onset being the most significant predictor of long-term outcome. Recent advances in MOG antibody testing offer improved sensitivity and specificity. To avoid misdiagnosis, MOG antibody testing should be undertaken in selected cases presenting clinical and paraclinical features that are felt to be in keeping with MOG-AD, using a validated cell-based assay. MRI characteristics can help in differentiating MOG-AD from other neuroinflammatory disorders, including multiple sclerosis and neuromyelitis optica. Cerebrospinal fluid oligoclonal bands are uncommon. Randomised control trials are limited, but observational open-label experience suggests a role for high-dose steroids and plasma exchange in the treatment of acute attacks, and for immunosuppressive therapies, such as steroids, oral immunosuppressants and rituximab as maintenance treatment.
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Affiliation(s)
- Ray Wynford-Thomas
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK.,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK
| | - Anu Jacob
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Valentina Tomassini
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, University Hospital of Wales, Heath Park, Cardiff, CF14 4XN, UK. .,Helen Durham Centre for Neuroinflammation, University Hospital of Wales, Cardiff, UK. .,Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff, UK.
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