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Seo D, So JM, Kim J, Jung H, Jang I, Kim H, Kang DW, Lim YM, Choi J, Lee EJ. Digital symbol-digit modalities test with modified flexible protocols in patients with CNS demyelinating diseases. Sci Rep 2024; 14:14649. [PMID: 38918552 PMCID: PMC11199480 DOI: 10.1038/s41598-024-65486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 06/20/2024] [Indexed: 06/27/2024] Open
Abstract
Cognitive impairment (CI) is prevalent in central nervous system demyelinating diseases, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). We developed a novel tablet-based modified digital Symbol Digit Modalities Test (MD-SDMT) with adjustable protocols that feature alternating symbol-digit combinations in each trial, lasting one or two minutes. We assessed 144 patients (99 with MS and 45 with NMOSD) using both MD-SDMT protocols and the traditional paper-based SDMT. We also gathered participants' feedback through a questionnaire regarding their preferences and perceived reliability. The results showed strong correlations between MD-SDMT and paper-based SDMT scores (Pearsons correlation: 0.88 for 2 min; 0.85 for 1 min, both p < 0.001). Among the 120 respondents, the majority preferred the digitalized SDMT (55% for the 2 min, 39% for the 1 min) over the paper-based version (6%), with the 2 min MD-SDMT reported as the most reliable test. Notably, patients with NMOSD and older individuals exhibited a preference for the paper-based test, as compared to those with MS and younger patients. In summary, even with short test durations, the digitalized SDMT effectively evaluates cognitive function in MS and NMOSD patients, and is generally preferred over the paper-based method, although preferences may vary with patient characteristics.
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Affiliation(s)
- Dayoung Seo
- AMIST, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Jeong Min So
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Jiyon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Heejae Jung
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Inhye Jang
- AMIST, University of Ulsan College of Medicine, Seoul, 05505, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Dong-Wha Kang
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea
| | - Jaesoon Choi
- Biomedical Engineering, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
| | - Eun-Jae Lee
- AMIST, University of Ulsan College of Medicine, Seoul, 05505, South Korea.
- Department of Neurology, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea.
- Translational Biomedical Research Group, Asan Medical Center, University of Ulsan, Seoul, 05505, South Korea.
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Kazzi C, Alpitsis R, O'Brien TJ, Malpas CB, Monif M. Cognitive and psychopathological features of neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease: A narrative review. Mult Scler Relat Disord 2024; 85:105596. [PMID: 38574722 DOI: 10.1016/j.msard.2024.105596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/06/2024]
Abstract
Clinicians are becoming increasingly aware of the cognitive and psychopathological consequences of neurological diseases, which were once thought to manifest with motor and sensory impairments only. The cognitive profile of multiple sclerosis, in particular, is now well-characterised. Similar efforts are being made to better characterise the cognitive profile of other central nervous system inflammatory demyelinating autoimmune disorders. This review discusses the current understanding of the cognitive and psychological features of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Detailed analysis of the cognitive sequelae of the above conditions can not only assist with understanding disease pathogenesis but also can guide appropriate management of the symptoms and consequently, improve the quality of life and long-term outcomes for these patients. This narrative review will also identify research gaps and provide recommendations for future directions in the field.
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Affiliation(s)
- Christina Kazzi
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, School of Translational Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Rubina Alpitsis
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, School of Translational Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Terence J O'Brien
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, School of Translational Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia
| | - Charles B Malpas
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, School of Translational Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia; Melbourne School of Psychological Sciences, University of Melbourne, VIC, Australia
| | - Mastura Monif
- Department of Neurosciences, Faculty of Medicine, Nursing and Health Sciences, School of Translational Medicine, Monash University, Level 6, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia; Department of Neurology, Alfred Health, Melbourne, VIC, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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Nakajima A, Yanagimura F, Saji E, Shimizu H, Toyoshima Y, Yanagawa K, Arakawa M, Hokari M, Yokoseki A, Wakasugi T, Okamoto K, Takebayashi H, Fujii C, Itoh K, Takei YI, Ohara S, Yamada M, Takahashi H, Nishizawa M, Igarashi H, Kakita A, Onodera O, Kawachi I. Stage-dependent immunity orchestrates AQP4 antibody-guided NMOSD pathology: a role for netting neutrophils with resident memory T cells in situ. Acta Neuropathol 2024; 147:76. [PMID: 38658413 DOI: 10.1007/s00401-024-02725-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/26/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the CNS characterized by the production of disease-specific autoantibodies against aquaporin-4 (AQP4) water channels. Animal model studies suggest that anti-AQP4 antibodies cause a loss of AQP4-expressing astrocytes, primarily via complement-dependent cytotoxicity. Nonetheless, several aspects of the disease remain unclear, including: how anti-AQP4 antibodies cross the blood-brain barrier from the periphery to the CNS; how NMOSD expands into longitudinally extensive transverse myelitis or optic neuritis; how multiphasic courses occur; and how to prevent attacks without depleting circulating anti-AQP4 antibodies, especially when employing B-cell-depleting therapies. To address these knowledge gaps, we conducted a comprehensive 'stage-dependent' investigation of immune cell elements in situ in human NMOSD lesions, based on neuropathological techniques for autopsied/biopsied CNS materials. The present study provided three major findings. First, activated or netting neutrophils and melanoma cell adhesion molecule-positive (MCAM+) helper T (TH) 17/cytotoxic T (TC) 17 cells are prominent, and the numbers of these correlate with the size of NMOSD lesions in the initial or early-active stages. Second, forkhead box P3-positive (FOXP3+) regulatory T (Treg) cells are recruited to NMOSD lesions during the initial, early-active or late-active stages, suggesting rapid suppression of proinflammatory autoimmune events in the active stages of NMOSD. Third, compartmentalized resident memory immune cells, including CD103+ tissue-resident memory T (TRM) cells with long-lasting inflammatory potential, are detected under "standby" conditions in all stages. Furthermore, CD103+ TRM cells express high levels of granzyme B/perforin-1 in the initial or early-active stages of NMOSD in situ. We infer that stage-dependent compartmentalized immune traits orchestrate the pathology of anti-AQP4 antibody-guided NMOSD in situ. Our work further suggests that targeting activated/netting neutrophils, MCAM+ TH17/TC17 cells, and CD103+ TRM cells, as well as promoting the expansion of FOXP3+ Treg cells, may be effective in treating and preventing relapses of NMOSD.
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Affiliation(s)
- Akihiro Nakajima
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Fumihiro Yanagimura
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, NHO Niigata National Hospital, 3-52 Akasakamachi, Kashiwazaki, Niigata, 945-8585, Japan
| | - Etsuji Saji
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Hiroshi Shimizu
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Yasuko Toyoshima
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, Brain Disease Center, Agano Hospital, 6317-15 Yasuda, Agano, Niigata, 959-2221, Japan
| | - Kaori Yanagawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Musashi Arakawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Musashi Clinic, 20-1 Hakusanura 2, Chuo-Ku, Niigata, 951-8131, Japan
| | - Mariko Hokari
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Akiko Yokoseki
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, Niigata Medical Center, 27-11 Kobari 3, Nishi-Ku, Niigata, 950-2022, Japan
| | - Takahiro Wakasugi
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Neurology, NHO Nishiniigata Chuo Hospital, 14-1 Masago 1, Nishi-Ku, Niigata, 950-2085, Japan
| | - Kouichirou Okamoto
- Department of Neurosurgery, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Hirohide Takebayashi
- Division of Neurobiology and Anatomy, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan
| | - Chihiro Fujii
- Department of Neurology, Kansai Medical University Medical Center, 10-15 Fumizonocho, Moriguchi, Osaka, 570-8507, Japan
- Department of Neurology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Kyoko Itoh
- Department of Pathology and Applied Neurobiology, Graduate School of Medical Sciences, Kyoto Prefectural University of Medicine, 465 Kajii-Cho, Kawaramachi-Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Yo-Ichi Takei
- Department of Neurology, NHO Matsumoto Medical Center, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan
| | - Shinji Ohara
- Department of Neurology, NHO Matsumoto Medical Center, 2-20-30 Muraimachi-Minami, Matsumoto, Nagano, 399-8701, Japan
- Department of Neurology, Iida Hospital, 1-15 Odori, Iida, Nagano, 395-8505, Japan
| | - Mitsunori Yamada
- Department of Brain Disease Research, Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto, Nagano, 390-8621, Japan
| | - Hitoshi Takahashi
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Department of Pathology and Laboratory Medicine, Niigata Neurosurgical Hospital, 3057 Yamada, Nishi-Ku, Niigata, 950-1101, Japan
| | - Masatoyo Nishizawa
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
- Niigata University of Health and Welfare, 1398 Shimami-Cho, Kita-Ku, Niigata, 950-3198, Japan
| | - Hironaka Igarashi
- Center for Integrated Human Brain Science, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8585, Japan.
- Medical Education Center, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi, Chuo-Ku, Niigata, 951-8510, Japan.
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Rivas-Alonso V, Cáceres J, Ramírez-Benítez E, Solís-Vivanco R. Cognitive impairment and its association with clinical variables in Mexican persons with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2024; 86:105612. [PMID: 38614055 DOI: 10.1016/j.msard.2024.105612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 01/19/2024] [Accepted: 04/07/2024] [Indexed: 04/15/2024]
Abstract
INTRODUCTION Cognitive impairment has a substantial impact on the daily function of people living with demyelinating diseases. However, the study of cognitive failures and their association with clinical variables in people suffering from neuromyelitis optica spectrum disorder (NMOSD) has been scarce, especially in the latin american (Mexican) population at early and middle stages of the disease. METHOD We applied the Rao's Brief Repeatable Battery of Neuropsychological tests and obtained data of lesion burden through magnetic resonance imaging (MRI), expression of AQPQ4-IgG antibodies, and degree of disability in 30 patients with NMOSD and 30 healthy participants as a control group. RESULTS About half of the NMOSD patients (47%) showed some degree of cognitive impairment, especially in the executive domain compared to the control group. Executive function scores were positively associated with the degree of physical disability. We found no associations between cognitive dysfunction and disease duration, AQPQ4-IgG antibodies, lesion burden, nor depression. CONCLUSIONS Executive functioning impairment is present in NMOSD and may predict the degree of functional disability in patients. Cognitive failures were not associated with immunological or radiological data, which emphasizes the relevance of applying systematic neuropsychological assessments in this clinical population.
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Affiliation(s)
- Verónica Rivas-Alonso
- Multiple Sclerosis and Demyelinating Disorders Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez (INNNMVS), Mexico
| | - Jairo Cáceres
- Multiple Sclerosis and Demyelinating Disorders Clinic, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez (INNNMVS), Mexico
| | - Edwin Ramírez-Benítez
- Laboratory of Cognitive and Clinical Neurophysiology, INNNMVS, Insurgentes Sur 3877, Col. La Fama, Tlalpan. C.P. 14600. Mexico City, Mexico; Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico
| | - Rodolfo Solís-Vivanco
- Laboratory of Cognitive and Clinical Neurophysiology, INNNMVS, Insurgentes Sur 3877, Col. La Fama, Tlalpan. C.P. 14600. Mexico City, Mexico; Faculty of Psychology, Universidad Nacional Autónoma de México, Mexico.
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Sivaroja Y, Sowmini PR, Muralidharan K, Reddy PGPK, Mugundhan K. Clinical and radiological spectrum of acquired inflammatory demyelinating diseases of the central nervous system in a tertiary care center. J Neurosci Rural Pract 2024; 15:313-319. [PMID: 38746498 PMCID: PMC11090556 DOI: 10.25259/jnrp_603_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/16/2024] [Indexed: 05/16/2024] Open
Abstract
Objectives Demyelinating diseases of central nervous system (CNS) are a broad spectrum of conditions with autoimmune process against myelin. In a resource limited country like India, it is imperative to perform proper clinical evaluation, neuroimaging to differentiate among various categories of CNS demyelinating diseases to decide regarding further workup and treatment. The objective of our study was to determine clinical presentation, imaging findings, serology results, diagnosis, and treatment outcome of primary demyelinating disorders of CNS. Materials and Methods In this prospective study, a total of 44 patients were enrolled over a period of 1 year. After proper evaluation, patients were categorized into different groups applying newer diagnostic criteria. Patients were treated with steroids, appropriate immunomodulatory therapy, and outcomes were analyzed. Results The majority of cases were of neuromyelitis optica spectrum disorder (NMOSD) (45.5%) with an overall female-to-male ratio of 3.4:1 and mean age of presentation was 30.5 ± 11.15. Myelitis (52.3%) followed by optic neuritis (45.5%) was the most common initial presentation. The most common site of involvement on magnetic resonance imaging was the spinal cord (particularly the cervicodorsal cord). The majority showed good response to therapy (77.27%) and two patients did not survive. Conclusion Higher disability observed among seropositive NMOSD patients warrants aggressive treatment during the first attack itself. It is important to suspect myelin oligodendrocyte glycoprotein antibody disease in patients with preceding viral infection. A good outcome in the majority is likely due to the availability of serological assays and aggressive immunomodulatory therapy.
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Affiliation(s)
- Yellaturi Sivaroja
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - P. R. Sowmini
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - K. Muralidharan
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - P. G. Pavan Kumar Reddy
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
| | - K. Mugundhan
- Department of Neurology, Government Stanley Medical College Hospital, Chennai, Tamil Nadu, India
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Amano E, Sato W, Kimura Y, Kimura A, Lin Y, Okamoto T, Sato N, Yokota T, Yamamura T. CD11c high B Cell Expansion Is Associated With Severity and Brain Atrophy in Neuromyelitis Optica. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200206. [PMID: 38350043 DOI: 10.1212/nxi.0000000000200206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/14/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica (NMO) is an autoimmune astrocytopathy mediated by anti-AQP4 antibody-producing B cells. Recently, a B-cell subset highly expressing CD11c and T-bet, originally identified as age-associated B cells, has been shown to be involved in the pathogenesis of various autoimmune diseases. The objective of this study was to determine the relationship between the frequency of CD11chigh B cells per CD19+ B cells in the peripheral blood of patients with NMO and the clinical profiles including the brain volume. METHODS In this observational study, 45 patients with anti-AQP4 antibody-positive NMO in remission and 30 healthy control subjects (HCs) were enrolled. Freshly isolated peripheral blood mononuclear cells were analyzed for immune cell phenotypes. The frequency of CD11chigh B cells per CD19+ B cells was assessed by flow cytometry and was evaluated in association with the clinical profiles of patients. Brain MRI data from 26 patients were included in the study for the analysis on the correlation between CD11chigh B-cell frequency and brain atrophy. RESULTS We found that the frequency of CD11chigh B cells in CD19+ B cells was significantly increased in patients with NMO compared with HCs. The expansion of CD11chigh B cells significantly correlated with EDSS, past relapse numbers, and disease duration. In addition, a higher frequency of CD11chigh B cells negatively correlated with total brain, white matter, and gray matter volumes and positively correlated with T2/FLAIR high lesion volumes. When the past clinical relapse episodes of patients with or without the expansion of CD11chigh B cells were compared, relapses in the brain occurred more frequently in patients with CD11chigh B-cell expansion. CD11chigh B cells had distinct features including expression of chemokine receptors associated with migration into peripheral inflammatory tissues and antigen presentation. CD11chigh B-cell frequency was positively correlated with T peripheral helper-1 (Tph-1) cell frequency. DISCUSSION Even during the relapse-free period, CD11chigh B cells could expand in the long disease context, possibly through the interaction with Tph-1 cells. The increased frequency of CD11chigh B cells associated with brain atrophy and disease severity, indicating that this cell population could be involved in chronic neuroinflammation in NMO.
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Affiliation(s)
- Eiichiro Amano
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Wakiro Sato
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yukio Kimura
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Atsuko Kimura
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Youwei Lin
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Tomoko Okamoto
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Noriko Sato
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takanori Yokota
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Takashi Yamamura
- From the Department of Immunology (E.A., W.S., A.K., T. Yamamura), National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Tokyo; Department of Neurology and Neurological Sciences (E.A., T. Yokota), Tokyo Medical and Dental University, Bunkyo; Department of Radiology (Y.K., N.S.); and Department of Neurology (Y.L., T.O.), National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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Vlahovic L, McDonald J, Hinman J, Tomczak A, Lock C, Palmer CA, Cook LJ, Yeaman MR, Burnett MK, Deutsch GK, Nelson LM, Han MH. Prevalence, Demographic, and Clinical Factors Associated With Cognitive Dysfunction in Patients With Neuromyelitis Optica Spectrum Disorder. Neurology 2024; 102:e207965. [PMID: 38165361 PMCID: PMC10834131 DOI: 10.1212/wnl.0000000000207965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is a chronic CNS demyelinating autoimmune disorder targeting the astrocyte antigen aquaporin-4 (AQP4), typically presenting with optic neuritis, transverse myelitis, and brain syndromes. Cognitive dysfunction (CD) in NMOSD is under-recognized and poorly understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with CD in NMOSD. METHODS This observational retrospective study with longitudinal follow-up describes a clinical cohort seen in the Collaborative International Research in Clinical and Longitudinal Experience Study in NMOSD. Serial Montreal Cognitive Assessments (MoCAs) were performed upon enrollment and at 6-month intervals to evaluate longitudinal cognitive function relative to demographic and disease-related factors. We used 2-tailed t test, analysis of variance, the χ2 test, linear regression for univariable and adjusted analyses and simultaneous linear regression and mixed-effects model for multivariable analyses. RESULTS Thirty-four percent (75/219) of patients met criteria for CD (MoCA <26); 29% (64/219) showed mild dysfunction (MoCA 20-26/30), and 5% (11/219) showed moderate (MoCA <20/30) dysfunction. Patients with less neurologic disability and lower pain scores had higher MoCA scores (95% CI 0.24-0.65 and 95% CI 0.09-0.42, respectively). Patients with at least high school education scored higher on the MoCA (95% CI 2.2-5). When comparing patients dichotomized for CD, patients never on rituximab scored higher than patients only treated with rituximab (p < 0.029). There was no significant association between annualized relapse rate, age, sex, disease duration, AQP4 serostatus or brain lesions, and CD. CD was more pronounced among Black than White patients (95% CI -2.7 to -0.7). Multivariable analysis of serial MoCA did not indicate change (p = 0.715). Descriptive analysis of serial MoCA showed 30% (45/150) of patients with worsening MoCA performance had impaired language and verbal recall. DISCUSSION To our knowledge, this is the largest study of diverse cohort to investigate CD in patients with NMOSD. Our findings demonstrate 34% of patients with NMOSD experience mild-to-moderate CD, while 30% of patients demonstrated decline on serial testing. The substantial prevalence of CD in this pilot report highlights the need for improved and validated screening tools and comprehensive measures to investigate CD in NMOSD.
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Affiliation(s)
- Luka Vlahovic
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jamie McDonald
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jessica Hinman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Anna Tomczak
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Christopher Lock
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Chella A Palmer
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lawrence J Cook
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Michael R Yeaman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Melinda K Burnett
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Gayle K Deutsch
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lorene M Nelson
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - May H Han
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
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8
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Valdivia-Tangarife ER, Cortés-Enríquez F, Morlett-Paredes A, Villaseñor-Cabrera T, Gámez-Nava JI, Mireles-Ramírez MA, González-López L, Macías-Islas MÁ. Frequency of cognitive impairment in patients with neuromyelitis optica spectrum disorder in Mexico. Mult Scler J Exp Transl Clin 2024; 10:20552173241231678. [PMID: 38410681 PMCID: PMC10896058 DOI: 10.1177/20552173241231678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 01/24/2024] [Indexed: 02/28/2024] Open
Abstract
Background Between 29% and 67% of neuromyelitis optica spectrum disorder patients have cognitive alterations. Objective To assess the frequency of cognitive impairment in patients with neuromyelitis optica spectrum disorder in Mexico using the Brief International Cognitive Assessment for Multiple Sclerosis. Methods We evaluated 40 neuromyelitis optica spectrum disorder patients and 40 healthy controls from Mexico. Results 28 (70.0%) patients with neuromyelitis optica spectrum disorder had cognitive impairment in two or more cognitive domains. Student´s T test showed statistically poor performance by neuromyelitis optica spectrum disorder patients compared to healthy controls on all three neuropsychological test scores. This significant difference was observed on the Symbols Digit Modalities Test (t = 8.875; p ≤ 0.001); California Verbal Learning Test-II memory (t = 10.418; p ≤ 0.001); and Brief Visuospatial Memory Test Revised (t = 6.123; p ≤ 0.001). Conclusions This study showed that 70% of neuromyelitis optica spectrum disorder patients exhibited cognitive impairment in two or more cognitive domains. Determining the frequency of cognitive impairment will guide the decision of Neuropsychologists in planning cognitive rehabilitation across various domains.
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Affiliation(s)
- Edgar R Valdivia-Tangarife
- Departamento de Neurociecias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Fernando Cortés-Enríquez
- Departamento de Neurología, Hospital General, No 14 del Instituto Mexicano del Seguro Social, Guadalajara, México
| | | | - Teresita Villaseñor-Cabrera
- Departamento de Neurociecias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
- O.P.D Hospital Civil Fray Antonio Alcalde, Guadalajara, México
| | - Jorge I Gámez-Nava
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Mario A Mireles-Ramírez
- Departamento de Neurología, Unidad de Alta Especialidad Médica, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Guadalajara, México
| | - Laura González-López
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
| | - Miguel Á Macías-Islas
- Departamento de Neurociecias, Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara, Guadalajara, México
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9
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Meng M, Zhang CY, Li YM, Yao YJ, Zhou FQ, Li YX, Zhang NNN, Tian DC, Zhang XH, Duan YY, Liu YO. Independent and reproducible hippocampal radiomics biomarkers for multisite multiple sclerosis and neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2024; 81:105146. [PMID: 38007962 DOI: 10.1016/j.msard.2023.105146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 11/18/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To investigate the abnormal radiomics features of the hippocampus in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD) and to explore the clinical implications of these features. METHODS 752 participants were recruited in this retrospective multicenter study (7 centers), which included 236 MS, 236 NMOSD, and 280 normal controls (NC). Radiomics features of each side of the hippocampus were extracted, including intensity, shape, texture, and wavelet features (N = 431). To identify the variations in these features, two-sample t-tests were performed between the NMOSD vs. NC, MS vs. NC, and NMOSD vs. MS groups at each site. The statistical results from each site were then integrated through meta-analysis. To investigate the clinical significance of the hippocampal radiomics features, we conducted further analysis to examine the correlations between these features and clinical measures such as Expanded Disability Status Scale (EDSS), Brief Visuospatial Memory Test (BVMT), California Verbal Learning Test (CVLT), and Paced Auditory Serial Addition Task (PASAT). RESULTS Compared with NC, patients with MS exhibited significant differences in 78 radiomics features (P < 0.05/862), with the majority of these being texture features. Patients with NMOSD showed significant differences in 137 radiomics features (P < 0.05/862), most of which were intensity features. The difference between MS and NMOSD patients was observed in 47 radiomics features (P < 0.05/862), mainly texture features. In patients with MS and NMOSD, the most significant features related to the EDSS were intensity and textural features, and the most significant features related to the PASAT were intensity features. Meanwhile, both disease groups observed a weak correlation between radiomics data and BVMT. CONCLUSION Variations in the microstructure of the hippocampus can be detected through radiomics, offering a new approach to investigating the abnormal pattern of the hippocampus in MS and NMOSD.
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Affiliation(s)
- Ming Meng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Cheng-Yi Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yong-Mei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ya-Jun Yao
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu-Qing Zhou
- Department of Radiology, the First Affiliated Hospital, Nanchang University, Nanchang, Jiangxi Province, China
| | - Yu-Xin Li
- Radiology department, Huashan Hospital, Fudan University, Shanghai, China
| | - Ning-Nan-Nan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, China
| | - De-Cai Tian
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Xing-Hu Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yun-Yun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Ya-Ou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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10
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Yang X, Liu Q, Lai MF, Ma XH, Hao XT, Xu JJ, Guo WJ. Case report: Orthostatic leg tremor as the initial manifestation in a patient with metabotropic glutamate receptor-5 encephalitis without cortical dysfunction: complexities in identification and treatment. Front Neurol 2023; 14:1288075. [PMID: 38162450 PMCID: PMC10755007 DOI: 10.3389/fneur.2023.1288075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Objective Metabotropic glutamate receptor 5 (mGluR5) encephalitis is such a rare type of autoimmune encephalitis that its diagnosis remains a challenge. Case report A 19-year-old female patient initially presented with anxiety and orthostatic leg tremors without cortical dysfunction. We found that this patient was positive for mGluR5 antibodies in both serum (1:1,000) and cerebrospinal fluid (1:32). After comprehensive intervention, the patient showed complete recovery at the 18-month follow-up. Discussion This report expands our knowledge of the possible presentations of mGluR5 encephalitis for early diagnosis, which makes it possible to prevent serious consequences and improve the prognosis.
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Affiliation(s)
- Xia Yang
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Qiong Liu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Ming-feng Lai
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao-hong Ma
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
- Psychiatric Laboratory and Mental Health Center, The State Key Laboratory of Biotherapy, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Xiao-ting Hao
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jia-jun Xu
- Mental Health Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Wan-jun Guo
- Affiliated Mental Health Center and Hangzhou Seventh People's Hospital, Zhejiang University School of Medicine, Hangzhou Seventh People's Hospital, Hangzhou, Zhejiang, China
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11
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmun Rev 2023; 22:103465. [PMID: 37852514 DOI: 10.1016/j.autrev.2023.103465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing neuroinflammatory autoimmune astrocytopathy, with a predilection for the optic nerves and spinal cord. Most cases are characterised by aquaporin-4-antibody positivity and have a relapsing disease course, which is associated with accrual of disability. Although the prognosis in NMOSD has improved markedly over the past few years owing to advances in diagnosis and therapeutics, it remains a severe disease. In this article, we review the evolution of our understanding of NMOSD, its pathogenesis, clinical features, disease course, treatment options and associated symptoms. We also address the gaps in knowledge and areas for future research focus.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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12
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Cacciaguerra L, Rocca MA, Filippi M. Understanding the Pathophysiology and Magnetic Resonance Imaging of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorders. Korean J Radiol 2023; 24:1260-1283. [PMID: 38016685 DOI: 10.3348/kjr.2023.0360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/09/2023] [Accepted: 08/21/2023] [Indexed: 11/30/2023] Open
Abstract
Magnetic resonance imaging (MRI) has been extensively applied in the study of multiple sclerosis (MS), substantially contributing to diagnosis, differential diagnosis, and disease monitoring. MRI studies have significantly contributed to the understanding of MS through the characterization of typical radiological features and their clinical or prognostic implications using conventional MRI pulse sequences and further with the application of advanced imaging techniques sensitive to microstructural damage. Interpretation of results has often been validated by MRI-pathology studies. However, the application of MRI techniques in the study of neuromyelitis optica spectrum disorders (NMOSD) remains an emerging field, and MRI studies have focused on radiological correlates of NMOSD and its pathophysiology to aid in diagnosis, improve monitoring, and identify relevant prognostic factors. In this review, we discuss the main contributions of MRI to the understanding of MS and NMOSD, focusing on the most novel discoveries to clarify differences in the pathophysiology of focal inflammation initiation and perpetuation, involvement of normal-appearing tissue, potential entry routes of pathogenic elements into the CNS, and existence of primary or secondary mechanisms of neurodegeneration.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milano, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milano, Italy.
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Alqwaifly M, Althobaiti AH, AlAibani NS, Banjar RZ, Alayed RS, Alsubaie SM, Alrashed AT. Patterns of Adult Neuromyelitis Optica Spectrum Disorder Patients Compared to Multiple Sclerosis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47565. [PMID: 38021935 PMCID: PMC10666196 DOI: 10.7759/cureus.47565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are central nervous system inflammatory conditions, now recognized to involve the brain, often identified by aquaporin-4 (AQP4) antibodies. We aimed to summarize the characteristics of adult NMOSD patients compared to multiple sclerosis (MS). A computerized search was conducted on MEDLINE via PubMed, Web of Science, and ProQuest using the relevant keywords. Three independent reviewers performed two-stage screening and data extraction. The Review Manager 5.4 program (Cochrane Collaboration, Windows, London, UK) was used for the analysis. The Joanna Briggs Institute (JIB) tool was used for the quality of included studies. Twenty-three articles were included. NMOSD patients were associated with older age at presentation and higher Expanded Disability Status Scale (MD = 3.88, 95% CI: 1.80 to 5.97, P = 0.0003) and (MD = 1.15, 95% CI: 0.58 to 1.72, P < 0.0001), respectively. The risk of NMOSD in females was significantly higher than MS (OR = 2.21, 95% CI: 1.41 to 3.46, P = 0.0005). Patients with NMOSD were associated with a lower risk of extrapyramidal symptoms (OR = 0.26, 95% CI: 0.11 to 0.60, P < 0.01), brainstem involvement symptoms (OR = 0.32, 95% CI: 0.16 to 0.64, P < 0.01), and developing brain lesions compared to MS (OR = 0.08, 95% CI: 0.03 to 0.18, P < 0.00001). The current evidence suggests that both NMOSD and MS have different demographic, clinical, and lesion characteristics. There is a need for additional validation of the identified differences compared with MS due to the lack of long-term systematic imaging investigations in NMOSD.
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Affiliation(s)
- Mohammed Alqwaifly
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU
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Lopes C, Sousa C, Fraga A, Guimarães J, Vicente S, Sá MJ. Cognitive impairment in Neuromyelitis Optica Spectrum Disorder: A retrospective study using the Brief International cognitive Assessment for Multiple Sclerosis (BICAMS). APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-7. [PMID: 37195824 DOI: 10.1080/23279095.2023.2210242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
BACKGROUND Neuromyelitis Optica Spectrum Disorder (NMOSD) is an inflammatory disease of the central nervous system. The study aimed to characterize the neuropsychological profile of NMOSD by comparing them with multiple sclerosis (MS) patients and healthy controls. METHOD Sixty-four participants were included:19 NMOSD, 27 MS, and 18 healthy controls. The neuropsychological protocol included the Portuguese version of Montreal Cognitive Assessment, the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS), Verbal Fluency (phonemic and semantic), the Hospital Anxiety and Depression Scale, and the Expanded Disability Status Scale for clinical groups. RESULTS NMOSD patients had significant lower cognitive performance when compared to HC mainly in information processing speed, concentration, language processing, and in executive functions (cognitive flexibility, sustained, and divided attention). No significant differences were observed between NMOSD and MS patients. Three predictors for cognitive impairment, according to BICAMS criteria, were found: depression, disease duration, and the level of disability. CONCLUSION The neuropsychological profile found in the present study for NMOSD is consistent with the previous findings. Information regarding the predictors of cognitive impairment in both diseases and their different associations are important for future research and for guiding interventions more suitable for the neuropsychological needs of affected patients.
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Affiliation(s)
- Catarina Lopes
- MS Clinic, Department of Neurology, University Hospital Center of São João, Oporto, Portugal
- Neuropsychological Unit, Department of Psychology, University Hospital Center of São João, Oporto, Portugal
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Claúdia Sousa
- MS Clinic, Department of Neurology, University Hospital Center of São João, Oporto, Portugal
- Neuropsychological Unit, Department of Psychology, University Hospital Center of São João, Oporto, Portugal
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Ana Fraga
- MS Clinic, Department of Neurology, University Hospital Center of São João, Oporto, Portugal
- Neuropsychological Unit, Department of Psychology, University Hospital Center of São João, Oporto, Portugal
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Joana Guimarães
- MS Clinic, Department of Neurology, University Hospital Center of São João, Oporto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Selene Vicente
- Faculty of Psychology and Educational Sciences, University of Porto, Porto, Portugal
| | - Maria José Sá
- MS Clinic, Department of Neurology, University Hospital Center of São João, Oporto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa, Porto, Portugal
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Zakani M, Nigritinou M, Ponleitner M, Takai Y, Hofmann D, Hillebrand S, Höftberger R, Bauer J, Lasztoczi B, Misu T, Kasprian G, Rommer P, Bradl M. Paths to hippocampal damage in neuromyelitis optica spectrum disorders. Neuropathol Appl Neurobiol 2023; 49:e12893. [PMID: 36811295 PMCID: PMC10947283 DOI: 10.1111/nan.12893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 02/03/2023] [Accepted: 02/14/2023] [Indexed: 02/24/2023]
Abstract
AIMS Many patients with neuromyelitis optica spectrum disorders (NMOSD) suffer from cognitive impairment affecting memory, processing speed and attention and suffer from depressive symptoms. Because some of these manifestations could trace back to the hippocampus, several magnetic resonance imaging (MRI) studies have been performed in the past, with a number of groups describing volume loss of the hippocampus in NMOSD patients, whereas others did not observe such changes. Here, we addressed these discrepancies. METHODS We performed pathological and MRI studies on the hippocampi of NMOSD patients, combined with detailed immunohistochemical analysis of hippocampi from experimental models of NMOSD. RESULTS We identified different pathological scenarios for hippocampal damage in NMOSD and its experimental models. In the first case, the hippocampus was compromised by the initiation of astrocyte injury in this brain region and subsequent local effects of microglial activation and neuronal damage. In the second case, loss of hippocampal volume was seen by MRI in patients with large tissue-destructive lesions in the optic nerves or the spinal cord, and the pathological work-up of tissue derived from a patient with such lesions revealed subsequent retrograde neuronal degeneration affecting different axonal tracts and neuronal networks. It remains to be seen whether remote lesions and associated retrograde neuronal degeneration on their own are sufficient to cause extensive volume loss of the hippocampus, or whether they act in concert with small astrocyte-destructive, microglia-activating lesions in the hippocampus that escape detection by MRI, either due to their small size or due to the chosen time window for examination. CONCLUSIONS Different pathological scenarios can culminate in hippocampal volume loss in NMOSD patients.
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Affiliation(s)
- Mona Zakani
- Division of Neuroimmunology, Center for Brain ResearchMedical University of ViennaViennaAustria
| | - Magdalini Nigritinou
- Division of Neuroimmunology, Center for Brain ResearchMedical University of ViennaViennaAustria
| | | | - Yoshiki Takai
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
| | - Daniel Hofmann
- Division of Neuroimmunology, Center for Brain ResearchMedical University of ViennaViennaAustria
| | - Sophie Hillebrand
- Division of Neuroimmunology, Center for Brain ResearchMedical University of ViennaViennaAustria
| | - Romana Höftberger
- Department of Neurology, Division of Neuropathology and NeurochemistryMedical University of ViennaViennaAustria
| | - Jan Bauer
- Division of Neuroimmunology, Center for Brain ResearchMedical University of ViennaViennaAustria
| | - Balint Lasztoczi
- Division of Cognitive Neurobiology, Center for Brain ResearchMedical University of ViennaViennaAustria
| | - Tatsuro Misu
- Department of NeurologyTohoku University Graduate School of MedicineSendaiJapan
| | - Gregor Kasprian
- Division of Biomedical Imaging and Image‐guided TherapyMedical University of ViennaViennaAustria
| | - Paulus Rommer
- Department of NeurologyMedical University of ViennaViennaAustria
| | - Monika Bradl
- Division of Neuroimmunology, Center for Brain ResearchMedical University of ViennaViennaAustria
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16
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Hümmert MW, Stern C, Paul F, Duchow A, Bellmann-Strobl J, Ayzenberg I, Schwake C, Kleiter I, Hellwig K, Jarius S, Wildemann B, Senel M, Berthele A, Giglhuber K, Luessi F, Grothe M, Klotz L, Schülke R, Gingele S, Faiss JH, Walter A, Warnke C, Then Bergh F, Aktas O, Ringelstein M, Stellmann JP, Häußler V, Havla J, Pellkofer H, Kümpfel T, Kopp B, Trebst C. Cognition in patients with neuromyelitis optica spectrum disorders: A prospective multicentre study of 217 patients (CogniNMO-Study). Mult Scler 2023:13524585231151212. [PMID: 36786424 DOI: 10.1177/13524585231151212] [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: 02/15/2023]
Abstract
BACKGROUND There is limited and inconsistent information on the prevalence of cognitive impairment in neuromyelitis optica spectrum disorders (NMOSD). OBJECTIVE To assess cognitive performance and changes over time in NMOSD. METHODS This study included data from 217 aquaporin-4-IgG-seropositive (80%) and double-seronegative NMOSD patients. Cognitive functions measured by Symbol Digit Modalities Test (SDMT), Paced Auditory Serial-Addition Task (PASAT), and/or Multiple Sclerosis Inventory Cognition (MuSIC) were standardized against normative data (N = 157). Intraindividual cognitive performance at 1- and 2-year follow-up was analyzed. Cognitive test scores were correlated with demographic and clinical variables and assessed with a multiple linear regression model. RESULTS NMOSD patients were impaired in SDMT (p = 0.007), MuSIC semantic fluency (p < 0.001), and MuSIC congruent speed (p < 0.001). No significant cognitive deterioration was found at follow-up. SDMT scores were related to motor and visual disability (pBon < 0.05). No differences were found between aquaporin-4-IgG-seropositive and double-seronegative NMOSD. CONCLUSIONS A subset of NMOSD patients shows impairment in visual processing speed and in semantic fluency regardless of serostatus, without noticeable changes during a 2-year observation period. Neuropsychological measurements should be adapted to physical and visual disabilities.
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Affiliation(s)
- Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Carlotta Stern
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany/ Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Ankelien Duchow
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany/Experimental and Clinical Research Center, Charité-Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Carolin Schwake
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany/Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Felix Luessi
- Department of Neurology, University Medical Center, Johannes Gutenberg University of Mainz, Mainz, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Luisa Klotz
- Department of Neurology, University of Münster, Münster, Germany
| | - Rasmus Schülke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Jürgen H Faiss
- Department of Neurology, Asklepios Expert Clinic Teupitz, Teupitz, Germany
| | - Annette Walter
- Department of Neurology, Herford Hospital, Herford, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany/Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany/Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille, France/APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and Multiple Sclerosis (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany/Data Integration for Future Medicine Consortium, LMU Hospital, Ludwig-Maximilians Universität München, Munich, Germany
| | - Hannah Pellkofer
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Neurology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany
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Ashtari F, Manouchehri N, Shaygannejad V, Barekatain M, Adibi I, Afshari-Safavi A, Ramezani N, Ghalamkari A, Barzegar M. Assessment of intelligence quotient in patients with neuromyelitis optica spectrum disease and multiple sclerosis. Mult Scler Relat Disord 2023; 70:104492. [PMID: 36587484 DOI: 10.1016/j.msard.2022.104492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 12/05/2022] [Accepted: 12/27/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Cognitive impairment is common in people living with neuromyelitis optica spectrum disease (NMOSD) and multiple sclerosis (MS). However, there is little published data on intelligence quotient (IQ) in NMOSD patients. Therefore, we performed the present study to compare IQ scores across NMOSD, MS, and control groups. METHOD In this cross-sectional study, 49 NMOSD (30 with positive aquaporin4 antibody), 41 MS, and 20 control individuals were recruited. The IQ score for each person was measured using Wechsler Adult Intelligence Scale-Revised (WAIS-R). Participants were reported on eleven scores of subsets, verbal IQ (VIQ), performance IQ (PIQ), and full score IQ (FSIQ). RESULT The scores of FSIQ, VIQ, PIQ, vocabulary, similarities, and digit-symbol in NMOSD and MS individuals were lower than the control group. Relative to control, NMOSD patients reported a lower score of information. We found no difference between NMOSD and MS groups, except in vocabulary and similarities. No significant difference between seropositive and seronegative NMOSD groups was observed except for the information and block design. In NMOSD group, a greater EDSS score was associated with decreased scores of FSIQ, VIQ, and PIQ. Being employed and being married were associated with greater scores of VIQ and PIQ, respectively. In both NMOSD and MS groups, advanced education was associated with increased scores of FSIQ and VIQ. CONCLUSION Our study showed decreased IQ scores in NMOSD and MS. Further studies are required to examine intellectual quotient in people with NMOSD and MS.
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Affiliation(s)
- Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Navid Manouchehri
- Department of Neurology, University of Texas Southwestern Medical Center at Dallas, TX, USA
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Barekatain
- Psychosomatic Research Center, Department of Psychiatry, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Iman Adibi
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Neda Ramezani
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arshia Ghalamkari
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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18
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Xue H, Wu M, Wang Y, Zhao Y, Zhang M, Zhang H. The circadian rhythms regulated by Cx43-signaling in the pathogenesis of Neuromyelitis Optica. Front Immunol 2023; 13:1021703. [PMID: 36726988 PMCID: PMC9885795 DOI: 10.3389/fimmu.2022.1021703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 12/29/2022] [Indexed: 01/18/2023] Open
Abstract
Introduction Neuromyelitis Optica (NMO) is an inflammatory demyelinating disease of the central nervous system (CNS). NMO manifests as selective and severe attacks on axons and myelin of the optic nerve and spinal cord, resulting in necrotic cavities. The circadian rhythms are well demonstrated to profoundly impact cellular function, behavior, and disease. This study is aimed to explore the role and molecular basis of circadian rhythms in NMO. Methods We used an Aquaporin 4(AQP4) IgG-induced NMO cell model in isolated astrocytes. The expression of Cx43 and Bmal1 were detected by real-time PCR and Western Blot. TAT-Gap19 and DQP-1105 were used to inhibit Cx43 and glutamate receptor respectively. The knockdown of Bmal1 were performed with the shRNA containing adenovirus. The levels of glutamate, anterior visual pathway (AVP), and vasoactive intestinal peptide (VIP) were quantified by ELISA kits. Results We found that Bmal1 and Clock, two essential components of the circadian clock, were significantly decreased in NMO astrocytes, which were reversed by Cx43 activation (linoleic acid) or glutamate. Moreover, the expression levels of Bmal1 and Clock were also decreased by Cx43 blockade (TAT-Gap19) or glutamate receptor inhibition (DQP-1105). Furthermore, adenovirus-mediated Bmal1 knockdown by shRNA (Ad-sh-Bmal1) dramatically decreased the levels of glutamate, AVP, and VIP from neurons, and significantly down-regulated the protein level of Cx43 in NMO astrocytes with Cx43 activation (linoleic acid) or glutamate treatment. However, Bmal1 knockdown did not alter these levels in normal astrocytes with Cx43 blockade (TAT-Gap19) or glutamate receptor inhibition (DQP-1105). Discussion Collectively, these results suggest that Cx43-glutamate signaling would be a critical upstream regulator that contributes to the NMO-induced rhythmic damage in SCN astrocytes.
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Affiliation(s)
- Huiru Xue
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Minghui Wu
- First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yongle Wang
- First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Yunfei Zhao
- First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China
| | - Meini Zhang
- Department of Neurology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Meini Zhang, ; Hui Zhang,
| | - Hui Zhang
- First Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi, China,Department of Medical Imaging, First Hospital of Shanxi Medical University, Taiyuan, Shanxi, China,*Correspondence: Meini Zhang, ; Hui Zhang,
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19
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Miao Y, Zhong X, Jia S, Bian Y, Han J, Qiu F. The Characteristics of Cognitive Proficiency in Patients with Acute Neuromyelitis Optica Spectrum Disease and its Correlation with Serum Aquaporin-4 Antibody Titer. Brain Sci 2023; 13:brainsci13010090. [PMID: 36672071 PMCID: PMC9857218 DOI: 10.3390/brainsci13010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Objective: To explore the characteristics and dynamic evolution of cognitive impairment in patients with neuromyelitis optica spectrum disorder (NMOSD). Methods: Twenty-five patients with acute NMOSD and 30 age-matched healthy individuals were consecutively recruited in this study. The Montreal Cognitive Assessment (MoCA), Chinese Version of Rey Auditory Vocabulary Learning Test (CRAVLT), Verbal Fluency Test (VFT), Digital Span Test (DST), Paced Auditory Serial Addition Task 3/2s version (PASAT-3/2), Rey−Osterrieth Complex Figure Test (ROCF) and Stroop Color and Word Test (CWT) were used to evaluate cognitive function. The correlations between cognitive function and serum aquaporin-4 (AQP-4) antibody titer were analyzed. Results: Sixty-four percent of patients with acute NMOSD had cognitive dysfunction. MoCA (p < 0.001), CRAVLT-N7 (p = 0.004), CRAVLT-N8 (p = 0.011), ROCF-C (p = 0.005), ROCF-R (p < 0.001), PASAT-3 (p = 0.013), PASAT-2 (p = 0.001) and CWT-A (p = 0.017) were significantly worse in patients with acute NMOSD than those in control group. During follow-up visits, significant differences of serum AQP-4 antibody titers were still noted in NMOSD patients (p < 0.001), while no significant differences were found by MoCA. Conclusion: A high number of patients with acute NMOSD suffer from cognitive dysfunction. Serum AQP-4 antibody titers can decrease during disease remission, while obvious cognitive decline in these patients still exists.
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Affiliation(s)
- Yan Miao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaoling Zhong
- Department of Neurology, School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital of Beijing, Beijing 100048, China
| | - Shuangshuang Jia
- Department of Neurology, Naval Clinical College, Anhui Medical University, Hefei 230032, China
| | - Yang Bian
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital of Beijing, Beijing 100048, China
| | - Jinming Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Correspondence: (J.H.); (F.Q.); Tel.: +86-1055473163 (F.Q.)
| | - Feng Qiu
- Department of Neurology, School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital of Beijing, Beijing 100048, China
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing 100853, China
- Correspondence: (J.H.); (F.Q.); Tel.: +86-1055473163 (F.Q.)
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20
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Eba S, Nishiyama S, Notsuda H, Oishi H, Noda M, Aoki M, Okada Y. Development of Paraneoplastic Neuromyelitis Optica after Lung Resection in a Patient with Squamous Cell Carcinoma. Ann Thorac Cardiovasc Surg 2023; 29:49-52. [PMID: 34690217 PMCID: PMC9939678 DOI: 10.5761/atcs.cr.21-00144] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Neurological paraneoplastic syndrome is a relatively rare condition in patients with malignant tumors. Recently, it has been reported that anti-Aquaporin 4 (AQP4) antibody is highly specific for neuromyelitis optica. The patient was a 76-year-old man. He underwent right upper lobectomy for squamous cell carcinoma of the lung. Although the immediate postoperative course was uneventful, neurological symptoms became apparent from postoperative day (POD) 4. Magnetic resonance imaging showed longitudinally extended edematous lesions in the spinal cord, and a cerebrospinal fluid examination was positive for anti-AQP4 antibody, leading to the diagnosis of paraneoplastic neuromyelitis optica. Despite multiple rounds of steroid pulse therapy and plasma exchange, the neurological symptoms worsened and the patient died on POD 46. The development of neuromyelitis optica in the early postoperative period could be related to the influence of surgical stress or epidural anesthesia.
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Affiliation(s)
- Shunsuke Eba
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan,Corresponding author: Shunsuke Eba, MD, PhD. Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, 4-1 Seiryomachi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Hirotsugu Notsuda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Hisashi Oishi
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Masafumi Noda
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University School of Medicine, Sendai, Miyagi, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Miyagi, Japan
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21
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Corbali O, Chitnis T. Pathophysiology of myelin oligodendrocyte glycoprotein antibody disease. Front Neurol 2023; 14:1137998. [PMID: 36925938 PMCID: PMC10011114 DOI: 10.3389/fneur.2023.1137998] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/09/2023] [Indexed: 03/08/2023] Open
Abstract
Myelin Oligodendrocyte Glycoprotein Antibody Disease (MOGAD) is a spectrum of diseases, including optic neuritis, transverse myelitis, acute disseminated encephalomyelitis, and cerebral cortical encephalitis. In addition to distinct clinical, radiological, and immunological features, the infectious prodrome is more commonly reported in MOGAD (37-70%) than NMOSD (15-35%). Interestingly, pediatric MOGAD is not more aggressive than adult-onset MOGAD, unlike in multiple sclerosis (MS), where annualized relapse rates are three times higher in pediatric-onset MS. MOGAD pathophysiology is driven by acute attacks during which T cells and MOG antibodies cross blood brain barrier (BBB). MOGAD lesions show a perivenous confluent pattern around the small veins, lacking the radiological central vein sign. Initial activation of T cells in the periphery is followed by reactivation in the subarachnoid/perivascular spaces by MOG-laden antigen-presenting cells and inflammatory CSF milieu, which enables T cells to infiltrate CNS parenchyma. CD4+ T cells, unlike CD8+ T cells in MS, are the dominant T cell type found in lesion histology. Granulocytes, macrophages/microglia, and activated complement are also found in the lesions, which could contribute to demyelination during acute relapses. MOG antibodies potentially contribute to pathology by opsonizing MOG, complement activation, and antibody-dependent cellular cytotoxicity. Stimulation of peripheral MOG-specific B cells through TLR stimulation or T follicular helper cells might help differentiate MOG antibody-producing plasma cells in the peripheral blood. Neuroinflammatory biomarkers (such as MBP, sNFL, GFAP, Tau) in MOGAD support that most axonal damage happens in the initial attack, whereas relapses are associated with increased myelin damage.
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Affiliation(s)
- Osman Corbali
- Harvard Medical School, Boston, MA, United States.,Department of Neurology, Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Boston, MA, United States
| | - Tanuja Chitnis
- Harvard Medical School, Boston, MA, United States.,Department of Neurology, Brigham and Women's Hospital, Ann Romney Center for Neurologic Diseases, Boston, MA, United States
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Yang Y, Rui Q, Wu X, Chen X, Han S, Yang Y, Wang X, Wu P, Dai H, Xue Q, Li Y. Altered functional connectivity associated with cognitive impairment in neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2022; 68:104113. [PMID: 35987110 DOI: 10.1016/j.msard.2022.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 08/07/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive impairment is one of the common symptoms in patients with neuromyelitis optica spectrum disorder (NMOSD). However, the underlying mechanism remains unclear. Resting-state functional magnetic resonance imaging (rs-fMRI) offers the opportunity to reveal the patterns of brain activity in patients with different cognitive states. Accordingly, this study investigated functional connectivity (FC) abnormalities within and between the main cognitive networks in cognitively impaired (CI) patients with NMOSD and their correlations with cognitive performance. METHODS Thirty-four patients with NMOSD and 39 healthy controls (HC) were included. Neuropsychological evaluations and rs-fMRI scanning were performed. Patients were classified as CI (n = 16) or cognitively preserved (CP; n = 18) according to neuropsychological evaluations. Seven components representing six main cognitive networks were selected by group independent component analysis. The differences in inter- and intranetwork FC among CI, CP, and HC groups were assessed. The correlation between FC values and neuropsychological data in NMOSD was calculated. RESULTS The CI group showed decreased intranetwork connectivity in the posterior default mode network (pDMN) compared with the HC group (P < 0.05, GRF corrected), and decreased internetwork connectivity between the salience network (SN) and pDMN, and between the SN and right frontoparietal network (rFPN) compared with CP and HC groups. The altered FC values were significantly correlated with cognitive performance in the whole NMOSD group. CONCLUSION The disconnection within the pDMN and between the SN and pDMN or rFPN might suggest the neural substrates underlying cognitive impairment in NMOSD.
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Affiliation(s)
- Yang Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Qianyun Rui
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiaojuan Wu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiang Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Shuting Han
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Yan Yang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiaoyuan Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Peng Wu
- Philips Healthcare, Shanghai 200072, China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Institute of Medical Imaging, Soochow University, Suzhou 215000, China.
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Clinical Research Center of Neurology, Jiangsu Institute of Clinical Immunology, The First Affiliated Hospital of Soochow University, Suzhou 215000, China.
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Institute of Medical Imaging, Soochow University, Suzhou 215000, China; National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou 215000, China.
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23
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Li J, He Y, Wang H, Chen J. Microglial/macrophage activation in the cerebrospinal fluid of neuromyelitis optica spectrum disorders. Brain Behav 2022; 12:e2798. [PMID: 36306394 PMCID: PMC9759122 DOI: 10.1002/brb3.2798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/05/2022] [Accepted: 08/06/2022] [Indexed: 11/07/2022] Open
Abstract
AIM The aims of this pilot study were to investigate the levels of biomarkers of microglial/macrophage activation-YKL-40, sCD163, and sCD14-in patients with neuromyelitis optica spectrum disorder (NMOSD) and determine the possible associations between these biomarkers and Expanded Disability Status Scale (EDSS) scores. METHODS We measured the levels of three microglia-/macrophage-related proteins (YKL-40, soluble CD163, and soluble CD14) in cerebrospinal fluid (CSF) using enzyme-linked immunosorbent assays. In addition, patients' neurological disability levels were assessed using EDSS scores. RESULTS NMOSD patients had significantly higher CSF levels of YKL-40(210.52 ± 161.62 for NMOSD and 63.18 ± 9.22 for control), sCD163 (87.23 ± 56.85 for NMOSD and 58.14 ± 7.66 for control), and sCD14 (68.22 ± 24.11 for NMOSD and 55.75 ± 9.48 for control) compared with controls. Furthermore, these biomarker levels were positively correlated with EDSS scores in patients with NMOSD (r = 0.303, p = .002 for YKL-40; r = 0310, p = .001 for sCD14; r = 0.250, p = .011 for sCD163), but not in patients with multiple sclerosis or glial fibrillary acidic protein astrocytopathy. CONCLUSION Our findings suggest that microglial/macrophage activation may be implicated in the pathogenesis of NMOSD.
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Affiliation(s)
- Jinghong Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Chenzhou, China
| | - Yan He
- Department of Neurology, Chenzhou No. 1 People's Hospital, Chenzhou, China
| | - Honghao Wang
- Neuroimmunology & Neuroinfection Group, Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Jinyu Chen
- Neuroimmunology & Neuroinfection Group, Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
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24
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West PK, Viengkhou B, Campbell IL, Hofer MJ. Microglia shield the murine brain from damage mediated by the cytokines IL-6 and IFN-α. Front Immunol 2022; 13:1036799. [PMID: 36389783 PMCID: PMC9650248 DOI: 10.3389/fimmu.2022.1036799] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 10/13/2022] [Indexed: 12/10/2023] Open
Abstract
Sustained production of elevated levels of the cytokines interleukin (IL)-6 or interferon (IFN)-α in the central nervous system (CNS) is detrimental and directly contributes to the pathogenesis of neurological diseases such as neuromyelitis optica spectrum disorders or cerebral interferonopathies, respectively. Using transgenic mice with CNS-targeted production of IL-6 (GFAP-IL6) or IFN-α (GFAP-IFN), we have recently demonstrated that microglia are prominent target and effector cells and mount stimulus-specific responses to these cytokines. In order to further clarify the phenotype and function of these cells, we treated GFAP-IL6 and GFAP-IFN mice with the CSF1R inhibitor PLX5622 to deplete microglia. We examined their ability to recover from acute microglia depletion, as well as the impact of chronic microglia depletion on the progression of disease. Following acute depletion in the brains of GFAP-IL6 mice, microglia repopulation was enhanced, while in GFAP-IFN mice, microglia did not repopulate the brain. Furthermore, chronic CSF1R inhibition was detrimental to the brain of GFAP-IL6 and GFAP-IFN mice and gave rise to severe CNS calcification which strongly correlated with the absence of microglia. In addition, PLX5622-treated GFAP-IFN mice had markedly reduced survival. Our findings provide evidence for novel microglia functions to protect against IFN-α-mediated neurotoxicity and neuronal dysregulation, as well as restrain calcification as a result of both IL-6- and IFN-α-induced neuroinflammation. Taken together, we demonstrate that CSF1R inhibition may be an undesirable target for therapeutic treatment of neuroinflammatory diseases that are driven by elevated IL-6 and IFN-α production.
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Affiliation(s)
| | | | | | - Markus J. Hofer
- School of Life and Environmental Sciences, Charles Perkins Centre and the Sydney Institute for Infectious Diseases, The University of Sydney, Sydney, NSW, Australia
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25
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Yan Z, Wang X, Zhu Q, Shi Z, Chen X, Han Y, Zheng Q, Wei Y, Wang J, Li Y. Alterations in White Matter Fiber Tracts Characterized by Automated Fiber-Tract Quantification and Their Correlations With Cognitive Impairment in Neuromyelitis Optica Spectrum Disorder Patients. Front Neurosci 2022; 16:904309. [PMID: 35844220 PMCID: PMC9283762 DOI: 10.3389/fnins.2022.904309] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate whether patients with neuromyelitis optica spectrum disorder (NMOSD) have tract-specific alterations in the white matter (WM) and the correlations between the alterations and cognitive impairment. Materials and Methods In total, 40 patients with NMOSD and 20 healthy controls (HCs) who underwent diffusion tensor imaging (DTI) scan and neuropsychological scale assessments were enrolled. Automated fiber-tract quantification (AFQ) was applied to identify and quantify 100 equally spaced nodes of 18 specific WM fiber tracts for each participant. Then the group comparisons in DTI metrics and correlations between different DTI metrics and neuropsychological scales were performed. Results Regardless of the entire or pointwise level in WM fiber tracts, patients with NMOSD exhibited a decreased fractional anisotropy (FA) in the left inferior fronto-occipital fasciculus (L_IFOF) and widespread increased mean diffusion (MD), axial diffusivity (AD), and radial diffusivity (RD), especially for the thalamic radiation (TR), corticospinal tract (CST), IFOF, inferior longitudinal fasciculus (ILF), superior longitudinal fasciculus (SLF) [p < 0.05, false discovery rate (FDR) correction], and the pointwise analyses performed more sensitive. Furthermore, the negative correlations among MD, AD, RD, and symbol digit modalities test (SDMT) scores in the left TR (L_TR) were found in NMOSD. Conclusion Patients with NMOSD exhibited the specific nodes of WM fiber tract damage, which can enhance our understanding of WM microstructural abnormalities in NMOSD. In addition, the altered DTI metrics were correlated with cognitive impairment, which can be used as imaging markers for the early identification of NMOSD cognitive impairment.
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26
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Cacciaguerra L, Carotenuto A, Pagani E, Mistri D, Radaelli M, Martinelli V, Filippi M, Rocca MA. MRI EVALUATION OF PERIVASCULAR SPACE ABNORMALITIES IN NEUROMYELITIS OPTICA. Ann Neurol 2022; 92:173-183. [PMID: 35596582 PMCID: PMC9544484 DOI: 10.1002/ana.26419] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/08/2022]
Abstract
Objective Astrocytes outline the perivascular space (PVS) and regulate fluid exchange through the aquaporin‐4 water channel. As neuromyelitis optica is an autoimmune astrocytopathy targeting aquaporin‐4, we hypothesized that it could be associatied with PVS abnormalities. Methods A total of 34 patients, and 46 age‐ and sex‐matched healthy controls from two independent cohorts (exploratory and validation dataset) underwent a standardized 3.0‐T magnetic resonance imaging protocol including conventional and diffusion tensor imaging. Susceptibility‐weighted imaging was also acquired in the exploratory dataset. We evaluated macroscopic and microstructural abnormalities of PVS in terms of enlargement and water diffusivity (DTI‐ALPS index). In the exploration dataset, a susceptibility‐weighted sequence was used to draw the regions of interest for the DTI‐ALPS index calculation in areas having veins perpendicular to lateral ventricles. Between‐group comparisons, correlations, and regression models were run to assess associations between PVS abnormalities, and clinical and magnetic resonance imaging variables. Results Patients had a higher frequency of severe PVS enlargement in the centrum semiovale (29.4% vs 8.7%), which correlated with brain atrophy, deep grey matter atrophy, and poorer cognitive performance (r‐values range: −0.44, −0.36; p values: 0.01–0.046). In both datasets, patients had reduced DTI‐ALPS index compared with controls (p values 0.004–0.038). Lower DTI‐ALPS index, deep gray matter volume, and cortical volume could discriminate between patients and controls (R2 = 0.62), whereas lower DTI‐ALPS index, higher number of myelitis, and higher T2‐lesion volume were associated with worse disability (R2 = 0.55). Interpretation Patients with neuromyelitis optica spectrum disorder are characterized by abnormal enlargement and impaired water diffusion along the PVS, whose clinical implications suggest a direct correlation with disease pathogenesis and severity. ANN NEUROL 2022;92:173–183
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Antonio Carotenuto
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Radaelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
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27
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Saab G, Munoz DG, Rotstein DL. Chronic Cognitive Impairment in AQP4+ NMOSD With Improvement in Cognition on Eculizumab: A Report of Two Cases. Front Neurol 2022; 13:863151. [PMID: 35645973 PMCID: PMC9136286 DOI: 10.3389/fneur.2022.863151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/19/2022] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment may be associated with aquaporin-4 antibody positive (AQP4+) NMOSD, particularly where there is prominent cerebral, corpus callosum, or thalamic involvement. It is unclear to what extent this phenomenon may be treatable after months to years. We describe two cases of AQP4+ NMOSD with cognitive impairment persisting over more than 6 months, where cognition improved after eculizumab was initiated. In the first case, a 51-year-old woman presented with a 2-month history of cognitive decline and ataxia, and diffuse involvement of the corpus callosum on MRI. AQP4 antibody testing returned positive. Cognitive impairment persisted on therapy with mycophenolate, then rituximab. She was switched to eculizumab from rituximab 18 months after disease onset because of breakthrough optic neuritis; memory and cognitive function improved on eculizumab. In the second case, a 26-year-old woman initially presented with visual, auditory and tactile hallucinations, and impairment in activities of daily living, and was given a diagnosis of schizophrenia. Nine months later she was hospitalized for increasing confusion. MRI showed leukoencephalopathy and diffuse involvement of the corpus callosum with multiple enhancing callosal lesions. AQP4 antibody testing was positive and CSF testing for other antibodies of autoimmune encephalitis was negative. She had some improvement in cognition with high dose corticosteroids but remained significantly impaired. On follow-up, her repeat MRI showed a small new right inferomedial frontal enhancing lesion although she did not complain of any new cognitive issues, her MOCA score was 21/30, and she was started on eculizumab. Two months after eculizumab initiation she and her family reported cognitive improvement and MOCA score was 25/30. Common features of these two cases included extensive callosal involvement and an element of ongoing gadolinium enhancement on MRI. Our experience suggests the possibility that cognitive impairment may be amenable to immunotherapy in certain cases of NMOSD.
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Affiliation(s)
- Georges Saab
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - David G. Munoz
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
| | - Dalia L. Rotstein
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- St. Michael's Hospital, Toronto, ON, Canada
- *Correspondence: Dalia L. Rotstein
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28
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Cognitive Performance and Health-Related Quality of Life in Patients with Neuromyelitis Optica Spectrum Disorder. J Pers Med 2022; 12:jpm12050743. [PMID: 35629165 PMCID: PMC9146457 DOI: 10.3390/jpm12050743] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/19/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The frequency of cognitive impairment (CI) reported in neuromyelitis optica spectrum disorder (NMOSD) is highly variable, and its relationship with demographic and clinical characteristics is poorly understood. We aimed to describe the cognitive profile of NMOSD patients, and to analyse the cognitive differences according to their serostatus; furthermore, we aimed to assess the relationship between cognition, demographic and clinical characteristics, and other aspects linked to health-related quality of life (HRQoL). Methods: This cross-sectional study included 41 patients (median age, 44 years; 85% women) from 13 Spanish centres. Demographic and clinical characteristics were collected along with a cognitive z-score (Rao’s Battery) and HRQoL patient-centred measures, and their relationship was explored using linear regression. We used the Akaike information criterion to model which characteristics were associated with cognition. Results: Fourteen patients (34%) had CI, and the most affected cognitive domain was visual memory. Cognition was similar in AQP4-IgG-positive and -negative patients. Gender, mood, fatigue, satisfaction with life, and perception of stigma were associated with cognitive performance (adjusted R2 = 0.396, p < 0.001). Conclusions: The results highlight the presence of CI and its impact on HRQoL in NMOSD patients. Cognitive and psychological assessments may be crucial to achieve a holistic approach in patient care.
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29
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Cacciaguerra L, Pagani E, Radaelli M, Mesaros S, Martinelli V, Ivanovic J, Drulovic J, Filippi M, Rocca MA. MR T2-relaxation time as an indirect measure of brain water content and disease activity in NMOSD. J Neurol Neurosurg Psychiatry 2022; 93:jnnp-2022-328956. [PMID: 35483915 DOI: 10.1136/jnnp-2022-328956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Since astrocytes at the blood-brain barrier are targeted by neuromyelitis optica spectrum disorder (NMOSD), this study aims to assess whether patients with NMOSD have a subclinical accumulation of brain water and if it differs according to disease activity. METHODS Seventy-seven aquaporin-4-positive patients with NMOSD and 105 healthy controls were enrolled at two European centres. Brain dual-echo turbo spin-echo MR images were evaluated and maps of T2 relaxation time (T2rt) in the normal-appearing white matter (NAWM), grey matter and basal ganglia were obtained. Patients with a clinical relapse within 1 month before or after MRI acquisition were defined 'active'. Differences between patients and controls were assessed using z-scores of T2rt obtained with age-adjusted and sex-adjusted linear models from each site. A stepwise binary logistic regression was run on clinical and MRI variables to identify independent predictors of disease activity. RESULTS Patients had increased T2rt in both white and grey matter structures (p range: 0.014 to <0.0001). Twenty patients with NMOSD were defined active. Despite similar clinical and MRI features, active patients had a significantly increased T2rt in the NAWM and grey matter compared with those clinically stable (p range: 0.010-0.002). The stepwise binary logistic regression selected the NAWM as independently associated with disease activity (beta=2.06, SE=0.58, Nagelkerke R2=0.46, p<0.001). CONCLUSIONS In line with the research hypothesis, patients with NMOSD have increased brain T2rt. The magnitude of this alteration might be useful for identifying those patients with active disease.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Marta Radaelli
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | | | - Jovana Ivanovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Beograd, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
- Nerorehabilitation Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurophysiology Service, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS Ospedale San Raffaele, Milano, Italy
- Neurology Unit, IRCCS Ospedale San Raffaele, Milano, Italy
- Vita-Salute San Raffaele University, Milano, Italy
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30
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Ouellette R. Advanced MRI quantification of neuroinflammatory disorders. J Neurosci Res 2022; 100:1389-1394. [PMID: 35460291 PMCID: PMC9321072 DOI: 10.1002/jnr.25054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/26/2022] [Accepted: 03/31/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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31
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The cytokines interleukin-6 and interferon-α induce distinct microglia phenotypes. J Neuroinflammation 2022; 19:96. [PMID: 35429976 PMCID: PMC9013466 DOI: 10.1186/s12974-022-02441-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/24/2022] [Indexed: 12/12/2022] Open
Abstract
Background Elevated production of the cytokines interleukin (IL)-6 or interferon (IFN)-α in the central nervous system (CNS) is implicated in the pathogenesis of neurological diseases such as neuromyelitis optica spectrum disorders or cerebral interferonopathies, respectively. Transgenic mice with CNS-targeted chronic production of IL-6 (GFAP-IL6) or IFN-α (GFAP-IFN) recapitulate important clinical and pathological features of these human diseases. The activation of microglia is a prominent manifestation found both in the human diseases and in the transgenic mice, yet little is known about how this contributes to disease pathology. Methods Here, we used a combination of ex vivo and in situ techniques to characterize the molecular, cellular and transcriptomic phenotypes of microglia in GFAP-IL6 versus GFAP-IFN mice. In addition, a transcriptomic meta-analysis was performed to compare the microglia response from GFAP-IL6 and GFAP-IFN mice to the response of microglia in a range of neurodegenerative and neuroinflammatory disorders. Results We demonstrated that microglia show stimulus-specific responses to IL-6 versus IFN-α in the brain resulting in unique and extensive molecular and cellular adaptations. In GFAP-IL6 mice, microglia proliferated, had shortened, less branched processes and elicited transcriptomic and molecular changes associated with phagocytosis and lipid processing. In comparison, microglia in the brain of GFAP-IFN mice exhibited increased proliferation and apoptosis, had larger, hyper-ramified processes and showed transcriptomic and surface marker changes associated with antigen presentation and antiviral response. Further, a transcriptomic meta-analysis revealed that IL-6 and IFN-α both contribute to the formation of a core microglia response in animal models of neurodegenerative and neuroinflammatory disorders, such as Alzheimer’s disease, tauopathy, multiple sclerosis and lipopolysaccharide-induced endotoxemia. Conclusions Our findings demonstrate that microglia responses to IL-6 and IFN-α are highly stimulus-specific, wide-ranging and give rise to divergent phenotypes that modulate microglia responses in neuroinflammatory and neurodegenerative diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-022-02441-x.
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32
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Andica C, Hagiwara A, Yokoyama K, Kato S, Uchida W, Nishimura Y, Fujita S, Kamagata K, Hori M, Tomizawa Y, Hattori N, Aoki S. Multimodal magnetic resonance imaging quantification of gray matter alterations in relapsing-remitting multiple sclerosis and neuromyelitis optica spectrum disorder. J Neurosci Res 2022; 100:1395-1412. [PMID: 35316545 DOI: 10.1002/jnr.25035] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/07/2022] [Accepted: 02/13/2022] [Indexed: 11/08/2022]
Abstract
Herein, we combined neurite orientation dispersion and density imaging (NODDI) and synthetic magnetic resonance imaging (SyMRI) to evaluate the spatial distribution and extent of gray matter (GM) microstructural alterations in patients with relapsing-remitting multiple sclerosis (RRMS) and neuromyelitis optica spectrum disorder (NMOSD). The NODDI (neurite density index [NDI], orientation dispersion index [ODI], and isotropic volume fraction [ISOVF]) and SyMRI (myelin volume fraction [MVF]) measures were compared between age- and sex-matched groups of 30 patients with RRMS (6 males and 24 females; mean age, 51.43 ± 8.02 years), 18 patients with anti-aquaporin-4 antibody-positive NMOSD (2 males and 16 females; mean age, 52.67 ± 16.07 years), and 19 healthy controls (6 males and 13 females; mean age, 51.47 ± 9.25 years) using GM-based spatial statistical analysis. Patients with RRMS showed reduced NDI and MVF and increased ODI and ISOVF, predominantly in the limbic and paralimbic regions, when compared with healthy controls, while only increases in ODI and ISOVF were observed when compared with NMOSD. Compared to NDI and MVF, the changes in ODI and ISOVF were observed more widely, including in the cerebellar cortex. These abnormalities were associated with disease progression and disability. In contrast, patients with NMOSD only showed reduced NDI mainly in the cerebellar, limbic, and paralimbic cortices when compared with healthy controls and patients with RRMS. Taken together, our study supports the notion that GM pathologies in RRMS are distinct from those of NMOSD. However, owing to the limitations of the study, the results should be cautiously interpreted.
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Affiliation(s)
- Christina Andica
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kazumasa Yokoyama
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shimpei Kato
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Wataru Uchida
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuma Nishimura
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiological Sciences, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Shohei Fujita
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koji Kamagata
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Masaaki Hori
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Yuji Tomizawa
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
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33
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Yang Y, Rui Q, Han S, Wu X, Wang X, Wu P, Shen Y, Dai H, Xue Q, Li Y. Reduced GABA levels in the medial prefrontal cortex are associated with cognitive impairment in patients with NMOSD. Mult Scler Relat Disord 2022; 58:103496. [PMID: 35032882 DOI: 10.1016/j.msard.2022.103496] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 12/02/2021] [Accepted: 01/01/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cognitive impairment is a symptom present in part of patients with neuromyelitis optica spectrum disorder (NMOSD) and its pathophysiology is unknown. Dysfunction of the GABAergic/glutamatergic pathways involving inhibitory and excitatory neurotransmitters have been implicated in several neurological disorders. This study aimed to investigate the changes in inhibitory gamma-aminobutyric acid (GABA) and excitatory glutamate and glutamine (Glx) neurotransmitter levels and their correlations with cognitive functions in patients with NMOSD. METHODS A total of 29 patients with NMOSD and 28 sex-, age-, and education-matched healthy controls (HCs) were included in the study. All participants underwent clinical and cognitive assessments and proton magnetic resonance spectroscopy scanning. Meshcher-Garwood point-resolved spectroscopy was used to measure GABA and Glx levels in the medial prefrontal cortex (mPFC) and left thalamus. Total creatine (tCr) was applied as an internal reference. The GABA and Glx levels in the patient group were compared with those in HCs and correlated with cognitive scores and clinical variables. RESULTS Patients with NMOSD showed lower GABA+/tCr levels in the mPFC compared with HCs (P = 0.028). The GABA+/tCr levels in the mPFC were significantly associated with verbal memory performance (r = 0.462, P = 0.027) and overall cognition (r = 0.440, P = 0.035) in the NMOSD group. The GABA+/tCr levels in the left thalamus or Glx/tCr levels in both regions were not significantly different between groups, nor were they related to any cognitive domain in patients with NMOSD (all P values > 0.05). CONCLUSION The GABA+ levels in the mPFC decreased and correlated with cognitive dysfunction in patients with NMOSD, suggesting that the changes in regional GABA+ levels might be a potential metabolic feature of cognitive decline in patients with NMOSD.
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Affiliation(s)
- Yang Yang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Qianyun Rui
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Shuting Han
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiaojuan Wu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Xiaoyuan Wang
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China
| | - Peng Wu
- Philips Healthcare, Shanghai 200072, China
| | - Yueping Shen
- Department of Statistics, Soochow University, Suzhou, Jiangsu 215000, China
| | - Hui Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu 215000, China.
| | - Qun Xue
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Clinical Research Center of Neurology, Jiangsu Institute of Clinical Immunology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China.
| | - Yonggang Li
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215000, China; Institute of Medical Imaging, Soochow University, Suzhou, Jiangsu 215000, China; National Clinical Research Center for Hematologic Diseases, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, China.
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34
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Camera V, Messina S, Elhadd KT, Sanpera-Iglesias J, Mariano R, Hacohen Y, Dobson R, Meletti S, Wassmer E, Lim MJ, Huda S, Hemingway C, Leite MI, Ramdas S, Palace J. Early predictors of disability of paediatric-onset AQP4-IgG-seropositive neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry 2022; 93:101-111. [PMID: 34583946 DOI: 10.1136/jnnp-2021-327206] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/01/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To describe onset clinical features predicting time to first relapse and time to long-term visual, motor and cognitive disabilities in paediatric-onset aquaporin-4 antibody (AQP4-IgG) neuromyelitis optica spectrum disorders (NMOSDs). METHODS In this retrospective UK multicentre cohort study, we recorded clinical data of paediatric-onset AQP4-IgG NMOSD. Univariate and exploratory multivariable Cox proportional hazard models were used to identify long-term predictors of permanent visual disability, Expanded Disability Status Scale (EDSS) score of 4 and cognitive impairment. RESULTS We included 49 paediatric-onset AQP4-IgG patients (38.8% white, 34.7% black, 20.4% Asians and 6.1% mixed), mean onset age of 12±4.1 years, and 87.7% were female. Multifocal onset presentation occurred in 26.5% of patients, and optic nerve (47%), area postrema/brainstem (48.9%) and encephalon (28.6%) were the most involved areas. Overall, 52.3% of children had their first relapse within 1 year from disease onset. Children with onset age <12 years were more likely to have an earlier first relapse (p=0.030), despite showing no difference in time to immunosuppression compared with those aged 12-18 years at onset. At the cohort median disease duration of 79 months, 34.3% had developed permanent visual disability, 20.7% EDSS score 4 and 25.8% cognitive impairment. Visual disability was associated with white race (p=0.032) and optic neuritis presentations (p=0.002). Cognitive impairment was predicted by cerebral syndrome presentations (p=0.048), particularly if resistant to steroids (p=0.034). CONCLUSIONS Age at onset, race, onset symptoms and resistance to acute therapy at onset attack predict first relapse and long-term disabilities. The recognition of these predictors may help to power future paediatric clinical trials and to direct early therapeutic decisions in AQP4-IgG NMOSD.
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Affiliation(s)
- Valentina Camera
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.,Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Silvia Messina
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.,Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Kariem Tarek Elhadd
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | - Romina Mariano
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.,Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square MS Centre, University College London, London, UK.,Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Ruth Dobson
- Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Stefano Meletti
- Department of Biomedical, Metabolic and Neurosciences, University of Modena and Reggio Emilia, Modena, Italy.,Neurology Unit, Azienda Ospedaliero-Universitaria di Modena, Modena, Italy
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Women's and Children's Hospitals NHS Foundation Trust, Birmingham, UK
| | - Ming J Lim
- Children's Neurosciences, Evelina London Children's Hospital, London, UK.,Department of Women and Children's Health, King's College London, London, UK
| | - Saif Huda
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK.,Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
| | - Sithara Ramdas
- Department of Paediatric Neurology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK.,Department of Paediatrics, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK .,Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford University Hospitals NHS Trust, Oxford, UK
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35
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Cousins O, Hodges A, Schubert J, Veronese M, Turkheimer F, Miyan J, Engelhardt B, Roncaroli F. The Blood‐CSF‐Brain Route of Neurological Disease: The Indirect Pathway into the Brain. Neuropathol Appl Neurobiol 2021; 48:e12789. [DOI: 10.1111/nan.12789] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/08/2021] [Accepted: 12/14/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Oliver Cousins
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Angela Hodges
- Department of Old Age Psychiatry, IoPPN, King’s College London London United Kingdom
| | - Julia Schubert
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Mattia Veronese
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Federico Turkheimer
- Department of Neuroimaging, IoPPN, King’s College London London United Kingdom
| | - Jaleel Miyan
- Division of Neuroscience and Experimental Psychology School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL
| | | | - Federico Roncaroli
- Division of Neuroscience and Experimental Psychology School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, M13 9PL
- Geoffrey Jefferson Brain Research Centre; Manchester Academic Health Science Centre Manchester UK
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36
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Molazadeh N, Filippatou AG, Vasileiou ES, Levy M, Sotirchos ES. Evidence for and against subclinical disease activity and progressive disease in MOG antibody disease and neuromyelitis optica spectrum disorder. J Neuroimmunol 2021; 360:577702. [PMID: 34547512 DOI: 10.1016/j.jneuroim.2021.577702] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/18/2021] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) and aquaporin-4 IgG seropositive neuromyelitis optica spectrum disorder (AQP4-IgG+ NMOSD) are generally considered to be relapsing disorders, without clinical progression or subclinical disease activity outside of clinical relapses, in contrast to multiple sclerosis (MS). With advances in the diagnosis and treatment of these conditions, prolonged periods of remission without relapses can be achieved, and the question of whether progressive disease courses can occur has re-emerged. In this review, we focus on studies exploring evidence for and against relapse-independent clinical progression and/or subclinical disease activity in patients with MOGAD and AQP4-IgG+ NMOSD.
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Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | | | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University, Baltimore, MD, USA.
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37
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Guo Y, Lennon VA, Parisi JE, Popescu B, Vasquez C, Pittock SJ, Howe CL, Lucchinetti CF. Spectrum of sublytic astrocytopathy in neuromyelitis optica. Brain 2021; 145:1379-1390. [PMID: 34718426 PMCID: PMC9128820 DOI: 10.1093/brain/awab394] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/22/2021] [Accepted: 09/18/2021] [Indexed: 11/30/2022] Open
Abstract
Neuromyelitis optica is an autoimmune inflammatory disorder targeting aquaporin-4 water channels in CNS astrocytes. Histopathological descriptions of astrocytic lesions reported in neuromyelitis optica so far have emphasized a characteristic loss of aquaporin-4, with deposition of IgG and complement and lysis of astrocytes, but sublytic reactions have been underappreciated. We performed a multi-modality study of 23 neuromyelitis optica autopsy cases (clinically and/or pathologically confirmed; 337 tissue blocks). By evaluating astrocytic morphology, immunohistochemistry and AQP4 RNA transcripts, and their associations with demyelinating activity, we documented a spectrum of astrocytopathy in addition to complement deposition, microglial reaction, granulocyte infiltration and regenerating activity. Within advanced demyelinating lesions, and in periplaque areas, there was remarkable hypertrophic astrogliosis, more subtle than astrocytic lysis. A degenerative component was suggested by ‘dystrophic’ morphology, cytoplasmic vacuolation, Rosenthal fibres and associated stress protein markers. The abundance of AQP4 mRNA transcripts in sublytic reactive astrocytes devoid of aquaporin-4 protein supported in vivo restoration following IgG-induced aquaporin-4 endocytosis/degradation. Astrocytic alterations extending beyond demyelinating lesions speak to astrocytopathy being an early and primary event in the evolving neuromyelitis optica lesion. Focal astrocytopathy observed without aquaporin-4 loss or lytic complement component deposition verifies that astrocytic reactions in neuromyelitis optica are not solely dependent on IgG-mediated aquaporin-4 loss or lysis by complement or by IgG-dependent leucocyte mediators. We conclude that neuromyelitis optica reflects a global astrocytopathy, initiated by binding of IgG to aquaporin-4 and not simply definable by demyelination and astrocytic lysis. The spectrum of astrocytic morphological changes in neuromyelitis optica attests to the complexity of factors influencing the range of astrocytic physiological responses to a targeted attack by aquaporin-4-specific IgG. Sublytic astrocytic reactions are no doubt an important determinant of the lesion’s evolution and potential for repair. Pharmacological manipulation of the astrocytic stress response may offer new avenues for therapeutic intervention.
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Affiliation(s)
- Yong Guo
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Bogdan Popescu
- Department of Anatomy and Cell Biology, College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | | | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Charles L Howe
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
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38
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Psychiatric symptoms as initial manifestation in neuromyelitis optica spectrum disorder without cortical lesions: A report of two cases. J Neuroimmunol 2021; 359:577693. [PMID: 34403863 DOI: 10.1016/j.jneuroim.2021.577693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/28/2021] [Accepted: 08/09/2021] [Indexed: 02/05/2023]
Abstract
Diagnosing neuromyelitis optica spectrum disorder (NMOSD) remains a challenge, especially in patients with atypical presentations. Here, we describe two NMOSD patients who initially presented psychiatric symptoms without cortical lesions. This report expands our understanding of the possible presentations of NMOSD. Knowledge of rare initial symptoms may allow timely diagnosis and early therapeutic intervention, preventing more severe attacks affecting the spinal cord or eyes.
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39
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Kumar S, Gangopadhyay G, Biswas A, Dubey S, Pandit A, Das S, Ray BK. A comparison of cognitive performances between neuromyelitis optica spectrum disorder and multiple sclerosis patients in Indian context. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To compare the frequency and pattern of cognitive impairment in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) patients.
Results
Twenty NMOSD and forty MS patients were included. Clinical and detailed neuropsychological assessment was done using frontal assessment battery and Kolkata cognitive battery supplemented with additional standard tests for different domains of cognitive functions. Domain wise tests were performed and compared. 15/20 (75%) NMOSD and 32/40 (80%) MS patients had cognitive impairment (p = 0.65). Executive function, verbal fluency, information processing speed, visuo-constructional ability, attention, complex calculation, and memory were more commonly involved in NMOSD in decreasing order. Compared to MS, the pattern was similar except that verbal fluency was more impaired in NMOSD. Expanded Disability Status scale (EDSS) correlated with cognitive involvement in NMOSD (p = 0.02) as against MS.
Conclusions
Executive function, verbal fluencies, and information processing speed were more affected compared to visual and verbal memory in NMOSD patients. The pattern of cognitive performance was similar in the MS group, even though clinical and radiological characteristics and pathophysiology is different, suggesting similar brain involvement.
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40
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Zeng P, Du C, Zhang R, Jia D, Jiang F, Fan M, Zhang C. Optical Coherence Tomography Reveals Longitudinal Changes in Retinal Damage Under Different Treatments for Neuromyelitis Optica Spectrum Disorder. Front Neurol 2021; 12:669567. [PMID: 34349719 PMCID: PMC8326361 DOI: 10.3389/fneur.2021.669567] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/18/2021] [Indexed: 12/01/2022] Open
Abstract
Background: Progressive retinal neuroaxonal damage after acute optic neuritis may occur in neuromyelitis optica spectrum disorder (NMOSD). However, it is unclear if treatments used to prevent attacks influence neurodegeneration. Objectives: We aimed to investigate retinal damage in patients treated with disease-modifying drugs in a longitudinal study. Methods: We retrospectively included 50 patients with aquaporin 4-antibody-seropositive NMOSD. Peripapillary retinal nerve fiber layer (pRNFL) thickness, macular ganglion cell complex (mGCC) thickness, total macular volume (TMV), and optic disc measures were acquired by spectral domain optical coherence tomography in patients treated with tocilizumab, rituximab, and azathioprine. Results: Longitudinally, in eyes with a history of ON (NMOSDON+), we observed annual thinning of mGCC [tocilizumab: −1.77 (−3.44, −0.09) μm, p = 0.041; rituximab: −2.03 (−3.58, −0.48) μm, p = 0.017; azathioprine: −1.79 (−2.22, −1.37) μm, p < 0.001], and pRNFL [tocilizumab: −2.07 (−0.75, −3.39) μm, p = 0.005; rituximab: −2.18 (−0.36, −4.00) μm, p = 0.023; azathioprine: −2.37 (−0.98, −3.75) μm, p = 0.003], reduced TMV [tocilizumab: −0.12 (−0.22, −0.01) mm3, p = 0.028; rituximab: −0.15 (−0.21, −0.08) mm3, p = 0.001; azathioprine: −0.12 (−0.20, −0.04) mm3, p = 0.006], and increased cup area [tocilizumab: 0.08 (−0.01, 0.16) mm2, p = 0.010; rituximab: 0.07 (0.01, 0.12) mm2, p = 0.019; azathioprine: 0.14 (0.02, 0.26) mm2, p = 0.023]. However, we detected no significant differences in annual changes in mGCC, pRNFL, TMV, and cup area between patients with tocilizumab, rituximab, and azathioprine in NMOSDON+ eyes. NMOSDON− eyes did not display mGCC or pRNFL thinning in patients treated with tocilizumab and rituximab. Intriguingly, we observed significant thinning of mGCC in patients treated with azathioprine compared with tocilizumab [−0.84 (−1.50, −0.18) μm vs. −0.19 (−0.87, 0.48) μm, p = 0.012] and rituximab [−0.84 (−1.50, −0.18) μm vs. −0.07 (−1.25, −2.51) μm, p = 0.015] in NMOSDON− eyes. Conclusions: This study demonstrated that retinal ganglion cell loss is independent of ON attacks in NMOSD. Tocilizumab and rituximab may delay mGCC thinning in NMOSDON− eyes compared with azathioprine.
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Affiliation(s)
- Pei Zeng
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chen Du
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongmei Jia
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Feng Jiang
- Department of Ophthalmology, Tianjin Medical University General Hospital, Tianjin, China
| | - Moli Fan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
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41
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Kim H, Lee EJ, Kim S, Choi LK, Kim HJ, Kim HW, Chung K, Seo D, Moon S, Kim KK, Lim YM. Longitudinal follow-up of serum biomarkers in patients with neuromyelitis optica spectrum disorder. Mult Scler 2021; 28:512-521. [PMID: 34212756 DOI: 10.1177/13524585211024978] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Recently, several serum biomarkers have been proposed in Neuromyelitis Optica Spectrum Disorders (NMOSD) to monitor disease activity. OBJECTIVE The objective of the study is to evaluate the longitudinal clinical value of serum biomarkers in patients with NMOSD. METHODS We prospectively recruited consecutive NMOSD patients with anti-aquaporin-4 antibody and obtained serum samples at enrollment, after 6-12 months of follow-up (main period), and at attacks. Using single-molecule array assays, we evaluated longitudinal changes of serum neurofilament light chain (NfL), glial fibrillary acidic protein (GFAP), and GFAP/NfL levels. RESULTS Overall, 64 patients (58 women) were enrolled (age: 51 years, disease duration: 6.7 years) and 133 samples were obtained. Among patients who did not develop new attacks during the main period (n = 62), serum levels of NfL, GFAP, and GFAP/NfL were significantly decreased over time in patients with attacks (<2 months) at enrollment (n = 14 (23%)), whereas serum NfL and GFAP levels gradually increased in the others (n = 48 (77%)). During the study, five (8%) patients developed new attacks; only serum GFAP levels increased consistently upon these events compared with baseline levels. To differentiate attacks from remissions, serum GFAP levels showed the largest area under the receiver operating characteristic curve (0.876, 95% confidence interval: 0.801-0.951). CONCLUSION Among NfL, GFAP, and GFAP/NfL, serum GFAP might be the most appropriate for monitoring NMOSD longitudinally, which warrants future confirming studies.
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Affiliation(s)
- Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Seoul, South Korea
| | - Seungmi Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Seoul, South Korea
| | - Lyn-Kyung Choi
- Graduate School of Medical Science and Engineering, Korea Advanced Institute of Science and Technology, Daejeon, South Korea
| | - Hyun-Ji Kim
- Department of Convergence Medicine, Asan Medical Institute of Convergence Science and Technology, Seoul, South Korea
| | - Hye Weon Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyuyoon Chung
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dayoung Seo
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seongshin Moon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
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42
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Takai Y, Misu T, Suzuki H, Takahashi T, Okada H, Tanaka S, Okita K, Sasou S, Watanabe M, Namatame C, Matsumoto Y, Ono H, Kaneko K, Nishiyama S, Kuroda H, Nakashima I, Lassmann H, Fujihara K, Itoyama Y, Aoki M. Staging of astrocytopathy and complement activation in neuromyelitis optica spectrum disorders. Brain 2021; 144:2401-2415. [PMID: 33711152 DOI: 10.1093/brain/awab102] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 02/15/2021] [Accepted: 02/24/2021] [Indexed: 01/25/2023] Open
Abstract
Aquaporin 4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD) is an autoimmune astrocytopathic disease pathologically characterized by the massive destruction and regeneration of astrocytes with diverse types of tissue injury with or without complement deposition. However, it is unknown whether this diversity is derived from differences in pathological processes or temporal changes. Furthermore, unlike for the demyelinating lesions in multiple sclerosis, there has been no staging of astrocytopathy in AQP4-IgG+NMOSD based on astrocyte morphology. Therefore, we classified astrocytopathy of the disease by comparing the characteristic features, such as AQP4 loss, inflammatory cell infiltration, complement deposition and demyelination activity, with the clinical phase. We performed histopathological analyses in eight autopsied cases of AQP4-IgG+NMOSD. There were six women and two men, with a median age of 56.5 years (range, 46-71 years) and a median disease duration of 62.5 months (range, 0.6-252 months). Astrocytopathy in AQP4-IgG+NMOSD was classified into the following four stages defined by the astrocyte morphology and immunoreactivity for glial fibrillary acidic protein (GFAP): (a) astrocyte lysis: Extensive loss of astrocytes with fragmented and/or dust-like particles; (b) progenitor recruitment: Loss of astrocytes except small nucleated cells with GFAP-positive fibre-forming foot processes; (c) protoplasmic gliosis: Presence of star-shaped astrocytes with abundant GFAP-reactive cytoplasm; and (d) fibrous gliosis: Lesions composed of densely packed mature astrocytes. The astrocyte lysis and progenitor recruitment stages dominated in clinically acute cases (within 2 months after the last recurrence). Findings common to both stages were the loss of AQP4, a decreased number of oligodendrocytes, the selective loss of myelin-associated glycoprotein and active demyelination with phagocytic macrophages. The infiltration of polymorphonuclear cells and T cells (CD4-dominant) and the deposition of activated complement (C9neo), which reflects the membrane attack complex, a hallmark of acute NMOSD lesions, were selectively observed in the astrocyte lysis stage (98.4% in astrocyte lysis, 1.6% in progenitor recruitment, and 0% in protoplasmic gliosis and fibrous gliosis). Although most of the protoplasmic gliosis and fibrous gliosis lesions were accompanied by inactive demyelinated lesions with a low amount of inflammatory cell infiltration, the deposition of complement degradation product (C3d) was observed in all four stages, even in fibrous gliosis lesions, suggesting the past or chronic occurrence of complement activation, which is a useful finding to distinguish chronic lesions in NMOSD from those in multiple sclerosis. Our staging of astrocytopathy is expected to be useful for understanding the unique temporal pathology of AQP4-IgG+NMOSD.
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Affiliation(s)
- Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Hiroyoshi Suzuki
- Department of Pathology, National Hospital Organization Sendai Medical Center, Sendai, 983-8520, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan.,Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, 992-1202, Japan
| | - Hiromi Okada
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, 060-8648, Japan
| | - Shinya Tanaka
- Department of Cancer Pathology, Faculty of Medicine, Hokkaido University, Sapporo, 060-0808, Japan
| | - Kenji Okita
- Department of neurology, Nagoya City University Graduate School of Medical Sciences, Nagoya, 467-8601, Japan
| | - Shunichi Sasou
- Department of Pathology, Japanese Red Cross Society Hachinohe Hospital, Hachinohe, 039-1104, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Chihiro Namatame
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Yuki Matsumoto
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Hirohiko Ono
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Kimihiko Kaneko
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan.,Department of Neurology, Japanese Red Cross Ishinomaki Hospital, Ishinomaki, 986-8522, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan.,Department of Neurology, South Miyagi Medical Center, Shibata, 989-1253, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, 983-8536, Japan
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, A-1090, Austria
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan.,Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Fukushima, 960-1295, Japan
| | - Yasuto Itoyama
- International University of Health and Welfare, Fukuoka, 814-0001, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, 980-8574, Japan
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Chen T, Bosco DB, Ying Y, Tian DS, Wu LJ. The Emerging Role of Microglia in Neuromyelitis Optica. Front Immunol 2021; 12:616301. [PMID: 33679755 PMCID: PMC7933531 DOI: 10.3389/fimmu.2021.616301] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Accepted: 01/04/2021] [Indexed: 12/13/2022] Open
Abstract
Neuromyelitis optica (NMO) is an autoantibody-triggered neuro-inflammatory disease which preferentially attacks the spinal cord and optic nerve. Its defining autoantibody is specific for the water channel protein, aquaporin-4 (AQP4), which primarily is localized at the end-feet of astrocytes. Histopathology studies of early NMO lesions demonstrated prominent activation of microglia, the resident immune sentinels of the central nervous system (CNS). Significant microglial reactivity is also observed in NMO animal models induced by introducing AQP4-IgG into the CNS. Here we review the potential roles for microglial activation in human NMO patients as well as different animal models of NMO. We will focus primarily on the molecular mechanisms underlying microglial function and microglia-astrocyte interaction in NMO pathogenesis. Understanding the role of microglia in NMO pathology may yield novel therapeutic approaches for this disease.
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Affiliation(s)
- Tingjun Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Dale B. Bosco
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Yanlu Ying
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Dai-Shi Tian
- Department of Neurology, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Neuroscience, Mayo Clinic, Jacksonville, FL, United States
- Department of Immunology, Mayo Clinic, Rochester, MN, United States
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Richard C, Ruiz A, Cavagna S, Bigotte M, Vukusic S, Masaki K, Suenaga T, Kira JI, Giraudon P, Marignier R. Connexins in neuromyelitis optica: a link between astrocytopathy and demyelination. Brain 2021; 143:2721-2732. [PMID: 32889550 DOI: 10.1093/brain/awaa227] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 04/01/2020] [Accepted: 05/06/2020] [Indexed: 01/26/2023] Open
Abstract
Neuromyelitis optica, a rare neuroinflammatory demyelinating disease of the CNS, is characterized by the presence of specific pathogenic autoantibodies directed against the astrocytic water channel aquaporin 4 (AQP4) and is now considered as an astrocytopathy associated either with complement-dependent astrocyte death or with astrocyte dysfunction. However, the link between astrocyte dysfunction and demyelination remains unclear. We propose glial intercellular communication, supported by connexin hemichannels and gap junctions, to be involved in demyelination process in neuromyelitis optica. Using mature myelinated cultures, we demonstrate that a treatment of 1 h to 48 h with immunoglobulins purified from patients with neuromyelitis optica (NMO-IgG) is responsible for a complement independent demyelination, compared to healthy donors' immunoglobulins (P < 0.001). In parallel, patients' immunoglobulins induce an alteration of connexin expression characterized by a rapid loss of astrocytic connexins at the membrane followed by an increased size of gap junction plaques (+60%; P < 0.01). This was co-observed with connexin dysfunction with gap junction disruption (-57%; P < 0.001) and increased hemichannel opening (+17%; P < 0.001), associated with glutamate release. Blocking connexin 43 hemichannels with a specific peptide was able to prevent demyelination in co-treatment with patients compared to healthy donors' immunoglobulins. By contrast, the blockade of connexin 43 gap junctions with another peptide was detrimental for myelin (myelin density -48%; P < 0.001). Overall, our results suggest that dysregulation of connexins would play a pathogenetic role in neuromyelitis optica. The further identification of mechanisms leading to connexin dysfunction and soluble factors implicated, would provide interesting therapeutic strategies for demyelinating disorders.
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Affiliation(s)
- Chloé Richard
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Anne Ruiz
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Sylvie Cavagna
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Maxime Bigotte
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Sandra Vukusic
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle, Lyon, France
| | - Katsuhisa Masaki
- Department of Neurology, Neurological institute, Graduate School of Medical Sciences, Kyushu University
| | | | - Jun-Ichi Kira
- Department of Neurology, Neurological institute, Graduate School of Medical Sciences, Kyushu University
| | - Pascale Giraudon
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France
| | - Romain Marignier
- INSERM U1028, CNRS UMR 5292, Lyon1 University, Center for Research in Neuroscience of Lyon, Lyon, France.,Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, Lyon, France.,Centre de référence des maladies inflammatoires rares du cerveau et de la moelle, Lyon, France
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Differential patterns of parafoveal and peripapillary vessel density in multiple sclerosis and neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2021; 49:102780. [PMID: 33508571 DOI: 10.1016/j.msard.2021.102780] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 01/14/2021] [Accepted: 01/16/2021] [Indexed: 12/23/2022]
Abstract
BACKGROUND To compare intraocular microvascular alterations between patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using optical coherence tomography angiography (OCT-A). METHODS Sixty patients were included in the study, 23 MS patients (36 eyes) and 37 NMOSD patients (47 eyes), all with a history of optic neuritis (ON). All subjects underwent comprehensive ophthalmic examinations, OCT-A, and high-definition-OCT imaging. OCT-A was used to measure the vessel density of the superficial and deep retinal capillary plexus (SRCP and DRCP) in the macular area and the radial peripapillary capillary (RPC) segment. Age, spherical equivalent, and gender were adjusted for in the analyses. RESULTS Patients with NMOSD showed significantly decreased vessel density of the SRCP (average, p = 0.0007; superior, p = 0.0009; inferior, p = 0.0002) and RPC segment (average, p < 0.0001; superior, p = 0.0004; inferior, p = 0.0052; temporal, p < 0.0001; nasal, p = 0.0001) compared to the MS patients. Parafoveal and peripapillary vessel density was significantly associated with the OCT parameters in both the MS and NMOSD patients. Parafoveal and peripapillary vessel density in the MS patients was significantly associated with visual function, including visual acuity and visual field defects, whereas only peripapillary vessel density was significantly associated with visual function in the NMOSD patients. CONCLUSION We demonstrated parafoveal and peripapillary vascular alterations between MS and NMOSD patients that varied in degree and pattern. We also found associations between vessel density and structural and functional parameters in MS and NMOSD patients. Further studies are needed to facilitate a greater understanding of the pathogenesis and its association with vascular alterations in these disorders.
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The prevalence of cognitive impairment in patients with neuromyelitis optica spectrum disorders (NMOSD): A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 49:102757. [PMID: 33486400 DOI: 10.1016/j.msard.2021.102757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate pooled prevalence of cognitive impairment in neuromyelitis opticaspectrum disorders (NMOSD) cases. METHODS We searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. We also searched the gray literature including references of the included studies, and conference abstracts which were published up to 20th October 2020. The search strategy included the MeSH and text words as (((Cognitive Dysfunctions) OR Cognitive Impairment) OR Cognitive Declines) OR Mild Cognitive Impairment) OR Mental Deterioration) AND (Neuromyelitis Optica spectrum disorder OR NMOSD OR Devic syndrome OR Neuromyelitis Optica spectrum disorders). RESULTS The literature search revealed 1830 articles, after deleting duplicates 1434 remained. For the meta-analysis, 25 studies were included. Totally, 761 NMOSD patients were evaluated and 329 patients had cognitive impairment. Mean age ranged from 34-53 years. The prevalence of cognitive impairment ranged from 3% to 75%.The pooled prevalence of cognitive impairment was 44%, 95%CI(35%-54%), (I2=89.1%, P<0.001) which shows a high statistical heterogeneity . By excluding the abstract of Jung et al which was published in 2009, we found that the pooled prevalence was 34% (95% CI:31-37%) (I2=0) CONCLUSION: Cognitive impairment should be considered in NMOSD patients as its pooled prevalence is estimated as 44%.
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Parissis D, Smyrni N, Ioannidis P, Grigoriadis N. Primary progression in NMOSD. Does it really exist? Mult Scler Relat Disord 2020; 48:102712. [PMID: 33450529 DOI: 10.1016/j.msard.2020.102712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/19/2020] [Indexed: 11/19/2022]
Abstract
Acute myelitis, in conjunction with a longitudinally extensive MRI pattern, is a core feature of aquaporin 4 IgG-associated neuromyelitis optica spectrum disorders (NMOSD). According to current diagnostic criteria for transverse myelitis and NMOSD, clinical worsening should not exceed 3-4 weeks from attack onset. Recently, we were able to document, through frequent clinical examination and radiological follow-up, the unusual case of an ab initio progressive myelopathy, ultimately attributed to aquaporin-4 autoimmunity. Although this case might merely represent an overlooked cluster of individual clinical attacks, it could, however, draw attention to the controversial concept of disease progression in the context of NMOSD.
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Affiliation(s)
- Dimitrios Parissis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Nikoletta Smyrni
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Panos Ioannidis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
| | - Nikolaos Grigoriadis
- 2nd Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Greece.
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48
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Width of the third ventricle as a highly-sensitive biomarker in chronic progressive neuro-Behçet's disease. J Neurol Sci 2020; 421:117284. [PMID: 33360732 DOI: 10.1016/j.jns.2020.117284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 11/20/2022]
Abstract
Chronic progressive neuro-Behçet's disease (CPNBD) is characterized by slowly progressive cognitive decline, cerebellar ataxia, and brainstem atrophy without acute encephalomeningitis. To evaluate the progression of CPNBD during treatment, we conducted a retrospective, longitudinal comparative analysis of the clinical features and brain magnetic resonance imaging (MRI) in patients with CPNBD. We classified participants into three groups: NBD with acute encephalomeningitis alone (Group A, 8 patients with acute neuro-Behçet's disease [ANBD]), primary progressive CPNBD (Group B, 3 patients), and a combination of acute encephalomeningitis, and chronic progression (Group C, 2 patients). Routine laboratory tests and monthly rate of enlargement of the width of the third ventricle (ΔWTVm) and relative value of ΔWTVm to the transverse cerebral diameter (ΔWTVIm) were statistically evaluated. Although higher cell count values and interleukin-6 concentration in the cerebrospinal fluid were observed in ANBD, both ΔWTVm (p = 0.008) and ΔWTVIm (p = 0.008) were significantly larger in CPNBD phase than in the ANBD phase. Effective treatment for CPNBD seemed to reduce ΔWTVm and ΔWTVIm in some patients. Sequential evaluation of WTV in patients with CPNBD is a highly sensitive candidate biomarker of early diagnosis and treatment efficacy.
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49
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Paul S, Mondal GP, Bhattacharyya R, Ghosh KC, Bhat IA. Neuromyelitis optica spectrum disorders. J Neurol Sci 2020; 420:117225. [PMID: 33272591 DOI: 10.1016/j.jns.2020.117225] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
The disease concept of Neuromyelitis Optica Spectrum Disorders(NMOSD) has undergone a significant change over the last two decades including the detection of Myelin Oligodendrocyte Glycoprotein(MOG) antibody in patients who are seronegative for aquaporin-4 antibody. Aquaporin-4 antibody positive NMOSD is now regarded as an immune astrocytopathy. Conversely, MOG antibody associated disease is known to target myelin rather than astrocytes, leading to an NMOSD syndrome with distinct clinical and radiological features. Incorporation of clinical features like area postrema syndrome, brainstem syndrome, diencephalic syndrome and cortical manifestations as core clinical characteristics into the revised diagnostic criteria has widened the clinical spectrum of NMOSD. With the development of these criteria, it is possible to make the diagnosis at an earlier stage so that effective immunosuppression can be instituted promptly for a better long-term prognosis. Newer therapeutic agents have been introduced for aquaporin-4 seropositive NMOSD disease; however, challenges remain in treating seronegative disease because of limited treatment options.
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Affiliation(s)
- Shabeer Paul
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Gouranga Prasad Mondal
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Ramesh Bhattacharyya
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Kartik Chandra Ghosh
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Imtiyaz Ahmad Bhat
- Department of Immunology & Molecular Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
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50
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Czarnecka D, Oset M, Karlińska I, Stasiołek M. Cognitive impairment in NMOSD-More questions than answers. Brain Behav 2020; 10:e01842. [PMID: 33022898 PMCID: PMC7667314 DOI: 10.1002/brb3.1842] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a type of central nervous system antibody-mediated disease which affects mainly optic nerves and spinal cord, but may also present with acute brainstem syndrome, acute diencephalic syndrome, and cerebral syndrome with typical brain lesions. One of the most disabling symptoms, diagnosed in 29%-67% of cases, is cognitive dysfunction, with such processes as memory, processing speed, executive function, attention, and verbal fluency being predominantly affected. However, description of cognition in NMOSD patients is still a relatively new area of research. METHODS A systematic MEDLINE search was performed to retrieve all studies that investigated cognitive impairment and its clinical correlates in patients with NMOSD. RESULTS We summarize the current knowledge on cognitive impairment profile, neuropsychological tests used to examine NMOSD patients, clinical and demographical variables affecting cognition, and magnetic resonance imaging correlates. We provide a comparison of cognitive profile of patients with multiple sclerosis and NMOSD. CONCLUSION Patients with NMOSD are at significant risk of cognitive deficits. However, the knowledge of cognitive symptoms in NMOSD and potential modifying interventions is still scarce. Further accumulation of clinical data may facilitate effective therapeutic interventions.
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Affiliation(s)
| | - Magdalena Oset
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Iwona Karlińska
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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