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Carra-Dallière C, Rollot F, Deschamps R, Ciron J, Vukusic S, Audoin B, Ruet A, Maillart E, Papeix C, Zephir H, Laplaud D, Cohen M, Bourre B, El-Bahi I, Labauge P, Casey R, Ayrignac X, Marignier R. Pregnancy and post-partum in patients with myelin-oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2023; 29:270-276. [PMID: 36453174 DOI: 10.1177/13524585221134214] [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: 12/03/2022]
Abstract
BACKGROUND AND OBJECTIVE Myelin-oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) frequently initiates during childbearing years. This study investigated the impact of pregnancy and post-partum on MOGAD activity. METHODS Retrospective analysis of clinical and demographic data from a multicenter French cohort of adult patients with MOGAD. All adult female patients who had a pregnancy after disease onset or in the year before disease onset were included. The annualized relapse rate was evaluated in patients who had a pregnancy after disease onset, to evaluate the impact of pregnancy and post-partum on MOGAD course. RESULTS Twenty-five informative pregnancies after disease onset were identified. No relapse was recorded during these pregnancies and only three relapses occurred during the first 3 months post-partum. The annualized relapse rate decreased from 0.67 (95% confidence interval: 0.40-1.10) during the pre-pregnancy period to 0 (95% confidence interval: 0-0.21) during pregnancy and to 0.22 (95% confidence interval: 0.09-0.53) during the first year post-partum. Among 144 female patients in their childbearing age recorded in the database, 18 (12.5%) reported their first symptoms during pregnancy or in the 12 months post-partum. DISCUSSION Our study suggests a marked reduction of MOGAD relapse rate during pregnancy and the post-partum period. Prospective studies on the role of pregnancy and delivery in MOGAD course are needed.
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Affiliation(s)
- Clarisse Carra-Dallière
- Department of Neurology, CRC-SEP, Montpellier University Hospital, Montpellier, France/Institute for Neurosciences of Montpellier (INM), INSERM and University of Montpellier, Montpellier, France
| | - Fabien Rollot
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France/Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR 5292, Centre de Recherche en Neurosciences de Lyon, Bron, France/Eugene Devic Edmus Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Romain Deschamps
- Department of Neurology, Hospital Fondation Adolphe de Rothschild, Paris, France
| | - Jonathan Ciron
- Department of Neurology, CRC-SEP, CHU Toulouse, Toulouse, France; Infinity, INSERM IMR1291-CNRS UMR5051, University Toulouse III, Toulouse, France
| | - Sandra Vukusic
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France/Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR 5292, Centre de Recherche en Neurosciences de Lyon, Bron, France/Eugene Devic Edmus Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Bertrand Audoin
- Department of Neurology, Hôpital de la Timone, APHM, Marseille, France
| | - Aurélie Ruet
- Department of Neurology, CHU Bordeaux, Bordeaux, France
| | - Elisabeth Maillart
- Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | | | - Hélène Zephir
- Department of Neurology, CHU Lille, INSERM U117, University of Lille, Lille, France
| | | | - Mikael Cohen
- Service de Neurologie, CRCSEP, Unit de Recherche Clinique Cote d'Azur (UR2CA-URRIS), Centre Hospitalier Universitaire Pasteur 2, Nice, France
| | | | - Illiasse El-Bahi
- Institute for Neurosciences of Montpellier (INM), INSERM and University of Montpellier, Montpellier, France
| | - Pierre Labauge
- Department of Neurology, CRC-SEP, Montpellier University Hospital, Montpellier, France/Institute for Neurosciences of Montpellier (INM), INSERM and University of Montpellier, Montpellier, France
| | - Romain Casey
- Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France/Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France/Observatoire Français de la Sclérose en Plaques, INSERM 1028 et CNRS UMR 5292, Centre de Recherche en Neurosciences de Lyon, Bron, France/Eugene Devic Edmus Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Xavier Ayrignac
- Department of Neurology, CRC-SEP, Montpellier University Hospital, Montpellier, France/Institute for Neurosciences of Montpellier (INM), INSERM and University of Montpellier, Montpellier, France
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France; INSERM 1028 et CNRS UMR5292, Centre des Neurosciences de Lyon -FORGETTING team, Bron, France/Université Claude Bernard Lyon 1, Villeurbanne, France
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102
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Maturu MVS, Datla AV, Maturu P, Talla VB, Dalai S. Unilateral Autoimmune Encephalitis: A Case Report on a Rare Manifestation of Myelin Oligodendrocyte Glycoprotein Antibody Disease. Cureus 2023; 15:e34994. [PMID: 36938270 PMCID: PMC10020014 DOI: 10.7759/cureus.34994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2023] [Indexed: 02/16/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG)-associated disease (MOGAD) is a rare, antibody-mediated inflammatory demyelinating disorder of the central nervous system (CNS) that has varying phenotypes. FLAIR (fluid-attenuated inversion recovery)-hyperintense Lesions in Anti-MOG-associated Encephalitis with Seizures (FLAMES) is a much rarer manifestation of cortical encephalitis encountered in MOGAD. We report a rare case of a nine-year-old girl who presented with a drop in her academic performance and right-sided Epilepsia partialis continua. Magnetic resonance imaging (MRI) of the brain detected evidence for unilateral (left) cortical encephalitis with peri-ictal juxtacortical edema. An electroencephalogram revealed a hemi-generalized poly spike and wave discharges in the left hemisphere, several of which correlated with myoclonic jerks. The cerebrospinal fluid (CSF) analysis was normal. Autoimmune workup resulted in a positive serum MOG-immunoglobulin G (IgG), which confirmed the diagnosis of FLAMES. The child showed an excellent clinical response to intravenous methylprednisolone and intravenous immunoglobulins therapy.
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Affiliation(s)
| | | | - Prajwala Maturu
- Psychiatry, Government Hospital for Mental Care, Visakhapatnam, IND
| | - Vinay B Talla
- Neurosurgery, Medicover Hospitals, Visakhapatnam, IND
| | - Sibasankar Dalai
- Interventional Neuroradiology, Medicover Hospitals, Visakhapatnam, IND
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103
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Zeng XD, Chen H, Hu WG. Myelin Oligodendrocyte Glycoprotein (MOG) antibody-associated meningoencephalitis due to Mycoplasma pneumoniae infection. Neurol Res 2023; 45:124-126. [PMID: 36111693 DOI: 10.1080/01616412.2022.2124794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Although myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorders include a wide spectrum of syndromes, manifestations with meningoencephalitis symptoms due to M. pneumoniae infection were quite infrequent. We admitted an 8-years-old girl who presented with recurrent fever accompanied by headache and mild cough, her Cerebral spinal fluid polynucleated cells was elevated and progressively higher, her cranial MRI showed meningeal enhancement initially and multiple intracranial lesions later, serum M. pneumoniae-IgM and MOG-IgG were positive, she was diagnosed with MOG-IgG associated meningoencephalitis due to M. pneumoniae infection, the treatment consisted of intravenous immunoglobulin, glucocorticoid, and erythromycin, then she was completely recovered.
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Affiliation(s)
- Xiang-Dong Zeng
- Department of Pediatric Neurology Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Hui Chen
- Department of Pediatric Neurology Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Wen-Guang Hu
- Department of Pediatric Neurology Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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104
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Wu Y, Zhou H, Ci X, Lin L, Zhang D, Lu J. Clinical characteristic of myelin oligodendrocyte glycoprotein antibody associated cortical encephalitis in adults and outcomes following glucocorticoid therapy. Front Aging Neurosci 2023; 14:1076361. [PMID: 36688157 PMCID: PMC9846213 DOI: 10.3389/fnagi.2022.1076361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023] Open
Abstract
Objective To describe the clinical and radiological features, as well as outcomes following glucocorticoid therapy and recurrence in adults suffering from cortical encephalitis associated with myelin oligodendrocyte glycoprotein (MOG) antibody. Methods The clinical information of nine adult patients suffering from cortical encephalitis associated with MOG antibody admitted to the Affiliated Brain Hospital of Nanjing Medical University from 2020 to 2022 was systematically reviewed. The clinical symptoms, laboratory data, imaging results, outcomes following glucocorticoid therapy and recurrence were evaluated. Result A total of 9 patients positive for MOG antibody and suffering from cortical encephalitis were included in our study (55.6% men, median age 29 years, 15-57 years). The most common clinical symptoms included headache (77.8%), fever (66.7%), and generalized seizures (55.6%). Some patients also experienced limb shaking (22.2%), leg numbness (22.2%), transient motor aphasia (11.1%), and vision loss (11.1%). The main features of cerebrospinal fluid () examination were increased intracranial pressure, pleocytosis, and elevated cerebrospinal fluid (CSF) protein. In addition, N-methyl-D-aspartate receptor (NMDAR) and MOG antibodies were found in the CSF of 3 patients, and NMDAR, MOG, and glial fibrillary acidic protein antibodies were found in the CSF of 1 patient. All patients were subjected to magnetic resonance imaging (MRI) and the images of eight of them showed T2 and/flair image hyperintense lesions, three showed meningeal or lesion enhancement and four showed white matter lesions, which were mostly located in the midline structures (75%). All patients received glucocorticoid therapy in the acute phase and in remission, and eight of them received an intravenous high dose of methylprednisolone, including one patient who received a simultaneous immunoglobulin therapy. One patient was treated with low-dose prednisolone tablets. Seven (77.8%) patients were wholly recovered at discharge, and 2 (22.2%) patients were left with slight symptoms. During the median 9-month follow-up (range: 2-36 months), 2 (22.2%) patients developed recurrence. Conclusion The clinical manifestations of adult MOG antibody-associated cortical encephalitis were significantly different from those of the typical MOG antibody-associated disease (MOGAD). Patients in the acute phase of the disease were prone to show signs similar to central nervous system infection, requiring clinicians to have the ability to recognize the disease to avoid misdiagnosis. In addition, seizures were common in MOG antibody-related encephalitis, and the type of seizures was age-related. Brain MRI results showed that the distribution of cerebral cortex lesions was closely related to the classification of cortical encephalitis. Based on the patient's response to the treatment, glucocorticoid therapy was effective against MOG antibody-associated cortical encephalitis, which is consistent with the treatment response and clinical prognosis of MOGAD. Therefore, our opinion was that MOG antibody might be the "responsible antibody" in MOG antibody-associated cortical encephalitis, although further studies are needed to confirm this hypothesis.
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105
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Branson HM, Longoni G. Clinical Neuroimaging in Pediatric Dysimmune Disorders of the Central Nervous System. Semin Roentgenol 2023; 58:67-87. [PMID: 36732013 DOI: 10.1053/j.ro.2022.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/23/2022] [Accepted: 11/08/2022] [Indexed: 12/12/2022]
Affiliation(s)
- Helen M Branson
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Department of Medical Imaging, Toronto, Ontario, Canada.
| | - Giulia Longoni
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, Toronto, Ontario, Canada; Garry Hurvitz Centre for Brain & Mental Health, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Department of Paediatrics, Toronto, Ontario, Canada
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106
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Guzmán J, Vera F, Soler B, Uribe-San-Martin R, García L, Del-Canto A, Schlatter A, Salazar M, Molt F, Ramirez K, Marín J, Pelayo C, Cruz JP, Bravo-Grau S, Cárcamo C, Ciampi E. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD) in Chile: lessons learned from challenging cases. Mult Scler Relat Disord 2023; 69:104442. [PMID: 36521387 DOI: 10.1016/j.msard.2022.104442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 10/16/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Associated Disease (MOGAD) is an emerging disorder recognized as a clinical entity distinct from Multiple Sclerosis and Aquaporin-4-positive Neuromyelitis Optica Spectrum Disorders (NMOSD-AQP4+), and its phenotypic spectrum continues to expand. Most information about its clinical course has emerged from retrospective studies, and treatment response both in acute and chronic-relapsing disease is still limited. We aimed to describe the clinical and paraclinical characteristics of monophasic and relapsing, paediatric and adult patients with MOGAD under regular clinical care in Chile, highlighting some challenging cases that are far from being considered benign. METHODS Observational, retrospective, and prospective longitudinal multicentre study including patients with positive serum MOG-IgG assessed by cell-based assay. RESULTS We include 35 patients, 71% women, median age at onset 30 years (range 1-68), 23% had paediatric onset, with a median disease-duration 24 months (range 12-348). In the whole cohort, the most frequent symptoms at onset were isolated optic neuritis (ON) (34%) and myelitis (22%). Encephalitis with seizures or encephalomyelitis was the most common presentation in paediatric-onset patients 75% (n = 6), compared to 11% (n = 3) of the adult-onset patients (p < 0.001). A relapsing course was observed in 34%, these patients were younger (25 vs. 34 years, p = 0.004) and with a longer disease duration (64 vs. 6 months, p = 0.004) compared to monophasic patients. Two patients developed encephalitis with seizures/status epilepticus, with concomitant positive CSF anti-NMDAR-IgG. Chronic immunotherapy was ever prescribed in 77%, the most frequent was rituximab (35%). Relapses under chronic immunotherapy occurred in 5/27 patients (18.5%), two of them under rituximab, one paediatric patient who started combined therapy with monthly IVIG and one adult patient that switched to satralizumab plus mycophenolate. The median EDSS at the last follow-up was 1.5 (range 0-6.0). CONCLUSION In Chile, patients with MOGAD exhibit a wide spectrum of clinical presentations at disease onset and during relapses. Close monitoring is needed, particularly in younger patients with short follow-up periods.
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Affiliation(s)
- Jorge Guzmán
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Vera
- Clinical Laboratory, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardita Soler
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology, Hospital Sótero del Río, Santiago, Chile
| | - Reinaldo Uribe-San-Martin
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology, Hospital Sótero del Río, Santiago, Chile
| | - Lorena García
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adolfo Del-Canto
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Fernando Molt
- Neurology, Facultad de Medicina, Universidad Católica del Norte, campus Hospital de Coquimbo, Coquimbo, Chile
| | - Karla Ramirez
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Marín
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Pelayo
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Cruz
- Neuroradiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Claudia Cárcamo
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ethel Ciampi
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology, Hospital Sótero del Río, Santiago, Chile.
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107
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Belova AN, Sheiko GE, Rakhmanova EM, Boyko AN. [Clinical features and modern diagnostic criteria of the disease associated with myelin oligodendrocyte glycoprotein antibody disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:47-56. [PMID: 37994888 DOI: 10.17116/jnevro202312311147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Demyelinating disease of the central nervous system associated with antibodies to myelin oligodendrocyte glycoprotein (MOGAD) has been proposed to be distinguished from neuromyelitis optica spectrum disorders (NMOSD) into a separate nosological form. The basis for the recognition of nosological independence was the presence of clinical features of this disease and the detection of a specific biomarker in the blood serum of patients - IgG class antibodies to MOG. The article summarizes the current data on the clinical and radiological phenotypes of MOGAD in children and adults and the features of the course of the disease. The requirements for the laboratory diagnosis of the disease and diagnostic criteria for MOGAD proposed by an international group of experts in 2023 are given.
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Affiliation(s)
- A N Belova
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - G E Sheiko
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - E M Rakhmanova
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
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108
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Asseyer S, Asgari N, Bennett J, Bialer O, Blanco Y, Bosello F, Camos-Carreras A, Carnero Contentti E, Carta S, Chen J, Chien C, Chomba M, Dale RC, Dalmau J, Feldmann K, Flanagan EP, Froment Tilikete C, Garcia-Alfonso C, Havla J, Hellmann M, Kim HJ, Klyscz P, Konietschke F, La Morgia C, Lana-Peixoto M, Leite MI, Levin N, Levy M, Llufriu S, Lopez P, Lotan I, Lugaresi A, Marignier R, Mariotto S, Mollan SP, Ocampo C, Cosima Oertel F, Olszewska M, Palace J, Pandit L, Peralta Uribe JL, Pittock S, Ramanathan S, Rattanathamsakul N, Saiz A, Samadzadeh S, Sanchez-Dalmau B, Saylor D, Scheel M, Schmitz-Hübsch T, Shifa J, Siritho S, Sperber PS, Subramanian PS, Tiosano A, Vaknin-Dembinsky A, Mejia Vergara AJ, Wilf-Yarkoni A, Zarco LA, Zimmermann HG, Paul F, Stiebel-Kalish H. The Acute Optic Neuritis Network (ACON): Study protocol of a non-interventional prospective multicenter study on diagnosis and treatment of acute optic neuritis. Front Neurol 2023; 14:1102353. [PMID: 36908609 PMCID: PMC9998999 DOI: 10.3389/fneur.2023.1102353] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 01/30/2023] [Indexed: 02/26/2023] Open
Abstract
Optic neuritis (ON) often occurs at the presentation of multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). The recommended treatment of high-dose corticosteroids for ON is based on a North American study population, which did not address treatment timing or antibody serostatus. The Acute Optic Neuritis Network (ACON) presents a global, prospective, observational study protocol primarily designed to investigate the effect of time to high-dose corticosteroid treatment on 6-month visual outcomes in ON. Patients presenting within 30 days of the inaugural ON will be enrolled. For the primary analysis, patients will subsequently be assigned into the MS-ON group, the aquapotin-4-IgG positive ON (AQP4-IgG+ON) group or the MOG-IgG positive ON (MOG-IgG+ON) group and then further sub-stratified according to the number of days from the onset of visual loss to high-dose corticosteroids (days-to-Rx). The primary outcome measure will be high-contrast best-corrected visual acuity (HC-BCVA) at 6 months. In addition, multimodal data will be collected in subjects with any ON (CIS-ON, MS-ON, AQP4-IgG+ON or MOG-IgG+ON, and seronegative non-MS-ON), excluding infectious and granulomatous ON. Secondary outcomes include low-contrast best-corrected visual acuity (LC-BCVA), optical coherence tomography (OCT), magnetic resonance imaging (MRI) measurements, serum and cerebrospinal fluid (CSF) biomarkers (AQP4-IgG and MOG-IgG levels, neurofilament, and glial fibrillary protein), and patient reported outcome measures (headache, visual function in daily routine, depression, and quality of life questionnaires) at presentation at 6-month and 12-month follow-up visits. Data will be collected from 28 academic hospitals from Africa, Asia, the Middle East, Europe, North America, South America, and Australia. Planned recruitment consists of 100 MS-ON, 50 AQP4-IgG+ON, and 50 MOG-IgG+ON. This prospective, multimodal data collection will assess the potential value of early high-dose corticosteroid treatment, investigate the interrelations between functional impairments and structural changes, and evaluate the diagnostic yield of laboratory biomarkers. This analysis has the ability to substantially improve treatment strategies and the accuracy of diagnostic stratification in acute demyelinating ON. Trial registration ClinicalTrials.gov, identifier: NCT05605951.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Jeffrey Bennett
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Omer Bialer
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yolanda Blanco
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, and Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Francesca Bosello
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Anna Camos-Carreras
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | | | - Sara Carta
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - John Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, United States
| | - Claudia Chien
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Mashina Chomba
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Kids Neuroscience Centre, Sydney, NSW, Australia.,Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,TY Nelson Department of Paediatric Neurology, Children's Hospital Westmead, Sydney, NSW, Australia
| | - Josep Dalmau
- ICREA-IDIBAPS, Service of Neurology, Hospital Clínic, University of Barcelona, Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, United States
| | - Kristina Feldmann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - Eoin P Flanagan
- Laboratory Medicine and Pathology, Departments of Neurology, Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Caroline Froment Tilikete
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | | | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mark Hellmann
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Republic of Korea
| | - Philipp Klyscz
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Konietschke
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany
| | - Chiara La Morgia
- Neurology Unit, IRCCS Institute of Neurological Sciences, Bologna, Italy.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Maria Isabel Leite
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Netta Levin
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Michael Levy
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Pablo Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Itay Lotan
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.,Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Romain Marignier
- Neuro-Ophthalmology Unit, Pierre Wertheimer Neurological Hospital, Hospices Civils de Lyon, Lyon 1 University, Lyon Neuroscience Research Center, INSERM U1028, CNRS UMR5292, IMPACT Team, Lyon, France
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Susan P Mollan
- Birmingham Neuro-Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom.,Translational Brian Science, Institute of Metabolism and Systems Research, University of Birmingham, Edgbaston, United Kingdom
| | | | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Maja Olszewska
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jacqueline Palace
- Department of Neurology, Oxford University Hospitals, National Health Service Trust, Oxford, United Kingdom
| | - Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte (Deemed to be University), Mangalore, India
| | | | - Sean Pittock
- Neuromyelitis Optica Research Laboratory, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Sudarshini Ramanathan
- Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.,Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital Westmead, Sydney, NSW, Australia.,Department of Neurology, Concord Hospital, Sydney, NSW, Australia
| | - Natthapon Rattanathamsakul
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Neurology Service, Hospital Clinic de Barcelona, Barcelona, Spain.,Institut d'Investigacions August Pi i Sunyer (IDIVAPS), University of Barcelona, Barcelona, Spain
| | - Sara Samadzadeh
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Bernardo Sanchez-Dalmau
- Ophthalmology Department, Hospital Clínic de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Deanna Saylor
- Department of Internal Medicine, University Teaching Hospital, Lusaka, Zambia.,Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Scheel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Jemal Shifa
- Department of Surgery, University of Botswana, Gaborone, Botswana
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Neuroscience Center, Bumrungrad International Hospital, Bangkok, Thailand
| | - Pia S Sperber
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Prem S Subramanian
- Programs in Neuroscience and Immunology, Departments of Neurology and Ophthalmology, Sue Anschutz-Rodgers Eye Center, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Alon Tiosano
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | | | - Adi Wilf-Yarkoni
- Department of Neurology, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Luis Alfonso Zarco
- Pontificia Universidad Javeriana and Hospital Unviersitario San Ignacio, Bogotá, Colombia
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,Einstein Center Digital Future, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.,Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.,Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hadas Stiebel-Kalish
- Department of Neuro-Ophthalmology, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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109
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Spagni G, Sun B, Monte G, Sechi E, Iorio R, Evoli A, Damato V. Efficacy and safety of rituximab in myelin oligodendrocyte glycoprotein antibody-associated disorders compared with neuromyelitis optica spectrum disorder: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2023; 94:62-69. [PMID: 36283808 DOI: 10.1136/jnnp-2022-330086] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Rituximab (RTX) efficacy in patients with myelin oligodendrocyte glycoprotein (MOG) antibody-associated disorders (MOGADs) is still poorly understood, though it appears to be lower than in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders (AQP4-IgG+NMOSDs). The aim of this systematic review and meta-analysis is to assess the efficacy and safety profile of RTX in patients with MOGAD and to compare RTX efficacy between MOGAD and AQP4-IgG+NMOSD. METHODS We searched original English-language articles published between 2012 and 2021 in MEDLINE, Cochrane, Central Register of Controlled Trials and clinicaltrials.gov, reporting data on RTX efficacy in patients with MOGAD. The main outcome measures were annualised relapse rate (ARR) and Expanded Disability Status Scale (EDSS) score mean differences (MDs) after RTX. The meta-analysis was performed with a random effects model. Covariates associated with the outcome measures were analysed with a linear meta-regression. RESULTS The systematic review included 315 patients (138 women, mean onset age 26.8 years) from 32 studies. Nineteen studies (282 patients) were included in the meta-analysis. After RTX, a significant decrease of ARR was found (MD: -0.92, 95% CI -1.24 to -0.60, p<0.001), markedly different from the AQP4-IgG+NMOSD (MD: -1.73 vs MOGAD -0.92, subgroup difference testing: Q=9.09, p=0.002). However, when controlling for the mean ARR pre-RTX, this difference was not significant. After RTX, the EDSS score decreased significantly (MD: -0.84, 95% CI -1.41 to -0.26, p=0.004). The frequency of RTX-related adverse events was 18.8% (36/192) and overall RTX-related mortality 0.5% (1/192). CONCLUSIONS RTX showed effective in MOGAD, although to a lesser extent than in AQP4-IgG+NMOSD, while the safety profile warrants some caution in its prescription. Randomised-controlled trials are needed to confirm these findings and provide robust evidence to improve treatment strategies in patients with MOGAD. PROSPERO REGISTRATION NUMBER CRD42020175439.
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Affiliation(s)
- Gregorio Spagni
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy.,Neurology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy, Roma, Italy
| | - Bo Sun
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gabriele Monte
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy.,Neuroscience, Ospedale Pediatrico Bambino Gesù, Roma, Italy
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Raffaele Iorio
- Neurology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy, Roma, Italy
| | - Amelia Evoli
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy.,Neurology Institute, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy, Roma, Italy
| | - Valentina Damato
- Neuroscience Department, Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy .,Department of Neurosciences, Drugs and Child Health, University of Florence, Firenze, Italy
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110
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Lotan I, Billiet T, Ribbens A, Van Hecke W, Huang B, Kister I, Lotan E. Volumetric brain changes in MOGAD: A cross-sectional and longitudinal comparative analysis. Mult Scler Relat Disord 2023; 69:104436. [PMID: 36512956 DOI: 10.1016/j.msard.2022.104436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/02/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Relatively little is known about how global and regional brain volumes changes in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) compare with Multiple Sclerosis (MS), Neuromyelitis optica spectrum disorder (NMOSD), and healthy controls (HC). OBJECTIVE To compare global and regional brain volumes in MOGAD, MS, NMOSD, and HC cross-sectionally as well as longitudinally in a subset of patients. METHODS We retrospectively reviewed all adult MOGAD and NMOSD patients with brain MRI performed in stable remission and compared them with MS patients and HC. Volumetric parameters were assessed using the FDA-approved icobrain software. adjusted for age and sex. RESULTS Twenty-four MOGAD, 47 NMOSD, 40 MS patients, and 37 HC were included in the cross-sectional analyses. Relative to HC, the age-adjusted whole brain (WB) volume was significantly lower in patients with MOGAD (p=0.0002), NMOSD (p=0.042), and MS (p=0.01). Longitudinal analysis of a subset of 8 MOGAD, 22 NMOSD, and 34 MS patients showed a reduction in the WB and cortical gray matter (CGM) volumes over time in all three disease groups, without statistically significant differences between groups. The MOGAD group had a greater loss of thalamic volume compared to MS (p=0.028) and NMOSD (p=0.023) and a greater loss of hippocampal volumes compared to MS (p=0.007). CONCLUSIONS Age-adjusted WB volume loss was evident in all neuroinflammatory conditions relative to HC in cross-sectional comparisons. In longitudinal analyses, MOGAD patients had a higher thalamic atrophy rate relative to MS and NMOSD, and a higher hippocampal atrophy rate relative to MS. Larger studies are needed to validate these findings and to investigate their clinical implications.
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Affiliation(s)
- Itay Lotan
- Department of Neurology, Division of Neuroimmunology and Neuroinfectious Disease, Massachusetts General Hospital and Harvard Medical School, Boston, USA; Multiple Sclerosis Comprehensive Care Center, New York University Grossman School of Medicine, New York, NY, USA.
| | | | | | | | - Benny Huang
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
| | - Ilya Kister
- Multiple Sclerosis Comprehensive Care Center, New York University Grossman School of Medicine, New York, NY, USA
| | - Eyal Lotan
- Department of Radiology, New York University Langone Medical Center, New York, NY, USA
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111
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Bennett JL, Costello F, Chen JJ, Petzold A, Biousse V, Newman NJ, Galetta SL. Optic neuritis and autoimmune optic neuropathies: advances in diagnosis and treatment. Lancet Neurol 2023; 22:89-100. [PMID: 36155661 DOI: 10.1016/s1474-4422(22)00187-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
Abstract
Optic neuritis is an inflammatory optic neuropathy that is commonly indicative of autoimmune neurological disorders including multiple sclerosis, myelin-oligodendrocyte glycoprotein antibody-associated disease, and neuromyelitis optica spectrum disorder. Early clinical recognition of optic neuritis is important in determining the potential aetiology, which has bearing on prognosis and treatment. Regaining high-contrast visual acuity is common in people with idiopathic optic neuritis and multiple sclerosis-associated optic neuritis; however, residual deficits in contrast sensitivity, binocular vision, and motion perception might impair vision-specific quality-of-life metrics. In contrast, recovery of visual acuity can be poorer and optic nerve atrophy more severe in individuals who are seropositive for antibodies to myelin oligodendrocyte glycoprotein, AQP4, and CRMP5 than in individuals with typical optic neuritis from idiopathic or multiple-sclerosis associated optic neuritis. Key clinical, imaging, and laboratory findings differentiate these disorders, allowing clinicians to focus their diagnostic studies and optimise acute and preventive treatments. Guided by early and accurate diagnosis of optic neuritis subtypes, the timely use of high-dose corticosteroids and, in some instances, plasmapheresis could prevent loss of high-contrast vision, improve contrast sensitivity, and preserve colour vision and visual fields. Advancements in our knowledge, diagnosis, and treatment of optic neuritis will ultimately improve our understanding of autoimmune neurological disorders, improve clinical trial design, and spearhead therapeutic innovation.
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Affiliation(s)
- Jeffrey L Bennett
- Department of Neurology and Department of Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, AB, Canada
| | - John J Chen
- Department of Ophthalmology and Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Axel Petzold
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, UK; Moorfields Eye Hospital, London, UK; Neuro-ophthalmology Expert Centre, Amsterdam, Netherlands
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven L Galetta
- Department of Neurology and Department of Opthalmology, NYU Langone Medical Center, New York, NY, USA
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112
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Sheremet NL, Eliseeva DD, Kalashnikova AK, Zakharova MN. [Typical and atypical optic neuritis]. Vestn Oftalmol 2023; 139:175-182. [PMID: 38235645 DOI: 10.17116/oftalma2023139061175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Optic neuritis (ON) is one of the most common neuro-ophthalmic causes of vision loss worldwide. Demyelinating ON can be idiopathic or be one of the symptoms of autoimmune demyelinating diseases of the central nervous system (CNS) such as multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Demographic, clinical and radiological signs of ON in these CNS diseases have differences. In this regard, typical and atypical ON are currently distinguished. Recognizing the clinical features that differentiate typical MS-associated ON from atypical ON in NMOSD and MOGAD is important for choosing the correct disease management and treatment strategy. This review summarizes the data from clinical, laboratory, instrumental methods of management used for the differential diagnosis of optic neuritis.
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Affiliation(s)
- N L Sheremet
- Kasnov Research Institute of Eye Diseases, Moscow, Russia
| | | | - A K Kalashnikova
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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113
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Svetozarskiy SN, Kopishinskaya SV, Ruina EA, Antipenko EA. [Clinical phenotypes of optic nerve damage in patients with neuromyelitis optica spectrum disorder]. Vestn Oftalmol 2023; 139:61-67. [PMID: 37067933 DOI: 10.17116/oftalma202313902161] [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: 04/18/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) comprise a group of autoimmune inflammatory demyelinating diseases of the central nervous system that manifest as optic neuritis and transverse myelitis. Its manifestation in the form of optic neuritis makes early diagnosis difficult because neuroimaging of the spinal cord is not a part of the routine examination algorithm for such patients. This article presents the results of a comprehensive ophthalmological examination of 4 patients (8 eyes) diagnosed with NMSOD. Optic neuritis was the disease debut in 3 patients and had 1-2 relapses, in all cases partial optic atrophy with moderate to severe loss of visual function occurred. The clinical picture was characterized by a pronounced heterogeneity in terms of both ophthalmological symptoms, and accession of neurological disorders. Treatment of NMOSD requires differential diagnosis with multiple sclerosis, which depends on the awareness of specialists and the inclusion of antibody titers to aquaporin-4 and myelin oligodendrocyte glycoprotein into the examination algorithm of patients with optical neuritis.
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Affiliation(s)
- S N Svetozarskiy
- Volga Regional Medical Center of the Federal Medical-Biological Agency, Nizhny Novgorod, Russia
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | | | - E A Ruina
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E A Antipenko
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
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114
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Li Y, Wang S, Liu P, Ma J, Liu X, Yuan J. Clinical features of patients with MOG-IgG associated disorders and analysis of the relationship between fibrinogen-to-albumin ratio and the severity at disease onset. Front Neurol 2023; 14:1140917. [PMID: 37153679 PMCID: PMC10157091 DOI: 10.3389/fneur.2023.1140917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/15/2023] [Indexed: 05/10/2023] Open
Abstract
Objective The study aimed to investigate the differences in clinical features between pediatric and adult patients with first-episode MOG-IgG associated disorders (MOGAD) and evaluate the relationship between the fibrinogen-to-albumin ratio (FAR) and the severity of neurological deficits at disease onset. Methods We retrospectively collected and analyzed biochemical test results, imaging characteristics, clinical manifestations, expanded disability status scale (EDSS) score, and FAR. The Spearman correlation analysis and logistic regression models were used to examine the association between FAR and severity. Receiver operating characteristic (ROC) curve analysis was to analyze the predictive ability of FAR for the severity of neurological deficits. Results Fever (50.0%), headache (36.1%), and blurred vision (27.8%) were the most common clinical manifestations in the pediatric group (<18 years old). However, in the adult group (≥18 years old), the most common symptoms were blurred vision (45.7%), paralysis (37.0%), and paresthesia (32.6%). Fever was more common in the pediatric group, while paresthesia was more common in the adult patients, with all differences statistically significant (P < 0.05). The most frequent clinical phenotype in the pediatric group was acute disseminated encephalomyelitis (ADEM; 41.7%), whereas optic neuritis (ON; 32.6%) and transverse myelitis (TM; 26.1%) were more common in the adult group. The differences in clinical phenotype between the two groups were statistically significant (P < 0.05). In both pediatric and adult patients, cortical/subcortical and brainstem lesions were the most common lesions on cranial magnetic resonance imaging (MRI), whereas, for spinal MRI, cervical and thoracic spinal cord lesions were the most commonly observed. According to binary logistic regression analysis, FAR was an independent risk factor for the severity of neurological deficits (odds ratio = 1.717; 95% confidence interval = 1.191-2.477; P = 0.004). FAR (r = 0.359, P = 0.001) was positively correlated with the initial EDSS score. The area under the ROC curve was 0.749. Conclusion The current study found age-dependent phenotypes in MOGAD patients as ADEM was more commonly observed in patients < 18 years old, while ON and TM were more frequently found in patients ≥18 years old. A high FAR level was an independent indicator for more severe neurological deficits at disease onset in patients with a first episode of MOGAD.
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115
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Corbali O, Chitnis T. Pathophysiology of myelin oligodendrocyte glycoprotein antibody disease. Front Neurol 2023; 14:1137998. [PMID: 36925938 PMCID: PMC10011114 DOI: 10.3389/fneur.2023.1137998] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) is a spectrum of diseases, including optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, and cerebral cortical encephalitis. In addition to distinct clinical, radiological, and immunological features, the infectious prodrome is more commonly reported in MOGAD (37-70%) than NMOSD (15-35%). Interestingly, pediatric MOGAD is not more aggressive than adult-onset MOGAD, unlike in multiple sclerosis (MS), where annualized relapse rates are three times higher in pediatric-onset MS. MOGAD pathophysiology is driven by acute attacks during which T cells and MOG antibodies cross blood brain barrier (BBB). MOGAD lesions show a perivenous confluent pattern around the small veins, lacking the radiological central vein sign. Initial activation of T cells in the periphery is followed by reactivation in the subarachnoid/perivascular spaces by MOG-laden antigen-presenting cells and inflammatory CSF milieu, which enables T cells to infiltrate CNS parenchyma. CD4+ T cells, unlike CD8+ T cells in MS, are the dominant T cell type found in lesion histology. Granulocytes, macrophages/microglia, and activated complement are also found in the lesions, which could contribute to demyelination during acute relapses. MOG antibodies potentially contribute to pathology by opsonizing MOG, complement activation, and antibody-dependent cellular cytotoxicity. Stimulation of peripheral MOG-specific B cells through TLR stimulation or T follicular helper cells might help differentiate MOG antibody-producing plasma cells in the peripheral blood. Neuroinflammatory biomarkers (such as MBP, sNFL, GFAP, Tau) in MOGAD support that most axonal damage happens in the initial attack, whereas relapses are associated with increased myelin damage.
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Affiliation(s)
- Osman Corbali
- Harvard Medical School, Boston, MA, United States.,Department of Neurology, Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Boston, MA, United States
| | - Tanuja Chitnis
- Harvard Medical School, Boston, MA, United States.,Department of Neurology, Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Boston, MA, United States
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116
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Schindler P, Aktas O, Ringelstein M, Wildemann B, Jarius S, Paul F, Ruprecht K. Glial fibrillary acidic protein as a biomarker in neuromyelitis optica spectrum disorder: a current review. Expert Rev Clin Immunol 2023; 19:71-91. [PMID: 36378751 DOI: 10.1080/1744666x.2023.2148657] [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: 11/16/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, often debilitating neuroinflammatory disease, whose predominant clinical manifestations are longitudinally extensive transverse myelitis and optic neuritis. About 80% of the patients with an NMOSD phenotype have pathogenic autoantibodies against the astrocyte water channel aquaporin-4 (AQP4-IgG). While therapeutic options for NMOSD have greatly expanded in recent years, well-established biomarkers for prognosis or treatment response are still lacking. Glial fibrillary acidic protein (GFAP) is mainly expressed in astrocytes and can be detected in cerebrospinal fluid (CSF) and blood of patients with NMOSD. AREAS COVERED Here, we comprehensively review the current knowledge on GFAP as a biomarker in NMOSD. EXPERT OPINION In patients with AQP4-IgG+ NMOSD, GFAP levels are elevated in CSF and serum during acute attacks and correlate with disability, consistent with the pathophysiology of this antibody-mediated astrocytopathy. Serum GFAP levels tend to be higher in AQP4-IgG+ NMOSD than in its differential diagnoses, multiple sclerosis, and myelin oligodendrocyte antibody-associated disease. Importantly, serum GFAP levels in AQP4-IgG+ NMOSD during remission may be predictive of future disease activity. Serial serum GFAP measurements are emerging as a biomarker to monitor disease activity in AQP4-IgG+ NMOSD and could have the potential for application in clinical practice.
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Affiliation(s)
- Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Cortese R, Mariotto S, Mancinelli CR, Tortorella C. Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know? Front Neurol 2022; 13:1048502. [PMID: 36601293 PMCID: PMC9806181 DOI: 10.3389/fneur.2022.1048502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Antibody-mediated central nervous system (CNS) disorders including those associated with aquaporin-4 or myelin oligodendrocyte glycoprotein IgG and autoimmune encephalitis often affect women of childbearing age. Pathogenic antibodies of these diseases can potentially alter reproductive functions and influence fetal development. Hormonal changes occurring during pregnancy may modify the course of autoimmune diseases by influencing relapse risk, attack severity, and affect the delivery and postpartum period. Moreover, balancing treatment related safety issues with the risk of potentially disabling relapses during pregnancy and breastfeeding are major challenges. Intentional prenatal, gestational, and post-partum counseling is paramount to address these issues and mitigate these risks. Fortunately, new insights on risk factors for adverse pregnancy outcomes and possible preventive strategies are emerging. This review aims to summarize the interplay between antibody-mediated CNS disorders and pregnancy during the prenatal, gestational, and postpartum periods, highlight current treatment recommendations, and discuss future areas of research.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,*Correspondence: Rosa Cortese
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
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Sutton P, Lutz MW, Hartsell FL, Kimbrough D, Tagg NT, Skeen M, Hudak NM, Eckstein C, Shah S. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease: Presentation and outcomes of adults at a single center. J Neuroimmunol 2022; 373:577987. [PMID: 36272183 DOI: 10.1016/j.jneuroim.2022.577987] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/18/2022] [Accepted: 10/11/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND/INTRODUCTION Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a chronic demyelinating disorder that has been increasingly recognized since the serum antibody became commercially available in 2017. The most common clinical presentation is optic neuritis, and first line acute treatment is intravenous (IV) steroids. However, there are many questions that remain unanswered. For clinicians and patients, the primary question is whether relapses will occur and whether to treat with chronic therapy. METHODS This retrospective chart review examined characteristics of thirty-three known adult MOGAD cases at a single institute. Data was collected on patient demographics, clinical presentation, objective diagnosis with MRI and serum antibody levels, acute and chronic treatment and disease outcomes. RESULTS Our MOGAD cases revealed a slight female to male predominance of 1.5:1. No racial groups were affected disproportionately, and age of symptom onset spanned a large range with a median of 40 years. The most common clinical and radiologic presentation was optic neuritis followed by transverse myelitis and brainstem symptoms/lesions. IV methylprednisolone was used in the vast majority of cases for acute treatment. 83.3% of our patients were treated with chronic therapy at some point during their disease course. Therapies include rituximab, IVIG, ocrelizumab, mycophenolate mofetil and ofatumumab. The majority of our patients were treated with rituximab and we did not see a significant benefit of yearly relapse reduction for rituximab versus other therapies. Our cohort had a higher-than- expected percentage of cases with relapsing disease (56.3%) compared to monophasic (43.8%). DISCUSSION/CONCLUSION Our study confirms prior data regarding the demographics, clinical presentation and radiologic presentation of MOGAD. There is no consensus on whether maintenance therapy should be started for MOGAD cases with a single clinical event. Our cohort showed a higher relapse rate than has been reported previously and all known relapses occurred within one year of diagnosis. More data is necessary to confirm risk of relapse in the years following diagnosis. In addition, further data on biomarkers are needed to predict the disease course could help guide management.
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Affiliation(s)
- Paige Sutton
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - Michael W Lutz
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - F Lee Hartsell
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - Dorlan Kimbrough
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - N Troy Tagg
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - Mark Skeen
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - Nicholas M Hudak
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - Christopher Eckstein
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA
| | - Suma Shah
- Duke University, Department of Neurology, 40 Duke Medicine Circle, Clinic 1L, Durham, NC 27710, USA.
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Sahoo D, Dash A, Dey A, Devi S. Myelin oligodendrocyte glycoprotein (MOG) antibody-associated longitudinally extensive transverse myelitis (LETM) and primary Sjogren syndrome: a rare association. BMJ Case Rep 2022; 15:e249915. [PMID: 36593613 PMCID: PMC9730373 DOI: 10.1136/bcr-2022-249915] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a recent addition to the field of central nervous system inflammatory disorders. It can have a wide range of presentations, including optic neuritis, transverse myelitis, acute disseminated encephalomyelitis or any combination of these. The aquaporin-4-positive neuromyelitis optica (NMO) is a close differential owing to the similar clinical presentation. There is a proven association between NMO and autoimmunity, whereas such an association is yet to be established in the case of MOGAD. Here we describe the case of a woman in her 30s presenting with sudden-onset quadriparesis with sensory and autonomic involvement who was diagnosed with MOGAD (cervicothoracic longitudinally extensive transverse myelitis) and found to have primary Sjogren syndrome on further workup. This association between MOGAD and autoimmunity should be kept in mind, as diagnosis of the former should alert the physician to the possibility of the latter's existence and the need to initiate an appropriate workup.
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Affiliation(s)
- Debananda Sahoo
- Department of General Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Anil Dash
- Department of General Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Anupam Dey
- Department of General Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
| | - Sujata Devi
- Department of General Medicine, All India Institute of Medical Sciences Bhubaneswar, Bhubaneswar, Odisha, India
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Wingerchuk DM, Weinshenker BG, McCormick D, Barron S, Simone L, Jarzylo L. Aligning payer and provider strategies with the latest evidence to optimize clinical outcomes for patients with neuromyelitis optica spectrum disorder. J Manag Care Spec Pharm 2022; 28:S3-S27. [DOI: 10.18553/jmcp.2022.28.12-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Details and outcomes of a large cohort of MOG-IgG associated optic neuritis. Mult Scler Relat Disord 2022; 68:104237. [PMID: 36252317 DOI: 10.1016/j.msard.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of this study was to examine the temporal relationship of eye pain to visual loss and investigate whether timing of steroid treatment affects the rate and extent of visual recovery in optic neuritis (ON) from MOG-IgG associated disease (MOGAD) in a large cohort of MOGAD patients with ON. METHODS This is a multicenter, retrospective cohort study of consecutive MOGAD patients with ON attacks seen from 2017 to 2021 fulfilling the following criteria: (1) clinical history of ON; (2) MOG-IgG seropositivity. ON attacks were evaluated for presence/duration of eye pain, nadir of vision loss, time to intravenous methylprednisolone (IVMP) treatment, time to recovery, and final visual outcomes. RESULTS There were 107 patients with 140 attacks treated with IVMP and details on timing of treatment and outcomes. Eye pain was present in 125/140 (89%) attacks with pain onset a median of 3 days (range, 0 to 20) prior to vision loss. Among 46 ON attacks treated with IVMP within 2 days of onset of vision loss, median time to recovery was 4 days (range, 0 to 103) compared to 15 days (range, 0 to 365) in 94 ON attacks treated after 2 days (p = 0.004). Those treated within 2 days had less severe VA loss at time of treatment (median LogMAR VA 0.48, range, 0.1 to 3) compared to those treated after 2 days (median LogMAR VA 1.7, range, 0 to 3; p < 0.001), and were more likely to have a VA outcome of 20/40 or better (98% vs 83%, p = 0.01). After adjustment for the initial VA at time of treatment, the differences in final VA were no longer significantly different (p = 0.14). In addition, some patients were documented to recover without steroid treatment. CONCLUSION This study suggests that pain precedes vision loss in the majority of ON attacks and early steroids may lead to better outcomes in MOG-IgG ON, but some patients can recover without steroid treatment. Prospective randomized clinical trials are required to confirm these findings.
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Li X, Miao X, Wang Y, Sun J, Gao H, Han J, Li Y, Wang Q, Sun C, Liu J. Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations. Front Immunol 2022; 13:1052678. [PMID: 36532021 PMCID: PMC9752826 DOI: 10.3389/fimmu.2022.1052678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To track the clinical outcomes in patients who initially presented with tumefactive demyelinating lesions (TDLs), we summarized the clinical characteristics of various etiologies, and identified possible relapse risk factors for TDLs. Methods Between 2001 and 2021, 116 patients initially presented with TDLs in our hospital were retrospectively evaluated. Patients were followed for relapse and clinical outcomes, and grouped according to various etiologies. Demographic information, clinical data, imaging data, and laboratory results of patients were obtained and analyzed. The risk factors of relapse were analyzed by the Log-Rank test and the Cox proportional hazard model in multivariate analysis. Result During a median follow-up period of 72 months, 33 patients were diagnosed with multiple sclerosis (MS), 6 patients with Balo, 6 patients with neuromyelitis optica spectrum disorders (NMOSD), 10 patients with myelin oligodendrocyte glycoprotein antibody-associated demyelination (MOGAD), 1 patient with acute disseminated encephalomyelitis (ADEM), and the remaining 60 patients still have no clear etiology. These individuals with an unknown etiology were categorized independently and placed to the other etiology group. In the other etiology group, 13 patients had recurrent demyelinating phases, while 47 patients did not suffer any more clinical events. Approximately 46.6% of TDLs had relapses which were associated with multiple functional system involvement, first-phase Expanded Disability Status Scale score, lesions morphology, number of lesions, and lesions location (P<0.05). And diffuse infiltrative lesions (P=0.003, HR=6.045, 95%CI:1.860-19.652), multiple lesions (P=0.001, HR=3.262, 95%CI:1.654-6.435) and infratentorial involvement (P=0.006, HR=2.289, 95%CI:1.064-3.853) may be independent risk factors for recurrence. Relapse free survival was assessed to be 36 months. Conclusions In clinical practice, around 46.6% of TDLs relapsed, with the MS group showing the highest recurrence rate, and lesions location, diffuse infiltrative lesions, and multiple lesions might be independent risk factors for relapse. Nevertheless, despite extensive diagnostic work and long-term follow-up, the etiology of TDLs in some patients was still unclear. And these patients tend to have monophase course and a low rate of relapse.
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Affiliation(s)
- Xinnan Li
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiuling Miao
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junzhao Sun
- Senior Department of Neurosurgery, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Haifeng Gao
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Jing Han
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuxin Li
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingjun Wang
- Department of Radiology, Sixth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
| | - Chenjing Sun
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
| | - Jianguo Liu
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
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Francis AG, Elhadd K, Camera V, Ferreira Dos Santos M, Rocchi C, Adib-Samii P, Athwal B, Attfield K, Barritt A, Craner M, Fisniku L, Iversen AKN, Leach O, Matthews L, Redmond I, O'Riordan J, Scalfari A, Tanasescu R, Wren D, Huda S, Leite MI, Fugger L, Palace J. Acute Inflammatory Diseases of the Central Nervous System After SARS-CoV-2 Vaccination. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200063. [PMID: 36411077 PMCID: PMC9679888 DOI: 10.1212/nxi.0000000000200063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Acute inflammatory CNS diseases include neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Both MOGAD and acute disseminated encephalomyelitis (ADEM) have been reported after vaccination. Consequently, the mass SARS-CoV-2 vaccination program could result in increased rates of these conditions. We described the features of patients presenting with new acute CNS demyelination resembling NMOSDs or MOGAD within 8 weeks of SARS-CoV-2 vaccination. METHODS The study included a prospective case series of patients referred to highly specialized NMOSD services in the UK from the introduction of SARS-CoV-2 vaccination program up to May 2022. Twenty-five patients presented with new optic neuritis (ON) and/or transverse myelitis (TM) ± other CNS inflammation within 8 weeks of vaccination with either AstraZeneca (ChAdOx1S) or Pfizer (BNT162b2) vaccines. Their clinical records and paraclinical investigations including MRI scans were reviewed. Serologic testing for antibodies to myelin oligodendrocyte glycoprotein (MOG) and aquaporin 4 (AQP4) was performed using live cell-based assays. Patients' outcomes were graded good, moderate, or poor based on the last clinical assessment. RESULTS Of 25 patients identified (median age 38 years, 14 female), 12 (48%) had MOG antibodies (MOGIgG+), 2 (8%) had aquaporin 4 antibodies (AQP4IgG+), and 11 (44%) had neither. Twelve of 14 (86%) antibody-positive patients received the ChAdOx1S vaccine. MOGIgG+ patients presented most commonly with TM (10/12, 83%), frequently in combination with ADEM-like brain/brainstem lesions (6/12, 50%). Transverse myelitis was longitudinally extensive in 7 of the 10 patients. A peak in new MOGAD cases in Spring 2021 was attributable to postvaccine cases. Both AQP4IgG+ patients presented with brain lesions and TM. Four of 6 (67%) seronegative ChAdOx1S recipients experienced longitudinally extensive TM (LETM) compared with 1 of 5 (20%) of the BNT162b2 group, and facial nerve inflammation was reported only in ChAdOx1S recipients (2/5, 40%). Guillain-Barre syndrome was confirmed in 1 seronegative ChAdOx1S recipient and suspected in another. DISCUSSION ChAdOx1S was associated with 12/14 antibody-positive cases, the majority MOGAD. MOGAD patients presented atypically, only 2 with isolated ON (1 after BNT162b2 vaccine) but with frequent ADEM-like brain lesions and LETM. Within the seronegative group, phenotypic differences were observed between ChAdOx1S and BNT162b2 recipients. These observations might support a causative role of the ChAdOx1S vaccine in inflammatory CNS disease and particularly MOGAD. Further study of this cohort could provide insights into vaccine-associated immunopathology.
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Affiliation(s)
- Anna G Francis
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.).
| | - Kariem Elhadd
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Valentina Camera
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Monica Ferreira Dos Santos
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Chiara Rocchi
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Poneh Adib-Samii
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Bal Athwal
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Kathrine Attfield
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Andrew Barritt
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Matthew Craner
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Leonora Fisniku
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Astrid K N Iversen
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Oliver Leach
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Lucy Matthews
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Ian Redmond
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Jonathan O'Riordan
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Antonio Scalfari
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Radu Tanasescu
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Damian Wren
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Saif Huda
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Maria Isabel Leite
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Lars Fugger
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Jacqueline Palace
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
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Extracellular Vesicles in Chronic Demyelinating Diseases: Prospects in Treatment and Diagnosis of Autoimmune Neurological Disorders. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111943. [PMID: 36431078 PMCID: PMC9693249 DOI: 10.3390/life12111943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 11/23/2022]
Abstract
Extracellular vesicles (EVs) represent membrane-enclosed structures that are likely to be secreted by all living cell types in the animal organism, including cells of peripheral (PNS) and central nervous systems (CNS). The ability to cross the blood-brain barrier (BBB) provides the possibility not only for various EV-loaded molecules to be delivered to the brain tissues but also for the CNS-to-periphery transmission of these molecules. Since neural EVs transfer proteins and RNAs are both responsible for functional intercellular communication and involved in the pathogenesis of neurodegenerative diseases, they represent attractive diagnostic and therapeutic targets. Here, we discuss EVs' role in maintaining the living organisms' function and describe deviations in EVs' structure and malfunctioning during various neurodegenerative diseases.
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Sun X, Liu M, Luo X, Yuan F, Wang C, Wang S, Xu Q, Zhang Y, Chen Y. Clinical characteristics and prognosis of pediatric myelin oligodendrocyte glycoprotein antibody-associated diseases in China. BMC Pediatr 2022; 22:666. [PMCID: PMC9673292 DOI: 10.1186/s12887-022-03679-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Research on myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD) among Chinese children is relatively rare. Therefore, this study aimed to explore and analyze the clinical characteristics and prognoses of Chinese children with acquired demyelinating syndromes (ADSs) who tested positive or negative for MOG-Ab. Methods The clinical data of children with MOGAD who were treated in the Department of Neurology at Shanghai Children's Hospital from January 2017 to October 2021 were retrospectively collected. Results Among 90 children with ADSs, 30 were MOG-Ab-positive, and 60 were MOG-Ab-negative. MOG-Ab-positive children experienced more prodromal infections than did MOG-Ab-negative children (P < 0.05). Acute disseminated encephalomyelitis was the most common ADSs in both groups. There were ten cases of a rebound increase in MOG-Ab titers. There were significant differences in the MOG titer-related prognosis and disease time course between the disease relapse group and the non-relapse group (P < 0.01). Among the MOG-Ab-positive patients, the most affected brain areas detected via magnetic resonance imaging (MRI) were the temporal lobe, cerebellar hemispheres, brainstem, and periventricular lesions. The most common shapes of the lesions were commas, triangles, or patches. The average improvement time based on brain MRI was much longer in MOG-Ab-positive than in MOG-Ab-negative children (P < 0.05). The initial treatment time correlated with the disease time course, and the prognosis may be affected by the disease time course and serum MOG-Ab titer (P < 0.05). Conclusion The clinical characteristics and imaging features of ADSs differed between MOG-Ab-positive and MOG-Ab-negative children. In addition to existing treatment plans, additional diagnoses and treatment plans should be developed to reduce recurrence and improve the prognoses of children with MOGAD.
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Affiliation(s)
- Xiaoang Sun
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Meiyan Liu
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaona Luo
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fang Yuan
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chunmei Wang
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Simei Wang
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Quanmei Xu
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yuanfeng Zhang
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yucai Chen
- grid.415625.10000 0004 0467 3069Department of Neurology, Shanghai Children’s Hospital, School of medicine, Shanghai Jiao Tong University, Shanghai, China
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Eaton J, Rahmlow M. Myelin oligodendrocyte glycoprotein associated transverse myelitis following brain abscess: Case report and literature review. J Neuroimmunol 2022; 372:577967. [PMID: 36126373 DOI: 10.1016/j.jneuroim.2022.577967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 08/28/2022] [Accepted: 08/31/2022] [Indexed: 12/31/2022]
Abstract
Transverse myelitis is a subacute immune mediated myelopathy secondary to a range of conditions. Post infectious transverse myelitis can be seen with several infectious etiologies. Myelin oligodendrocyte glycoprotein associated disease (MOGAD) is a relatively recently defined condition frequently manifesting with longitudinally extensive transverse myelitis. Cases of MOGAD have occurred after infection, typically respiratory tract infections. We report an unusual case of MOGAD transverse myelitis following a streptococcal brain abscess which has not been previously reported.
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Affiliation(s)
- James Eaton
- Vanderbilt University Medical Center, Department of Neurology, 1301 Medical Center Drive, Suite 3930 TVC, USA.
| | - Megan Rahmlow
- Vanderbilt University Medical Center, Department of Neurology, 1301 Medical Center Drive, Suite 3930 TVC, USA.
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Du Y, Xiao L, Ding Z, Huang K, Xiao B, Feng L. MOGAD Involving Cranial Neuropathies: A Case Report and Review of Literature. Brain Sci 2022; 12:1529. [PMID: 36421853 PMCID: PMC9688642 DOI: 10.3390/brainsci12111529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 10/13/2023] Open
Abstract
Myelin-oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an autoimmune-mediated demyelinating disease of the central nervous system (CNS). Patients with MOGAD may develop any combination of optic neuritis (ON), myelitis, brainstem syndrome and encephalitis. Reports of MOGAD with cranial nerve involvement are rare. Herein, we report a MOGAD patient with cranial neuropathies. In addition, we summarized the clinical features of the previously reported six MOG-IgG-positive cases with cranial nerve involvement and discussed the underlying mechanisms of MOGAD involving cranial nerves. Cranial neuropathy is an emerging phenotype in MOGAD, which has characteristics of both central and peripheral nervous system (PNS) involvement, with the trigeminal nerve being the most commonly affected nerve. MOG antibody testing in patients with cranial neuropathies is warranted, and immunotherapy is advocated when the risk of relapse is high. Although higher antibody titers and persistently positive serological test results are predictive of disease recurrence, the long-term outcomes of MOG-IgG-positive patients with cranial neuropathies remain largely unknown.
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Affiliation(s)
- Yangsa Du
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Ling Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Zijin Ding
- Department of Anesthesiology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Kailing Huang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha 410008, China
- Department of Neurology, Xiangya Hospital, Central South University (Jiangxi Branch), Nanchang 330000, China
- National Clinical Research Center for Geriatric Diseases, Xiangya Hospital, Central South University, Changsha 410008, China
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Mewes D, Kuchling J, Schindler P, Khalil AAA, Jarius S, Paul F, Chien C. Diagnostik der Neuromyelitis-optica-Spektrum-Erkrankung (NMOSD) und der MOG-Antikörper-assoziierten Erkrankung (MOGAD). Klin Monbl Augenheilkd 2022; 239:1315-1324. [DOI: 10.1055/a-1918-1824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ZusammenfassungDie Aquaporin-4-Antikörper-positive Neuromyelitis-optica-Spektrum-Erkrankung (engl. NMOSD) und die Myelin-Oligodendrozyten-Glykoprotein-Antikörper-assoziierte Erkrankung (engl. MOGAD) sind
Autoimmunerkrankungen des zentralen Nervensystems. Typische Erstmanifestationen sind bei Erwachsenen Optikusneuritis und Myelitis. Eine Beteiligung auch von Hirn und Hirnstamm, spätestens im
weiteren Verlauf, ist häufig. Während die NMOSD nahezu immer schubförmig verläuft, nimmt die MOGAD gelegentlich einen monophasischen Verlauf. Die Differenzialdiagnostik ist anspruchsvoll und
stützt sich auf u. a. auf radiologische und serologische Befunde. Die Abgrenzung von der häufigeren neuroinflammatorischen Erkrankung, Multiple Sklerose (MS), ist von erheblicher Bedeutung,
da sich Behandlung und langfristige Prognose von NMOSD, MOGAD und MS wesentlich unterscheiden. Die vielfältigen Symptome und die umfangreiche Diagnostik machen eine enge Zusammenarbeit
zwischen Ophthalmologie, Neurologie und Radiologie erforderlich. Dieser Artikel gibt einen Überblick über typische MRT-Befunde und die serologische Antikörperdiagnostik bei NMOSD und MOGAD.
Zwei illustrative Fallberichte aus der ärztlichen Praxis ergänzen die Darstellung.
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Affiliation(s)
- Darius Mewes
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Biomedical Innovation Academy, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Joseph Kuchling
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Biomedical Innovation Academy, Berlin Institute of Health at Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Patrick Schindler
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Ahmed Abdelrahim Ahmed Khalil
- Centrum für Schlaganfallforschung, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Abteilung Neurologie, Max-Planck-Institut für Kognitions- und Neurowissenschaften, Leipzig, Deutschland
- Mind Brain Body Institute, Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Sven Jarius
- AG Molekulare Neuroimmunologie, Neurologische Klinik, Universität Heidelberg, Heidelberg, Deutschland
| | - Friedemann Paul
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Neurologie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
| | - Claudia Chien
- Experimental and Clinical Research Center, Charité Universitätsmedizin Berlin & Max-Delbrück-Centrum für molekulare Medizin Berlin, Berlin, Deutschland
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Charité – Universitätsmedizin Berlin, Berlin, Deutschland
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Cacciaguerra L, Sechi E, Rocca MA, Filippi M, Pittock SJ, Flanagan EP. Neuroimaging features in inflammatory myelopathies: A review. Front Neurol 2022; 13:993645. [PMID: 36330423 PMCID: PMC9623025 DOI: 10.3389/fneur.2022.993645] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/16/2022] [Indexed: 11/15/2022] Open
Abstract
Spinal cord involvement can be observed in the course of immune-mediated disorders. Although multiple sclerosis (MS) represents the leading cause of inflammatory myelopathy, an increasing number of alternative etiologies must be now considered in the diagnostic work-up of patients presenting with myelitis. These include antibody-mediated disorders and cytotoxic T cell-mediated diseases targeting central nervous system (CNS) antigens, and systemic autoimmune conditions with secondary CNS involvement. Even though clinical features are helpful to orient the diagnostic suspicion (e.g., timing and severity of myelopathy symptoms), the differential diagnosis of inflammatory myelopathies is often challenging due to overlapping features. Moreover, noninflammatory etiologies can sometimes mimic an inflammatory process. In this setting, magnetic resonance imaging (MRI) is becoming a fundamental tool for the characterization of spinal cord damage, revealing a pictorial scenario which is wider than the clinical manifestations. The characterization of spinal cord lesions in terms of longitudinal extension, location on axial plane, involvement of the white matter and/or gray matter, and specific patterns of contrast enhancement, often allows a proper differentiation of these diseases. For instance, besides classical features, such as the presence of longitudinally extensive spinal cord lesions in patients with aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), novel radiological signs (e.g., H sign, trident sign) have been recently proposed and successfully applied for the differential diagnosis of inflammatory myelopathies. In this review article, we will discuss the radiological features of spinal cord involvement in autoimmune disorders such as MS, AQP4+NMOSD, myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and other recently characterized immune-mediated diseases. The identification of imaging pitfalls and mimics that can lead to misdiagnosis will also be examined. Since spinal cord damage is a major cause of irreversible clinical disability, the recognition of these radiological aspects will help clinicians achieve a correct and prompt diagnosis, treat early with disease-specific treatment and improve patient outcomes.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Elia Sechi
- Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Maria A. Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sean J. Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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Wendel EM, Thonke HS, Bertolini A, Baumann M, Blaschek A, Merkenschlager A, Karenfort M, Kornek B, Lechner C, Pohl D, Pritsch M, Schanda K, Schimmel M, Thiels C, Waltz S, Wiegand G, Anlar B, Barisic N, Blank C, Breu M, Broser P, Della Marina A, Diepold K, Eckenweiler M, Eisenkölbl A, Freilinger M, Gruber-Sedlmayr U, Hackenberg A, Iff T, Knierim E, Koch J, Kutschke G, Leiz S, Lischetzki G, Nosadini M, Pschibul A, Reiter-Fink E, Rohrbach D, Salandin M, Sartori S, Schlump JU, Stoffels J, Strautmanis J, Tibussek D, Tüngler V, Utzig N, Reindl M, Rostásy K. Temporal Dynamics of MOG Antibodies in Children With Acquired Demyelinating Syndrome. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 9:9/6/e200035. [PMID: 36229191 PMCID: PMC9562044 DOI: 10.1212/nxi.0000000000200035] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 08/04/2022] [Indexed: 11/06/2022]
Abstract
Background and Objective The spectrum of myelin oligodendrocyte glycoprotein (MOG) antibody–associated disorder (MOGAD) comprises monophasic diseases such as acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), and transverse myelitis and relapsing courses of these presentations. Persistently high MOG antibodies (MOG immunoglobulin G [IgG]) are found in patients with a relapsing disease course. Prognostic factors to determine the clinical course of children with a first MOGAD are still lacking. The objective of the study is to assess the clinical and laboratory prognostic parameters for a risk of relapse and the temporal dynamics of MOG‐IgG titers in children with MOGAD in correlation with clinical presentation and disease course. Methods In this prospective multicenter hospital-based study, children with a first demyelinating attack and complete data set comprising clinical and radiologic findings, MOG-IgG titer at onset, and clinical and serologic follow-up data were included. Serum samples were analyzed by live cell-based assay, and a titer level of ≥1:160 was classified as MOG-IgG–positive. Results One hundred sixteen children (f:m = 57:59) with MOGAD were included and initially diagnosed with ADEM (n = 59), unilateral ON (n = 12), bilateral ON (n = 16), myelitis (n = 6), neuromyelitis optica spectrum disorder (n = 8) or encephalitis (n = 6). The median follow-up time was 3 years in monophasic and 5 years in relapsing patients. There was no significant association between disease course and MOG-IgG titers at onset, sex, age at presentation, or clinical phenotype. Seroconversion to MOG-IgG–negative within 2 years of the initial event showed a significant risk reduction for a relapsing disease course. Forty-two/one hundred sixteen patients (monophasic n = 26, relapsing n = 16) had serial MOG-IgG testing in years 1 and 2 after the initial event. In contrast to relapsing patients, monophasic patients showed a significant decrease of MOG-IgG titers during the first and second years, often with seroconversion to negative titers. During the follow-up, MOG-IgG titers were persistently higher in relapsing than in monophasic patients. Decrease in MOG-IgG of ≥3 dilution steps after the first and second years was shown to be associated with a decreased risk of relapses. In our cohort, no patient experienced a relapse after seroconversion to MOG-IgG–negative. Discussion In this study, patients with declining MOG-IgG titers, particularly those with seroconversion to MOG-IgG–negative, are shown to have a significantly reduced relapse risk.
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Zhong G, Zhang J, Liu X, Yang S, Gu H. Astrocytoma with myelin oligodendrocyte glycoprotein antibody associated encephalomyelitis: A case report. Medicine (Baltimore) 2022; 101:e31003. [PMID: 36221336 PMCID: PMC9542675 DOI: 10.1097/md.0000000000031003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Demyelination is similar with malignancy in clinical symptoms. Magnetic resonance imaging (MRI) is an important auxiliary examination in the diagnosis of demyelinating diseases and malignancy. Since MRI and symptoms can be difficult to distinguish demyelination from malignancy, other auxiliary examinations, such as demyelinating disease-specific antibodies, play an important role in distinguishing them. Previous studies have reported demyelinating disease-specific antibodies in patients with malignancy. What's more, it is more difficult to confirm the diagnosis when the malignant tumor co-occurs with demyelinating diseases, which has never been reported in previous studies. We report the diagnosis of myelin oligodendrocyte glycoprotein antibody associated encephalomyelitis (MOG-EM) in a patient who had astrocytoma for several years. CASE PRESENTATION Patient's concerns and diagnoses: our case report records a 49-year-old woman with astrocytoma for more than 4 years, who recently developed the symptoms of MOG-EM, including dizziness, vomiting, and vision loss. This astrocytoma patient was diagnosed with MOG-EM according to comprehensive evidence, including MRI, visual evoked potential (VEP), serum myelin oligodendrocyte glycoprotein antibody (MOG-IgG), and therapeutic effect. Interventions and outcomes: this patient was diagnosed with astrocytoma by surgical biopsy 4 years earlier. This patient has been treated with tumor resection, postoperative radiation treatment and chemotherapy. After treatment, the patient was left with right limb weakness while other symptoms were improved. Recently, the intravenous steroid agent was used to treat this patient after being diagnosed with MOG-EM. Dizziness, vomiting, and vision loss have gone into remission. This patient did not relapse in 7 months after discharge. This patient is still being followed up at the outpatient clinic. And the patient will next be treated with azathioprine. CONCLUSIONS In previous studies, polyclonal antibody has been found in cancer patients, such as aquaporin-4 and MOG-IgG in astrocytoma patients. But the case of our study finds that astrocytoma can coexist with MOG-EM. Therefore, MOG-EM should not be excluded easily in astrocytoma patients when the relative antibody of encephalomyelitis is positive. What's more, it reminds us that the pathogenesis of MOG-EM might be related to astrocytoma.
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Affiliation(s)
| | - Jia Zhang
- Heyuan People’s Hospital, Heyuan, Guangdong, China
| | - Xi Liu
- Heyuan People’s Hospital, Heyuan, Guangdong, China
- * Correspondence: Department of Neurology, Heyuan People’s Hospital, Heyuan, Guangdong, China (e-mail: )
| | | | - Hongli Gu
- Heyuan People’s Hospital, Heyuan, Guangdong, China
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Jarius S, Bieber N, Haas J, Wildemann B. MOG encephalomyelitis after vaccination against severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2): case report and comprehensive review of the literature. J Neurol 2022; 269:5198-5212. [PMID: 35737110 PMCID: PMC9219396 DOI: 10.1007/s00415-022-11194-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/09/2022] [Accepted: 05/10/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND In around 20% of cases, myelin oligodendrocyte glycoprotein (MOG) immunoglobulin (IgG)-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) first occurs in a postinfectious or postvaccinal setting. OBJECTIVE To report a case of MOG-EM with onset after vaccination with the Pfizer BioNTech COVID-19 mRNA vaccine BNT162b2 (Comirnaty®) and to provide a comprehensive review of the epidemiological, clinical, radiological, electrophysiological and laboratory features as well as treatment outcomes of all published patients with SARS-CoV-2 vaccination-associated new-onset MOG-EM. METHODS Case report and review of the literature. RESULTS In our patient, MOG-IgG-positive (serum 1:1000, mainly IgG1 and IgG2; CSF 1:2; MOG-specific antibody index < 4) unilateral optic neuritis (ON) occurred 10 days after booster vaccination with BNT162b2, which had been preceded by two immunizations with the vector-based Oxford AstraZeneca vaccine ChAdOx1-S/ChAdOx1-nCoV-19 (AZD1222). High-dose steroid treatment with oral tapering resulted in complete recovery. Overall, 20 cases of SARS-CoV2 vaccination-associated MOG-EM were analysed (median age at onset 43.5 years, range 28-68; female to male ratio = 1:1.2). All cases occurred in adults and almost all after immunization with ChAdOx1-S/ChAdOx1 nCoV-19 (median interval 13 days, range 7-32), mostly after the first dose. In 70% of patients, more than one CNS region (spinal cord, brainstem, supratentorial brain, optic nerve) was affected at onset, in contrast to a much lower rate in conventional MOG-EM in adults, in which isolated ON is predominant at onset and ADEM-like phenotypes are rare. The cerebrospinal fluid white cell count (WCC) exceeded 100 cells/μl in 5/14 (36%) patients with available data (median peak WCC 58 cells/μl in those with pleocytosis; range 6-720). Severe disease with tetraparesis, paraplegia, functional blindness, brainstem involvement and/or bladder/bowel dysfunction and a high lesion load was common, and treatment escalation with plasma exchange (N = 9) and/or prolonged IVMP therapy was required in 50% of cases. Complete or partial recovery was achieved in the majority of patients, but residual symptoms were significant in some. MOG-IgG remained detectable in 7/7 cases after 3 or 6 months. CONCLUSIONS MOG-EM with postvaccinal onset was mostly observed after vaccination with ChAdOx1-S/ChAdOx1 nCoV-19. Attack severity was often high at onset. Escalation of immunotherapy was frequently required. MOG-IgG persisted in the long term.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
- Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - N Bieber
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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Molazadeh N, Bose G, Lotan I, Levy M. Autoimmune diseases and cancers overlapping with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): A systematic review. Mult Scler J Exp Transl Clin 2022; 8:20552173221128170. [PMID: 36311694 PMCID: PMC9597055 DOI: 10.1177/20552173221128170] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 09/06/2022] [Indexed: 11/24/2022] Open
Abstract
Background Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has various similarities with AQP4-IgG-seropositive Neuromyelitis Optica Spectrum Disorder (AQP4-IgG + NMOSD) in terms of clinical presentations, magnetic resonance imaging (MRI) findings, and response to treatment. But unlike AQP4-IgG + NMOSD, which is known to coexist with various autoimmune diseases and cancers, an association of MOGAD with these conditions is less clear. Methods We conducted a systematic search in PubMed, Scopus, Web of Science, and Embase based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA). Duplicates were removed using Mendeley 1.19.8 (USA production) and the citations were uploaded into Covidence systematic review platform for screening. Results The most common autoimmune disease overlapping with MOGAD was anti-N-Methyl-D-Aspartate receptor encephalitis (anti-NMDAR-EN), followed by autoimmune thyroid disorders, and the most common autoantibody was antinuclear antibody (ANA), followed by AQP4-IgG (double-positive MOG-IgG and AQP4-IgG). A few sporadic cases of cancers and MOG-IgG-associated paraneoplastic encephalomyelitis were found. Conclusion Unlike AQP4-IgG + NMOSD, MOGAD lacks clustering of autoimmune diseases and autoantibodies associated with systemic and organ-specific autoimmunity. Other than anti-NMDAR-EN and perhaps AQP4-IgG + NMOSD, the evidence thus far does not support the need for routine screening of overlapping autoimmunity and neoplasms in patients with MOGAD.
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Affiliation(s)
- Negar Molazadeh
- Negar Molazadeh, Neuromyelitis Optica
Research Laboratory, Division of Neuroimmunology & Neuroinfectious Disease,
Department of Neurology, Massachusetts General Hospital, Building 114, 16th St,
Room 3150, Charlestown, MA 02129, USA.
Twitter: http://twitter.com/NegarMowlazadeh
| | - Gauruv Bose
- Department of Neurology, Massachusetts General
Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Itay Lotan
- Department of Neurology, Massachusetts General
Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Michael Levy
- Department of Neurology, Massachusetts General
Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Galym A, Akhmetova N, Zhaksybek M, Safina S, Boldyreva MN, Rakhimbekova FK, Idrissova ZR. Clinical and Genetic Analysis in Pediatric Patients with Multiple Sclerosis and Related Conditions: Focus on DR Genes of the Major Histocompatibility Complex. Open Neurol J 2022. [DOI: 10.2174/1874205x-v16-e2207200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
There are several diseases recognized as variants of MS: post-infectious acute disseminated encephalitis, multiple sclerosis (MS), Rasmussen leukoencephalitis and Schilder's leukoencephalitis and related, but separate neuroimmune condition – Neuromyelitis Devic’s. In Kazakhstan diagnosis of such diseases was rare and immune modified treatment was only admitted after the age of 18. Clinical and immunogenetic study of MS spectrum diseases in Kazakhstan would allow to justify early targeted treatment.
Objective:
The aim of the study was to investigate genes of the main complex of human histocompatibility (MHC) associated with diseases of MS spectrum in Kazakhstani population.
Methods:
Complex clinical, neuroimaging and immunogenetic studies were performed in 34 children (24 girls, 10 boys) aged 4 to 18 years. 21 children were diagnosed with MS (11 Kazakh origin and 10 – Russian; 4 boys, 17 girls), 7 with leucoencephalitis (all Kazakh, 5 boys, 2 girls) and 6 with Devic neuromyelitis optica (all Kazakh, 1 boy, 5 girls). Genotyping of HLA DRB1, DQA1, DQB1 genes was performed for all patients.
Results:
MS group was characterized by classical relapsing-remitting MS. Predominant haplotype as a linkage complex was DRB1*15:01~DQA1*01:02~DQB1*06:02 in 20 (47.6%) of 42 DR-alleles, in 16 (76.2%) patients. MS relative risk (RR) was 13,36 for ethnic Kazakhs and RR=5,55 in Russians.
Leukoencephalitis had 7 children, with 28.6% mortality rate. The haplotype DRB1*15:01~DQA1*01:02~DQB1*06:02 as a linkage complex was detected 3 patients (4 alleles), RR=5,88.
Devic’s neuromyelitis optica (NMO) clinical course was characterized by fast and prolonged progression. There was predominance of DRB1*14 allele with RR=3,38.
Conclusion:
Summarizing, in the Kazakh population the haplotype DRB1*15:01∼DQA1*01:02∼DQB1*06:02 as a linkage complex was associated with prediction to MS and leukoencephalitis, but not to Devic’s NMO. Our study highlights the importance of awareness of MS and related disorders diagnosis which allows to implement early admission of disease-modified treatment in pediatric MS in Kazakhstan.
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Lotan I, Nishiyama S, Manzano GS, Lydston M, Levy M. COVID-19 and the risk of CNS demyelinating diseases: A systematic review. Front Neurol 2022; 13:970383. [PMID: 36203986 PMCID: PMC9530047 DOI: 10.3389/fneur.2022.970383] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
Abstract
Background Viral infections are a proposed possible cause of inflammatory central nervous system (CNS) demyelinating diseases, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). During the past 2 years, CNS demyelinating events associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection have been reported, but causality is unclear. Objective To investigate the relationship between CNS demyelinating disease development and exacerbation with antecedent and/or concurrent SARS-CoV-2 infection. Methods A systematic literature review of all publications describing either a new diagnosis or relapse of CNS demyelinating diseases (MS, NMOSD, MOGAD) in association with SARS-CoV-2 infection was performed utilizing PRISMA guidelines. Descriptive statistics were used for data analysis, using a case analysis approach. Results Sixty-seven articles met the inclusion criteria for the study. Most of the reported cases of NMOSD (n = 13, 72.2% of reported cases) and MOGAD (n = 27, 96.5% of reported cases) were of new disease onset, presenting with typical clinical and radiographic features of these conditions, respectively. In contrast, reported MS cases varied amongst newly diagnosed cases (n = 10, 10.5% of reported cases), relapses (n = 63, 66.4%) and pseudo-relapses (n = 22, 23.2%). The median duration between COVID-19 infection and demyelinating event onset was 11.5 days (range 0–90 days) in NMOSD, 6 days (range−7 to +45 days) in MOGAD, and 13.5 days (range−21 to +180 days) in MS. Most cases received high-dose corticosteroids with a good clinical outcome. Conclusion Based upon available literature, the rate of CNS demyelinating events occurring in the setting of preceding or concurrent SARS-CoV-2 infection is relatively low considering the prevalence of SARS-CoV-2 infection. The clinical outcomes of new onset or relapsing MS, NMOSD, or MOGAD associated with antecedent or concurrent infection were mostly favorable. Larger prospective epidemiological studies are needed to better delineate the impact of COVID-19 on CNS demyelinating diseases.
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Affiliation(s)
- Itay Lotan
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
- *Correspondence: Itay Lotan ;
| | - Shuhei Nishiyama
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Giovanna S. Manzano
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
| | - Melissa Lydston
- Treadwell Virtual Library for the Massachusetts General Hospital, Boston, MA, United States
| | - Michael Levy
- Division of Neuroimmunology and Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States
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Ciapă MA, Șalaru DL, Stătescu C, Sascău RA, Bogdănici CM. Optic Neuritis in Multiple Sclerosis—A Review of Molecular Mechanisms Involved in the Degenerative Process. Curr Issues Mol Biol 2022; 44:3959-3979. [PMID: 36135184 PMCID: PMC9497878 DOI: 10.3390/cimb44090272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/26/2022] Open
Abstract
Multiple sclerosis is a central nervous system inflammatory demyelinating disease with a wide range of clinical symptoms, ocular involvement being frequently marked by the presence of optic neuritis (ON). The emergence and progression of ON in multiple sclerosis is based on various pathophysiological mechanisms, disease progression being secondary to inflammation, demyelination, or axonal degeneration. Early identification of changes associated with axonal degeneration or further investigation of the molecular processes underlying remyelination are current concerns of researchers in the field in view of the associated therapeutic potential. This article aims to review and summarize the scientific literature related to the main molecular mechanisms involved in defining ON as well as to analyze existing data in the literature on remyelination strategies in ON and their impact on long-term prognosis.
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Affiliation(s)
| | - Delia Lidia Șalaru
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Correspondence:
| | - Cristian Stătescu
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Radu Andy Sascău
- Cardiology Clinic, Institute of Cardiovascular Diseases, 700503 Iași, Romania
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
| | - Camelia Margareta Bogdănici
- Department of Surgical Specialties (II), University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iași, Romania
- Ophthalmology Clinic, Saint Spiridon Hospital, Iași 700111, Romania
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Ojha PT, Barvalia PP, Singh R, Soni G, Kadam N, Nagendra S, Aglave V, Jagiasi K. Atypical Optic Neuritis: The Potential Red Flags. Neurol India 2022; 70:1982-1987. [PMID: 36352598 DOI: 10.4103/0028-3886.359189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Many potential causes of optic nerve inflammation exist, including typical and atypical causes, which require different management strategies. OBJECTIVE The objective of this study is to identify red flags that help differentiate typical from atypical optic neuritis (ON). MATERIALS AND METHODS This prospective study included 66 patients (100 eyes) with immune-mediated ON from January 2016 to June 2019, carefully excluding the nonimmune causes. The clinico-radiological features, investigations, therapy, and outcome were analyzed. RESULTS We evaluated 33 cases each of typical and atypical ON. The typical group included 29 idiopathic ON and four associated with multiple sclerosis. Atypical ON included 19 neuromyelitis optica (NMO), seven MOG-associated ON (MOG-ON), and others due to Sjogren's syndrome, granulomatous polyangiitis, sarcoidosis, and IgG4 disease. Atypical ON occurred significantly and more frequently with extremes of ages (<10 or >70 years), bilateral simultaneous or severe vision loss with early disc pallor, multiple attacks, symptoms/neuro-imaging indicating non-MS disease e.g., long segment ON/myelitis, large confluent lesions, the involvement of optic tract, chiasma, area postrema or diencephalon, and (pachy) meningitis. Systemic involvement and poor outcomes despite steroids and second-line immunosuppression were observed more often in the atypical ON. CONCLUSIONS The red flags indicating atypical ON are onset at extremes of age, multiple attacks, bilateral simultaneous or severe to very severe vision loss, early disc pallor, neurological symptoms, or imaging abnormalities suggesting non-MS disease, systemic involvement, and poor steroid responsiveness. The awareness might help the clinician promptly identify and escalate therapy to ensure a better outcome.
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Affiliation(s)
- Pawan T Ojha
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Prachi P Barvalia
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Rakesh Singh
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Girish Soni
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Nikhil Kadam
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Shashank Nagendra
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Vikram Aglave
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
| | - Kamlesh Jagiasi
- Department of Neurology, Grant Medical College and Sir JJ Group of Hospitals, Mumbai, Maharashtra, India
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Liu Z, Wang Y, Ding Y, Wang H, Zhang J, Wang H. CXCL7 aggravates the pathological manifestations of neuromyelitis optica spectrum disorder by enhancing the inflammatory infiltration of neutrophils, macrophages and microglia. Clin Immunol 2022; 245:109139. [DOI: 10.1016/j.clim.2022.109139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/30/2022] [Accepted: 09/12/2022] [Indexed: 11/03/2022]
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Otiv M, Botre A, Shah P. Measles-rubella vaccine-associated MOG-antibody positive acute demyelinating encephalomyelitis with optic neuritis in a child. Ther Adv Vaccines Immunother 2022; 10:25151355221115016. [PMID: 35966175 PMCID: PMC9373146 DOI: 10.1177/25151355221115016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/06/2022] [Indexed: 11/16/2022] Open
Abstract
Measles-rubella (MR) vaccine-associated encephalopathy is rare and coexistence with optic neuritis (ON) has never been reported. Only two patients (one child and one adult) had 'MR Vaccine-associated myelin-oligodendrocyte-glycoprotein antibody (MOGAb) positive encephalopathy'. Myelin oligodendrocyte glycoprotein (MOG), a surface myelin protein, is the target of the immune system in this disease. We describe a critical unique case of 'post-MR Vaccine, MOG-antibody positive Acute Disseminated Encephalo-Myelitis (ADEM) with optic neuritis', who recovered with immunotherapy.
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Affiliation(s)
| | - Abhijeet Botre
- Pediatric Neurologist, KEM Hospital, Mudliyar Road, Rasta Peth, Pune 411011, Maharashtra, India
| | - Pawan Shah
- Synergy Kids' Hospital, Ahmedabad, India
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140
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Diem L, Hammer H, Hoepner R, Pistor M, Remlinger J, Salmen A. Sex and gender differences in autoimmune demyelinating CNS disorders: Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and myelin-oligodendrocyte-glycoprotein antibody associated disorder (MOGAD). INTERNATIONAL REVIEW OF NEUROBIOLOGY 2022; 164:129-178. [PMID: 36038203 DOI: 10.1016/bs.irn.2022.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Multiple sclerosis (MS), Neuromyelitis optica spectrum disorder (NMOSD) and Myelin-Oligodendrocyte-Glycoprotein antibody associated disorder (MOGAD) are demyelinating disorders of the central nervous system (CNS) of autoimmune origin. Here, we summarize general considerations on sex-specific differences in the immunopathogenesis and hormonal influences as well as key clinical and epidemiological elements. Gender-specific issues are widely neglected starting with the lacking separation of sex as a biological variable and gender comprising the sociocultural components. As for other autoimmune diseases, female preponderance is common in MS and NMOSD. However, sex distribution in MOGAD seems equal. As in MS, immunotherapy in NMOSD and MOGAD is crucial to prevent further disease activity. Therefore, we assessed data on sex differences of the currently licensed disease-modifying treatments for efficacy and safety. This topic seems widely neglected with only fragmented information resulting from post-hoc analyses of clinical trials or real-world post-marketing studies afflicted with lacking power and/or inherent sources of bias. In summary, biological hypotheses of sex differences including genetic factors, the constitution of the immune system and hormonal influences are based upon human and preclinical data, especially for the paradigmatic disease of MS whereas specific data for NMOSD and MOGAD are widely lacking. Epidemiological and clinical differences between men and women are well described for MS and to some extent for NMOSD, yet, with remaining contradictory findings. MOGAD needs further detailed investigation. Sex-specific analyses of safety and efficacy of long-term immunotherapies need to be addressed in future studies designed and powered to answer the pressing questions and to optimize and individualize treatment.
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Affiliation(s)
- Lara Diem
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Helly Hammer
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Robert Hoepner
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Max Pistor
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland
| | - Jana Remlinger
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland; Department of Biomedical Research and Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Anke Salmen
- Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse, Bern, Switzerland.
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The Treatment of Myelin Oligodendrocyte Glycoprotein Antibody Disease: A State-of-the-Art Review. J Neuroophthalmol 2022; 42:292-296. [PMID: 35944137 DOI: 10.1097/wno.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is an important etiology of neurologic morbidity and specifically, atypical, and relapsing optic neuritis. This review summarizes acute treatment and long-term prevention approaches in MOGAD. EVIDENCE ACQUISITION PubMed and Google Scholar databases were manually searched and reviewed. RESULTS We review the evidence base for acute treatment of MOGAD with corticosteroids and adjunct therapies, such as intravenous immunoglobulin (IVIg) and plasma exchange. We discuss the utility of prolonged corticosteroid tapering after the acute attack. We then summarize the commonly used disease-modifying treatments for relapsing MOGAD, including chronic low-dose corticosteroids, classic antirheumatic immune suppressants, biologic agents, and IVIg. CONCLUSIONS While acute MOGAD attacks are usually treated with high-dose IV corticosteroids, longer oral corticosteroid tapers may prevent rapid relapse. Multiple long-term treatment strategies are being employed in recurrent MOGAD, with IVIg is emerging as probably the most effective therapy.
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Kim KH, Kim SH, Hyun JW, Kim Y, Park H, Kim HJ. Seroprevalence of anti-myelin oligodendrocyte glycoprotein antibodies in adults with myelitis. Ann Clin Transl Neurol 2022; 9:1481-1486. [PMID: 35932473 PMCID: PMC9463949 DOI: 10.1002/acn3.51642] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022] Open
Abstract
Although myelitis is the second most common presentation in adults with myelin oligodendrocyte glycoprotein (MOG) antibody‐associated disease (MOGAD), studies on MOG‐IgG seroprevalence in patients with myelitis episodes are sparse. Herein, we investigated MOG‐IgG seroprevalence in Korean adults who exhibited myelitis since 2017. Among 151 adults with acute myelitis, 11 (7.3%) tested positive for MOG‐IgG by the initial screening and 10 (6.6%) patients were finally diagnosed with MOGAD during the study period. This study is the first to provide data on MOG‐IgG seroprevalence in adults with myelitis and supports the clinical utility and importance of MOG‐IgG testing in myelitis episodes.
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Affiliation(s)
- Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Yeseul Kim
- Division of Rare and Refractory Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Hyewon Park
- Division of Rare and Refractory Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea.,Division of Rare and Refractory Cancer, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
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143
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Han JY, Kim SY, Kim H, Hwang H, Choi J, Chae JH, Kim KJ, Cheon JE, Lim BC. Clinico-radiological characteristics of anti-myelin oligodendrocyte glycoprotein antibody-associated autoimmune encephalitis in children. Dev Med Child Neurol 2022; 64:998-1007. [PMID: 35106761 DOI: 10.1111/dmcn.15174] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/08/2021] [Accepted: 01/05/2022] [Indexed: 11/30/2022]
Abstract
AIM To investigate the clinical characteristics and prevalence of paediatric anti-myelin oligodendrocyte glycoprotein (MOG) antibody-associated autoimmune encephalitis. METHOD A total of 94 paediatric patients (46 males, 48 females, median age 9 years 5 months, range: 8 months-17 years 8 months) with autoimmune encephalitis were recruited at Seoul National University Children's Hospital. We evaluated autoantibody status and identified patients with anti-MOG antibody-associated autoimmune encephalitis. Retrospective reviews of medical records were performed to describe clinical presentations, laboratory findings, treatments, and outcomes. RESULTS Eight patients (five males, three females, median age 11 years 9 months) with anti-MOG antibody-associated encephalitis were identified (8.5% of those with autoimmune encephalitis), one of whom was copositive for anti-N-methyl-d-aspartate receptor (NMDAR) antibodies. Anti-NMDAR antibodies were identified in 23 patients (23 out of 94, 24.5%). Unilateral or bilateral cortical involvement was identified in five patients. Focal contrast enhancement was also identified in three of the five patients with cortical lesions. All patients showed favourable response to immunotherapy with a Modified Rankin Scale ≤2 at the last follow-up. Relapse was found in one patient and clinico-radiological remission was achieved with cyclic intravenous immunoglobulin therapy. INTERPRETATION Anti-MOG antibody-associated encephalitis accounts for a significant proportion of clinically defined paediatric patients with autoimmune encephalitis. Anti-MOG antibody-associated encephalitis should be included in the clinical spectrum of anti-MOG-associated diseases.
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Affiliation(s)
- Ji Yeon Han
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Soo Yeon Kim
- Rare Disease Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Jieun Choi
- Department of Pediatrics, Seoul Metropolitan Boramae Hospital, Seoul, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea.,Rare Disease Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Republic of Korea
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144
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Longbrake E. Myelin Oligodendrocyte Glycoprotein-Associated Disorders. Continuum (Minneap Minn) 2022; 28:1171-1193. [PMID: 35938661 PMCID: PMC9523511 DOI: 10.1212/con.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Anti-myelin oligodendrocyte glycoprotein (MOG) autoantibodies have become a recognized cause of a pathophysiologically distinct group of central nervous system (CNS) autoimmune diseases. MOG-associated disorders can easily be confused with other CNS diseases such as multiple sclerosis or neuromyelitis optica, but they have a distinct clinical phenotype and prognosis. RECENT FINDINGS Most patients with MOG-associated disorders exhibit optic neuritis, myelitis, or acute disseminated encephalomyelitis (ADEM) alone, sequentially, or in combination; the disease may be either monophasic or relapsing. Recent case reports have continued to expand the clinical spectrum of disease, and increasingly larger cohort studies have helped clarify its pathophysiology and natural history. SUMMARY Anti-MOG-associated disorders comprise a substantial subset of patients previously thought to have other seronegative CNS diseases. Accurate diagnosis is important because the relapse patterns and prognosis for MOG-associated disorders are unique. Immunotherapy appears to successfully mitigate the disease, although not all agents are equally effective. The emerging large-scale data describing the clinical spectrum and natural history of MOG-associated disorders will be foundational for future therapeutic trials.
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Jarius S, Bräuninger S, Chung HY, Geis C, Haas J, Komorowski L, Wildemann B, Roth C. Inositol 1,4,5-trisphosphate receptor type 1 autoantibody (ITPR1-IgG/anti-Sj)-associated autoimmune cerebellar ataxia, encephalitis and peripheral neuropathy: review of the literature. J Neuroinflammation 2022; 19:196. [PMID: 35907972 PMCID: PMC9338677 DOI: 10.1186/s12974-022-02545-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 06/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background In 2014, we first described novel autoantibodies to the inositol 1,4,5-trisphosphate receptor type 1 (ITPR1-IgG/anti-Sj) in patients with autoimmune cerebellar ataxia (ACA) in this journal. Here, we provide a review of the available literature on ITPR1-IgG/anti-Sj, covering clinical and paraclinical presentation, tumour association, serological findings, and immunopathogenesis. Methods Review of the peer-reviewed and PubMed-listed English language literature on ITPR1-IgG/anti-Sj. In addition, we provide an illustrative report on a new patient with ITPR1-IgG-associated encephalitis with cognitive decline and psychosis. Results So far, at least 31 patients with serum ITPR1-IgG/anti-Sj have been identified (clinical information available for 21). The most common manifestations were ACA, encephalopathy with seizures, myelopathy, and (radiculo)neuropathy, including autonomic neuropathy. In 45% of cases, an underlying tumour was present, making the condition a facultative paraneoplastic neurological disorder. The neurological syndrome preceded tumour diagnosis in all but one case. In most cases, immunotherapy had only moderate or no effect. The association of ITPR1-IgG/anti-Sj with manifestations other than ACA is corroborated by the case of a 48-year-old woman with high-titre ITPR1-IgG/anti-Sj antibodies and rapid cognitive decline, affecting memory, attention and executive function, and psychotic manifestations, including hallucinations, investigated here in detail. FDG-PET revealed right-temporal glucose hypermetabolism compatible with limbic encephalitis. Interestingly, ITPR1-IgG/anti-Sj mainly belonged to the IgG2 subclass in both serum and cerebrospinal fluid (CSF) in this and further patients, while it was predominantly IgG1 in other patients, including those with more severe outcome, and remained detectable over the entire course of disease. Immunotherapy with intravenous methylprednisolone, plasma exchange, and intravenous immunoglobulins, was repeatedly followed by partial or complete recovery. Long-term treatment with cyclophosphamide was paralleled by relative stabilization, although the patient noted clinical worsening at the end of each treatment cycle. Conclusions The spectrum of neurological manifestations associated with ITPR1 autoimmunity is broader than initially thought. Immunotherapy may be effective in some cases. Studies evaluating the frequency of ITPR1-IgG/anti-Sj in patients with cognitive decline and/or psychosis of unknown aetiology are warranted. Tumour screening is essential in patients presenting with ITPR1-IgG/anti-Sj.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | | | - Ha-Yeun Chung
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Christian Geis
- Section Translational Neuroimmunology, Department of Neurology, Jena University Hospital, Jena, Germany
| | - Jürgen Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Lars Komorowski
- Institute for Experimental Immunology, affiliated to EUROIMMUN Medizinische Labordiagnostika AG, Lübeck, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Christian Roth
- Department of Neurology, DRK-Kliniken Nordhessen, Kassel, Germany.
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Stathopoulos P, Dalakas MC. The role of complement and complement therapeutics in neuromyelitis optica spectrum disorders. Expert Rev Clin Immunol 2022; 18:933-945. [PMID: 35899480 DOI: 10.1080/1744666x.2022.2105205] [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: 11/04/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are characterized in the majority of cases by the presence of IgG1 autoantibodies against aquaporin 4 (AQP4) and myelin-oligodendrocyte glycoprotein (MOG), both capable of activating complement. AREAS COVERED We review evidence of complement involvement in NMOSD pathophysiology from pathological, in vitro, in vivo, human studies, and clinical trials. EXPERT OPINION In AQP4 NMOSD, complement deposition is a prominent pathological feature, while in vitro and in vivo studies have demonstrated complement-dependent pathogenicity of AQP4 antibodies. Consistent with these studies, the anti-C5 monoclonal antibody eculizumab was remarkably effective and safe in a phase 2/3 trial of AQP4-NMOSD patents leading to FDA-approved indication. Several other anti-complement agents, either approved or in trials for other neuro-autoimmunities, like myasthenia, CIDP, and GBS, are also relevant to NMOSD generating an exciting group of evolving immunotherapies. Limited but compelling in vivo and in vitro data suggest that anti-complement therapeutics may be also applicable to a subset of MOG NMOSD patients with severe disease. Overall, anticomplement agents, along with the already approved anti-IL6 and anti-CD19 monoclonal antibodies sartralizumab and inebilizumab, are rapidly changing the therapeutic algorithm in NMOSD, a previously difficult-to-treat autoimmune neurological disorder.
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Affiliation(s)
- Panos Stathopoulos
- Department of Neurology, National and Kapodistrian University of Athens, Athens, Greece
| | - Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, PA, USA.,Neuroimmunology Unit, National and Kapodistrian University of Athens, Athens, Greece
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147
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Update on glial antibody-mediated optic neuritis. Jpn J Ophthalmol 2022; 66:405-412. [PMID: 35895155 DOI: 10.1007/s10384-022-00932-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 10/16/2022]
Abstract
Optic neuritis (ON) refers to inflammatory demyelinating lesions of the optic nerve, which can cause acute or subacute vision loss and is a major cause of vision loss in young adults. Much of our understanding of typical ON is from the Optic Neuritis Treatment Trial. Glial autoantibodies to aquaporin-4 immunoglobulin (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin (MOG-IgG) are recently established biomarkers of ON that have revolutionized our understanding of atypical ON. The detection of glial antibodies is helpful in the diagnosis, treatment, and follow-up of patients with different types of ON. AQP4-IgG and MOG-IgG screening is strongly recommended for patients with atypical ON. Research on the pathogenesis of NMOSD and MOGAD will promote the development and marketing of targeted immunotherapies. The application of new and efficient drugs, such as the selective complement C5 inhibitor, IL-6 receptor inhibitor, B cell-depleting agents, and drugs against other monoclonal antibodies, provides additional medical evidence. This review provides information on the diagnosis and management of glial antibody-mediated ON.
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148
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Wang X, Kong L, Zhao Z, Shi Z, Chen H, Lang Y, Lin X, Du Q, Zhou H. Effectiveness and tolerability of different therapies in preventive treatment of MOG-IgG-associated disorder: A network meta-analysis. Front Immunol 2022; 13:953993. [PMID: 35958613 PMCID: PMC9360318 DOI: 10.3389/fimmu.2022.953993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/28/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundImmunotherapy has been shown to reduce relapses in patients with myelin oligodendrocyte glycoprotein antibody-associated disorder (MOG-AD); however, the superiority of specific treatments remains unclear.AimTo identify the efficacy and tolerability of different treatments for MOG-AD.MethodsSystematic search in Pubmed, Embase, Web of Science, and Cochrane Library databases from inception to March 1, 2021, were performed. Published articles including patients with MOG-AD and reporting the efficacy or tolerability of two or more types of treatment in preventing relapses were included. Reported outcomes including incidence of relapse, annualized relapse rate (ARR), and side effects were extracted. Network meta-analysis with a random-effect model within a Bayesian framework was conducted. Between group comparisons were estimated using Odds ratio (OR) or mean difference (MD) with 95% credible intervals (CrI).ResultsTwelve studies that compared the efficacy of 10 different treatments in preventing MOG-AD relapse, including 735 patients, were analyzed. In terms of incidence of relapse, intravenous immunoglobulins (IVIG), oral corticosteroids (OC), mycophenolate mofetil (MMF), azathioprine (AZA), and rituximab (RTX) were all significantly more effective than no treatment (ORs ranged from 0.075 to 0.34). On the contrary, disease-modifying therapy (DMT) (OR=1.3, 95% CrI: 0.31 to 5.0) and tacrolimus (TAC) (OR=5.9, 95% CrI: 0.19 to 310) would increase the incidence of relapse. Compared with DMT, IVIG significantly reduced the ARR (MD=−0.85, 95% CrI: −1.7 to −0.098). AZA, MMF, OC and RTX showed a trend to decrease ARR, but those results did not reach significant differences. The combined results for relapse rate and adverse events, as well as ARR and adverse events showed that IVIG and OC were the most effective and tolerable therapies.ConclusionsWhilst DMT should be avoided, IVIG and OC may be suited as first-line therapies for patients with MOG-AD. RTX, MMF, and AZA present suitable alternatives.
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Affiliation(s)
- Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Zhengyang Zhao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- Mental Health Centre and Psychiatric Laboratory, West China Hospital, Sichuan University, Chengdu, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanlin Lang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xue Lin
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
- *Correspondence: Hongyu Zhou,
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Sehgal V, Bansal P, Arora S, Kapila S, Bedi GS. Myelin Oligodendrocyte Glycoprotein Antibody Disease After COVID-19 Vaccination - Causal or Incidental? Cureus 2022; 14:e27024. [PMID: 35989780 PMCID: PMC9386328 DOI: 10.7759/cureus.27024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/05/2022] Open
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Neuromyelitis Optica Spectrum Disorder: From Basic Research to Clinical Perspectives. Int J Mol Sci 2022; 23:ijms23147908. [PMID: 35887254 PMCID: PMC9323454 DOI: 10.3390/ijms23147908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 07/08/2022] [Accepted: 07/15/2022] [Indexed: 02/05/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system characterized by relapses and autoimmunity caused by antibodies against the astrocyte water channel protein aquaporin-4. Over the past decade, there have been significant advances in the biologic knowledge of NMOSD, which resulted in the IDENTIFICATION of variable disease phenotypes, biomarkers, and complex inflammatory cascades involved in disease pathogenesis. Ongoing clinical trials are looking at new treatments targeting NMOSD relapses. This review aims to provide an update on recent studies regarding issues related to NMOSD, including the pathophysiology of the disease, the potential use of serum and cerebrospinal fluid cytokines as disease biomarkers, the clinical utilization of ocular coherence tomography, and the comparison of different animal models of NMOSD.
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