201
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Matà S, Lolli F. Neuromyelitis optica: An update. J Neurol Sci 2011; 303:13-21. [DOI: 10.1016/j.jns.2011.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 12/01/2010] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
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202
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Crane JM, Lam C, Rossi A, Gupta T, Bennett JL, Verkman AS. Binding affinity and specificity of neuromyelitis optica autoantibodies to aquaporin-4 M1/M23 isoforms and orthogonal arrays. J Biol Chem 2011; 286:16516-24. [PMID: 21454592 DOI: 10.1074/jbc.m111.227298] [Citation(s) in RCA: 150] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Autoantibodies against astrocyte water channel aquaporin-4 (AQP4) are highly specific for the neuroinflammatory disease neuromyelitis optica (NMO). We measured the binding of NMO autoantibodies to AQP4 in human astrocyte-derived U87MG cells expressing M1 and/or M23 AQP4, or M23 mutants that do not form orthogonal array of particles (OAPs). Binding affinity was quantified by two-color fluorescence ratio imaging of cells stained with NMO serum or a recombinant monoclonal NMO autoantibody (NMO-rAb), together with a C terminus anti-AQP4 antibody. NMO-rAb titrations showed binding with dissociation constants down to 44 ± 7 nm. Different NMO-rAbs and NMO patient sera showed a wide variation in NMO-IgG binding to M1 versus M23 AQP4. Differences in binding affinity rather than stoichiometry accounted for M1 versus M23 binding specificity, with consistently greater affinity of NMO-IgG binding to M23 than M1 AQP4. Binding and OAP measurements in cells expressing different M1:M23 ratios or AQP4 mutants indicated that the differential binding of NMO-IgG to M1 versus M23 was due to OAP assembly rather than to differences in the M1 versus M23 N termini. Purified Fab fragments of NMO-IgG showed similar patterns of AQP4 isoform binding, indicating that structural changes in the AQP4 epitope upon array assembly, and not bivalent cross-linking of whole IgG, result in the greater binding affinity to OAPs. Our study establishes a quantitative assay of NMO-IgG binding to AQP4 and indicates remarkable, OAP-dependent heterogeneity in NMO autoantibody binding specificity.
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Affiliation(s)
- Jonathan M Crane
- Department of Medicine, University of California, San Francisco, California 94143, USA
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Dujmovic I, Mader S, Schanda K, Deisenhammer F, Stojsavljevic N, Kostic J, Berger T, Drulovic J, Reindl M. Temporal dynamics of cerebrospinal fluid anti-aquaporin-4 antibodies in patients with neuromyelitis optica spectrum disorders. J Neuroimmunol 2011; 234:124-30. [PMID: 21316112 DOI: 10.1016/j.jneuroim.2011.01.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2010] [Revised: 01/17/2011] [Accepted: 01/19/2011] [Indexed: 11/29/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are associated with anti-aquaporin-4 autoantibodies (AQP4-IgG). Limited data is available on longitudinal cerebrospinal fluid (CSF) AQP4-IgG and their relation to disease activity and inflammatory parameters. AQP4-IgG titers were measured in matched longitudinal serum and CSF samples of 12 patients with NMOSD by an immunofluorescence assay and correlated with clinical parameters. CSF AQP4-IgG were present in patients with high serum titers and correlated with spinal MRI lesion length and CSF parameters. Clinical improvement was associated with a decrease in CSF, but not serum, AQP4-IgG titers. Thus, CSF AQP4-IgG were associated with clinical activity and neuroinflammation.
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Affiliation(s)
- Irena Dujmovic
- Clinic of Neurology, Clinical Center of Serbia, Belgrade, Serbia
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204
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Moura FC, Fernandes DB, Apóstolos-Pereira SL, Callegaro D, Marchiori PE, Monteiro ML. Optical coherence tomography evaluation of retinal nerve fiber layer in longitudinally extensive transverse myelitis. ARQUIVOS DE NEURO-PSIQUIATRIA 2011; 69:69-73. [DOI: 10.1590/s0004-282x2011000100014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Accepted: 08/10/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To compare optical coherence tomography (OCT) measurements on the retinal nerve fiber layer (RNFL) of healthy controls and patients with longitudinally extensive transverse myelitis (LETM) without previous optic neuritis. METHOD: Twenty-six eyes from 26 patients with LETM and 26 control eyes were subjected to automated perimetry and OCT for comparison of RNFL measurements. RESULTS: The mean deviation values from perimetry were significantly lower in patients with LETM than in controls (p<0.0001). RNFL measurements in the nasal quadrant and in the 3-o'clock segment were significantly smaller in LETM eyes than in controls. (p=0.04 and p=0.006, respectively). No significantly differences in other RNFL measurements were found. CONCLUSION: Patients with LETM may present localized RNFL loss, particularly on the nasal side of the optic disc, associated with slight visual field defects, even in the absence of previous episodes of optic neuritis. These findings emphasize the fact that patients with LETM may experience attacks of subclinical optic nerve damage.
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206
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207
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Collongues N, Marignier R, Zéphir H, Blanc F, Vukusic S, Outteryck O, Fleury M, Ruet A, Borgel F, Thouvenot E, Moreau T, Defer G, Derache N, Pelletier J, Audoin B, Debouverie M, Labauge P, Gout O, Camu W, Brassat D, Brochet B, Vermersch P, Confavreux C, Seze JD. High-risk syndrome for neuromyelitis optica: a descriptive and comparative study. Mult Scler 2011; 17:720-4. [DOI: 10.1177/1352458510396923] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Neuromyelitis optica (NMO) frequently begins with a monofocal episode of optic neuritis or myelitis. A concept named high-risk syndrome (HRS) for NMO has been proposed for patients with monofocal episodes and NMO-IgG antibodies. Objective: To describe HRS patients and compare them with NMO patients. Methods: We identified 30 patients with HRS: 18 with extensive myelitis (HRM) and 12 with optic neuritis (HRON), in a database pooling patients from 25 centres in France. Clinical, laboratory/magnetic resonance imaging (MRI) data and outcome were analysed and compared with a national cohort of 125 NMO patients extracted from the same database. Results: Mean follow-up was 4.8 years. Mean age at onset was 42.8 years (range: 12.4–70) with a female:male ratio of 0.9. Asymptomatic lesions were report on visual evoked potentials in 4/8 tested HRM patients and on spinal cord MRI in 2/7 HRON patients. Three patients died, two owing to a cervical lesion. HRS and NMO patients had similar clinical/paraclinical data, except for a predominance of men in the HRS group and a later mean age at onset in the HRM subgroup. Conclusion: The description of HRS patients is compatible with a monofocal form of NMO. Asymptomatic lesions could be included in a new set of NMO diagnostic criteria.
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Affiliation(s)
- N Collongues
- Strasbourg University Hospital, Strasbourg, France
| | | | - H Zéphir
- Lille University Hospital, Lille, France
| | - F Blanc
- Strasbourg University Hospital, Strasbourg, France
| | - S Vukusic
- Lyon University Hospital, Lyon, France
| | | | - M Fleury
- Strasbourg University Hospital, Strasbourg, France
| | - A Ruet
- Bordeaux University Hospital, Bordeaux, France
| | - F Borgel
- Grenoble University Hospital, Grenoble, France
| | - E Thouvenot
- Montpellier University Hospital, Montpellier, France
| | - T Moreau
- Dijon University Hospital, Dijon, France
| | - G Defer
- Caen University Hospital, Caen, France
| | - N Derache
- Caen University Hospital, Caen, France
| | - J Pelletier
- Marseille University Hospital, Marseille, France
| | - B Audoin
- Marseille University Hospital, Marseille, France
| | | | - P Labauge
- Nîmes University Hospital, Nîmes, France
| | - O Gout
- Rothschild Foundation Hospital, Paris, France
| | - W Camu
- Montpellier University Hospital, Montpellier, France
| | - D Brassat
- Toulouse University Hospital, Toulouse, France
| | - B Brochet
- Bordeaux University Hospital, Bordeaux, France
| | | | | | - J de Seze
- Strasbourg University Hospital, Strasbourg, France
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208
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Graves J, Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 2010; 4:1409-22. [PMID: 21188152 PMCID: PMC3000766 DOI: 10.2147/opth.s6383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and leading cause of disability in young adults. Vision impairment is a common component of disability for this population of patients. Injury to the optic nerve, brainstem, and cerebellum leads to characteristic syndromes affecting both the afferent and efferent visual pathways. The objective of this review is to summarize the spectrum of eye disorders in patients with MS, their natural history, and current strategies for diagnosis and management. We emphasize the most common disorders including optic neuritis and internuclear ophthalmoparesis and include new techniques, such as optical coherence tomography, which promise to better our understanding of MS and its effects on the visual system.
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Affiliation(s)
- Jennifer Graves
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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209
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de Sèze J, Arndt C. [Recurrent inflammatory optic neuritis and neuromyelitis optica]. Rev Neurol (Paris) 2010; 166:966-9. [PMID: 21126746 DOI: 10.1016/j.neurol.2010.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Revised: 09/23/2010] [Accepted: 09/29/2010] [Indexed: 10/18/2022]
Abstract
Inflammatory optic neuritis (ON) represents a frequent clinical situation in neurology and ophthalmology. When MRI and CSF analysis are normal, ON is considered idiopathic with a suspected viral etiology. However, in several cases either a recurrence or a myelitis may occur. In the first case, it is relapsing inflammatory optic neuritis (RION) and in the second case it is neuromyelitis optica (NMO). Nevertheless, predictive criteria of a recurrence or an extension of the disease to spinal cord remains unknown, excepted for anti-NMO IgG antibodies which are probably highly specific for a future evolution to NMO. In the present paper, the authors successively present the two clinical situations (RION and NMO) and attempt to summarize diagnostic and prognostic criteria.
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Affiliation(s)
- J de Sèze
- Service de neurologie, CHU de Strasbourg, 1, place de l'hôpital, 67091 Strasbourg cedex, France.
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210
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Should Most Patients With Optic Neuritis be Tested for Neuromyelitis Optica Antibodies and Should This Affect Their Treatment? J Neuroophthalmol 2010; 30:376-8; discussion 378-9. [DOI: 10.1097/wno.0b013e3181f68c19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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211
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Frequency and prognostic impact of antibodies to aquaporin-4 in patients with optic neuritis. J Neurol Sci 2010; 298:158-62. [DOI: 10.1016/j.jns.2010.07.011] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2010] [Revised: 07/15/2010] [Accepted: 07/21/2010] [Indexed: 10/19/2022]
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212
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Sellner J, Cepok S, Kalluri SR, Nestler A, Kleiter I, Kümpfel T, Linker R, Melms A, Menge T, Tumani H, Paul F, Hemmer B, Berthele A. Aquaporin 4 antibody positive central nervous system autoimmunity and multiple sclerosis are characterized by a distinct profile of antibodies to herpes viruses. Neurochem Int 2010; 57:662-7. [DOI: 10.1016/j.neuint.2010.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2010] [Revised: 07/22/2010] [Accepted: 08/03/2010] [Indexed: 12/15/2022]
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213
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Abstract
Antibodies to aquaporin-4 (also known as AQP4-Ab or NMO-IgG) are sensitive and highly specific serum markers of autoimmune neuromyelitis optica (NMO). Second-generation recombinant diagnostic assays can detect AQP4-Ab in >or=80% of patients with NMO, and a role for AQP4-Ab in the pathophysiology of this condition was corroborated by a series of in vitro studies that demonstrated disruption of the blood-brain barrier, impairment of glutamate homeostasis and induction of necrotic cell death by AQP4-Ab-positive serum. Additional evidence for such a role has emerged from clinical observations, including the demonstration of a correlation between serum levels of AQP4-Ab and disease activity. The finding of NMO-like CNS lesions and clinical disease following passive transfer of AQP4-Ab-positive serum in several independent animal studies provided definitive proof for a pathogenic role of AQP4-Ab in vivo. Together, these findings provide a strong rationale for the use of therapies targeted against B cells or antibodies in the treatment of NMO. In this Review, we summarize the latest evidence in support of a direct involvement of AQP4-Ab in the immunopathogenesis of NMO, and critically appraise the diagnostic tests currently available for the detection of this serum reactivity.
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214
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Delayed onset of experimental autoimmune encephalomyelitis in Olig1 deficient mice. PLoS One 2010; 5. [PMID: 20927333 PMCID: PMC2947525 DOI: 10.1371/journal.pone.0013083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Accepted: 09/03/2010] [Indexed: 11/23/2022] Open
Abstract
Background Olig1 is a basic helix-loop-helix (bHLH) transcription factor that is essential for oligodendrogenesis and efficient remyelination. However, its role in neurodegenerative disorders has not been well-elucidated. Methodology/Principal Findings Here we investigated the effects of Olig1 deficiency on experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis (MS). We show that the mean disease onset of myelin oligodendrocyte glycoprotein (MOG)-induced EAE in Olig1−/− mice is significantly slower than wide-type (WT) mice (19.8±2.2 in Olig1−/− mice and 9.5±0.3 days in WT mice). In addition, 10% of Olig1−/− mice did not develop EAE by the end of the observation periods (60 days). The severity of EAE, the extent of demyelination, and the activation of microglial cells and astrocytes in spinal cords, were significantly milder in Olig1−/− mice compared with WT mice in the early stage. Moreover, the visual function, as assessed by the second-kernel of multifocal electroretinograms, was better preserved, and the number of degenerating axons in the optic nerve was significantly reduced in Olig1−/− mice. Interestingly, Olig1 deficiency had no effect on T cell response capability, however, it reduced the expression of myelin proteins such as MOG, myelin basic protein (MBP) and myelin-associated glycoprotein (MAG). The expression of Olig2 remained unchanged in the optic nerve and brain, and it was reduced in the spinal cord of Olig1−/− mice. Conclusions/Significance Our results suggest that the Olig1 signaling pathways may be involved in the incidence rate and the severity of neurological symptoms in MS.
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Matiello M, Kim HJ, Kim W, Brum DG, Barreira AA, Kingsbury DJ, Plant GT, Adoni T, Weinshenker BG. Familial neuromyelitis optica. Neurology 2010; 75:310-5. [PMID: 20660861 DOI: 10.1212/wnl.0b013e3181ea9f15] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Detection of aquaporin-4-specific immunoglobulin G (IgG) has expanded the spectrum of neuromyelitis optica (NMO). Rare reports of familial aggregation have suggested a component of genetic susceptibility but these reports mostly antedated the discovery of the NMO-IgG biomarker and recently updated diagnostic criteria. METHODS We report a case series describing the demographic, clinical, neuroimaging, and NMO-IgG serologic status of 12 multiplex NMO pedigrees with a total of 25 affected individuals. RESULTS Twenty-one patients (84%) were women. Families were Asian (n = 5), Latino (n = 4), white (n = 1), or African (n = 2). Apparent transmission was either maternal (n = 5) or paternal (n = 2). In 1 family, 3 individuals had NMO; in the others, 2 individuals were affected. Sibling pairs (n = 6), parent-child (n = 4), and aunt-niece (n = 3) pairs were observed. Nineteen patients (76%) were NMO-IgG positive. Twelve (48%) had clinical or serologic evidence of another autoimmune disease. Familial occurrence of NMO occurs in approximately 3% of patients with well-established diagnosis of NMO. CONCLUSIONS A small proportion of patients with NMO have relatives with this condition, but familial occurrence is more common than would be expected from its frequency in the general population. Familial NMO is indistinguishable from sporadic NMO based on clinical symptoms, age at onset, sex distribution, and frequency of NMO-IgG detection. One or 2 generations were affected and affected individuals represented a small fraction of family members. Taken together, these data suggest complex genetic susceptibility in NMO.
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Affiliation(s)
- M Matiello
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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216
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Jarius S, Franciotta D, Paul F, Ruprecht K, Bergamaschi R, Rommer PS, Reuss R, Probst C, Kristoferitsch W, Wandinger KP, Wildemann B. Cerebrospinal fluid antibodies to aquaporin-4 in neuromyelitis optica and related disorders: frequency, origin, and diagnostic relevance. J Neuroinflammation 2010; 7:52. [PMID: 20825655 PMCID: PMC2945323 DOI: 10.1186/1742-2094-7-52] [Citation(s) in RCA: 163] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Accepted: 09/08/2010] [Indexed: 12/04/2022] Open
Abstract
Background In 70-80% of cases, neuromyelitis optica (NMO) is associated with highly specific serum auto-antibodies to aquaporin-4 (termed AQP4-Ab or NMO-IgG). Recent evidence strongly suggests that AQP4-Ab are directly involved in the immunopathogenesis of NMO. Objective To assess the frequency, syndrome specificity, diagnostic relevance, and origin of cerebrospinal fluid (CSF) AQP4-Ab in patients with NMO spectrum disorders (NMOSD). Methods 87 CSF samples from 37 patients with NMOSD and 42 controls with other neurological diseases were tested for AQP4-Ab in a cell based assay using recombinant human AQP4. Twenty-three paired CSF and serum samples from AQP4-Ab seropositive NMOSD patients were further analysed for intrathecal IgG synthesis to AQP4. Results AQP4-Ab were detectable in 68% of CSF samples from AQP4-Ab seropositive patients with NMOSD, but in none of the CSF samples from AQP4-Ab seronegative patients with NMOSD and in none of the control samples. Acute disease relapse within 30 days prior to lumbar puncture, AQP4-Ab serum titres >1:250, and blood-CSF barrier dysfunction, but not treatment status, predicted CSF AQP4-Ab positivity. A positive AQP4-specific antibody index was present in 1/23 samples analysed. Conclusions AQP4-Ab are detectable in the CSF of most patients with NMOSD, mainly during relapse, and are highly specific for this condition. In the cohort analysed in this study, testing for CSF AQP4-Ab did not improve the sensitivity and specificity of the current diagnostic criteria for NMO. The substantial lack of intrathecal AQP4-Ab synthesis in patients with NMOSD may reflect the unique localisation of the target antigen at the blood brain barrier, and is important for our understanding of the immunopathogenesis of the disease.
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Affiliation(s)
- Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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217
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Affiliation(s)
- Brian G Weinshenker
- Department of Neurology, Mayo Clinic College of Medicine, 200, First Street, SW, Rochester, MN 55905, USA
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218
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Marignier R. Anti-aquaporin-4 antibodies in Devic's neuromyelitis optica: therapeutic implications. Ther Adv Neurol Disord 2010; 3:311-21. [PMID: 21179621 PMCID: PMC3002663 DOI: 10.1177/1756285610382478] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Devic's neuromyelitis optica (DNMO) is a demyelinating and inflammatory disease of the central nervous system (CNS) essentially restricted to the spinal cord and the optic nerves. It is a rare disorder with a prevalence estimated at less than 1/100,000 in Western countries. Since the first description by Eugène Devic in 1894, the relationship between DNMO and multiple sclerosis (MS) has been controversial. Recent clinical, epidemiological, pathological and immunological data demonstrate that MS and DNMO are distinct entities. This distinction between DNMO and MS is crucial, as prognosis and treatment are indeed different. DNMO is now considered to be an autoimmune, antibody-mediated disease especially since the identification of a specific serum autoantibody, named NMO-IgG and directed against the main water channel of the CNS, aquaporin-4 (AQP4). The assessment of AQP4 antibodies (Abs) has initially been proposed to differentiate DNMO and MS. It has also enlarged the clinical spectrum of DNMO and proved to be helpful in predicting relapses and conversion to DNMO after a first episode of longitudinally extensive transverse myelitis or isolated optic neuritis. Lastly, the discovery of the pathogenic role of AQP4 Abs in DNMO leads to a better understanding of detailed DNMO immunopathology and the elaboration of relevant novel treatment strategies specific to DNMO. In this review, we summarize the present and future therapeutic implications generated by the discovery of the various pathogenic mechanisms of AQP4 Abs in DNMO pathophysiology.
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Affiliation(s)
- Romain Marignier
- Service de Neurologie A and EDMUS Coordinating Center, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, F-69677, France
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219
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A case of neuromyelitis optica developing into myelitis 25 years after optic neuritis. Jpn J Ophthalmol 2010; 54:372-3. [DOI: 10.1007/s10384-010-0818-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Accepted: 03/04/2010] [Indexed: 10/19/2022]
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220
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Jarius S, Franciotta D, Bergamaschi R, Wildemann B, Wandinger KP. Immunoglobulin M antibodies to aquaporin-4 in neuromyelitis optica and related disorders. Clin Chem Lab Med 2010; 48:659-63. [PMID: 20184532 DOI: 10.1515/cclm.2010.127] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Neuromyelitis optica (NMO, Devic syndrome) is an inflammatory disorder of the central nervous system of putative autoimmune etiology that primarily affects the optic nerves and spinal cord. NMO is frequently associated with immunoglobulin G (IgG) antibodies to aquaporin-4 (AQP4-IgG), which are thought to be involved in the patho-genesis of the disease. The frequency and diagnostic relevance of immunoglobulin M (IgM) antibodies to aquaporin-4 (AQP4-IgM) in patients with NMO is essentially not known. Testing for AQP4-IgM may be of importance since 20%-30% of patients with NMO are negative for AQP4-IgG. Moreover, IgM antibodies are more potent activators of complement compared with IgG, and are detectable at NMO lesional sites. METHODS Serum samples from 42 patients with NMO spectrum disorders (NMOSD) and from 66 controls were tested for IgM AQP4-Ab using a cell-based assay employing HEK293 cells transfected with human full length AQP4. To control for possible interactions between IgG and IgM, serum was depleted of IgG prior to testing by indirect immunofluorescence. RESULTS IgM AQP4-Ab were detectable in 4/42 samples from patients with NMOSD, but in none of the 66 control samples. In three patients, titers were higher following depletion of total IgG from the samples. One sample was positive only after precipitation of total IgG. CONCLUSIONS AQP4 antibodies of the IgM class exist in almost 10% of patients with NMO and might contribute to lesion pathology. Routine testing for AQP4-IgM appears to not be justified, as all AQP4-IgM positive patients were also positive for AQP4-IgG, and none of the AQP4-IgG negative samples were positive for AQP4-IgM.
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Affiliation(s)
- Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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221
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Nakajima H, Hosokawa T, Sugino M, Kimura F, Sugasawa J, Hanafusa T, Takahashi T. Visual field defects of optic neuritis in neuromyelitis optica compared with multiple sclerosis. BMC Neurol 2010; 10:45. [PMID: 20565857 PMCID: PMC2904295 DOI: 10.1186/1471-2377-10-45] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Accepted: 06/18/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that predominantly affects the optic nerves and the spinal cord, and is possibly mediated by an immune mechanism distinct from that of multiple sclerosis (MS). Central scotoma is recognized as a characteristic visual field defect pattern of optic neuritis (ON), however, the differing pathogenic mechanisms of NMO and MS may result in different patterns of visual field defects for ON. METHODS Medical records of 15 patients with NMO and 20 patients with MS having ON were retrospectively analyzed. A thorough systemic and neurological examination was performed for evaluating ON. The total number of relapses of ON and visual fields was investigated. Visual fields were obtained by Goldmann perimeter with each ON relapse. RESULTS All MS patients experienced central scotoma, with 90% of them showing central scotoma with every ON relapse. However, 53% of NMO patients showed central scotoma with every ON relapse (p = 0.022), and the remaining 47% of patients experienced non-central scotoma (altitudinal, quadrant, three quadrant, hemianopia, and bitemporal hemianopia). Thirteen percent of NMO patients did not experience central scotoma during their disease course. Altitudinal hemianopia was the most frequent non-central scotoma pattern in NMO. CONCLUSIONS NMO patients showed higher incidence of non-central scotoma than MS, and altitudinal hemianopia may be characteristic of ON occurring in NMO. As altitudinal hemianopia is highly characteristic of ischemic optic neuropathy, we suggest that an ischemic mechanism mediated by anti-aquaporin-4 antibody may play a role in ON in NMO patients.
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Affiliation(s)
- Hideto Nakajima
- Department of Internal Medicine I, Osaka Medical College, Takatsuki, Osaka, Japan.
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Abstract
Acute optic neuritis (ON) has various etiologies. The most common presentation is inflammatory, demyelinating, idiopathic, or "typical" ON, which may be associated with multiple sclerosis. This must be differentiated from "atypical" causes of ON, which differ in their clinical presentation, natural history, management, and prognosis. Clinical "red flags" for an atypical cause of ON include absent or persistent pain, exudates and hemorrhages on fundoscopy, very severe, bilateral, or progressive visual loss, and failure to recover. In typical ON, steroids shorten the duration of the attack, but do not influence visual outcome. This is in contrast to atypical ON associated with conditions such as sarcoidosis and neuromyelitis optica, which require aggressive immunosuppression and sometimes plasma exchange. The visual prognosis of typical ON is generally good. The prognosis in atypical ON is more variable. New developments aimed at designing better treatments for patients who fail to recover are discussed, focusing on recent research elucidating mechanisms of damage and recovery in ON. Future therapeutic directions may include enhancing repair processes, such as remyelination or adaptive neuroplasticity, or alternative methods of immunomodulation. Pilot studies investigating the safety and proof-of-principle of stem cell treatment are currently underway.
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Affiliation(s)
- Thomas M Jenkins
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Ahmed T Toosy
- Department of Brain Repair and Rehabilitation, UCL Institute of Neurology, University College London, London, UK
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Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X, Du Pasquier RA, Polman CH, Sorensen PS, Hemmer B. EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol 2010; 17:1019-32. [PMID: 20528913 DOI: 10.1111/j.1468-1331.2010.03066.x] [Citation(s) in RCA: 293] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica (NMO) or Devic's disease is a rare inflammatory and demyelinating autoimmune disorder of the central nervous system (CNS) characterized by recurrent attacks of optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM), which is distinct from multiple sclerosis (MS). The guidelines are designed to provide guidance for best clinical practice based on the current state of clinical and scientific knowledge. SEARCH STRATEGY Evidence for this guideline was collected by searches for original articles, case reports and meta-analyses in the MEDLINE and Cochrane databases. In addition, clinical practice guidelines of professional neurological and rheumatological organizations were studied. RESULTS Different diagnostic criteria for NMO diagnosis [Wingerchuk et al. Revised NMO criteria, 2006 and Miller et al. National Multiple Sclerosis Society (NMSS) task force criteria, 2008] and features potentially indicative of NMO facilitate the diagnosis. In addition, guidance for the work-up and diagnosis of spatially limited NMO spectrum disorders is provided by the task force. Due to lack of studies fulfilling requirement for the highest levels of evidence, the task force suggests concepts for treatment of acute exacerbations and attack prevention based on expert opinion. CONCLUSIONS Studies on diagnosis and management of NMO fulfilling requirements for the highest levels of evidence (class I-III rating) are limited, and diagnostic and therapeutic concepts based on expert opinion and consensus of the task force members were assembled for this guideline.
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Affiliation(s)
- J Sellner
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
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224
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Abstracts of the 2010 Meeting of the International Neuro-Ophthalmology Society, Lyon, France. Neuroophthalmology 2010. [DOI: 10.3109/01658107.2010.485833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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225
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Wandinger KP, Stangel M, Witte T, Venables P, Charles P, Jarius S, Wildemann B, Probst C, Iking-Konert C, Schneider M. Autoantibodies against aquaporin-4 in patients with neuropsychiatric systemic lupus erythematosus and primary Sjögren's syndrome. ACTA ACUST UNITED AC 2010; 62:1198-200. [PMID: 20131265 DOI: 10.1002/art.27337] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Klaus-Peter Wandinger
- University Medical Center Eppendorf, Hamburg, Germany, and Euroimmun, Lübeck, Germany
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226
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Matiello M, Magana SM, Weinshenker BG. ASYMPTOMATIC SPINAL CORD INVOLVEMENT IN POSTERIOR REVERSIBLE ENCEPHALOPATHY SYNDROME. Neurology 2010; 74:1478-9; author reply 1479. [DOI: 10.1212/wnl.0b013e3181d8a4a3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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227
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Illes Z. Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1759-1961.2010.00011.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Jarius S, Probst C, Borowski K, Franciotta D, Wildemann B, Stoecker W, Wandinger K. Standardized method for the detection of antibodies to aquaporin-4 based on a highly sensitive immunofluorescence assay employing recombinant target antigen. J Neurol Sci 2010; 291:52-6. [DOI: 10.1016/j.jns.2010.01.002] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2009] [Revised: 01/06/2010] [Accepted: 01/06/2010] [Indexed: 01/01/2023]
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230
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Kurne A, Karabudak R, Yalcin-Cakmakli G, Gursoy-Ozdemir Y, Aydin P, Ilksen-Colpak A, Lule S, Kansu T. Recurrent optic neuritis: clues from a long-term follow up study of recurrent and bilateral optic neuritis patients. Eye Brain 2010; 2:15-20. [PMID: 28539758 DOI: 10.2147/eb.s8888] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM Optic neuritis (ON) can be recurrent, with unilateral or bilateral presentation. Diagnosis of recurrent cases may be challenging. In this study long-term follow-up of recurrent and/or bilateral ON patients is reported in an effort to guide differential diagnosis and treatment. METHODS The study included 474 optic neuropathy patients. Of these, 70 patients with recurrent unilateral or bilateral, and nonrecurrent bilateral ON were assessed. The characteristics of each ON attack, laboratory and magnetic resonance imaging (MRI) findings, associated diseases and response to treatment were noted for each patient. Most of the patients were reevaluated in the outpatient clinic. Seven patients were investigated for neuromyelitis optica (NMO)-immunoglobulin G (IgG) seropositivity. RESULTS Forty-seven patients had recurrent unilateral ON and 23 had bilateral ON. Mean follow-up was 7.55 years. Final diagnoses for recurrent unilateral group were multiple sclerosis (MS) (n = 29), chronic relapsing inflammatory optic neuritis (CRION) (n = 11), NMO (n = 4), or autoimmune thyroid disease (n = 3); and for bilateral ON group, MS (n = 4), vasculitis (n = 13), postinfectious ON (n = 4), and sarcoidosis (n = 2). Three patients were positive for NMO antibodies. CONCLUSION Based on the data collected, we conclude when recurrent ON causes moderate to severe visual loss in the absence of cranial MRI findings typical of MS, other diagnoses should be considered, including NMO.
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Affiliation(s)
| | | | | | | | | | | | - Sevda Lule
- Institute of Neurological Sciences and Psychiatry, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Marignier R, Confavreux C. Neuro-optico-myélite aiguë de Devic et les syndromes neurologiques apparentés. Presse Med 2010; 39:371-80. [DOI: 10.1016/j.lpm.2009.06.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 06/16/2009] [Accepted: 06/18/2009] [Indexed: 11/25/2022] Open
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232
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Meinl E, Derfuss T, Linington C. Identifying targets for autoantibodies in CNS inflammation: Strategies and achievements. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1759-1961.2009.00006.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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233
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Blanco Y, Hankiewicz K, Llufriu S, Sabater L, Graus F, Saiz A. Clinical spectrum associated with aquaporin-4 antibodies (NMO-IgG). NEUROLOGÍA (ENGLISH EDITION) 2010. [DOI: 10.1016/s2173-5808(10)70002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Bradl M, Misu T, Takahashi T, Watanabe M, Mader S, Reindl M, Adzemovic M, Bauer J, Berger T, Fujihara K, Itoyama Y, Lassmann H. Neuromyelitis optica: pathogenicity of patient immunoglobulin in vivo. Ann Neurol 2009; 66:630-43. [PMID: 19937948 DOI: 10.1002/ana.21837] [Citation(s) in RCA: 422] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Severe inflammation and astrocyte loss with profound demyelination in spinal cord and optic nerves are typical pathological features of neuromyelitis optica (NMO). A diagnostic hallmark of this disease is the presence of serum autoantibodies against the water channel aquaporin-4 (AQP-4) on astrocytes. METHODS We induced acute T-cell-mediated experimental autoimmune encephalomyelitis in Lewis rats and confronted the animals with an additional application of immunoglobulins from AQP-4 antibody-positive and -negative NMO patients, multiple sclerosis patients, and control subjects. RESULTS The immunoglobulins from AQP-4 antibody-positive NMO patients are pathogenic. When they reach serum titers in experimental animals comparable with those seen in NMO patients, they augment clinical disease and induce lesions in the central nervous system that are similar in structure and distribution to those seen in NMO patients, consisting of AQP-4 and astrocyte loss, granulocytic infiltrates, T cells and activated macrophages/microglia cells, and an extensive immunoglobulin and complement deposition on astrocyte processes of the perivascular and superficial glia limitans. AQP-4 antibody containing NMO immunoglobulin injected into naïve rats, young rats with leaky blood-brain barrier, or after transfer of a nonencephalitogenic T-cell line did not induce disease or neuropathological alterations in the central nervous system. Absorption of NMO immunoglobulins with AQP-4-transfected cells, but not with mock-transfected control cells, reduced the AQP-4 antibody titers and was associated with a reduction of astrocyte pathology after transfer. INTERPRETATION Human anti-AQP-4 antibodies are not only important in the diagnosis of NMO but also augment disease and induce NMO-like lesions in animals with T-cell-mediated brain inflammation.
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Affiliation(s)
- Monika Bradl
- Department of Neuroimmunology, Medical University Vienna, Center for Brain Research, Vienna, Austria
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236
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Haller S, Pereira VM, Lalive PH, Chofflon M, Vargas MI, Lövblad KO. Magnetic resonance imaging in multiple sclerosis. Top Magn Reson Imaging 2009; 20:313-323. [PMID: 21187724 DOI: 10.1097/rmr.0b013e318207a390] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVES multiple sclerosis (MS) is an inflammatory disease of unknown origin affecting the central nervous system. Magnetic resonance imaging (MRI) plays an increasingly important role in its diagnosis and further monitoring of disease progress. METHODS the typical MRI appearance of MS on conventional MRI sequences and current diagnostic criteria for MS are discussed. Advanced imaging techniques are reviewed with respect to application in MS. Finally, the atypical variants of MS are briefly reviewed. CONCLUSIONS although MRI is not intended and will not replace clinical assessment in MS, the recognized MRI criteria may aid in establishing an earlier and more accurate diagnosis of MS in the context of a clinical suspicion or clinically isolated syndrome. In addition, MRI might contribute to rule out differential diagnoses for MS. Moreover, MRI may be used to monitor the evolution of MS and in pharmaceutical trials. Advanced imaging techniques might, in the future, further characterize MS lesion subtypes and potentially guide tailored therapy.
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Affiliation(s)
- Sven Haller
- ServiceNeuro-Diagnostique et Neuro-Interventionnel DISIM, University Hospitals of Geneva, Geneva, Switzerland.
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237
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Csécsei P, Trauninger A, Komoly S, Illés Z. Neuromyelitis optica spectrum: novel concept of pathogenesis, diagnosis and treatment of Devic’s disease. Orv Hetil 2009; 150:2101-9. [DOI: 10.1556/oh.2009.28724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The identification of autoantibodies generated against the brain isoform water channel aquaporin4 in the sera of patients, changed the current diagnostic guidelines and concept of neuromyelitis optica (NMO). In a number of cases, clinical manifestation is spatially limited to myelitis or relapsing optic neuritis creating a diverse. NMO spectrum. Since prevention of relapses provides the only possibility to reduce permanent disability, early diagnosis and treatment is mandatory. In the present study, we discuss the potential role of neuroimaging and laboratory tests in differentiating the NMO spectrum from other diseases, as well as the diagnostic procedures and therapeutic options. We also present clinical cases, to provide examples of different clinical settings, diagnostic procedures and therapeutic decisions.
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Affiliation(s)
- Péter Csécsei
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Neurológiai Klinika Pécs Rét u. 2. 7623
| | - Anita Trauninger
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Neurológiai Klinika Pécs Rét u. 2. 7623
| | - Sámuel Komoly
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Neurológiai Klinika Pécs Rét u. 2. 7623
| | - Zsolt Illés
- Pécsi Tudományegyetem, Általános Orvostudományi Kar, Klinikai Központ Neurológiai Klinika Pécs Rét u. 2. 7623
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Intractable hiccup caused by medulla oblongata lesions: A study of an autopsy patient with possible neuromyelitis optica. J Neurol Sci 2009; 285:241-5. [PMID: 19577262 DOI: 10.1016/j.jns.2009.06.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2009] [Revised: 05/17/2009] [Accepted: 06/09/2009] [Indexed: 11/20/2022]
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240
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Jacob A. Neuromyelitis optica - an update: 2007-2009. Ann Indian Acad Neurol 2009; 12:231-7. [PMID: 20182570 PMCID: PMC2824950 DOI: 10.4103/0972-2327.58277] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 06/28/2009] [Accepted: 07/06/2009] [Indexed: 11/04/2022] Open
Abstract
Neuromyelitis optica is an inflammatory demyelinating disorder of the central nervous system. The discovery of a specific antibody (NMO IgG /aquaporin-4 antibody) in patients with this condition has led to a marked revival of research on the disease. This article summarizes the major advances in neuromyelitis optica, particularly in the last 2 years, and supplements the previous review published in this Journal in 2007. Important among these developments are: the epidemiological studies, which have provided estimates of incidence and prevalence; identification of mutations in the aquaporin-4 gene; improved understanding of the effects of anti-aquaporin-4 antibody on astrocytes; roles of excitatory amino acid transporter type 2 and glutamate; requirement of aquaporin-4 to be in orthogonal arrays to be antigenic; recognition of the presence of aquaporin-4 antibody in patients with cancer and posterior reversible encephalopathy syndrome; possibility of monitoring the disease using the antibody, and the effectiveness of rituximab and mycophenolate in preventing relapses.
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Affiliation(s)
- Anu Jacob
- The Walton Centre for Neurology and Neurosurgery, Liverpool, L97LJ, United Kingdom
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241
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Klawiter EC, Alvarez E, Xu J, Paciorkowski AR, Zhu L, Parks BJ, Cross AH, Naismith RT. NMO-IgG detected in CSF in seronegative neuromyelitis optica. Neurology 2009; 72:1101-3. [PMID: 19307546 DOI: 10.1212/01.wnl.0000345066.57745.50] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- E C Klawiter
- Neurology, Box 8111, 660 S. Euclid Ave., Washington University, St. Louis, MO 63110, USA.
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242
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Effect of geranylgeranylacetone on optic neuritis in experimental autoimmune encephalomyelitis. Neurosci Lett 2009; 462:281-5. [DOI: 10.1016/j.neulet.2009.07.028] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Revised: 07/03/2009] [Accepted: 07/13/2009] [Indexed: 11/21/2022]
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243
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Cakmakli G, Kurne A, Güven A, Serdaroğlu A, Topaloğlu H, Teber S, Anlar B. Childhood optic neuritis: the pediatric neurologist's perspective. Eur J Paediatr Neurol 2009; 13:452-7. [PMID: 18945627 DOI: 10.1016/j.ejpn.2008.09.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 09/09/2008] [Accepted: 09/10/2008] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic neuritis in children may be an isolated, usually postinfectious event, or the symptom of a more widespread disorder. AIM To investigate the etiological spectrum of optic neuritis in children in association with diagnostic findings and follow-up results. METHODS We retrospectively examined the records of 31 children aged 4-15 (mean 9.7+/-2.9) years in whom isolated optic neuritis was the presenting neurological symptom. RESULTS Monophasic bilateral optic neuritis was the most common presentation (45%), followed by the unilateral (32%) and recurrent (22%) forms. Initial cranial MRI was abnormal in 12/31 patients. During a mean follow-up of 2.2 years (6 months-15 years), 6/14 bilateral cases, 9/10 unilateral and 5/7 recurrent cases were diagnosed with various disorders including total eight with MS. The MS group tended to start with unilateral optic neuritis, was older (mean 11.6+/-1.5 vs. 8.8+/-2.9 years), and included more girls than the other groups. CONCLUSIONS Optic neuritis in children is frequently part of a systemic or neurological disorder even in the presence of normal cranial imaging. These patients should be evaluated and followed-up in pediatric neurology clinics.
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Affiliation(s)
- Gül Cakmakli
- Hacettepe University Faculty of Medicine, Department of Neurology, Ankara, Turkey
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244
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Cohen AB, Pless M. OPTIC NEUROPATHY WITH DISC EDEMA. Continuum (Minneap Minn) 2009. [DOI: 10.1212/01.con.0000348828.57490.1e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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245
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Chan KH, Ramsden DB, Yu YL, Kwok KHH, Chu ACY, Ho PWL, Kwan JSC, Lee R, Lim E, Kung MHW, Ho SL. Neuromyelitis optica-IgG in idiopathic inflammatory demyelinating disorders amongst Hong Kong Chinese. Eur J Neurol 2009; 16:310-6. [PMID: 19138340 DOI: 10.1111/j.1468-1331.2008.02376.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Idiopathic inflammatory demyelinating disorders (IIDD) affect the central nervous system. In classical multiple sclerosis (CMS), brain, optic nerves [optic neuritis (ON)] and spinal cord [acute transverse myelitis (ATM)] are affected. In neuromyelitis optica (NMO), optic nerves and spinal cord are predominantly affected. NMO-IgG, an autoantibody targeting aquaporin-4, is a marker for NMO. We studied the frequency and clinical relevance of NMO-IgG seropositivity in IIDD patients. METHODS Neuromyelitis optica-IgG was detected by indirect immunofluorescence using primate cerebellum. RESULTS Neuromyelitis optica-IgG was detected in six of 10 NMO patients (60%), six of 10 idiopathic relapsing transverse myelitis (IRTM) patients (60%), two of nine idiopathic relapsing ON patients (22%), one of 11 patients (9%) having single ON attack, one of 30 CMS patients (3%), and none of patients having single ATM attack or controls. Comparing NMO-IgG seropositive (n = 12) with NMO-IgG seronegative (n = 8) patients having NMO or IRTM, NMO-IgG seropositivity was associated with a higher relapse rate in first 2 years, 1.5 and 0.6 attacks/year for seropositive and seronegative groups respectively (P = 0.006), and non-significant trend towards more severe ON and myelitis with poorer clinical outcome. CONCLUSION Neuromyelitis optica -IgG facilitates diagnosis of NMO spectrum disorders. NMO-IgG seropositivity is associated with higher relapse rate in first 2 years.
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Affiliation(s)
- K H Chan
- University Department of Medicine, Research Center for Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
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Hickman SJ, Ko M, Chaudhry F, Jay WM, Plant GT. Optic Neuritis: An Update Typical and Atypical Optic Neuritis. Neuroophthalmology 2009. [DOI: 10.1080/01658100802391905] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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247
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McKeon A, Pittock SJ. Neuromyelitis optica and the evolving spectrum of water channel autoimmunity: a new direction. Eur J Neurol 2009; 16:433-5. [PMID: 19348617 DOI: 10.1111/j.1468-1331.2008.02385.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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248
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Cabrera-Gómez JA, Bonnan M, González-Quevedo A, Saiz-Hinarejos A, Marignier R, Olindo S, Graus F, Smadja D, Merle H, Thomas L, Gómez-García A, Cabre P. Neuromyelitis optica positive antibodies confer a worse course in relapsing-neuromyelitis optica in Cuba and French West Indies. Mult Scler 2009; 15:828-33. [PMID: 19498017 DOI: 10.1177/1352458509104585] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In Caucasian populations Neuromyelitis Optica (NMO-IgG) antibody has been detected in 27.1% / 78.2% of patients with relapsing-NMO (R-NMO). The prevalence reported for the disease in the Caribbean is 3.1/100,000 in the French West Indies (FWI) and 0.52 /100,000 in Cuba, but the NMO antibody status is unknown. Objective To assess the NMO-IgG antibody status of Cuban/FWI RNMO patients, comparing with European cases tested at the same laboratories. Methods Serum NMO-IgG antibodies were assayed in 48 R-NMO patients (Wingerchuck´s 1999 criteria): Cuba (24)/FWI (24), employing Lennon et al´s method. We compared the demographic, clinical, disability and laboratory data between NMO-IgG +/- patients. All the data were reviewed and collected blinded to the NMO-IgG status. Results Seropositivity of the NMO-IgG antibody demonstrated a lower rate in the Caribbean (33.3%), as compared with Caucasian patients from Spain/Italy (62.5%) and France (53.8%). Caribbean patients with NMO-IgG (+) displayed more attacks, more spinal attacks and a higher EDSS than NMO-IgG (-) cases, while brain and spinal cord MRI lesions were more frequent during remission, with more vertebral segments, more gray, white matter and holocord involvement. Conclusions NMO IgG positive antibodies in NMO patients had a lower rate in the Caribbean area – where the population has a predominant African ancestry – than in Caucasian Europeans, suggesting the influence of a possible ethnic factor in the pathogenesis of the disease, but they confer a worse course with more attacks, more disability and MRI lesions.
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Affiliation(s)
- JA Cabrera-Gómez
- Cuban Multiple Sclerosis Society and International Neurological Restoration Center, Havana, Cuba
| | - M Bonnan
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - A González-Quevedo
- Institute of Neurology and Neurosurgery, Havana, Cuba. Calle 29 y D, Vedado, La Habana, Cuba
| | - A Saiz-Hinarejos
- Service of Neurology Hospital Clinic and Institut d’Invesigación Biomèdica August Pi i Sanyer (IAIBAPS), University of Barcelona, Villarroel, Barcelona, Spain
| | - R Marignier
- Hôpital Neurologique Pierre Wertheimer, Lyon, France; U842 INSERM, Faculté Laënnec, Lyon Cedex
| | - S Olindo
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - F Graus
- Service of Neurology Hospital Clinic and Institut d’Invesigación Biomèdica August Pi i Sanyer (IAIBAPS), University of Barcelona, Villarroel, Barcelona, Spain
| | - D Smadja
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - H Merle
- Department of Ophthalmology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - L Thomas
- Emergency Department, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - A Gómez-García
- Sancti Spiritus Children Hospital, Sancti Spiritus, Cuba
| | - P Cabre
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
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249
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Petzold A. Isolated, relapsing and progressive demyelinating diseases of the central nervous system. J Neurol 2009; 255 Suppl 6:69-76. [PMID: 19300963 DOI: 10.1007/s00415-008-6013-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Many patients ask, "Can I get this again?" (a relapse) and "How bad is it? Will I end up in a wheelchair?" (severity/progression). These two questions guide this brief review of the clinical spectrum of demyelinating diseases of the central nervous system.
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Affiliation(s)
- Axel Petzold
- The Department of Neuroimmunology, Institute of Neurology, University College London (UCL), Queen Square, London, WC1N 3BG, UK.
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McKeon A, Lennon VA, Jacob A, Matiello M, Lucchinetti CF, Kale N, Chan KH, Weinshenker BG, Apiwattinakul M, Wingerchuk DM, Pittock SJ. Coexistence of myasthenia gravis and serological markers of neurological autoimmunity in neuromyelitis optica. Muscle Nerve 2009; 39:87-90. [PMID: 19086079 DOI: 10.1002/mus.21197] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
We systematically evaluated the frequency of neurological disorders and muscle and neural autoantibodies in 177 patients with neuromyelitis optica (NMO) and in 250 control subjects (173 healthy; 77 multiple sclerosis, MS, patients). An excess of myasthenia gravis (MG, 2%), and muscle-type acetylcholine receptor antibody (11%) was detected among NMO patients. The presence of neural or muscle autoantibodies was more common in NMO patients (34%) than in MS patients or healthy controls (7%), P < 0.0001. The coexistence of NMO and MG should be considered in atypical or refractory presentations of either disorder.
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Affiliation(s)
- Andrew McKeon
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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