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Parthasarathy D, Lily Therese K, Ambika S, Krishnan S, Priyadarshini Santhakumar D. Simultaneous screening for antibodies to myelin oligodendrocyte glycoprotein and aquaporin-4 in patients with optic neuritis using cell-based assay. CURRENT JOURNAL OF NEUROLOGY 2022; 21:29-34. [PMID: 38011487 PMCID: PMC9527861 DOI: 10.18502/cjn.v21i1.9359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Background: This study was aimed to test simultaneous detection of antibodies to myelin oligodendrocyte glycoprotein (MOG)/aquaporin4 (AQP4) in serum samples of patients with clinically-diagnosed optic neuritis (ON), by fixed cell-based immunofluorescence assay (CBIFA). Methods: The study involved 237 serum samples of patients with ON which were tested for MOG and AQP4 antibodies using fixed CBIFA kit which utilizes AQP4 or MOG protein transfected cells as a substrate. Results: Of 237 serum samples, 22 (9%) were positive for AQP4, 66 (28%) were positive for MOG, and 138 (58%) were negative for both AQP4 and MOG antibodies. 11 (5%) patients with clinically-diagnosed multiple sclerosis (MS) were negative for both antibodies. None of the samples were positive for both AQP4 and MOG. Among 237, 132 women [18 (13.6%) and 37 (28%)] and 105 men [4 (3.8%) and 29 (27.6%)] were positive for AQP4/MOG antibodies and remaining percentage belonged to double negative and MS. Seropositivity rate was higher in women than men. Antibodies to MOG were significantly higher than AQP4 antibodies and evenly found in all age groups. There was no ambiguous result encountered in the study. Conclusion: In this study, the seropositivity for antibodies to MOG is more than AQP4 antibody in patients with ON. Fixed CBIFA is a useful tool for laboratory diagnosis of ON in the clinical setting of neuro-ophthalmology to plan the next line of treatment management effectively.
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Affiliation(s)
- Durgadevi Parthasarathy
- L&T Microbiology Research Centre, Kamal Nayan Bajaj Building for Research in Vision and Opthalmology, Vision Research Foundation, Chennai, India
| | - Kulandai Lily Therese
- L&T Microbiology Research Centre, Kamal Nayan Bajaj Building for Research in Vision and Opthalmology, Vision Research Foundation, Chennai, India
| | - Selvakumar Ambika
- Department of Neuro-ophthalmology, Sankara Nethralaya Hospital, Medical Research Foundation, Chennai, India
| | - Selvi Krishnan
- L&T Microbiology Research Centre, Kamal Nayan Bajaj Building for Research in Vision and Opthalmology, Vision Research Foundation, Chennai, India
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Optical Coherence Tomography in Neuromyelitis Optica spectrum disorder and Multiple Sclerosis: A population-based study. Mult Scler Relat Disord 2020; 47:102625. [PMID: 33227631 DOI: 10.1016/j.msard.2020.102625] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 11/08/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND The aim of this study was to identify and compare the characteristics of retinal nerve layers using spectral domain-optical coherence tomography (SD-OCT) in neuromyelitis optica spectrum disorder (NMOSD), relapsing-remitting multiple sclerosis (RRMS) and healthy controls (HCs). METHODS It is a cross-sectional population-based study in Isfahan, Iran. We enrolled 98 participants including 45 NMOSD patients (90 eyes), 35 RRMS patients (70 eyes) and 18 HCs (36 eyes). Evaluation criteria were thickness of different sectors in peripapillary retinal nerve fiber layer (pRNFL) and intra-retinal layers around the macula. History of previous optic neuritis (ON) was obtained through chart review and medical record. RESULTS Without considering ON, total macular, ganglion cell layer (GCL) and pRNFL were significantly thinner in both groups of patients compared to HCs. On macular examination, GCL and total macular thickness were significantly thinner than HCs in all NMOSD and RRMS eyes with and without history of ON. While there was no significant difference between MS-ON and MS without a history of ON in the macular measures, the reduction in total macular and GCL thickness was significantly greater in NMOSD-ON compared to NMOSD without a history of ON. Also in NMOSD-ON eyes, the RNFL, GCL, IPL and GCIPL layers were significantly thinner than that of MS-ON. On the other hand, the pRNFL study showed significant thinning of all quadrants in the RRMS and NMOSD groups relative to HCs. While the decrease of pRNFL thickness in the eyes of NMOSD-ON and MS with and without a previous history of ON was significantly greater than that of HCs, no difference was observed between NMOSD without ON and HCs. In addition, in NMOSD patients, pRNFL was significantly thinner in eyes with history of ON compared to non ON-eyes. Furthermore, in patients with a history of ON, reduction in all sectors of pRNFl (except in T) was significantly greater in NMOSD compared to MS patients. CONCLUSION Our findings showed that although macular and retinal damage occurred in both NMOSD and RRMS patients without significant differences, the severity of injury in eyes with history of ON was significantly higher in NMOSD compared to MS patients, that could be considered as a marker to distinguish them. In addition, our results confirmed the absence of subclinical optic nerve involvement in NMOSD unlike MS patients.
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Rezaeimanesh N, Jahromi SR, Ghorbani Z, Moghadasi AN, Hekmatdoost A, Moghadam NB, Sahraian MA. Low carbohydrate diet score and odds of neuromyelitis optica spectrum disorder: A case-control study. INT J VITAM NUTR RES 2020; 92:321-330. [PMID: 32795169 DOI: 10.1024/0300-9831/a000677] [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: 11/19/2022]
Abstract
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating inflammatory disease of The Central nervous system. We aimed to investigate the association between low carbohydrate diet (LCD) and NMOSD odds. Method: Seventy NMOSD patients with definite diagnosis and 164 hospital-based controls were enrolled in this case-control study. Dietary data was obtained using a validated 168-item food frequency questionnaire. To determine the LCD score, participants were stratified into 11 groups according to carbohydrate, protein, fat, animal fat, animal protein, vegetable fat and vegetable protein intakes. Higher intake of protein and fat, and lower intake of carbohydrate received a higher score between 0-10. Macronutrients scores were summed together and LCD scores calculated. The association between LCD scores and likelihood of being assigned to NMOSD group was investigated using multiple regression models. Results: Total LCD scores increased from the median of 21.00 in the first decile to 53.00 in the tenth decile of LCD score. After adjustment for confounding factors including age, gender, BMI, energy intake, cigarette smoking and alcohol consumption, an inverse association was detected between LCD scores and odds of NMOSD. The odds of suffering from NMOSD declined significantly about 78% (OR: 0.22; 95% CI: 0.05-0.87) and 76% (OR: 0.24; 95% CI: 0.06-0.93) in the fifth and sixth deciles of LCD score compared to the first decile. Conclusion: From the obtained results it can be speculated that higher carbohydrate and lower protein and fat intakes may be associate with the increased odds of NMOSD. However, further studies are needed to confirm these results.
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Affiliation(s)
- Nasim Rezaeimanesh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran, Student Research Committee, Department and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Beladi Moghadam
- Department of neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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4
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Shaygannejad V, Maljaei MB, Bank SS, Mirmosayyeb O, Maracy MR, Askari G. Association between Sun Exposure, Vitamin D Intake, Serum Vitamin D Level, and Immunoglobulin G Level in Patients with Neuromyelitis Optica Spectrum Disorder. Int J Prev Med 2018; 9:68. [PMID: 30167098 PMCID: PMC6106131 DOI: 10.4103/ijpvm.ijpvm_45_16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system inflammatory disorder in which immunoglobulin G (IgG) autoantibodies possibly play a pathogenic role against the aquaporin-4 water channel protein. Vitamin D may modulate B-cell function and decrease the IgG synthesis and may play a role in NMOSD as a crucial factor. The aim of this study was to investigate the relation between Vitamin D intakes from food, Vitamin D intake from sunlight exposure, blood Vitamin D levels, and IgG-neuromyelitis optica (NMO) level in serum of patients with NMOSD and NMO. Method: In this cross-sectional study, food Frequency Questionnaires (FFQ) and Sun Exposure Questionnaire (SEQ) were completed to evaluate of vitamin D intakes from food and sun light exposure. Moreover, serum levels of 25(OH) vitamin D3 and IgG-NMO were assessed in patients with NMOSD and NMO. Results: We assessed IgG-NMO levels in 29 patients with NMOSD that nine patients (n = 31%) were positive and for the rest it was negative. Sunlight exposure scale (P = 0.01) and 25(OH) D3 (P = 0.04) in IgG-NMO-negative patients were significantly more than patients with positive IgG-NMO. Age, gender, and latitude were not confounder variables. A positive significant correlation was observed between the sun exposure scale and serum levels of 25(OH) D3 in all participants (r = 0.747, P ≤ 0.001). Conclusions: Physiological variation in Vitamin D may apply a significant effect on IgG-NMO synthesis in patients with NMO. Vitamin D may have significant role in pathogenesis of NMOSD and NMO.
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Affiliation(s)
- Vahid Shaygannejad
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Bagher Maljaei
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran.,Department of Nutrition, School of Public Health, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Saraf Bank
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neuroscience Research Center, Department of Neurology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.,Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
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Melamed E, Levy M, Waters PJ, Sato DK, Bennett JL, John GR, Hooper DC, Saiz A, Bar-Or A, Kim HJ, Pandit L, Leite MI, Asgari N, Kissani N, Hintzen R, Marignier R, Jarius S, Marcelletti J, Smith TJ, Yeaman MR, Han MH, Aktas O, Apiwattanakul M, Banwell B, Bichuetti D, Broadley S, Cabre P, Chitnis T, De Seze J, Fujihara K, Greenberg B, Hellwig K, Iorio R, Jarius S, Klawiter E, Kleiter I, Lana-Peixoto M, Nakashima, O'Connor K, Palace J, Paul F, Prayoonwiwat N, Ruprecht K, Stuve O, Tedder T, Tenembaum S, Garrahan JP, Aires B, van Herle K, van Pelt D, Villoslada P, Waubant E, Weinshenker B, Wingerchuk D, Würfel J, Zamvil S. Update on biomarkers in neuromyelitis optica. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2015; 2:e134. [PMID: 26236760 PMCID: PMC4516398 DOI: 10.1212/nxi.0000000000000134] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 06/01/2015] [Indexed: 11/15/2022]
Abstract
Neuromyelitis optica (NMO) (and NMO spectrum disorder) is an autoimmune inflammatory disease of the CNS primarily affecting spinal cord and optic nerves. Reliable and sensitive biomarkers for onset, relapse, and progression in NMO are urgently needed because of the heterogeneous clinical presentation, severity of neurologic disability following relapses, and variability of therapeutic response. Detecting aquaporin-4 (AQP4) antibodies (AQP4-IgG or NMO-IgG) in serum supports the diagnosis of seropositive NMO. However, whether AQP4-IgG levels correlate with disease activity, severity, response to therapy, or long-term outcomes is unclear. Moreover, biomarkers for patients with seronegative NMO have yet to be defined and validated. Collaborative international studies hold great promise for establishing and validating biomarkers that are useful in therapeutic trials and clinical management. In this review, we discuss known and potential biomarkers for NMO.
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Affiliation(s)
- Esther Melamed
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Michael Levy
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Patrick J Waters
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Douglas Kazutoshi Sato
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Jeffrey L Bennett
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Gareth R John
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Douglas C Hooper
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Albert Saiz
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Amit Bar-Or
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Ho Jin Kim
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Lakha Pandit
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Maria Isabel Leite
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Nasrin Asgari
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Najib Kissani
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Rogier Hintzen
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Romain Marignier
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Sven Jarius
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - John Marcelletti
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Terry J Smith
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - Michael R Yeaman
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
| | - May H Han
- Stanford University (E.M., M.H.H.), Stanford, CA; Johns Hopkins University (M.L.), Baltimore, MD; University of Oxford (P.J.W.), UK; Tohoku University (D.K.S.), Sendai, Japan; University of São Paulo (D.K.S.), Brazil; University of Colorado (J.L.B.), Denver; Mt. Sinai University (G.R.J.), New York, NY; Thomas Jefferson University (D.C.H.), Philadelphia, PA; IDIBAPS (A.S.), Barcelona, Spain; Montreal Neurological Institute and Hospital (A.B.-O.), McGill University, Montreal, Quebec, Canada; Research Institute and Hospital of National Cancer Center (H.J.K.), Goyang, Korea; KS Hegde Medical Academy (L.P.), Nitte University, Mangalore, India; Oxford University Hospital (M.I.L.), Oxford, UK; University of Southern Denmark (N.A.), Odense; Vejle Hospital (N.A.), Denmark; University Hospital (N.K.), Marrakech, Morocco; MS Center (R.H.), Erasmus MC University Medical Center, Rotterdam, the Netherlands; Service de Neurologie A (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Bron, France; Molecular Neuroimmunology (S.J.), Department of Neurology, University Hospital Heidelberg, Germany; Tandem Labs (J.M.), San Diego, CA; University of Michigan Medical School (T.J.S.), Ann Arbor, MI; and David Geffen School of Medicine (M.R.Y.), University of California, Los Angeles
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Wingerchuk DM, Banwell B, Bennett JL, Cabre P, Carroll W, Chitnis T, de Seze J, Fujihara K, Greenberg B, Jacob A, Jarius S, Lana-Peixoto M, Levy M, Simon JH, Tenembaum S, Traboulsee AL, Waters P, Wellik KE, Weinshenker BG. International consensus diagnostic criteria for neuromyelitis optica spectrum disorders. Neurology 2015; 85:177-89. [PMID: 26092914 PMCID: PMC4515040 DOI: 10.1212/wnl.0000000000001729] [Citation(s) in RCA: 2999] [Impact Index Per Article: 333.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 01/28/2015] [Indexed: 12/12/2022] Open
Abstract
Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The new nomenclature defines the unifying term NMO spectrum disorders (NMOSD), which is stratified further by serologic testing (NMOSD with or without AQP4-IgG). The core clinical characteristics required for patients with NMOSD with AQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable. The IPND also proposed validation strategies and achieved consensus on pediatric NMOSD diagnosis and the concepts of monophasic NMOSD and opticospinal MS.
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Affiliation(s)
- Dean M Wingerchuk
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN.
| | - Brenda Banwell
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Jeffrey L Bennett
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Philippe Cabre
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - William Carroll
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Tanuja Chitnis
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Jérôme de Seze
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Kazuo Fujihara
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Benjamin Greenberg
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Anu Jacob
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Sven Jarius
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Marco Lana-Peixoto
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Michael Levy
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Jack H Simon
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Silvia Tenembaum
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Anthony L Traboulsee
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Patrick Waters
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Kay E Wellik
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN
| | - Brian G Weinshenker
- From the Departments of Neurology (D.M.W.) and Library Services (K.E.W.), Mayo Clinic, Scottsdale, AZ; the Children's Hospital of Philadelphia (B.B.), PA; the Departments of Neurology and Ophthalmology (J.L.B.), University of Colorado Denver, Aurora; the Service de Neurologie (P.C.), Centre Hospitalier Universitaire de Fort de France, Fort-de-France, Martinique; Department of Neurology (W.C.), Sir Charles Gairdner Hospital, Perth, Australia; the Department of Neurology (T.C.), Massachusetts General Hospital, Boston; the Department of Neurology (J.d.S.), Strasbourg University, France; the Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; the Departments of Neurology and Neurotherapeutics (B.G.), University of Texas Southwestern Medical Center, Dallas; The Walton Centre NHS Trust (A.J.), Liverpool, UK; the Molecular Neuroimmunology Group, Department of Neurology (S.J.), University Hospital Heidelberg, Germany; the Center for Multiple Sclerosis Investigation (M.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; the Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Portland VA Medical Center and Oregon Health and Sciences University (J.H.S.), Portland; the Department of Neurology (S.T.), National Pediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; the Department of Medicine (A.L.T.), University of British Columbia, Vancouver, Canada; Nuffield Department of Clinical Neurosciences (P.W.), University of Oxford, UK; and the Department of Neurology (B.G.W.), Mayo Clinic, Rochester, MN.
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Association Between the Single Nucleotide Polymorphism and the Level of Aquaporin-4 Protein Expression in Han and Minority Chinese with Inflammatory Demyelinating Diseases of the Central Nervous System. Mol Neurobiol 2015; 53:2878-2885. [PMID: 25895050 DOI: 10.1007/s12035-015-9171-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to determine whether or not aquaporin-4 (AQP4) gene mutations are related to the pathogenesis of inflammatory demyelinating diseases in the central nervous system. Polymorphisms of AQP4 exons 1-5 were determined by sequencing DNA from 67 patients with central nervous system inflammatory demyelinating diseases, including neuromyelitis optica (NMO), multiple sclerosis, recurrent or simultaneous bilateral optic neuritis, and longitudinally extensive transverse myelitis. A plasmid with the identified new missense mutation was constructed, and human embryonic kidney cells (HEK293A) were transfected with either the pEGFP-N1-AQP4-M23 vector (bearing the identified mutated cDNA sequence) or with the plasmid bearing the wild-type AQP4 gene sequence. AQP4 protein expression was analyzed in both experimental groups using Western Blot analysis following protein extraction from transfected cells. A synonymous mutation (rs1839318) was detected on exon 3, and an additional synonymous mutation was detected on the exon 2-2 (rs72557968). Most importantly, a new missense mutation was detected on exon 2-1. According to Western blot analysis, the mutated cDNA sequence yielded increased AQP4 protein expression in comparison with the wild-type cDNA sequence (P < 0.05). AQP4 gene mutations are uncommon, occurring in only 3 out of 67 patients. Although it is possible that the mutations contributed to an increased risk of inflammatory central nervous system disease in these individuals, it is unlikely that mutations are a significant contributor to most patients with NMO spectrum disorders in China.
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8
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Waters PJ, Pittock SJ, Bennett JL, Jarius S, Weinshenker BG, Wingerchuk DM. Evaluation of aquaporin-4 antibody assays. CLINICAL & EXPERIMENTAL NEUROIMMUNOLOGY 2014. [PMID: 27840658 DOI: 10.1111/cen3.12107"] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aquaporin-4 (AQP4) is a water channel protein that is most highly, but not exclusively, expressed in the central nervous system. In 2005 AQP4 was shown to be the antigenic target of neuromyelitis optica-immunoglobulin G (NMO-IgG, or AQP4-IgG), an antibody found specifically in patients with NMO and in formes frustes of NMO, such as longitudinally extensive transverse myelitis (LETM) or optic neuritis (ON). This discovery facilitated the clinical, pathological, and radiological distinction of NMO and the spectrum of NMO-related disorders from classical multiple sclerosis. In addition to its use as a diagnostic tool, AQP4-IgG predicts a high risk of relapse in patients with a clinically isolated syndrome of either LETM or ON. As disability in NMO is attack-related, early diagnosis and treatment are predicted to have a major effect on long-term disability. Thus, the importance of sensitive and specific assays to detect AQP4-IgG cannot be overstated. Both academic institutions and commercial companies have developed assays to identify AQP4-IgG in patients' sera or cerebrospinal fluid. Both AQP4 isoforms from different species have been used as the antigenic target in the form of frozen tissue sections in indirect immunofluorescence assays, partially purified protein for fluorescence immunoprecipitation assay, radioimmunoprecipita-tion assay or enzyme-linked immunosorbent assay, or transfected into cells for cell based assays or flow cytometry. We carried out a systematic review of the literature reporting different methodologies used to identify AQP4-IgG, examine whether longitudinal AQP4-IgG titers predict relapses in seropositive patients, and attempt to establish a reasonable timeframe for retesting negative serum samples.
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Affiliation(s)
- Patrick J Waters
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sean J Pittock
- Departments of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado Denver, Aurora, CO, USA
| | - Sven Jarius
- Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brian G Weinshenker
- Departments of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dean M Wingerchuk
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
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9
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Differentiation of neuromyelitis optica from multiple sclerosis in a cohort from the mainland of China. Chin Med J (Engl) 2014. [DOI: 10.1097/00029330-201409200-00004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
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10
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Waters PJ, Pittock SJ, Bennett JL, Jarius S, Weinshenker BG, Wingerchuk DM. Evaluation of aquaporin-4 antibody assays. ACTA ACUST UNITED AC 2014; 5:290-303. [PMID: 27840658 DOI: 10.1111/cen3.12107] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Aquaporin-4 (AQP4) is a water channel protein that is most highly, but not exclusively, expressed in the central nervous system. In 2005 AQP4 was shown to be the antigenic target of neuromyelitis optica-immunoglobulin G (NMO-IgG, or AQP4-IgG), an antibody found specifically in patients with NMO and in formes frustes of NMO, such as longitudinally extensive transverse myelitis (LETM) or optic neuritis (ON). This discovery facilitated the clinical, pathological, and radiological distinction of NMO and the spectrum of NMO-related disorders from classical multiple sclerosis. In addition to its use as a diagnostic tool, AQP4-IgG predicts a high risk of relapse in patients with a clinically isolated syndrome of either LETM or ON. As disability in NMO is attack-related, early diagnosis and treatment are predicted to have a major effect on long-term disability. Thus, the importance of sensitive and specific assays to detect AQP4-IgG cannot be overstated. Both academic institutions and commercial companies have developed assays to identify AQP4-IgG in patients' sera or cerebrospinal fluid. Both AQP4 isoforms from different species have been used as the antigenic target in the form of frozen tissue sections in indirect immunofluorescence assays, partially purified protein for fluorescence immunoprecipitation assay, radioimmunoprecipita-tion assay or enzyme-linked immunosorbent assay, or transfected into cells for cell based assays or flow cytometry. We carried out a systematic review of the literature reporting different methodologies used to identify AQP4-IgG, examine whether longitudinal AQP4-IgG titers predict relapses in seropositive patients, and attempt to establish a reasonable timeframe for retesting negative serum samples.
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Affiliation(s)
- Patrick J Waters
- Neuroimmunology Group, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Sean J Pittock
- Departments of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado Denver, Aurora, CO, USA
| | - Sven Jarius
- Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brian G Weinshenker
- Departments of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Dean M Wingerchuk
- Department of Neurology, Mayo Clinic College of Medicine, Scottsdale, AZ, USA
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İdiman E, Özakbaş S. The limited demyelinating diseases: the voyage of optic neuritis and transverse myelitis to multiple sclerosis and neuromyelitis. Expert Rev Neurother 2014. [DOI: 10.1586/ern.11.16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gelfand JM. Multiple sclerosis: diagnosis, differential diagnosis, and clinical presentation. HANDBOOK OF CLINICAL NEUROLOGY 2014; 122:269-90. [PMID: 24507522 DOI: 10.1016/b978-0-444-52001-2.00011-x] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
The diagnosis of multiple sclerosis (MS) is based on demonstrating evidence of inflammatory-demyelinating injury within the central nervous system that is disseminated in both time and space. Diagnosis is made through a combination of the clinical history, neurologic examination, magnetic resonance imaging and the exclusion of other diagnostic possibilities. Other so-called "paraclinical" tests, including the examination of the cerebrospinal fluid, the recording of evoked potentials, urodynamic studies of bladder function, and ocular coherence tomography, may be helpful in establishing the diagnosis for individual patients, but are often unnecessary. Differential diagnosis in MS must be guided by clinical presentation and neurologic localization. While the list of conditions that can mimic MS clinically or radiologically is long, in clinical practice there are few conditions that truly mimic MS on both fronts. A positive test for a putative MS "mimic" does not unto itself exclude the diagnosis of MS. Typical symptoms of MS include discrete episodes ("attacks" or "relapses") of numbness, tingling, weakness, vision loss, gait impairment, incoordination, imbalance, and bladder dysfunction. In between attacks, patients tend to be stable, but may experience fatigue and heat sensitivity. Some MS patients go on to experience, or only experience, an insidious worsening of neurologic function and accumulation of disability ("progression") that is not associated with discrete relapse activity. Progression accounts for most of the long-term disability in MS. Diagnostic criteria for MS have evolved over the past several decades, with each revision impacting the apparent prevalence and prognosis of the disorder - the result has been to encourage earlier diagnosis without compromising accuracy.
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Affiliation(s)
- Jeffrey M Gelfand
- Department of Neurology, University of California, San Francisco, USA.
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Chen Y, Li R, Wu AM, Shu YQ, Lu ZQ, Hu XQ. The complement and immunoglobulin levels in NMO patients. Neurol Sci 2013; 35:215-20. [DOI: 10.1007/s10072-013-1481-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 06/11/2013] [Indexed: 10/26/2022]
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Sriram S. Role of glial cells in innate immunity and their role in CNS demyelination. J Neuroimmunol 2011; 239:13-20. [PMID: 21907419 DOI: 10.1016/j.jneuroim.2011.08.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 08/09/2011] [Accepted: 08/16/2011] [Indexed: 12/11/2022]
Abstract
The adaptive and innate arms of the immune system are the two pillars of host defense against environmental pathogens. Multiple sclerosis (MS) is an inflammatory demyelinating disease of the CNS which is considered to be autoimmune and is thought to result from breakdown in the usual checks and balances of the adaptive immune response. The major pathological outcome of the disease is "the MS plaque" a unique feature of CNS demyelination characterized by the destruction of oligodendrocytes with loss of myelin and underlying axons. The MS plaque is not seen in other inflammatory disorders of the CNS. The prevailing opinion suggests that MS is mediated by the activation of an adaptive immune response which targets neural antigens. Currently, the role of an innate immune in the development of the lesions in MS has remained unclear. We explore the potential cellular elements of the innate immune system and in particular glial cells, which are likely candidates in inducing the specific pathological picture that is evident in MS. Activated microglia and the release of molecules which are detrimental to oligodendrocyte have been suggested as mechanisms by which innate immunity causes demyelination in MS. However a microglia/macrophage centric model does not explain the specificity of lesion development in MS. We propose that activation pathways of receptors of the innate immune system present on oligodendrocytes and astrocytes rather than microglia are central to the pathogenesis of demyelination seen in MS.
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Affiliation(s)
- Subramaniam Sriram
- Department of Neurology, Multiple Sclerosis Research Center, Vanderbilt University Medical Center, Nashville, Tennessee 37212, USA.
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Kitley JL, Leite MI, George JS, Palace JA. The differential diagnosis of longitudinally extensive transverse myelitis. Mult Scler 2011; 18:271-85. [PMID: 21669935 DOI: 10.1177/1352458511406165] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Longitudinally extensive transverse myelitis refers to florid and widespread inflammation of the spinal cord causing T2 hyperintensity on spinal magnetic resonance imaging that is seen to extend over three or more vertebral segments. Whilst rare, longitudinally extensive transverse myelitis is clinically important as it can lead to catastrophic morbidity, and a group of these patients are at risk of further attacks. Early identification and establishment of the underlying aetiology is vital in order to initiate appropriate therapy and optimize outcomes. Whilst longitudinally extensive transverse myelitis is classically associated with neuromyelitis optica, there are many other causes. These include other inflammatory aetiologies, infection, malignancy and metabolic disturbance. Some of these are readily treatable. Laboratory and radiological investigations can help to differentiate these causes. Treatment of longitudinally extensive transverse myelitis hinges on distinguishing inflammatory and non-inflammatory aetiologies and identifying patients who are at high risk of a recurrent course.
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Asgari N, Owens T, Frøkiaer J, Stenager E, Lillevang ST, Kyvik KO. Neuromyelitis optica (NMO)--an autoimmune disease of the central nervous system (CNS). Acta Neurol Scand 2011; 123:369-84. [PMID: 20880299 DOI: 10.1111/j.1600-0404.2010.01416.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
In the past 10 years, neuromyelitis optica (NMO) has evolved from Devic's categorical clinical description into a broader disease spectrum. Serum IgG antibodies have been identified in NMO patients with the water channel aquaporin-4 (AQP4) as their main target antigen. AQP4 antibodies/NMO-IgG have been shown to be a highly specific and moderately sensitive serum biomarker for NMO. The immunopathology of NMO lesions supports that anti-AQP4 antibodies/NMO-IgG are involved in the pathogenesis of NMO. In vitro studies have demonstrated that human NMO-IgG induce necrosis and impair glutamate transport in astrocytes. Certain ethnic groups, notably of Asian and African origin, seem to be more susceptible to NMO than others. The genetic background for these putative differences is not known, a weak human leucocyte antigen association has been identified. AQP4 gene variants could represent a genetic susceptibility factor for different clinical phenotypes within the NMO spectrum. Experimental models have been described including a double-transgenic myelin-specific B- and T-cell mouse. NMO-like disease has been induced with passive transfer of human anti-AQP4 antibodies to the plasma of mice with pre-established experimental autoimmune encephalomyelitis or by intrathecal administration to naive mice. NMO may be characterized as a channelopathy of the central nervous system with autoimmune characteristics.
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Affiliation(s)
- N Asgari
- Multiple Sclerosis Clinic of Southern Jutland, Sønderborg, Vejle, Esbjerg hospitals, and Institute of Molecular Medicine, University of Southern Denmark, Odense C, Denmark.
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17
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García Domínguez JM, Guzmán de Villoria Lebiedziejewski J. [Neurological catastrophes in demyelinating diseases]. Neurologia 2010; 25 Suppl 1:30-6. [PMID: 21129595 DOI: 10.1016/s0213-4853(10)70048-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Demyelinating diseases may cause neurological catastrophes in several ways. Rapidly progressing disease or severe acute bouts may seriously threaten the patient's life. Diagnostic procedures, errors in identifying the clinical picture and even treatments themselves may result in a catastrophe. This article reviews the most frequent catastrophic scenarios.
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Affiliation(s)
- J M García Domínguez
- Servicio de Neurología, Hospital General Universitario Gregorio Marañón, Madrid, España.
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18
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Brinar VV, Habek M. Diagnostic imaging in acute disseminated encephalomyelitis. Expert Rev Neurother 2010; 10:459-67. [PMID: 20187866 DOI: 10.1586/ern.10.9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Acute disseminated encephalomyelitis is an idiopathic inflammatory demyelinating disease of the CNS that is particularly difficult to differentiate from the first episode of multiple sclerosis, so called clinically isolated syndrome. Currently, no diagnostic criteria exist that could reliably differentiate these two diseases. More importantly no single clinical, neuroimaging or cerebrospinal fluid feature defines a disorder with absolute certainty. This review will summarize clinical and paraclinical characteristics of acute disseminated encephalomyelitis in adults, with special emphasis on diagnostic imaging.
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Affiliation(s)
- Vesna V Brinar
- University of Zagreb, School of Medicine and University Hospital Centre Zagreb, Department of Neurology and Referral Center for Demyelinating Diseases of the Central Nervous System, Zagreb, Croatia.
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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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Greer KA, Wong AK, Liu H, Famula TR, Pedersen NC, Ruhe A, Wallace M, Neff MW. Necrotizing meningoencephalitis of Pug dogs associates with dog leukocyte antigen class II and resembles acute variant forms of multiple sclerosis. ACTA ACUST UNITED AC 2010; 76:110-8. [PMID: 20403140 DOI: 10.1111/j.1399-0039.2010.01484.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Necrotizing meningoencephalitis (NME) is a disorder of Pug Dogs that appears to have an immune etiology and high heritability based on population studies. The present study was undertaken to identify a genetic basis for the disease. A genome-wide association scan with single tandem repeat (STR) markers showed a single strong association near the dog leukocyte antigen (DLA) complex on CFA12. Fine resolution mapping with 27 STR markers on CFA12 further narrowed association to the region containing DLA-DRB1, -DQA1 and, -DQB1 genes. Sequencing confirmed that affected dogs were more likely to be homozygous for specific alleles at each locus and that these alleles were linked, forming a single high risk haplotype. The strong DLA class II association of NME in Pug Dogs resembles that of human multiple sclerosis (MS). Like MS, NME appears to have an autoimmune basis, involves genetic and nongenetic factors, has a relatively low incidence, is more frequent in females than males, and is associated with a vascularly orientated nonsuppurative inflammation. However, NME of Pug Dogs is more aggressive in disease course than classical human MS, appears to be relatively earlier in onset, and involves necrosis rather than demyelination as the central pathobiologic feature. Thus, Pug Dog encephalitis (PDE) shares clinical features with the less common acute variant forms of MS. Accordingly, NME of Pug Dogs may represent a naturally occurring canine model of certain idiopathic inflammatory disorders of the human central nervous system.
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Affiliation(s)
- K A Greer
- School of Natural Sciences and Mathematics, Indiana University East, Richmond, IN 47374, USA.
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21
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Abstract
Leukoencephalopathies in adults are frequent and exhibit highly variable aetiology, including multiple acquired causes such as inflammatory, vascular or toxic diseases and neoplasias. In contrast leukodystrophies are genetically determined, chronic progressive myelin disorders with a variable pathogenetic background and a great diversity of clinical and paraclinical findings. Some diseases, namely those with an additional inborn error of metabolism, are treatable. Genetic counselling appears to be of major importance for patients and their families. In the light of numerous acquired adulthood leukoencephalopathies a clear delineation of late-onset genetic leukodystrophies is necessary. Clinical symptoms and MRI patterns of some of the major leukodystrophies are reported, including possibilities of biochemical and genetic testing.
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Affiliation(s)
- T Weber
- Klinik für Neurologie, Marienkrankenhaus Hamburg, 22087 Hamburg.
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