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Xu Y, Meng H, Fan M, Yin L, Sun J, Yao Y, Wei Y, Cong H, Wang H, Song T, Yang CS, Feng J, Shi FD, Zhang X, Tian DC. A Simple Score (MOG-AR) to Identify Individuals at High Risk of Relapse After MOGAD Attack. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200309. [PMID: 39250723 PMCID: PMC11385954 DOI: 10.1212/nxi.0000000000200309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/11/2024]
Abstract
BACKGROUND AND OBJECTIVES To identify predictors for relapse in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and to develop and validate a simple risk score for predicting relapse. METHODS In China National Registry of Neuro-Inflammatory Diseases (CNRID), we identified patients with MOGAD from March 2023 and followed up prospectively to September 2023. The primary endpoint was MOGAD relapse, confirmed by an independent panel. Patients were randomly divided into model development (75%) and internal validation (25%) cohorts. Prediction models were constructed and internally validated using Andersen-Gill models. Nomogram and relapse risk score were generated based on the final prediction models. RESULTS A total of 188 patients (comprising 612 treatment episodes) were included in cohorts. Female (HR: 0.687, 95% CI 0.524-0.899, p = 0.006), onset age 45 years or older (HR: 1.621, 95% CI 1.242-2.116, p < 0.001), immunosuppressive therapy (HR: 0.338, 95% CI 0.239-0.479, p < 0.001), oral corticosteroids >3 months (HR 0.449, 95% CI 0.326-0.620, p < 0.001), and onset phenotype (p < 0.001) were identified as factors associated with MOGAD relapse. A predictive score, termed MOG-AR (Immunosuppressive therapy, oral Corticosteroids, Onset Age, Sex, Attack phenotype), derived in prediction model, demonstrated strong predictive ability for MOGAD relapse. MOG-AR score of 13-16 indicates a higher risk of relapse (HR: 3.285, 95% CI 1.473-7.327, p = 0.004). DISCUSSION The risk of MOGAD relapse seems to be predictable. Further validation of MOG-AR score developed from this cohort to determine appropriate treatment and monitoring frequency is warranted. TRIAL REGISTRATION INFORMATION CNRID, NCT05154370, registered December 13, 2021, first enrolled December 15, 2021.
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Affiliation(s)
- Yun Xu
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Huaxing Meng
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Moli Fan
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Linlin Yin
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Jiali Sun
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Yajun Yao
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Yuzhen Wei
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Hengri Cong
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Huabing Wang
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Tian Song
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Chun-Sheng Yang
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Jinzhou Feng
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Fu-Dong Shi
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - Xinghu Zhang
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
| | - De-Cai Tian
- From the Department of Neurology (Y.X., L.Y., J.S., Y.Y., Y.W., H.C., H.W., T.S., F.-D.S., X.Z., D.-C.T.), China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University; Department of Neurology (H.M.), First Hospital of Shanxi Medical University, Taiyuan; Department of Neurology (M.F., C.-S.Y., F.-D.S.), Tianjin Neurological Institute, Tianjin Medical University General Hospital; and Department of Neurology (J.F.), The First Affiliated Hospital of Chongqing Medical University, China
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Fonseca E, Olivé-Cirera G, Martinez-Hernandez E, Guasp M, Naranjo L, Ruiz-García R, Caballero E, González-Álvarez V, Delgadillo V, Romeu G, Del-Prado-Sánchez C, Cabrera-Maqueda JM, Benito-León J, Iñiguez C, Garcia-Dominguez JM, Calles C, Cano A, Álvarez-Bravo G, González-Suárez I, Oreja-Guevara C, Ros M, Millan-Pascual J, Meca-Lallana JE, Borrega Canelo L, Martín-Martínez J, Palao M, Gracia J, Villaverde-González R, Llufriu S, Blanco Y, Saiz A, Dalmau J, Sepulveda M, Armangue T. Investigating the 2023 MOGAD Criteria in Children and Adults With MOG-Antibody Positivity Within and Outside Attacks. Neurology 2024; 103:e209682. [PMID: 39190859 DOI: 10.1212/wnl.0000000000209682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The 2023 criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) perform well in adults but have not been assessed in children. METHODS This prospective observational nationwide study includes children and adults with demyelinating syndromes or encephalitis, whose serum or CSF was found MOG-immunoglobulin G (IgG) positive at Institut d'Investigacions Biomèdiques August Pi i Sunyer-Hospital Clínic of Barcelona (Spain). Exclusion criteria were lack of clinical information and follow-up <1 year, and serum unavailable for antibody testing. The primary outcome was to assess the accuracy of the 2023 MOGAD criteria, using as gold standard the most plausible diagnosis after a follow-up >1 year. MOGAD criteria were retrospectively applied assessing core syndromes, supportive clinical-radiological features, and MOG-IgG titers. Patients tested ≤3 months of a disease attack (acute phase) or afterward (remission) were considered separately. The positive predictive value (PPV) of the criteria (true-positive [patients classified as MOGAD and MOGAD diagnosis last follow-up] divided by total positive [all patients classified as MOGAD]), and its 95% CI, was calculated with the Wilson procedure. RESULTS A total of 257 patients (133 children) were included in the study (median age 15 years [interquartile range 6-38], 54% female). Among 202 patients assessed during a disease attack, 158 (78%) had high MOG-IgG serum titers, 36 (18%) low titers, and 8 (4%) antibodies only in CSF. No differences were identified between patients with high and low titers, but those with low titers were more likely to have an alternative diagnosis at last follow-up (2/36 [6%] vs 0/158, p = 0.012). Supportive features were present in 230 of 257 (89%) patients, regardless of age, MOG-IgG titers, and core syndromes except for optic neuritis in adults whose assessment with orbital MRI was not systematic. Overall, 240 of 257 (94%) patients were well classified by the MOGAD criteria (e.g., 236 eventually having MOGAD and 4 alternative diagnoses), and 17 were wrongly classified (e.g., 11 eventually having MOGAD and 6 alternative diagnoses). Although the criteria classified better during disease attacks than during remissions (187 [96%] vs 49 [89%] serum MOG-IgG-positive patients were well-classified, p = 0.038), the PPV was high in both settings (99% [95% CI 97-100] vs 98% [95% CI 89-100]). DISCUSSION The 2023 MOGAD criteria correctly identified most children and adults with MOGAD. The highest accuracy occurred when they were applied during disease attacks. CLASSIFICATION OF EVIDENCE This study provides Class IV evidence that the 2023 MOGAD criteria accurately identify adults and children with MOGAD.
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Affiliation(s)
- Elianet Fonseca
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Gemma Olivé-Cirera
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Mar Guasp
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Laura Naranjo
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Raquel Ruiz-García
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eva Caballero
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Veronica González-Álvarez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Veronica Delgadillo
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Gemma Romeu
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Cristina Del-Prado-Sánchez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jose Maria Cabrera-Maqueda
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Julián Benito-León
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Cristina Iñiguez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jose Manuel Garcia-Dominguez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Carmen Calles
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Antonio Cano
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Gary Álvarez-Bravo
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Ines González-Suárez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Celia Oreja-Guevara
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Marta Ros
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jorge Millan-Pascual
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jose E Meca-Lallana
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Laura Borrega Canelo
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Jesús Martín-Martínez
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Maria Palao
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Julia Gracia
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Ramón Villaverde-González
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Sara Llufriu
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Yolanda Blanco
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Albert Saiz
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Josep Dalmau
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Maria Sepulveda
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Thais Armangue
- From the Neuroimmunology Program (E.F., G.O.-C., E.M.-H., M.G., E.C., J.M.C.-M., S.L., Y.B., A.S., J.D., M.S., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic de Barcelona, Pediatric Neuroimmunology Unit (E.F., V.G.-Á., V.D., T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, and Sant Joan de Déu Private Foundation for Research and Education (IRSJD) Sant Joan de Déu Children's Hospital (E.F.), University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell; Immunology Service (L.N., R.R.G.), Hospital Clinic, and Ophtalmology Service (G.R., C.d.-P.-S.), Sant Joan de Déu Children's Hospital, University of Barcelona; Department of Neurology (J.B.-L.), University Hospital "12 de Octubre"; Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12) (J.B.-L.); Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED) (J.B.-L.); Department of Medicine, Faculty of Medicine (J.B.-L.), Complutense University, Madrid; Neurology Service (C.I.), Hospital Clínico Universitario, Zaragoza; Neurology Service (J.M.G.D.), Hospital General Universitario Gregorio Marañón, Madrid; Neurology Service (C.C.), Hospital Universitario Son Espases, Palma de Mallorca; Neurology Service (A.C.), Hospital de Mataró, Barcelona; Unit of Neuroimmunology and Multiple Sclerosis of Girona (UNIEMTG) (G.Á.B.), Department of Neurology, University Hospital Dr. Josep Trueta of Girona; Neurology Service (I.G.-S.), Hospital Álvaro Cunqueiro, Vigo; Department of Neurology (C.O.-G.), Hospital Clinico San Carlos, IdISSC, Madrid; Departament of Medicine (C.O.-G.), Medicine Faculty, Universidad Complutense de Madrid (UCM); Neurology Service (M.R.), Hospital Parc Taulí, Sabadell, Barcelona; Multiple Sclerosis CSUR and Clinical Neuroimmunology Unit (J.M.-P., J.E.M.-L.), Neurology Department, Hospital Clínico Universitario Virgen de la Arrixaca (IMIB-Arrixaca), Clinical Neuroimmunology and Multiple Sclerosis Cathedra, UCAM, Universidad Católica San Antonio de Murcia; Neurology Service (L.B.C.), Hospital Universitario Fundación Alcorcón, Madrid; Neurology Service (J.M.-M.), Hospital Universitario Miguel Servet, Zaragoza; Neurology Service (M.P., J.G.), Complejo Hospitalario Universitario de Albacete; Neurology Service (R.V.-G.), Hospital Universitario JM Morales Meseguer, Internal Medicine Department, Universidad de Murcia, Spain; Department of Neurology (J.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Catalan Institution for Research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
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3
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Moura J, Samões R, Sousa AP, Figueiroa S, Mendonça T, Abreu P, Guimarães J, Melo C, Sousa R, Soares M, Correia AS, Marques IB, Perdigão S, Alves I, Felgueiras H, Nzwalo H, Mendes I, Almeida V, Boleixa D, Carneiro P, Neves E, Silva AM, Sá MJ, Santos E. Prognostic factors associated with disability in a cohort of neuromyelitis optica spectrum disorder and MOG-associated disease from a nationwide Portuguese registry. J Neurol Sci 2024; 464:123176. [PMID: 39146881 DOI: 10.1016/j.jns.2024.123176] [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: 10/10/2023] [Revised: 08/08/2024] [Accepted: 08/11/2024] [Indexed: 08/17/2024]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) and MOG-associated disease (MOGAD) are an increasingly recognized group of demyelinating disorders of the central nervous system. Previous studies suggest that prognosis is predicted by older age at onset, number of relapses, the severity of the first attack and autoantibody status. OBJECTIVE To study prognostic factors associated with disability progression and additional relapses in the 3-year follow-up of a national NMOSD/MOGAD cohort. RESULTS Out of 180 of the initial Portuguese cohort, data on 82 patients was available at the end of the follow-up period (2019-2022). Two patients died. Twenty (24.4%) patients had one or more attack in this period (25 attacks in total), mostly transverse myelitis (TM) (56.0%) or optic neuritis (32.0%). MOGAD was significantly associated with a monophasic disease course (p = 0.03), with milder attacks (p = 0.01), while AQP4 + NMOSD was associated with relapses (p = 0.03). The most common treatment modalities were azathioprine (38.8%) and rituximab (18.8%). AQP4 + NMOSD more frequently required chronic immunosuppressive treatment, particularly rituximab (p = 0.01). Eighteen (22.5%) had an EDSS ≥6 at the end of the follow-up. AQP4 + NMOSD (p < 0.01) and the occurrence of transverse myelitis (TM) during disease (p = 0.04) correlated with an EDSS≥6 at the end of the follow-up period. MOGAD was significantly associated with an EDSS<6 (p < 0.01), and MOG+ cases that reached an EDSS>6 were significantly older (64.0 ± 2.8 versus 31.0 ± 17.1, p = 0.017). A bivariate logistic regression model including the serostatus and TM attacks during disease history successfully predicted 72.2% of patients that progressed to an EDSS≥6. CONCLUSION This study highlights that myelitis predict increased disability (EDSS≥6) in NMOSD/MOGAG and AQP4 positivity is associated with increased disability.
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Affiliation(s)
- João Moura
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal.
| | - Raquel Samões
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Ana Paula Sousa
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Sónia Figueiroa
- Neuropediatrics Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Teresa Mendonça
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Pedro Abreu
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Guimarães
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Claúdia Melo
- Neuropediatrics Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Raquel Sousa
- Neuropediatrics Service, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Mafalda Soares
- Neurology Service, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - Ana Sofia Correia
- Neurology Service, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | | | - Sandra Perdigão
- Neurology Service, Hospital de Viana do Castelo/Unidade Local de Saúde do Alto Minho, Viana do Castelo, Portugal
| | - Ivânia Alves
- Neurology Service, Centro Hospitalar Tâmega e Sousa, Penafiel, Portugal
| | - Helena Felgueiras
- Neurology Service, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Hipólito Nzwalo
- Neurology Unit, Hospital do Litoral Alentejano, Santiago do Cacém, Portugal
| | - Irene Mendes
- Neurology Service, Hospital Garcia da Orta, Almada, Portugal
| | - Vânia Almeida
- Neurology Service, Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Daniela Boleixa
- Departamento de Ensino, Formação e Investigação (DEFI), Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Paula Carneiro
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal; Immunology Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Esmeralda Neves
- Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal; Immunology Service, Centro Hospitalar Universitário de Santo António, Porto, Portugal
| | - Ana Martins Silva
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
| | - Maria José Sá
- Neurology Service, Centro Hospitalar Universitário São João, Porto, Portugal; Faculdade de Ciências da Saúde, Universidade de Fernando Pessoa, Porto, Portugal
| | - Ernestina Santos
- Neurology Service, Department of Neurosciences, Centro Hospitalar Universitário de Santo António, Porto, Portugal; Unit for Multidisciplinary Research in Biomedicine, Instituto de Ciências Biomédicas de Abel Salazar da Universidade do Porto, Porto, Portugal
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4
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Pratt LT, Meirson H, Shapira Rootman M, Ben-Sira L, Shiran SI. Radiological features in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease-diagnostic criteria and lesion dynamics. Pediatr Radiol 2024:10.1007/s00247-024-06023-2. [PMID: 39243314 DOI: 10.1007/s00247-024-06023-2] [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: 05/15/2024] [Revised: 07/30/2024] [Accepted: 07/31/2024] [Indexed: 09/09/2024]
Abstract
The spectrum of acquired pediatric demyelinating syndromes has been expanding over the past few years, to include myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), as a distinct neuroimmune entity, in addition to pediatric-onset multiple sclerosis (POMS) and aquaporin 4-IgG-seropositive neuromyelitis optica spectrum disorder (AQP4+NMOSD). The 2023 MOGAD diagnostic criteria require supporting clinical or magnetic resonance imaging (MRI) features in patients with low positive myelin oligodendrocyte glycoprotein IgG titers or when the titers are not available, highlighting the diagnostic role of imaging in MOGAD. In this review, we summarize the key diagnostic features in MOGAD, in comparison to POMS and AQP4+NMOSD. We describe the lesion dynamics both during attack and over time. Finally, we propose a guideline on timing of imaging in clinical practice.
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Affiliation(s)
- Li-Tal Pratt
- Pediatric Radiology, Imaging Division, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel.
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Hadas Meirson
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Pediatric Neurology Institute, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Liat Ben-Sira
- Pediatric Radiology, Imaging Division, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shelly I Shiran
- Pediatric Radiology, Imaging Division, Tel Aviv Sourasky Medical Center, 6 Weizmann Street, 6423906, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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5
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Geraldes R, Arrambide G, Banwell B, Rovira À, Cortese R, Lassmann H, Messina S, Rocca MA, Waters P, Chard D, Gasperini C, Hacohen Y, Mariano R, Paul F, DeLuca GC, Enzinger C, Kappos L, Leite MI, Sastre-Garriga J, Yousry T, Ciccarelli O, Filippi M, Barkhof F, Palace J. The influence of MOGAD on diagnosis of multiple sclerosis using MRI. Nat Rev Neurol 2024:10.1038/s41582-024-01005-2. [PMID: 39227463 DOI: 10.1038/s41582-024-01005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 09/05/2024]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated demyelinating disease that is challenging to differentiate from multiple sclerosis (MS), as the clinical phenotypes overlap, and people with MOGAD can fulfil the current MRI-based diagnostic criteria for MS. In addition, the MOG antibody assays that are an essential component of MOGAD diagnosis are not standardized. Accurate diagnosis of MOGAD is crucial because the treatments and long-term prognosis differ from those for MS. This Expert Recommendation summarizes the outcomes from a Magnetic Resonance Imaging in MS workshop held in Oxford, UK in May 2022, in which MS and MOGAD experts reflected on the pathology and clinical features of these disorders, the contributions of MRI to their diagnosis and the clinical use of the MOG antibody assay. We also critically reviewed the literature to assess the validity of distinctive imaging features in the current MS and MOGAD criteria. We conclude that dedicated orbital and spinal cord imaging (with axial slices) can inform MOGAD diagnosis and also illuminate differential diagnoses. We provide practical guidance to neurologists and neuroradiologists on how to navigate the current MOGAD and MS criteria. We suggest a strategy that includes useful imaging discriminators on standard clinical MRI and discuss imaging features detected by non-conventional MRI sequences that demonstrate promise in differentiating these two disorders.
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Affiliation(s)
- Ruth Geraldes
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
| | - Mara Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (CLH) Biomedical Research Centre, London, UK
| | - Claudio Gasperini
- Multiple Sclerosis Centre, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital and University, Basel, Switzerland
| | - M Isabel Leite
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tarek Yousry
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, UK
- University College London Hospitals (UCLH) National Institute for Health and Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Jacqueline Palace
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
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6
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Farina A, Villagrán-García M, Fourier A, Pinto AL, Chorfa F, Timestit N, Alberto T, Aupy J, Benaiteau M, Birzu C, Campetella L, Cotton F, Dalle S, Delaruelle CF, Dumez P, Germi R, Le Maréchal M, Maillet D, Marignier R, Pegat A, Psimaras D, Rafiq M, Picard G, Desestret V, Quadrio I, Honnorat J, Joubert B. Diagnostic and prognostic biomarkers in immune checkpoint inhibitor-related encephalitis: a retrospective cohort study. THE LANCET REGIONAL HEALTH. EUROPE 2024; 44:101011. [PMID: 39170102 PMCID: PMC11338149 DOI: 10.1016/j.lanepe.2024.101011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2024] [Revised: 07/06/2024] [Accepted: 07/11/2024] [Indexed: 08/23/2024]
Abstract
Background Immune checkpoint inhibitor-related encephalitis (ICI-encephalitis) is not well characterised and diagnostic and prognostic biomarkers are lacking. We aimed to comprehensively characterise ICI-encephalitis and identify diagnostic biomarkers and outcome predictors. Methods This retrospective observational study included all patients with ICI-encephalitis studied in the French Reference Centre on Paraneoplastic Neurological Syndromes (PNS) and Autoimmune Encephalitis (2015-2023). ICI encephalitis was considered definite in case of inflammatory findings at paraclinical tests and/or well-characterised neural antibodies. Predictors of immune-related adverse event (irAE) treatment response, defined as a Common Terminology Criteria for Adverse Events v5.0 grade < 3 at any time after therapeutic intervention, were assessed by logistic regression analysis, and predictors of mortality by Cox regression analysis. Neurofilament light chain (NfL) was measured by enzyme-linked immunosorbent assay. Findings Sixty-seven patients with definite encephalitis were identified (median age, 69 years; 66% male). A focal syndrome was observed in 43/67 patients (64%; limbic encephalitis, cerebellar ataxia, and/or brainstem encephalitis), while 24/67 (36%) had meningoencephalitis, a non-focal syndrome with altered mental status (22/24 patients, 92%) and pleocytosis (24/24 patients, 100%). Patients with focal encephalitis more frequently had abnormal brain MRI (26/42, 62% versus 8/24, 33%, p = 0.025), PNS-related antibodies (36/43, 84% versus 1/24, 4%, p < 0.001), and neuroendocrine cancers (22/43, 51% versus 1/24, 4%; p < 0.001) than patients with meningoencephalitis. Focal encephalitis patients had a lower rate of irAE treatment response (7/39, 18%) and higher mortality (27/43, 63%) compared to meningoencephalitis patients (12/22, 77% and 5/24, 21%, respectively, p < 0.001 each). PNS-related antibodies were associated with less irAE treatment response, independently of age, sex, and baseline severity (adjusted OR 0.05; 95%CI [0.01; 0.19]; p < 0.001) as well as higher mortality, independently of age and cancer type (adjusted HR 5.07; 95% CI [2.12; 12.12]; p < 0.001). Serum NfL discriminated patients with definite ICI-encephalitis (n = 27) from cancer-matched controls (n = 16; optimal cut-off >273.5 pg/mL, sensitivity 81%, specificity 88%, AUC 0.87, 95% CI [0.76; 0.98]) and irAE treatment responders (n = 10) from non-responders (n = 17, optimal cut-off >645 pg/mL, sensitivity 90%, specificity 65%; AUC 0.75, 95% CI [0.55; 0.94]). Interpretation ICI-encephalitis corresponds to a set of clinically-recognisable syndromes. Patients with focal encephalitis, PNS-related antibodies, and/or higher serum NfL have low irAE treatment response rates. Research is needed on the underlying immunopathogenesis to foster therapeutic innovations. Funding Agence Nationale de la Recherche.
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Affiliation(s)
- Antonio Farina
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Macarena Villagrán-García
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Anthony Fourier
- Lyon Neuroscience Research Center (CRNL), Université de Lyon, CNRS, INSERM, Lyon, France
| | - Anne-Laurie Pinto
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Fatima Chorfa
- Service de Biostatistique et Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Noémie Timestit
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Tifanie Alberto
- Department of Neurology, CRC SEP, Centre Hospitalier of Lille, Lille, France
| | - Jérôme Aupy
- Department of Clinical Neurosciences, Centre Hospitalier of Bordeaux, Bordeaux, France
- CNRS, IMN, UMR 5293, University of Bordeaux, Bordeaux, France
| | - Marie Benaiteau
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Cristina Birzu
- AP-HP, Hospital Group Pitié-Salpêtrière, Neuro-oncology Department Paris, France
- Inserm U1127, CNRS, Paris Brain Institute, Institut du Cerveau (ICM), Paris, France
| | - Lucia Campetella
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - François Cotton
- Radiology Department, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Stéphane Dalle
- Deparment of Dermatology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, Lyon 69002, France
| | - Clara Fontaine Delaruelle
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, Lyon 69002, France
- Department of Pneumology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Pauline Dumez
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Rafaele Germi
- Virology, Grenoble-Alpes University Hospital, Grenoble, France
| | - Marion Le Maréchal
- Infectious Disease Unit, Grenoble-Alpes University Hospital, Grenoble, France
| | - Denis Maillet
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, Lyon 69002, France
- Department of Medical Oncology, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Pierre Bénite, France
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hospices Civils de Lyon, Lyon, France
| | - Antoine Pegat
- Service ENMG et Pathologies Neuromusculaires, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
- Pathophysiology and Genetics of Neuron and Muscle, CNRS UMR 5261, INSERM U1315, INMG, Université Claude Bernard Lyon 1, Faculté de Médecine Lyon Est, Lyon, France
| | - Dimitri Psimaras
- AP-HP, Hospital Group Pitié-Salpêtrière, Neuro-oncology Department Paris, France
- Inserm U1127, CNRS, Paris Brain Institute, Institut du Cerveau (ICM), Paris, France
| | - Marie Rafiq
- Department of Cognitive Neurology, Epilepsy and Movement Disorders, Toulouse Purpan University Hospital Center, Toulouse, France
| | - Géraldine Picard
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Virginie Desestret
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Isabelle Quadrio
- Lyon Neuroscience Research Center (CRNL), Université de Lyon, CNRS, INSERM, Lyon, France
| | - Jérôme Honnorat
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
| | - Bastien Joubert
- French Reference Centre on Paraneoplastic Neurological Syndromes and Autoimmune Encephalitis, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France
- MeLiS-UCBL-CNRS UMR 5284, INSERM U1314, Université Claude Bernard Lyon 1, Lyon, France
- ImmuCare, Institute of Cancerology, Hospices Civils de Lyon, Lyon 69002, France
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7
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Ding Y, Zhang L, Huang A, Meng X, Li X. A Confused Case Diagnosed as Cerebral Infarction or Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Case Rep Neurol Med 2024; 2024:9941341. [PMID: 39220233 PMCID: PMC11364470 DOI: 10.1155/2024/9941341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 07/29/2024] [Accepted: 08/03/2024] [Indexed: 09/04/2024] Open
Abstract
In order to discuss the clinical and MRI features, diagnosis, and prevention of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), we reported an adult case of MOG antibody-related disease misdiagnosed as cerebral infarction. This patient's first clinical symptom was limb weakness, that different from previous reports of MOG antibody-related diseases, such as brainstem encephalitis, neuromyelitis optical, and transverse myelitis. The main treatment plan is high-dose corticosteroid therapy combined with immunoglobulin therapy. This case indicated that some MOGAD patients lack of specificity in the clinical manifestations and imaging perhaps would be misdiagnosed as cerebral infarction, encephalitis, immune peripheral neuropathy, MS, NMOSD, and other diseases. For patients with atypical clinical manifestations or imaging, it is especially important to take antibody detection as early as possible to make correct diagnosis and active treatment in time to avoid disability.
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Affiliation(s)
- Yanan Ding
- Department of NeurologyLiaocheng Hospital Affiliated to Shandong First Medical University (Liaocheng People's Hospital), Liaocheng 252000, Shandong, China
| | - Li Zhang
- Department of NeurologyLiaocheng Hospital Affiliated to Shandong First Medical University (Liaocheng People's Hospital), Liaocheng 252000, Shandong, China
| | - Anqi Huang
- Department of NeurologyLiaocheng Hospital Affiliated to Shandong First Medical University (Liaocheng People's Hospital), Liaocheng 252000, Shandong, China
| | - Xianyue Meng
- Department of NeurologyLiaocheng Hospital Affiliated to Shandong First Medical University (Liaocheng People's Hospital), Liaocheng 252000, Shandong, China
| | - Xueli Li
- Department of NeurologyLiaocheng Hospital Affiliated to Shandong First Medical University (Liaocheng People's Hospital), Liaocheng 252000, Shandong, China
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8
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Guniganti R, Rho S, Morales-Leόn JF, Mar S, Lee A, Goyal M, Reynolds MM, Van Stavern GP. A single-center retrospective series of OCT and MRI findings in pediatric MOGAD optic neuritis patients. CANADIAN JOURNAL OF OPHTHALMOLOGY 2024:S0008-4182(24)00246-1. [PMID: 39182513 DOI: 10.1016/j.jcjo.2024.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 05/21/2024] [Accepted: 07/29/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Whether optical computed tomography (OCT) and magnetic resonance imaging (MRI) findings are associated with final visual acuity in children with myelin oligodendrocyte glycoprotein antibody disease (MOGAD) optic neuritis is unclear. METHODS We retrospectively reviewed the charts of pediatric patients with MOGAD optic neuritis seen at St. Louis Children's Hospital/Barnes Jewish Hospital since 2016. RESULTS In the 12 patients in this study, presenting visual acuity was worse in the optic neuritis-affected eyes but significantly improved from presentation to follow-up, such that, at last follow-up, there was no longer a statistical difference between the affected and unaffected eyes. The number of affected eyes with nerve enhancement and the amount of optic nerve affected, as well as thickness of the retinal nerve fiber layer (RNFL), ganglion cell layer (GCL), and macula, decreased from presentation to follow-up. Ultimately, none of these variables were associated with final visual acuity. CONCLUSION In this cohort, pediatric MOGAD optic neuritis patients had positive visual outcomes despite significant RNFL thinning and involvement of the optic nerve on MRI, leading to a lack of correlation between follow-up visual acuity and OCT and MRI measures of disease severity, respectively.
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Affiliation(s)
- Ridhima Guniganti
- Department of Ophthalmology & Visual Sciences, Washington University in St Louis, St. Louis, MO, USA
| | - Shinji Rho
- Department of Ophthalmology & Visual Sciences, Washington University in St Louis, St. Louis, MO, USA
| | - Juan F Morales-Leόn
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, MO, USA
| | - Soe Mar
- Division of Pediatric & Developmental Neurology, Department of Neurology, St Louis Children's Hospital, St. Louis, MO, USA
| | - Andrew Lee
- Department of Ophthalmology & Visual Sciences, Washington University in St Louis, St. Louis, MO, USA
| | - Manu Goyal
- Mallinckrodt Institute of Radiology, Washington University in St Louis, St. Louis, MO, USA
| | - Margaret M Reynolds
- Department of Ophthalmology & Visual Sciences, Washington University in St Louis, St. Louis, MO, USA
| | - Gregory P Van Stavern
- Department of Ophthalmology & Visual Sciences, Washington University in St Louis, St. Louis, MO, USA.
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9
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Deschamps R, Guillaume J, Ciron J, Audoin B, Ruet A, Maillart E, Pique J, Benyahya L, Laplaud DA, Michel L, Collongues N, Cohen M, Ayrignac X, Thouvenot E, Zephir H, Bourre B, Froment Tilikete C, Moreau T, Cantagrel P, Kerschen P, Cabasson S, Maubeuge N, Hankiewicz K, Nifle C, Berger E, Megherbi H, Magy L, Klapczynski F, Sarov Riviere M, Giannesini C, Hamelin L, Giroux M, Branger P, Maurousset A, Mathey G, Moulin M, Mélé N, Papeix C, Marignier R. Early Maintenance Treatment Initiation and Relapse Risk Mitigation After a First Event of MOGAD in Adults: The MOGADOR2 Study. Neurology 2024; 103:e209624. [PMID: 38991174 DOI: 10.1212/wnl.0000000000209624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Because myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified autoimmune disorder, the natural history of MOGAD is still not well described. The objective of this study was to describe the long-term outcomes of adult patients with MOGAD. In addition, we aimed to identify factors affecting relapse risk and neurologic outcomes. METHODS Clinical and biological data were obtained from patients with a first event of MOGAD and included in the French nationwide incident cohort between February 2014 and March 2017. Only patients aged 18 years or older at disease onset and with observation period of at least 3 months were included. Data were collected prospectively until July 2023 and registered in the dedicated French nationwide database. This form includes every relapse with phenotype description during follow-up, date of last assessment, final clinical outcome with Expanded Disability Status Scale score and visual acuity, and maintenance therapy. The probability of recurrence-free survival was assessed using the Kaplan-Meier method. RESULTS We included 128 patients. The onset phenotype was isolated optic neuritis in 81 patients (63.3%) and isolated myelitis in 25 patients (19.5%). The median follow-up duration was 77.8 months (range 3.2-111.2), with 49 patients (38.3%) experienced at least one relapse. Median times from onset to second and third attacks were 3.2 (1.0-86.2) and 13.0 (2.6-64.4) months, respectively. At the last assessment, Expanded Disability Status Scale Score was ≥3 and ≥6 in 22 (17.2%) and 6 (4.7%) patients, respectively. Eighty patients received at least one maintenance treatment. This treatment was initiated after the first attack in 47 patients (36.7% of the whole cohort) and at the time of a second attack in 25 (19.5%). Multivariate analysis revealed that initiating maintenance treatment after the first attack was associated with a lower relapse risk (OR = 0.26 [95% CI 0.11-0.62], p = 0.002). In patients receiving maintenance therapy after first attack, the 2-year, 4-year, 6-year, and 8-year relapse risks were 11%, 15%, 20%, and 20%, respectively. In other patients, the risks were 41%, 46%, 51%, and 56%. DISCUSSION The highest risk of a relapse in MOGAD occurs early, and initiating maintenance therapy from the first attack substantially reduced the relapse risk. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that initiating maintenance therapy from the first attack in patients with MOGAD reduces the relapse risk.
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Affiliation(s)
- Romain Deschamps
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Jessica Guillaume
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Jonathan Ciron
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Bertrand Audoin
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Aurélie Ruet
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Elisabeth Maillart
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Julie Pique
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Lakhdar Benyahya
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - David A Laplaud
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Laure Michel
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Nicolas Collongues
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Mikael Cohen
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Xavier Ayrignac
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Eric Thouvenot
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Helene Zephir
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Bertrand Bourre
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Caroline Froment Tilikete
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Thibault Moreau
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Paul Cantagrel
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Philippe Kerschen
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Sebastien Cabasson
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Nicolas Maubeuge
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Karolina Hankiewicz
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Chantal Nifle
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Eric Berger
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Hana Megherbi
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Laurent Magy
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Frederic Klapczynski
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Mariana Sarov Riviere
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Claire Giannesini
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Lorraine Hamelin
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Marianne Giroux
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Pierre Branger
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Aude Maurousset
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Guillaume Mathey
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Maximilien Moulin
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Nicolas Mélé
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Caroline Papeix
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
| | - Romain Marignier
- From the Department of Neurology (R.D.); Clinical Research Department (J.G.), Rothschild Foundation Hospital, Paris; Department of Neurology (J.C.), University Hospital of Toulouse; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Hôpital de la Timone; Department of Neurology (A.R.), University Hospital of Bordeaux; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (E.M., C.G.), Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, Paris; Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM) (J.P., L.B., R.M.), Department of Neurology, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer; Department of Neurology (D.A.L.), CR2TI-Inserm U1064, CIC1314, Nantes Université, University Hospital of Nantes; Department of Neurology (L. Michel), INSERM UMR 1236, Université de Rennes 1, University Hospital of Rennes, Rennes, France; Center for Clinical Investigation (N.C.), INSERM U1434; Biopathology of Myelin, Neuroprotection and Therapeutic Strategy, INSERM U1119; Department of Neurology, University Hospital of Strasbourg; CRC SEP Neurologie Pasteur 2 (M.C.), University Hospital of Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice; CRC SEP (X.A.), CRMR Leukofrance, Department of Neurology, INM / U1298, Gui de Chauliac Hospital, University Hospital of Montpellier; Department of Neurology (E.T.), University Hospital of Nimes; CRC SEP (H.Z.), Department of Neurology, U 1172, University Hospital of Lille; Department of Neurology (B.B.), University Hospital of Rouen; Neuro Ophthalmology Unit (C.F.T.), Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon Neuroscience Research Center CRNL U1028 UMR 5292, IMPACT F-69500, Neurological Hospital of Lyon; Department of Neurology (T.M.), University Hospital of Dijon; Department of Neurology (P.C.), University Hospital of la Rochelle; Department of Neurology (P.K.), Hospital of Luxembourg, Luxembourg-Ville, Luxembourg; Department of Child Neurology and Child Intensive Care Unit (S.C.), Hospital of Pau; Department of Neurology (N. Maubeuge), University Hospital of Poitiers; Department of Neurology (K.H.), Delafontaine Hospital, Saint-Denis; Department of Neurology (C.N.), Andre Mignot hospital, Hospital of Versailles, Le Chesnay; Department of Neurology (E.B.), University Hospital of Besancon; Department of Neurology (H.M.), Sud Francilien Hospital, Corbeil-Essonnes; CRC SEP Limoges/Poitiers (L. Magy), CRMR Maladies Neuromusculaires AOC (FILNEMUS), UR 2018 NeurIT, University Hospital of Limoges; Department of Neurology (F.K.), Meaux Hospital; Department of Neurology (M.S.R.), University Hospital of Bicêtre, Le Kremlin-Bicêtre; Department of Neurology (L.H.), Felix Guyon University Hospital, Saint Denis, Reunion; Department of Neurology (M.G.), Hospital of Valenciennes; Department of Neurology (P.B.), University Hospital of Caen Normandie; CRC SEP (A.M.), Department of Neurology, University Hospital of Tours, Bretonneau Hospital; Department of Neurology (G.M.), Nancy University Hospital; Université de Lorraine, EA 4360 APEMAC, Vandoeuvre-Lès-Nancy; Department of Neurology (M.M.), University Hospital of Reims; Department of Neurology (N. Mélé), Sainte-Anne Hospital, GHU Paris Psychiatrie et Neurosciences, Paris Cité University, INSERM 1266; and Department of Neurology (C.P.), Rothschild Foundation Hospital, Paris, France
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Stefan KA, Ciotti JR. MOG Antibody Disease: Nuances in Presentation, Diagnosis, and Management. Curr Neurol Neurosci Rep 2024; 24:219-232. [PMID: 38805147 DOI: 10.1007/s11910-024-01344-z] [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] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE OF REVIEW Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a distinct neuroinflammatory condition characterized by attacks of optic neuritis, transverse myelitis, and other demyelinating events. Though it can mimic multiple sclerosis and neuromyelitis optica spectrum disorder, distinct clinical and radiologic features which can discriminate these conditions are now recognized. This review highlights recent advances in our understanding of clinical manifestations, diagnosis, and treatment of MOGAD. RECENT FINDINGS Studies have identified subtleties of common clinical attacks and identified more rare phenotypes, including cerebral cortical encephalitis, which have broadened our understanding of the clinicoradiologic spectrum of MOGAD and culminated in the recent publication of proposed diagnostic criteria with a familiar construction to those diagnosing other neuroinflammatory conditions. These criteria, in combination with advances in antibody testing, should simultaneously lead to wider recognition and reduced incidence of misdiagnosis. In addition, recent observational studies have raised new questions about when to treat MOGAD chronically, and with which agent. MOGAD pathophysiology informs some of the relatively unique clinical and radiologic features which have come to define this condition, and similarly has implications for diagnosis and management. Further prospective studies and the first clinical trials of therapeutic options will answer several remaining questions about the peculiarities of this condition.
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Affiliation(s)
- Kelsey A Stefan
- Department of Neurology, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA
| | - John R Ciotti
- Department of Neurology, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA.
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11
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Hacohen Y. Pediatric Autoimmune Neurologic Disorders. Continuum (Minneap Minn) 2024; 30:1160-1188. [PMID: 39088292 DOI: 10.1212/con.0000000000001464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVE This article discusses common principles in diagnosing and managing autoimmune neurologic conditions in children. LATEST DEVELOPMENTS The key to improving outcomes in all patients with autoimmune neurologic diseases is making an early diagnosis, promptly initiating treatment, and identifying patients who will benefit from long-term maintenance treatment. Some neuroinflammatory syndromes can be diagnosed with an antibody biomarker (eg, aquaporin-4 antibodies, N-methyl-d-aspartate [NMDA] receptor antibodies), whereas others require clinical diagnostic criteria (eg, multiple sclerosis, opsoclonus-myoclonus syndrome). A proportion of children will be labeled as seronegative, and further investigations for other inflammatory or monogenetic etiologies need to be carried out in parallel with treating the central nervous system inflammation. Time to treatment and treatment escalation were shown to correlate with outcomes in many patients with these disorders. The choice and duration of treatment should be evaluated considering side effects and risks in the short and long terms. The presence of a highly inflammatory disease process in children supports the use of highly effective disease-modifying therapies in pediatrics. ESSENTIAL POINTS The phenotypes of pediatric autoimmune neurologic conditions may change across different age groups, as the brain is still actively developing. In general, the presentation in children is more inflammatory, but overall disability is lower, likely because of better neuroplasticity and repair. Convincing evidence has increasingly emerged to support the biological rationale that effective immunosuppressive therapies used in adult neuroimmunology are equally effective in children.
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12
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Jeyakumar N, Lerch M, Dale RC, Ramanathan S. MOG antibody-associated optic neuritis. Eye (Lond) 2024; 38:2289-2301. [PMID: 38783085 PMCID: PMC11306565 DOI: 10.1038/s41433-024-03108-y] [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: 01/19/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a demyelinating disorder, distinct from multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). MOGAD most frequently presents with optic neuritis (MOG-ON), often with characteristic clinical and radiological features. Bilateral involvement, disc swelling clinically and radiologically, and longitudinally extensive optic nerve hyperintensity with associated optic perineuritis on MRI are key characteristics that can help distinguish MOG-ON from optic neuritis due to other aetiologies. The detection of serum MOG immunoglobulin G utilising a live cell-based assay in a patient with a compatible clinical phenotype is highly specific for the diagnosis of MOGAD. This review will highlight the key clinical and radiological features which expedite diagnosis, as well as ancillary investigations such as visual fields, visual evoked potentials and cerebrospinal fluid analysis, which may be less discriminatory. Optical coherence tomography can identify optic nerve swelling acutely, and atrophy chronically, and may transpire to have utility as a diagnostic and prognostic biomarker. MOG-ON appears to be largely responsive to corticosteroids, which are often the mainstay of acute management. However, relapses are common in patients in whom follow-up is prolonged, often in the context of early or rapid corticosteroid tapering. Establishing optimal acute therapy, the role of maintenance steroid-sparing immunotherapy for long-term relapse prevention, and identifying predictors of relapsing disease remain key research priorities in MOG-ON.
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Affiliation(s)
- Niroshan Jeyakumar
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Magdalena Lerch
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Clinical Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- TY Nelson Department of Neurology, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Neurology, Concord Hospital, Sydney, NSW, Australia.
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13
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McClelland AC, Benitez SJ, Burns J. COVID-19 Neuroimaging Update: Pathophysiology, Acute Findings, and Post-Acute Developments. Semin Ultrasound CT MR 2024; 45:318-331. [PMID: 38518814 DOI: 10.1053/j.sult.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
COVID-19 has prominent effects on the nervous system with important manifestations on neuroimaging. In this review, we discuss the neuroimaging appearance of acute COVID-19 that became evident during the early stages of the pandemic. We highlight the underlying pathophysiology mediating nervous system effects and neuroimaging appearances including systemic inflammatory response such as cytokine storm, coagulopathy, and para/post-infections immune mediated phenomena. We also discuss the nervous system manifestations of COVID-19 and the role of imaging as the pandemic has evolved over time, including related to the development of vaccines and the emergence of post-acute sequalae such as long COVID.
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Affiliation(s)
| | - Steven J Benitez
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Judah Burns
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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14
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Passoke S, Stern C, Häußler V, Kümpfel T, Havla J, Engels D, Jarius S, Wildemann B, Korporal-Kuhnke M, Senel M, Stellmann JP, Warnke C, Grothe M, Schülke R, Gingele S, Kretschmer JR, Klotz L, Walter A, Then Bergh F, Aktas O, Ringelstein M, Ayzenberg I, Schwake C, Kleiter I, Sperber PS, Rust R, Schindler P, Bellmann-Strobl J, Paul F, Kopp B, Trebst C, Hümmert MW. Cognition in patients with myelin oligodendrocyte glycoprotein antibody-associated disease: a prospective, longitudinal, multicentre study of 113 patients (CogniMOG-Study). J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333994. [PMID: 39084862 DOI: 10.1136/jnnp-2024-333994] [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: 04/07/2024] [Accepted: 07/08/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Data on cognition in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are limited to studies with small sample sizes. Therefore, we aimed to analyse the extent, characteristics and the longitudinal course of potential cognitive deficits in patients with MOGAD. METHODS The CogniMOG-Study is a prospective, longitudinal and multicentre observational study of 113 patients with MOGAD. Individual cognitive performance was assessed using the Paced Auditory Serial Addition Task (PASAT), the Symbol Digit Modalities Test (SDMT) and the Multiple Sclerosis Inventory Cognition (MuSIC), which are standardised against normative data from healthy controls. Cognitive performance was assessed at baseline and at 1-year and 2-year follow-up assessments. Multiple linear regression was used to analyse demographic and clinical predictors of cognitive deficits identified in previous correlation analyses. RESULTS At baseline, the study sample of MOGAD patients showed impaired standardised performance on MuSIC semantic fluency (mean=-0.29, 95% CI (-0.47 to -0.12)) and MuSIC congruent speed (mean=-0.73, 95% CI (-1.23 to -0.23)). Around 1 in 10 patients showed deficits in two or more cognitive measures (11%). No decline in cognition was observed during the 1-year and 2-year follow-up period. Cerebral lesions were found to be negatively predictive for SDMT (B=-8.85, 95% CI (-13.57 to -4.14)) and MuSIC semantic fluency (B=-4.17, 95% CI (-6.10 to -2.25)) test performance. CONCLUSIONS Based on these data, we conclude that MOGAD patients show reduced visuomotor processing speed and semantic fluency to the extent that the disease burden includes cerebral lesions.
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Affiliation(s)
- Sarah Passoke
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Carlotta Stern
- Department of Neurology, Hannover Medical School, Hannover, Germany
- University Hospital Innsbruck, Innsbruck, Austria
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, University Hospital Munich, Ludwig Maximilian University Munich, Munich, Germany
| | - Daniel Engels
- Institute of Clinical Neuroimmunology, University Hospital Munich, Ludwig Maximilian University Munich, Munich, 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
| | - Mirjam Korporal-Kuhnke
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Aix-Marseille Univ, CNRS, CRMBM, UMR 7339, Marseille Cedex, France
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Matthias Grothe
- Department of Neurology, University Medicine of Greifswald, Greifswald, Germany
| | - Rasmus Schülke
- Department of Psychiatry, Socialpsychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Stefan Gingele
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | | | - Luisa Klotz
- Department of Neurology, University of Münster, Münster, Germany
| | - Annette Walter
- Department of Neurology, Herford Hospital, Herford, Germany
| | | | - Orhan Aktas
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty and University Hospital, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, 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
| | - Pia Sophie Sperber
- Germany Center for Cardiovascular Diseases (DZHK), partner site Berlin, Berlin, Germany
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rebekka Rust
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Medical Immunology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Patrick Schindler
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Neuroscience Clinical Research Center (NCRC), Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Bruno Kopp
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
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15
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Virupakshaiah A, Schoeps VA, Race J, Waltz M, Sharayah S, Nasr Z, Moseley CE, Zamvil SS, Gaudioso C, Schuette A, Casper TC, Rose J, Flanagan EP, Rodriguez M, Tillema JM, Chitnis T, Gorman MP, Graves JS, Benson LA, Rensel M, Abrams A, Krupp L, Lotze TE, Aaen G, Wheeler Y, Schreiner T, Waldman A, Chong J, Mar S, Waubant E. Predictors of a relapsing course in myelin oligodendrocyte glycoprotein antibody-associated disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333464. [PMID: 38964848 DOI: 10.1136/jnnp-2024-333464] [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: 01/23/2024] [Accepted: 05/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described demyelinating disorder, and children represent about 50% of all cases. Almost half of the patients experience relapses, but very few studies have evaluated predictors of relapse risk, challenging clinical management. The study aimed to identify predictors at MOGAD onset that are associated with a relapsing course. METHODS Prospectively collected data from paediatric patients with MOGAD seen by the US Network of Paediatric MS Centres were leveraged. Univariable and adjusted multivariable models were used to predict recurrent disease. RESULTS We identified 326 MOGAD cases (mean age at first event 8.9 years [SD 4.3], 57% female, 77% white and 74% non-Hispanic) and 46% relapsed during a mean follow-up of 3.9 years (SD 4.1). In the adjusted multivariable model, female sex (HR 1.66, 95% CI 1.17 to 2.36, p=0.004) and Hispanic/Latino ethnicity (HR 1.77, 95% CI 1.19 to 2.64, p=0.005) were associated with a higher risk of relapsing MOGAD. Maintenance treatment initiated before a second event with rituximab (HR 0.25, 95% CI 0.07 to 0.92, p=0.037) or intravenous immunoglobulin (IVIG) (HR 0.35, 95% CI 0.14 to 0.88, p=0.026) was associated with lower risk of a second event in multivariable analyses. Conversely, maintenance steroids were associated with a higher estimated relapse risk (HR 1.76, 95% CI 0.90 to 3.45, p=0.097). CONCLUSION Sex and ethnicity are associated with relapsing MOGAD. Use of rituximab or IVIG therapy shortly after onset is associated with a lower risk of the second event. Preventive treatment after a first event could be considered for those with a higher relapse risk.
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Affiliation(s)
- Akash Virupakshaiah
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Vinicius A Schoeps
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | | | | | - Siefaddeen Sharayah
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Zahra Nasr
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Carson E Moseley
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Scott S Zamvil
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
- Program in Immunology, UCSF, San Francisco, California, USA
| | - Cristina Gaudioso
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | | | | | - John Rose
- The University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Tanuja Chitnis
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark P Gorman
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer S Graves
- Department of Neurology, University of California San Diego, La Jolla, California, USA
| | | | | | | | - Lauren Krupp
- Pediatric MS Center, NYU Langone Health, New York, New York, USA
| | | | - Gregory Aaen
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Yolanda Wheeler
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Amy Waldman
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janet Chong
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Soe Mar
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Emmanuelle Waubant
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
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16
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Tachibana M, Takano S, Ohta Y, Shinoda K, Yamanouchi H. Pattern Visually Evoked Potentials (pVEPs) and Retinal Nerve Fiber Thickness in a Japanese Girl With Anti-myelin Oligodendrocyte Glycoprotein Antibody Seropositive Optic Neuritis. Cureus 2024; 16:e65254. [PMID: 39184699 PMCID: PMC11342402 DOI: 10.7759/cureus.65254] [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: 07/24/2024] [Indexed: 08/27/2024] Open
Abstract
We report our findings in a 5-year-old Japanese girl with unilateral optic neuritis who was seropositive for anti-myelin-oligodendrocyte glycoprotein (MOG) antibody. Functional and microstructural changes were assessed longitudinally for 3.5 years by serial recordings of the pattern visual evoked potentials (pVEPs) and optical coherence tomography (OCT) during the acute and chronic phases. On the initial visit, the best-corrected visual acuity (BCVA) in the right eye was light perception. She was treated with 450 mg of intravenous methylprednisolone pulses followed by a gradual tapering of the oral prednisolone. The visual acuity decreased to no light perception, and plasmapheresis combined with high-dose intravenous immunoglobulin therapy was performed. The BCVA quickly improved to 1.0, and no recurrence was detected for approximately four years. The implicit times of N75, P100, and N145 of the pVEPs and peripapillary retinal nerve fiber (pRNFL) thickness in the OCT images were measured during the course of the disease process. The pRNFL thickness of the right eye decreased and was less than one-half of the baseline value at one year and then stabilized. In contrast, the optic pathway function assessed by pVEPs improved. The implicit times of the N75 and P100 components of the right eye were shortened and stabilized at approximately one year. However, the implicit times in the right eye were still longer than that of the left eye. Our findings documented the course of the function and structures of an eye with anti-MOG antibody-positive optic neuritis. This information should be helpful for the understanding of the pathology and prognosis of this disease entity. Further analysis of the pVEPs and structural changes in more cases is needed.
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Affiliation(s)
| | | | - Yuri Ohta
- Ophthalmology, Saitama Medical University, Iruma-gun, JPN
| | - Kei Shinoda
- Ophthalmology, Saitama Medical University, Iruma-gun, JPN
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17
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Varley JA, Champsas D, Prossor T, Pontillo G, Abdel-Mannan O, Khaleeli Z, Petzold A, Toosy AT, Trip SA, Wilson H, Mallon DH, Hemingway C, Mankad K, Loon Chou MK, Church AJ, Hart MS, Lunn MP, Brownlee W, Hacohen Y, Ciccarelli O. Validation of the 2023 International Diagnostic Criteria for MOGAD in a Selected Cohort of Adults and Children. Neurology 2024; 103:e209321. [PMID: 38870448 PMCID: PMC11244737 DOI: 10.1212/wnl.0000000000209321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To test the performance of the 2023 myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) criteria in adults and children with inflammatory demyelinating conditions who were tested for MOG antibodies (Abs). METHODS This was a retrospective study of patients tested for MOG-Abs from 2018 to 2022 in 2 specialist hospitals. The inclusion criteria comprised ≥1 attendance in an adult or pediatric demyelinating disease clinic and complete clinical and MRI records. The final clinical diagnosis of MOGAD, made by the treating neurologist, was taken as the benchmark against which the new criteria were tested. The international MOGAD diagnostic criteria were applied retrospectively; they stipulate at least 1 clinical or MRI supporting feature for MOGAD diagnosis in positive fixed MOG cell-based assay without a titer. The performance MOG-Ab testing alone for MOGAD diagnosis was also assessed and compared with that of MOGAD criteria using the McNemar test. RESULTS Of the 1,879 patients tested for MOG-Abs, 539 (135 pediatric and 404 adults) met the inclusion criteria. A clinical diagnosis of MOGAD was made in 86/539 (16%) patients (37 adults, 49 children), with a median follow-up of 3.6 years. The MOGAD diagnostic criteria had sensitivity of 96.5% (adults 91.9%, children 100%), specificity of 98.9% (adults 98.8%, children 98.9%), positive predictive value of 94.3% (adults 89.4%, children 98%), negative predictive value of 99.3% (adults 99.2%, children 100%), and accuracy of 98.5% (adults 98.3%, children 99.2%). When compared with MOG-Ab testing alone, a difference was seen only in adults: a significantly higher specificity (98.9% vs 95.6%, p = 0.0005) and nonstatistically significant lower sensitivity (91.9% vs 100%, p = 0.08). DISCUSSION The international MOGAD diagnostic criteria exhibit high performance in selected patients with inflammatory demyelinating diseases (who had a high pretest probability of having MOGAD) compared with best clinical judgment; their performance was better in children than in adults. In adults, the MOGAD criteria led to an improvement in specificity and positive predictive value when compared with MOG-Ab testing alone, suggesting that the requirement of at least 1 clinical or MRI supporting feature is important. Future work should address the generalizability of the diagnostic criteria to cohorts of greater clinical diversity seen within neurologic settings.
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Affiliation(s)
- James A Varley
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Dimitrios Champsas
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Timothy Prossor
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Giuseppe Pontillo
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Omar Abdel-Mannan
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Zhaleh Khaleeli
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Axel Petzold
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Ahmed T Toosy
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Sachid A Trip
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Heather Wilson
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Dermot H Mallon
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Cheryl Hemingway
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Kshitij Mankad
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Michael Kin Loon Chou
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Andrew J Church
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Melanie S Hart
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Michael P Lunn
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Wallace Brownlee
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Yael Hacohen
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
| | - Olga Ciccarelli
- From the Queen Square MS Centre (J.A.V., G.P., O.A.-M., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., C.H., M.S.H., W.B., Y.H., O.C.), Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London; Department of Brain Sciences (J.A.V.), Charing Cross Hospital, Imperial College London; Department of Neurology (D.C., O.A.-M., C.H., Y.H.), Great Ormond Street Hospital for Children; The National Hospital for Neurology and Neurosurgery (T.P., Z.K., A.P., A.T.T., S.A.T., H.W., D.H.M., M.S.H., M.P.L., W.B., O.C.), UCLH NHS Trust, London, United Kingdom; Neuro-ophthalmology Expert Centre (A.P.), Amsterdam UMC, the Netherlands; Moorfields Eye Hospital NHS Foundation Trust (A.P.); Department of Radiology (K.M.), Great Ormond Street Hospital for Children; Neuroimmunology and CSF Laboratory (M.K.L.C., A.J.C., M.S.H., M.P.L.), National Hospital for Neurology and Neurosurgery; National Institute for Health and Care Research (NIHR) (M.S.H., M.P.L., W.B., O.C.), University College London Hospitals Biomedical Research Centre; and Department of Neuromuscular Diseases (M.P.L.), UCL Queen Square Institute of Neurology, University College London, United Kingdom
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Rechtman A, Zveik O, Haham N, Brill L, Vaknin-Dembinsky A. A protective effect of lower MHC-II expression in MOGAD. J Neuroimmunol 2024; 391:578351. [PMID: 38703720 DOI: 10.1016/j.jneuroim.2024.578351] [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: 03/26/2024] [Revised: 04/21/2024] [Accepted: 04/25/2024] [Indexed: 05/06/2024]
Abstract
Myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) is a demyelinating central nervous system disorder. We aimed to uncover immune pathways altered in MOGAD to predict disease progression. Using nanostring nCounter technology, we analyzed immune gene expression in PBMCs from MOGAD patients and compare it with healthy controls (HCs). We found 35 genes that distinguished MOGAD patients and HCs. We then validated those results in a larger cohort including MS and NMOSD patients. Expressions of HLA-DRA was significantly lower in MOGAD patients. This reduction in HLA-DRA, correlated with a monophasic disease course and greater brain volume, enhancing our ability to predict MOGAD progression.
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Affiliation(s)
- Ariel Rechtman
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omri Zveik
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Nitsan Haham
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Livnat Brill
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah- Medical Center, Ein-Kerem, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
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Maillart E, Deiva K, Marignier R. Clinical characteristics of patients with myelin oligodendrocyte glycoprotein antibodies. Curr Opin Neurol 2024; 37:338-344. [PMID: 38497310 DOI: 10.1097/wco.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
PURPOSE OF REVIEW The clinical landscape associated to myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) has undergone a remarkable transformation over the past two decades, primarily driven by advancements in antibody detection techniques that have enhanced both the specificity and sensitivity of assays, enabling the identification of novel clinical phenotypes. RECENT FINDINGS Recent pivotal research publications, comprehensive reviews from established research groups, and most notably the first proposed international criteria for MOG-Ab associated disease (MOGAD) have substantially enriched our understanding of the clinical features associated with MOG-Ab. This review presents a comprehensive overview of the clinical characteristics of patients with MOG-Ab, systematically examining each core clinical syndrome defined by the proposed international MOGAD criteria. We incorporated recent insights and discussed potential challenges in applying these criteria across diverse clinical scenarios. SUMMARY The proposed international MOGAD criteria provide a comprehensive, homogeneous, and specific framework for characterizing the clinical features of patients with MOG-Ab, encompassing both paediatric and adult populations. In the future, the widespread adoption of specific and reliable assays for MOG-Ab detection, complemented by the development of surrogate fluid and imaging markers, holds promise for better characterizing atypical presentations, only-cerebrospinal fluid positivity and the MOGAD "seronegative" situations.
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Affiliation(s)
- Elisabeth Maillart
- Centre de Référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)
- Department of Neurology, Hôpital Pitié-Salpêtrière, APHP, Paris
| | - Kumaran Deiva
- Centre de Référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)
- Department of Pediatric Neurology, Bicêtre Hospital, University Hospitals Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre
| | - Romain Marignier
- Centre de Référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuroinflammation, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, France
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20
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Czeisler BM. Emergent Management of Central Nervous System Demyelinating Disorders. Continuum (Minneap Minn) 2024; 30:781-817. [PMID: 38830071 DOI: 10.1212/con.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article reviews the various conditions that can present with acute and severe central nervous system demyelination, the broad differential diagnosis of these conditions, the most appropriate diagnostic workup, and the acute treatment regimens to be administered to help achieve the best possible patient outcomes. LATEST DEVELOPMENTS The discovery of anti-aquaporin 4 (AQP4) antibodies and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in the past two decades has revolutionized our understanding of acute demyelinating disorders, their evaluation, and their management. ESSENTIAL POINTS Demyelinating disorders comprise a large category of neurologic disorders seen by practicing neurologists. In the majority of cases, patients with these conditions do not require care in an intensive care unit. However, certain disorders may cause severe demyelination that necessitates intensive care unit admission because of numerous simultaneous multifocal lesions, tumefactive lesions, or lesions in certain brain locations that lead to acute severe neurologic dysfunction. Intensive care may be necessary for the management and prevention of complications for patients who have severely altered mental status, rapidly progressive neurologic worsening, elevated intracranial pressure, severe cerebral edema, status epilepticus, or respiratory failure.
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Ross R, Kenney R, Balcer LJ, Galetta SL, Krupp L, O'Neill KA, Grossman SN. Myelin Oligodendrocyte Glycoprotein Antibody Disease Optic Neuritis: A Structure-Function Paradox? J Neuroophthalmol 2024; 44:172-177. [PMID: 38526582 DOI: 10.1097/wno.0000000000002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a demyelinating disorder that most commonly presents with optic neuritis (ON) and affects children more often than adults. We report 8 pediatric patients with MOG-associated ON and characterize focal optical coherence tomography (OCT) abnormalities over time that help distinguish this condition from the trajectories of other demyelinating disorders. These OCT findings are examined in the context of longitudinal visual function testing. METHODS This is a retrospective case series of 8 pediatric patients with MOG-associated ON who were referred for neuro-ophthalmic evaluation. Longitudinal data for demographics, clinical history, physical examination, and OCT obtained in the course of clinical evaluations were collected through retrospective medical record review. RESULTS Patients demonstrated acute peripapillary retinal nerve fiber layer (RNFL) thickening in one or both eyes, consistent with optic disc swelling. This was followed by steady patterns of average RNFL thinning, with 9 of 16 eyes reaching significantly low RNFL thickness using OCT platform reference databases ( P < 0.01), accompanied by paradoxical recovery of high-contrast visual acuity (HCVA) in every patient. There was no correlation between HCVA and any OCT measures, although contrast sensitivity (CS) was associated with global thickness, PMB thickness, and nasal/temporal (N/T) ratio, and color vision was associated with PMB thickness. There was a lower global and papillomacular bundle (PMB) thickness ( P < 0.01) in clinically affected eyes compared with unaffected eyes. There was also a significantly higher N:T ratio in clinically affected eyes compared with unaffected eyes in the acute MOG-ON setting ( P = 0.03), but not in the long-term setting. CONCLUSIONS MOG shows a pattern of prominent retinal atrophy, as demonstrated by global RNFL thinning, with remarkable preservation of HCVA but remaining deficits in CS and color vision. These tests may be better clinical markers of vision changes secondary to MOG-ON. Of the OCT parameters measured, PMB thickness demonstrated the most consistent correlation between structural and functional measures. Thus, it may be a more sensitive marker of clinically significant retinal atrophy in MOG-ON. The N:T ratio in acute clinically affected MOG-ON eyes in our study was higher than the N:T ratio of neuromyelitis optica (NMO)-ON eyes and similar to the N:T ratio in multiple sclerosis (MS)-ON eyes as presented in the prior literature. Therefore, MOG may share a more similar pathophysiology to MS compared with NMO.
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Affiliation(s)
- Ruby Ross
- Department of Neurology (RR, RK, LJB, SLG, LK, KAON, SNG), Department of Population Health (RK, LJB), and Department of Ophthalmology (LJB, SLG), New York University Grossman School of Medicine, New York, New York
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22
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Gklinos P, Dobson R. Myelin Oligodendrocyte Glycoprotein-Antibody Associated Disease: An Updated Review of the Clinical Spectrum, Pathogenetic Mechanisms and Therapeutic Management. Antibodies (Basel) 2024; 13:43. [PMID: 38804311 PMCID: PMC11130828 DOI: 10.3390/antib13020043] [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: 03/16/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
Clinical syndromes associated with antibodies against myelin oligodendrocyte glycoprotein (MOG) are now recognized as a distinct neurological disease entity, and are gaining increasing attention. The pathogenic mechanisms underlying MOG-antibody disease (MOGAD) remain incompletely understood. Case series, facilitated by registries, and observational studies over the past few years have shed increasing light on the clinical aspects and therapeutic approaches of MOGAD. MOGAD may manifest with a variety of clinical syndromes, including acute disseminated encephalomyelitis (ADEM), autoimmune encephalitis, optic neuritis (ON) and transverse myelitis (TM). MOGAD can be either monophasic or relapsing. This review aims to provide a comprehensive updated description of the clinical spectrum, paraclinical features, and prognosis of MOG-antibody disease, as well as summarize its therapeutic considerations. Randomized clinical trials, standardized diagnostic criteria and treatment guidelines are the steps forward.
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Affiliation(s)
- Panagiotis Gklinos
- First Neurology Department, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK;
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Trewin BP, Dale RC, Qiu J, Chu M, Jeyakumar N, Dela Cruz F, Andersen J, Siriratnam P, Ma KKM, Hardy TA, van der Walt A, Lechner-Scott J, Butzkueven H, Broadley SA, Barnett MH, Reddel SW, Brilot F, Kalincik T, Ramanathan S. Oral corticosteroid dosage and taper duration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333463. [PMID: 38744459 DOI: 10.1136/jnnp-2024-333463] [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: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND We sought to identify an optimal oral corticosteroid regimen at the onset of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), which would delay time to first relapse while minimising cumulative corticosteroid exposure. METHODS In a retrospective multicentre cohort study, Cox proportional hazards models examined the relationship between corticosteroid course as a time-varying covariate and time to first relapse. Simon-Makuch and Kaplan-Meier plots identified an optimal dosing strategy. RESULTS We evaluated 109 patients (62 female, 57%; 41 paediatric, 38%; median age at onset 26 years, (IQR 8-38); median follow-up 6.2 years (IQR 2.6-9.6)). 76/109 (70%) experienced a relapse (median time to first relapse 13.7 months; 95% CI 8.2 to 37.9). In a multivariable model, higher doses of oral prednisone delayed time to first relapse with an effect estimate of 3.7% (95% CI 0.8% to 6.6%; p=0.014) reduced hazard of relapse for every 1 mg/day dose increment. There was evidence of reduced hazard of relapse for patients dosed ≥12.5 mg/day (HR 0.21, 95% CI 0.07 to 0.6; p=0.0036), corresponding to a 79% reduction in relapse risk. There was evidence of reduced hazard of relapse for those dosed ≥12.5 mg/day for at least 3 months (HR 0.12, 95% CI 0.03 to 0.44; p=0.0012), corresponding to an 88% reduction in relapse risk compared with those never treated in this range. No patient with this recommended dosing at onset experienced a Common Terminology Criteria for Adverse Events grade >3 adverse effect. CONCLUSIONS The optimal dose of 12.5 mg of prednisone daily in adults (0.16 mg/kg/day for children) for a minimum of 3 months at the onset of MOGAD delays time to first relapse.
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Affiliation(s)
- Benjamin P Trewin
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Institute for Neuroscience and Muscle Research, Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Qiu
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa Chu
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Niroshan Jeyakumar
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fionna Dela Cruz
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jane Andersen
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Brain Autoimmunity, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Pakeeran Siriratnam
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Kit Kwan M Ma
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Todd A Hardy
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Concord, New South Wales, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Helmut Butzkueven
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon A Broadley
- School of Medicine, Griffith University, Nathan, Queensland, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael H Barnett
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University Of Sydney, Camperdown, New South Wales, Australia
| | - Stephen W Reddel
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Concord, New South Wales, Australia
| | - Fabienne Brilot
- Brain Autoimmunity, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tomas Kalincik
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Concord, New South Wales, Australia
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Anto AM, Allu SVV, Acharya S, Vakde T, Omoregi E, Pandey U. Uncovering the Diagnostic Challenge of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Case Study of Acute Bilateral Vision Loss. Cureus 2024; 16:e60612. [PMID: 38903369 PMCID: PMC11187441 DOI: 10.7759/cureus.60612] [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: 05/19/2024] [Indexed: 06/22/2024] Open
Abstract
We discuss a perplexing case of a 51-year-old female with a history of asthma and morbid obesity, presenting with acute bilateral vision loss of unknown etiology. The patient's clinical course was marked by a constellation of symptoms, including blurry vision, eyeball pain, photophobia, headache, nausea, and dizziness, prompting a multidisciplinary approach for diagnostic evaluation. Despite a comprehensive workup and a temporal artery biopsy ruling out large vessel arteritis, the etiology of vision loss remained elusive until myelin oligodendrocyte glycoprotein (MOG) antibody testing returned positive, implicating myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). High-dose corticosteroid therapy was initiated. However, the patient had worsening visual symptoms and was started on plasmapheresis and subsequent administration of Rituximab to prevent relapses, along with a long-term steroid taper regimen. This case underscores the diagnostic challenge of optic neuritis, particularly in MOGAD. It emphasizes the importance of a thorough evaluation and multidisciplinary collaboration.
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Affiliation(s)
| | | | | | - Trupti Vakde
- Pulmonary and Crticial Care, BronxCare Health System, New York, USA
| | | | - Udesh Pandey
- Internal Medicine, BronxCare Health System, New York, USA
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Abdel-Mannan O, Champsas D, Tur C, Lee V, Manivannan S, Usman H, Skippen A, Desai I, Chitre M, Forsyth R, Kneen R, Ram D, Ramdas S, Rossor T, West S, Wright S, Palace J, Wassmer E, Hemingway C, Lim MJ, Mankad K, Ciccarelli O, Hacohen Y. Evolution of brain MRI lesions in paediatric myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and its relevance to disease course. J Neurol Neurosurg Psychiatry 2024; 95:426-433. [PMID: 37979966 DOI: 10.1136/jnnp-2023-332542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/23/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Lesion resolution is often observed in children with myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and asymptomatic lesions are less commonly reported in MOGAD than in multiple sclerosis (MS). OBJECTIVE We aimed to evaluate brain MRI changes over time in paediatric MOGAD. METHODS Retrospective study in eight UK paediatric neuroscience centres. Acute brain MRI and available follow-up MRIs were reviewed. Predictors for lesion dynamic were evaluated using multivariable regression and Kaplan-Meier survival analyses were used to predict risk of relapse, disability and MOG-Ab status. RESULTS 200 children were included (MOGAD 97; MS 103). At first MRI post attack, new symptomatic and asymptomatic lesions were seen more often in MS versus MOGAD (52/103 vs 28/97; p=0.002 and 37/103 vs 11/97; p<0.001); 83% of patients with MOGAD showed at least one lesion's resolution at first follow-up scan, and 23% had normal MRI. Only 1 patient with MS had single lesion resolution; none had normal MRI. Disappearing lesions in MOGAD were seen in 40% after the second attack, 21% after third attack and none after the fourth attack.New lesions at first follow-up scan were associated with increased likelihood of relapse (p=0.02) and persistent MOG-Ab serostatus (p=0.0016) compared with those with no new lesions. Plasma exchange was associated with increased likelihood of lesion resolution (p=0.01). Longer time from symptom onset to steroids was associated with increased likelihood of new lesions; 50% increase at 20 days (p=0.01). CONCLUSIONS These striking differences in lesion dynamics between MOGAD and MS suggest greater potential to repair. Early treatment with steroids and plasma exchange is associated with reduced likelihood of new lesions.
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Affiliation(s)
- Omar Abdel-Mannan
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
| | - Dimitrios Champsas
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Carmen Tur
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
- Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Institute of Research, Barcelona, Spain
| | - Vanessa Lee
- Children's Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Haroon Usman
- Department of Paediatric Neurology, The Great North Children's Hospital, Newcastle Upon Tyne, UK
| | - Alison Skippen
- Department of Paediatric Neurology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Ishita Desai
- Department of Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - Manali Chitre
- Paediatric Neurology, Addenbrooke's Hospital, Cambridge, UK
| | - Rob Forsyth
- Paediatric Neurology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Rachel Kneen
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
- Neurology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Dipak Ram
- Department of Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - Sithara Ramdas
- Department of Paediatric Neurology, Oxford Radcliffe Hospitals NHS Trust, Oxford, UK
| | - Thomas Rossor
- Children's Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Siobhan West
- Department of Neurology, Royal Manchester Children's Hospital, Manchester, UK
| | - Sukhvir Wright
- Paediatric Neurology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Aston Neuroscience Institute, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - Evangeline Wassmer
- Paediatric Neurology, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
- Aston Neuroscience Institute, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK
| | - Ming J Lim
- Children's Neurosciences, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kshitij Mankad
- Neuroradiology, Great Ormond Street Hospital for Children NHS Trust, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - Yael Hacohen
- Department of Neuroinflammation, UCL Institute of Neurology, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
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Fu X, Zhan Q, Zhang L, Tian X. Case report: Shingles-associated probable Bickerstaff brainstem encephalitis with IgM anti-sulfatide positivity. Front Immunol 2024; 15:1358886. [PMID: 38660303 PMCID: PMC11041370 DOI: 10.3389/fimmu.2024.1358886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 03/21/2024] [Indexed: 04/26/2024] Open
Abstract
Background Bickerstaff brainstem encephalitis (BBE) is a rare disease considered caused by acute demyelination of the brainstem, most often resulting from secondary autoimmune responses. To our knowledge, this is the first probable case report of shingles-associated BBE with anti-sulfatide IgM positivity. Case presentation We report the case of an 83-year-old woman with symptoms of progressive limb weakness, difficulty swallowing food, and disturbed consciousness that occurred 4 weeks following herpes zoster infection. Autoimmune anti-sulfatide antibodies were positive and fluid-attenuated inversion recovery (FLAIR) sequences revealed clear high signal intensity in pons and bilateral thalamus. Our patient's condition improved markedly with glucocorticoid treatment. After 2 months of treatment, our patient was fully recovered. We considered that for her case, BBE is the most appropriate diagnosis. Conclusions We emphasize the importance of a careful medical history and assessment of clinical symptoms, performing MRI, testing autoimmune antibodies for rapid diagnosis, and ruling out differential diagnoses. Further studies involving more patients with BBE with IgM anti-sulfatide autoantibodies will increase the understanding of the clinical characteristics and advance the diagnosis and treatment of this syndrome. Meanwhile, it is crucial for dermatologists to know about this severe neurological complication following shingles.
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Affiliation(s)
- Xiaoxue Fu
- Baoding First Central Hospital, Baoding, Hebei, China
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27
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Nguyen L, Wang CX, Hernandez RS, Greenberg BM. Clinical analysis of myelin oligodendrocyte glycoprotein antibody-associated disease in a diverse cohort of children: A single-center observational study. Mult Scler Relat Disord 2024; 84:105497. [PMID: 38364768 DOI: 10.1016/j.msard.2024.105497] [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: 09/18/2023] [Revised: 12/06/2023] [Accepted: 02/10/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Prognostic markers for relapse and neurological disability following the first clinical event in children with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) remain lacking. We investigated the clinical profiles and early prognostic factors associated with relapsing disease or impaired functional outcome in a large single-center cohort of pediatric MOGAD. METHODS We retrospectively analyzed the clinical and paraclinical data and treatment outcomes of children with MOGAD seen at Children's Health in Dallas, Texas from 2009 to 2022. Univariate analyses were used to evaluate factors from initial event associated with relapsing disease course and impaired functional outcome (modified Rankin scale [mRS] >1) at final follow-up. RESULTS Our cohort comprised of 87 children of diverse race/ethnicity. Presentation with acute disseminated encephalomyelitis (ADEM) was more frequent in children aged ≤8 years and Caucasian background, whereas presentation with optic neuritis was more common in children aged >8 years and other race/ethnicity. 44.3 % (27/61) had relapsing disease course, of whom 48.0 % had multiple relapses. 30.3 % (23/76) had final mRS >1. Children with abnormal electroencephalogram had reduced relapse risk. Children with ADEM presentation, severe disease, low MOG-IgG titer, and central and systemic inflammation (represented by cerebrospinal fluid pleocytosis and serum leukocytosis, respectively) at onset had higher likelihood of final mRS >1. CONCLUSION Abnormal electroencephalogram at the first event was associated with reduced relapse risk while disease severity and peripheral inflammation significantly contributed to final neurological disability. Further studies are needed to validate these findings as early risk factors for disability and relapse and to identify optimal treatment strategies.
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Affiliation(s)
- Linda Nguyen
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Cynthia X Wang
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Roberto S Hernandez
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Benjamin M Greenberg
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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28
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Molazadeh N, Bilodeau PA, Salky R, Bose G, Lotan I, Romanow G, Anderson MR, Matiello M, Chitnis T, Levy M. Predictors of relapsing disease course following index event in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). J Neurol Sci 2024; 458:122909. [PMID: 38335710 DOI: 10.1016/j.jns.2024.122909] [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: 07/24/2023] [Revised: 12/27/2023] [Accepted: 01/29/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune disease that can present as a monophasic or relapsing disease course. Here, we investigate the predictors of developing relapsing disease with a focus on the index event. METHODS MOGAD patients followed at Massachusetts General Hospital and Brigham and Women's Hospital were included. Data on demographic, clinical, and laboratory features were collected. Time-to-event survival analysis was performed using a Cox proportional hazards model. Univariate and multivariate regression analyses were performed. RESULTS We included 124 patients with a diagnosis of MOGAD of which 62.1% (n = 77) were female. The median (IQR) onset age and follow-up time were 31 (16, 45), and 4.08 (2.2, 7.9) years respectively. In total, 40.3% (n = 50) of patients remained monophasic and, 59.7% (n = 74) developed a relapsing course. The median (IQR) time between the index event and the second attack was 3(2, 13.7) months. Starting maintenance therapy following the index event was associated with decreased risk of relapsing disease (HR:0.26; 95%CI: 0.12, 0.54; P < 0.001). Maintenance therapy with intravenous immunoglobulin (HR:0.1; 95% CI:0.01, 0.78, P = 0.02), rituximab (HR: 0.21; 95%CI: 0.08, 0.55; P = 0.001), and mycophenolate mofetil (HR: 0.27; 95%CI: 0.09, 0.77; P = 0.01) was associated with a decreased risk of relapsing disease course. A polyphasic first attack (HR:2.4; 95%CI:1.31, 4.4; P = 0.004) and high CSF protein (HR:2.06; 95%CI: 1.01, 4.16; P = 0.04) were associated with a relapsing course. CONCLUSIONS In MOGAD patients, starting maintenance therapy following the index event reduces the risk of relapsing disease regardless of age, sex, and onset phenotype, while polyphasic first attack, and elevated CSF protein predict relapsing disease course.
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Affiliation(s)
- Negar Molazadeh
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Philippe A Bilodeau
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca Salky
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gauruv Bose
- Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Medicine (Neurology), The University of Ottawa and Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Itay Lotan
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriela Romanow
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Monique R Anderson
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Marcelo Matiello
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Brigham MS Center, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Bilodeau PA, Vishnevetsky A, Molazadeh N, Lotan I, Anderson M, Romanow G, Salky R, Healy BC, Matiello M, Chitnis T, Levy M. Effectiveness of immunotherapies in relapsing myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2024; 30:357-368. [PMID: 38314479 DOI: 10.1177/13524585241226830] [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: 02/06/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can cause optic neuritis, transverse myelitis, or acute disseminated encephalomyelitis (ADEM). Immunotherapy is often used for relapsing disease, but there is variability in treatment decisions. OBJECTIVE The objective was to determine the annualized relapse rates (ARRs) and incidence rate ratios (IRRs) compared to pre-treatment and relapse-freedom probabilities among patients receiving steroids, B-cell depletion (BCD), intravenous immunoglobulin (IVIG), and mycophenolate mofetil (MMF). METHODS Retrospective cohort study of patients with relapsing MOGAD treated at Mass General Brigham. ARRs and IRRs compared to pre-treatment, and relapse-freedom probability and odds ratio for relapse-freedom compared to prednisone were calculated. RESULTS A total of 88 patients met the inclusion criteria. The ARR on IVIG was 0.13 (95% confidence interval (CI) = 0.06-0.27) and the relapse-freedom probability after at least 6 months of therapy was 72%. The ARR on BCD was 0.51 (95% CI = 0.34-0.77), and the relapse-freedom probability was 33%. The ARR on MMF was 0.32 (95% CI = 0.19-0.53) and the relapse-freedom probability was 49%. In pediatric-onset disease, MMF had the lowest ARRs (0.15, 95% CI = 0.07-0.33). CONCLUSION IVIG had the lowest ARRs and IRRs compared to pre-treatment and the highest relapse-freedom odds ratio compared to prednisone, while BCD had the lowest. In pediatric-onset MOGAD, MMF had the lowest ARRs.
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Affiliation(s)
- Philippe Antoine Bilodeau
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Anastasia Vishnevetsky
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Negar Molazadeh
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Itay Lotan
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Monique Anderson
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gabriela Romanow
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Rebecca Salky
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Brian C Healy
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Marcelo Matiello
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Tanuja Chitnis
- Brigham Multiple Sclerosis Center, Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Levy
- Division of Neuroimmunology & Neuroinfectious Disease, Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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Cheng Y, Wu Y. Pediatric acute bilateral optic neuritis: A case report. Biomed Rep 2024; 20:40. [PMID: 38357228 PMCID: PMC10865288 DOI: 10.3892/br.2024.1728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/05/2024] [Indexed: 02/16/2024] Open
Abstract
With the improvement of diagnostic technology, the diagnosis of optic neuritis (ON) has become increasingly accurate. Due to the special characteristics of the pediatric population, there is currently a lack of large-scale studies and related guidelines on pediatric ON. This case report describes the complete diagnosis and treatment process of a 7-year-old male patient with bilateral acute ON, from onset to symptom relief. During the outpatient stage, the patient was suspected of having different types of ON by different departments, but the diagnosis was confirmed through antibody testing after hospitalization. The treatment plan for this case was based on the current plan for adults and the prognosis was better than that of adults with similar characteristics. This suggests that pediatric ON has its own features and requires more case reports and clinical research for further exploration and summary.
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Affiliation(s)
- Yu Cheng
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, P.R. China
| | - Yuan Wu
- Department of Ophthalmology, Peking University First Hospital, Beijing 100034, P.R. China
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Moon Y, Park KA, Han J, Hwang JM, Kim SJ, Han SH, Lee BJ, Kang MC, Goh YH, Lim BC, Yang HK, Jung JH. Risk of central nervous system demyelinating attack or optic neuritis recurrence after pediatric optic neuritis in Korea. Neurol Sci 2024; 45:1173-1183. [PMID: 37853292 DOI: 10.1007/s10072-023-07125-9] [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: 07/27/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
PURPOSE To investigate the rate of development of symptomatic central nervous system (CNS) demyelinating attacks or recurrent optic neuritis (ON) after the first episode of ON and its risk factors for Korean pediatric patients. METHODS This multicenter retrospective cohort study included the patients under 18 years of age (n=132) diagnosed with ON without previous or simultaneous CNS demyelinating diseases. We obtained the clinical data including the results of neuro-ophthalmological examinations, magnetic resonance images (MRIs), antibody assays, and laboratory tests. We investigated the chronological course of demyelinating disease with respect to the occurrence of neurological symptoms and/or signs, and calculated the 5-year cumulative probability of CNS demyelinating disease or ON recurrence. RESULTS: During the follow-up period (63.1±46.7 months), 18 patients had experienced other CNS demyelinating attacks, and the 5-year cumulative probability was 14.0±3.6%. Involvement of the extraorbital optic nerve or optic chiasm and asymptomatic lesions on the brain or spinal MRI at initial presentation were significant predictors for CNS demyelinating attack after the first ON. The 5-year cumulative probability of CNS demyelinating attack was 44.4 ± 24.8% in the AQP4-IgG group, 26.2±11.4% in the MOG-IgG group, and 8.7±5.9% in the double-negative group (P=0.416). Thirty-two patients had experienced a recurrence of ON, and the 5-year cumulative probability was 24.6±4.0%. In the AQP4-IgG group, the 5-year cumulative probability was 83.3±15.2%, which was significantly higher than in the other groups (P<0.001). CONCLUSIONS A careful and multidisciplinary approach including brain/spinal imaging and antibody assay can help predict further demyelinating attacks in pediatric ON patients.
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Affiliation(s)
- Yeji Moon
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jinu Han
- Institute of Vision Research, Department of Ophthalmology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea
| | - Seong-Joon Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea
| | - Sueng-Han Han
- Institute of Vision Research, Department of Ophthalmology, Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min Chae Kang
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yong Hyu Goh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Children's Hospital, Seoul, South Korea
| | - Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, 82 Gumi-ro 173 Beon-gil Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.
| | - Jae Ho Jung
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Hospital, 101, Daehak-ro Jongno-gu, Seoul, 03080, South Korea.
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Wang YL, Zhu MY, Yuan ZF, Ren XY, Guo XT, Hua Y, Xu L, Zhao CY, Jiang LH, Zhang X, Sheng GX, Jiang PF, Zhao ZY, Gao F. Proteomic profiling of cerebrospinal fluid in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease. World J Pediatr 2024; 20:259-271. [PMID: 36507981 PMCID: PMC10957615 DOI: 10.1007/s12519-022-00661-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 11/15/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder of the central nervous system. METHODS Extracted proteins from 34 cerebrospinal fluid (CSF) samples [patients with MOGAD (MOG group, n = 12); healthy controls (HC group, n = 12); patients with MOG seronegative and metagenomics next-generation sequencing-negative inflammatory neurological diseases (IND group, n = 10)] were processed and subjected to label-free quantitative proteomics. Supervised partial least squares-discriminant analysis (PLS-DA) and orthogonal PLS-DA (O-PLS-DA) models were also performed based on proteomics data. Functional analysis of differentially expressed proteins (DEPs) was performed using Gene Ontology, InterPro, and Kyoto Encyclopedia Genes and Genomes. An enzyme-linked immunosorbent assay was used to determine the complement levels in serum from patients with MOGAD. RESULTS Four hundred and twenty-nine DEPs (149 upregulated and 280 downregulated proteins) were identified in the MOG group compared to the HC group according to the P value and fold change (FC). Using the O-PLS-DA model, 872 differentially abundant proteins were identified with variable importance projection (VIP) scores > 1. Five proteins (gamma-glutamyl hydrolase, cathepsin F, interalpha-trypsin inhibitor heavy chain 5, latent transforming growth factor beta-binding protein 4 and leukocyte-associated immunoglobulin-like receptor 1) overlapping between the top 30 DEPs with top-ranked P value and FC and top 30 proteins in PLS-DA VIP lists were acquired. Functional analysis revealed that the dysregulated proteins in the MOG group were primarily involved in complement and coagulation cascades, cell adhesion, axon guidance, and glycosphingolipid biosynthesis compared to the HC group. CONCLUSION The proteomic alterations in CSF samples from children with MOGAD identified in the current study might provide opportunities for developing novel biomarker candidates.
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Affiliation(s)
- Yi-Long Wang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Meng-Ying Zhu
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Zhe-Feng Yuan
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Xiao-Yan Ren
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Xiao-Tong Guo
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Yi Hua
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Lu Xu
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Cong-Ying Zhao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Li-Hua Jiang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Xin Zhang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Guo-Xia Sheng
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Pei-Fang Jiang
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China
| | - Zheng-Yan Zhao
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China.
| | - Feng Gao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
- Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310052, China.
- Children's Hospital, National Clinical Research Center for Child Health, Zhejiang University School of Medicine, Hangzhou 310052, China.
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Teru SS, Dogiparthi J, Bonitz TJ, Buzas C. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Case Report. Cureus 2024; 16:e55652. [PMID: 38586776 PMCID: PMC10996974 DOI: 10.7759/cureus.55652] [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: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a newly discovered autoimmune demyelinating disorder. The clinical manifestations of MOGAD are divergent but often characterized by inflammatory central nervous system (CNS) deficits such as optic neuritis, encephalitis, or transverse myelitis that predominantly affect the pediatric population. Despite the distinct features often associated with MOGAD, the disease exhibits a diverse range of clinical manifestations, making timely diagnosis and treatment challenging. In particular, distinguishing MOGAD from multiple sclerosis (MS) is important for adequate treatment and the prevention of relapsing disease. In this report, we present a rare case of MOGAD in a 57-year-old male who initially exhibited symptoms of bilateral optic nerve edema and flame hemorrhage. This led to an initial misdiagnosis of pseudotumor cerebri. Serological analysis at a tertiary care center ultimately led to the diagnosis of MOGAD after multiple visits to the ophthalmologist with worsening vision deficits.
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Affiliation(s)
- Smaran S Teru
- Medical School, Lake Erie College of Osteopathic Medicine, Erie, USA
| | | | - Thomas J Bonitz
- Medical School, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Chris Buzas
- Ophthalmology, Lake Erie College of Osteopathic Medicine, Erie, USA
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Ren C, Zhou A, Zhou J, Zhuo X, Dai L, Tian X, Yang X, Gong S, Ding C, Fang F, Ren X, Zhang W. Encephalitis is an Important Phenotype of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Diseases: A Single-Center Cohort Study. Pediatr Neurol 2024; 152:98-106. [PMID: 38242024 DOI: 10.1016/j.pediatrneurol.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is considered a demyelinating disease of the central nervous system, but an increasing number of encephalitis cases associated with MOG antibodies have been reported recently. METHODS This was a single-center, retrospective study. All data for pediatric patients with MOGAD diagnosed at Beijing Children's Hospital from January 2017 to January 2022 were collected. Clinical characteristics and outcomes were analyzed, and treatment responses were compared between the rituximab (RTX) and mycophenolate mofetil (MMF) groups. RESULTS A total of 190 patients (age range: 5 months to 16 years; median age: 7.2 years; females: 97) were included in this study. The phenotypes of the first attack included acquired demyelinating syndromes (105 [55%]), encephalitis other than acute disseminated encephalomyelitis (82 [43%]), and isolated meningitis (3 [2%]). After a median follow-up of 30.4 months (interquartile range: 14.8-43.7), 64 (34%) patients had relapses. Fifty-one of the 64 (80%) patients who had relapse received maintenance therapy, including MMF (41), RTX (11), maintenance intravenous immunoglobulin (two), and tocilizumab (two). The annualized relapse rates decreased significantly after treatment in both the RTX and MMF cohorts (P < 0.05); however, there were no significant differences between the two groups (P = 0.56). A total of 178 (94%) patients had complete (175 patients) or almost complete (three patients) recovery (modified Rankin scale [mRS] < 2), and 12 had moderate to severe deficits (mRS ≥ 2). CONCLUSIONS The spectrum of pediatric MOGAD is broader than previously reported and includes demyelinating syndromes and encephalitis. Encephalitis is an important initial phenotype observed in pediatric patients with MOGAD.
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Affiliation(s)
- Changhong Ren
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Anna Zhou
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Ji Zhou
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiuwei Zhuo
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lifang Dai
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaojuan Tian
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xinying Yang
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shuai Gong
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Changhong Ding
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaotun Ren
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Weihua Zhang
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.
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Fournel J, Hermier M, Martin A, Gamondès D, Tommasino E, Broussolle T, Morgado A, Baassiri W, Cotton F, Berthezène Y, Bani-Sadr A. It Looks Like a Spinal Cord Tumor but It Is Not. Cancers (Basel) 2024; 16:1004. [PMID: 38473365 DOI: 10.3390/cancers16051004] [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: 02/07/2024] [Revised: 02/23/2024] [Accepted: 02/26/2024] [Indexed: 03/14/2024] Open
Abstract
Differentiating neoplastic from non-neoplastic spinal cord pathologies may be challenging due to overlapping clinical and radiological features. Spinal cord tumors, which comprise only 2-4% of central nervous system tumors, are rarer than non-tumoral myelopathies of inflammatory, vascular, or infectious origins. The risk of neurological deterioration and the high rate of false negatives or misdiagnoses associated with spinal cord biopsies require a cautious approach. Facing a spinal cord lesion, prioritizing more common non-surgical myelopathies in differential diagnoses is essential. A comprehensive radiological diagnostic approach is mandatory to identify spinal cord tumor mimics. The diagnostic process involves a multi-step approach: detecting lesions primarily using MRI techniques, precise localization of lesions, assessing lesion signal intensity characteristics, and searching for potentially associated anomalies at spinal cord and cerebral MRI. This review aims to delineate the radiological diagnostic approach for spinal cord lesions that may mimic tumors and briefly highlight the primary pathologies behind these lesions.
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Affiliation(s)
- Julien Fournel
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Marc Hermier
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Anna Martin
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Delphine Gamondès
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Emanuele Tommasino
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Théo Broussolle
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Alexis Morgado
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Wassim Baassiri
- Department of Spine and Spinal Cord Neurosurgery, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
| | - Francois Cotton
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
- Department of Radiology, South Lyon Hospital, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69495 Pierre-Bénite, France
| | - Yves Berthezène
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
| | - Alexandre Bani-Sadr
- Department of Neuroradiology, East Group Hospital, Hospices Civils de Lyon, 59 Bd Pinel, 69500 Bron, France
- CREATIS Laboratory, CNRS UMR 5220, INSERM U1294, Claude Bernard Lyon I University, 7 Avenue Jean Capelle, 69100 Villeurbanne, France
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Zheng S, Wang Y, Geng J, Liu X, Huo L. Global trends in research on MOG antibody-associated disease: bibliometrics and visualization analysis. Front Immunol 2024; 15:1278867. [PMID: 38370410 PMCID: PMC10869486 DOI: 10.3389/fimmu.2024.1278867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Objective The purpose of this study was to investigate the current research status, focus areas, and developmental trends in the field of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) through an analysis of scientific literature. Methods The relevant research articles on MOGAD published from 1947 to 2022 were retrieved from the Web of Science database. The quantitative output of MOGAD related research articles, their distribution by country/region, data on collaborative publishing, influential authors, high-yield institutions, keywords, hotspots, and development trends were analyzed. Additionally, visual knowledge maps were generated using VOSviewer and Citespace. Results There has been a steady increase in the number of MOGAD related publications indicating that the subject has garnered increasing interest among researchers globally. The United States has been the leading contributor with 496 papers (19.25%), followed by China (244, 9.63%), Japan (183, 7.10%), the United Kingdom (154, 5.98%), and Germany (149, 5.78%). Among these countries, the United Kingdom boasts the highest citation frequency at the rate of 46.49 times per paper. Furthermore, active collaboration in MOGAD related research is observed primarily between the United States and countries such as Canada, Germany, Australia, Italy, the United Kingdom and Japan. Mayo Clinic ranks first in total articles published (109) and frequency of citations per article (77.79). Takahashi Toshiyuki from Tohoku University is the most prolific author, while Multiple Sclerosis and Related Disorders is the most widely read journal in this field. "Disease Phenotype", "Treatment", "Novel Coronavirus Infection and Vaccination", "Immunopathological Mechanisms", "Clinical characteristics of children" and "Prognosis" are the primary keywords clusters in this field. "Novel Coronavirus Infection and Vaccination" and "Immunopathological Mechanisms" are research hotspots and have great development potential. Conclusion The past three decades have witnessed a significant expansion of research on MOGAD. The pathogenetic mechanism of MOGAD is poised to be the prominent research focus in this field in the foreseeable future.
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Affiliation(s)
- Shuhan Zheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Wang
- National Science Library, Chinese Academy of Sciences, Beijing, China
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing, China
| | - Jiaming Geng
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing, China
- Department of Pharmaceutical Biotechnology, China Medical University-The Queen’s University if Belfast Joint College, Shenyang, China
| | - Xueyan Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liang Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Bucur J, Kaiser KP, Biller ML, Jandewerth T, Kenikstul N, Kohnen T. [Bilateral Myelin oligodendrocyte glycoprotein (MOG)antibody-associated optic nerve neuritis]. DIE OPHTHALMOLOGIE 2024; 121:152-156. [PMID: 37934235 DOI: 10.1007/s00347-023-01936-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 08/18/2023] [Accepted: 09/11/2023] [Indexed: 11/08/2023]
Affiliation(s)
- Julian Bucur
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Klemens Paul Kaiser
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Marvin Lucas Biller
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Tyll Jandewerth
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Ninel Kenikstul
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
| | - Thomas Kohnen
- Klinik für Augenheilkunde, Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland
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Huang Y, Luo W, Cheng X, Sun X, Wang Y, Shu Y, Lu Z, Hu X, Qiu W, Kermode A, Zhong X. Clinical and imaging features of patients with late-onset myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Relat Disord 2024; 82:105405. [PMID: 38194895 DOI: 10.1016/j.msard.2023.105405] [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: 09/01/2023] [Revised: 11/12/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND There is an age-dependent change in the clinical phenotype of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). However, the clinical features of late-onset MOGAD have not been well described. METHODS Clinical data of 110 MOGAD patients, including 21 late-onset patients with onset age greater than or equal to 50 years old were retrospectively analyzed. RESULTS Compared to pediatric- and younger adult-onset ones, late-onset MOGAD patients experienced milder disease onset (p < 0.001), more monophasic course (p < 0.001), fewer relapses (p = 0.007), less cerebrospinal fluid leukocytosis (p = 0.021), less longitudinally extensive transverse myelitis (onset p = 0.026, whole course p = 0.028), fewer lesions in basal ganglia (whole course p = 0.012), thalamus (whole course p = 0.040) and cerebellum (whole course p = 0.028). However, they had more cerebral symptoms (p = 0.021 onset and whole course), more lesions in white matter (onset p = 0.005, whole course p < 0.001) and periventricular area (onset p = 0.026), along with longer and delayed therapeutic intervention (p < 0.001). The main differences in clinical characteristics between late-onset patients with and without these brain involvements might be comorbidities. CONCLUSIONS Late-onset MOGAD are more likely to experience delayed diagnosis. Brain involvement may be modulated by comorbidities of the elderly, which alter the clinical manifestations of late-onset MOGAD.
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Affiliation(s)
- Yiying Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjing Luo
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Cheng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Shu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Allan Kermode
- Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia; Institute for Immunology and Infectious Disease, Murdoch University, Perth, Australia.
| | - Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [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] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Gericke FC, Hanson JVM, Hackenberg A, Gerth-Kahlert C. Visual outcome measures in pediatric myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Eur J Paediatr Neurol 2024; 48:113-120. [PMID: 38217965 DOI: 10.1016/j.ejpn.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 12/08/2023] [Accepted: 12/27/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) comprises various age-dependent clinical phenotypes and may be monophasic, multiphasic, or chronic. Optic neuritis (ON) is a common manifestation and frequently appears in combination with other MOGAD phenotypes, particularly in young children. Despite permanent structural damage to the retinal nerve fiber layer (RNFL), children often experience complete visual recovery. AIMS To analyze the progression and impact of MOGAD on the visual system of pediatric patients independently of the history of ON. METHODS This retrospective study included children who met specific criteria: myelin oligodendrocyte glycoprotein (MOG) immunoglobulin G (IgG) seropositivity, acute presentation of MOGAD, and written general consent. Main outcome measures were global peripapillary retinal nerve fiber layer (pRNFL) thickness, and near and distance visual acuity, analyzed using descriptive statistics. RESULTS We identified 10 patients with median age of 7.7 years at first event: 7 patients manifested with acute disseminated encephalomyelitis (ADEM) (with ON 5/7, ADEM only 1/7, with transverse myelitis (TM) 1/7), 2 with isolated ON, and 1 patient with neuromyelitis optica spectrum disorder (NMOSD)-like phenotype with ON. Among ON patients, 5/8 were affected bilaterally, with 3 initially diagnosed with unilateral ON but experiencing subsequent involvement of the fellow eye. None of the patients without previous ON showed a deterioration of visual acuity and, if evaluated, a reduction of the pRNFL. CONCLUSION Most pediatric MOGAD-ON patients in our cohort presented with acute vison loss and optic disc edema. All patients achieved complete visual recovery, independent of number of relapses or initial visual loss. The pRNFL thickness decreased for several months and stabilized at reduced levels after 12 months in the absence of further relapses. MOGAD may not have subclinical/'silent' effects on the visual system, as visual acuity and pRNFL were not affected in patients without ON.
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Affiliation(s)
| | - James V M Hanson
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Annette Hackenberg
- Department of Neuropediatrics, University Children's Hospital Zurich, Switzerland
| | - Christina Gerth-Kahlert
- Department of Ophthalmology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.
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Dayrit KC, Chua-Ley EO. Use of Tocilizumab Followed by Rituximab Desensitization on Relapsing Myelin Oligodendrocyte Antibody Disease: A Case Report. Cureus 2024; 16:e52374. [PMID: 38361670 PMCID: PMC10868627 DOI: 10.7759/cureus.52374] [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: 01/16/2024] [Indexed: 02/17/2024] Open
Abstract
Myelin oligodendrocyte antibody disease is a demyelinating disorder that usually presents with a monophasic course. Relapse in this demyelinating disorder is rare, and those who relapse have a weaker response to standard therapy. In this case report, we report a three-year follow-up on a case of a female patient who was diagnosed with myelin oligodendrocyte antibody disease at 21 years old. The patient initially presented with transverse myelitis followed by optic neuritis five months after the onset of transverse myelitis. On relapse, the patient was initially treated with rituximab only to present with type 1 hypersensitivity reaction. Due to the hypersensitivity reaction, the treatment regimen was shifted to tocilizumab, for which she completed a total of five cycles. With tocilizumab treatment, she was noted to have one relapse of symptoms triggered by COVID-19 infection. However, due to tocilizumab-associated alopecia, the patient was shifted to rituximab infusion with desensitization. She then underwent four cycles of rituximab with desensitization, which she tolerated well, and is now in full remission after the fourth cycle of rituximab with no residual deficits. As relapse in myelin oligodendrocyte antibody disease is rare, studies regarding the use of tocilizumab and rituximab as second-line treatment for this disorder are limited. Literature regarding treatment with rituximab infusion with desensitization is even more limited. This case report highlights the potential use of tocilizumab and rituximab in relapsing cases of myelin oligodendrocyte antibody disease, as well as the need for additional literature regarding the use of tocilizumab and rituximab with or without desensitization in relapse in myelin oligodendrocyte antibody disease.
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Affiliation(s)
- Kelsey C Dayrit
- Section of Neurology, Cardinal Santos Medical Center, San Juan, PHL
- Department of Clinical Neurosciences, University of the East Ramon Magsaysay Memorial Medical Center, Quezon, PHL
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Tisavipat N, Juan HY, Chen JJ. Monoclonal antibody therapies for aquaporin-4-immunoglobulin G-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Saudi J Ophthalmol 2024; 38:2-12. [PMID: 38628414 PMCID: PMC11017007 DOI: 10.4103/sjopt.sjopt_102_23] [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: 05/06/2023] [Accepted: 08/20/2023] [Indexed: 04/19/2024] Open
Abstract
Monoclonal antibody therapies mark the new era of targeted treatment for relapse prevention in aquaporin-4 (AQP4)-immunoglobulin G (IgG)-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD). For over a decade, rituximab, an anti-CD20 B-cell-depleting agent, had been the most effectiveness treatment for AQP4-IgG+NMOSD. Tocilizumab, an anti-interleukin-6 receptor, was also observed to be effective. In 2019, several randomized, placebo-controlled trials were completed that demonstrated the remarkable efficacy of eculizumab (anti-C5 complement inhibitor), inebilizumab (anti-CD19 B-cell-depleting agent), and satralizumab (anti-interleukin-6 receptor), leading to the Food and Drug Administration (FDA) approval of specific treatments for AQP4-IgG+NMOSD for the first time. Most recently, ravulizumab (anti-C5 complement inhibitor) was also shown to be highly efficacious in an open-label, external-controlled trial. Although only some patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) warrant immunotherapy, there is currently no FDA-approved treatment for relapse prevention in MOGAD. Observational studies showed that tocilizumab was associated with a decrease in relapses, whereas rituximab seemed to have less robust effectiveness in MOGAD compared to AQP4-IgG+NMOSD. Herein, we review the evidence on the efficacy and safety of each monoclonal antibody therapy used in AQP4-IgG+NMOSD and MOGAD, including special considerations in children and women of childbearing potential.
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Affiliation(s)
| | - Hui Y. Juan
- Virginia Commonwealth University School of Medicine, Richmond, VA, United States
| | - John J. Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
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Keehn CC, Yazdian A, Hunt PJ, Davila-Siliezar P, Laylani NA, Lee AG. Monoclonal antibodies in neuro-ophthalmology. Saudi J Ophthalmol 2024; 38:13-24. [PMID: 38628411 PMCID: PMC11017005 DOI: 10.4103/sjopt.sjopt_256_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/12/2023] [Accepted: 11/14/2023] [Indexed: 04/19/2024] Open
Abstract
Neuro-ophthalmologic diseases include a broad range of disorders affecting the afferent and efferent visual pathways. Recently, monoclonal antibody (mAb) therapies have emerged as a promising targeted approach in the management of several of these complex conditions. Here, we describe the mechanism-specific applications and advancements in neuro-ophthalmologic mAb therapies. The application of mAbs in neuro-ophthalmologic diseases highlights our increasing understanding of disease-specific mechanisms in autoimmune conditions such as neuromyelitis optica, thyroid eye disease, and myasthenia gravis. Due to the specificity of mAb therapies, applications in neuro-ophthalmologic diseases have yielded exceptional clinical outcomes, including both reduced rate of relapse and progression to disability, visual function preservation, and quality of life improvement. These advancements have not only expanded the range of treatable neuro-ophthalmologic diseases but also reduced adverse events and increased the response rate to treatment. Further research into neuro-ophthalmologic disease mechanisms will provide accurate and specific targeting of important disease mediators through applications of future mAbs. As our understanding of these diseases and the relevant therapeutic targets evolve, we will continue to build on our understanding of how mAbs interfere with disease pathogenesis, and how these changes improve clinical outcomes and quality of life for patients.
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Affiliation(s)
- Caroline C. Keehn
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Arman Yazdian
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Patrick J. Hunt
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
| | - Pamela Davila-Siliezar
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
| | - Noor A. Laylani
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
| | - Andrew G. Lee
- Department of Ophthalmology, Baylor College of Medicine, Houston, USA
- Department of Ophthalmology, Blanton Eye Institute, Houston Methodist Hospital, Houston, USA
- Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, USA
- Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medicine, New York, USA
- Department of Ophthalmology, University of Texas Medical Branch, Galveston, USA
- Department of Ophthalmology, Texas A and M College of Medicine, Bryan, Texas, USA
- Department of Ophthalmology, University of Buffalo, Buffalo, NY, USA
- Department of Ophthalmology, The University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Forcadela M, Rocchi C, San Martin D, Gibbons EL, Wells D, Woodhall MR, Waters PJ, Huda S, Hamid S. Timing of MOG-IgG Testing Is Key to 2023 MOGAD Diagnostic Criteria. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200183. [PMID: 37977848 PMCID: PMC10758949 DOI: 10.1212/nxi.0000000000200183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/14/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a recently identified autoimmune demyelinating disorder of the CNS affecting both adults and children. Diagnostic criteria for MOGAD have recently been published. We aimed to validate the 2023 MOGAD diagnostic criteria in a real-world cohort of patients with atypical CNS inflammation. METHODS All patients referred to the National neuromyelitis optica spectrum disorder (NMOSD) specialized service at The Walton Center NHS Foundation Trust between 2012 and 2023 with an atypical demyelinating syndrome were evaluated. We systematically applied the 2023 MOGAD diagnostic criteria and previous 2018 International Diagnostic Recommendations for MOG encephalomyelitis to our retrospective cohort. RESULTS 474 patients were screened and 66 were excluded for lack of clinical information. Preexisting diagnoses within our cohort included the following: MOGAD, n = 127; AQP4-IgG NMOSD, n = 125; seronegative NMOSD, n = 33; multiple sclerosis (MS), n = 10; and other diagnoses, n = 113. Of patients with preexisting MOGAD, 97% (123/127) fulfilled the 2023 MOGAD diagnostic criteria. Three patients with a low-positive MOG-IgG did not meet supportive features though 2/3 had insufficient investigations. Alternative diagnoses could not be excluded in 1 patient with MS-MOGAD overlap. No patients with a non-MOGAD diagnosis were found to fulfill the 2023 diagnostic criteria. The sensitivity and specificity of the 2023 MOGAD diagnostic criteria were 97% and 100% with no false positives, improving on 2018 International Diagnostic Recommendations for MOG encephalomyelitis. Low-positive MOG-IgG results were more often associated with a longer time from disease onset to sampling (p < 0.001). In addition, in patients with a MOG-IgG1 test within 6 months of clinical onset, approximately 25% can become low positive by 6 months. Of patients with preexisting MOGAD, 9% (12/127) had insufficient investigations and examinations to fully evaluate additional supportive features. However, in those who were completely evaluated, supportive features were fulfilled in 97% (111/115). DISCUSSION The 2023 MOGAD diagnostic criteria were highly sensitive and specific and closely align with historically established cases of MOGAD. However, because additional supportive features are stipulated for patients with a low-positive MOG-IgG result, missed diagnoses may occur due to delayed testing or insufficient investigations.
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Affiliation(s)
- Mirasol Forcadela
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Chiara Rocchi
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Daniel San Martin
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Emily L Gibbons
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Daniel Wells
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Mark R Woodhall
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Patrick J Waters
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Saif Huda
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom
| | - Shahd Hamid
- From the The Walton Centre NHS Foundation Trust (M.F., C.R., D.S.M., E.L.G., D.W., Saif Huda, Shahd Hamid), Liverpool; and Oxford Autoimmune Neurology Group (M.R.W., P.J.W.), Nuffield Department of Clinical Neurosciences, University of Oxford, United Kingdom.
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Chaumont H, Bérard N, Karam JP, Lobjois Q, Tressieres B, Signate A, Lannuzel A, Cabre P. Mitoxantrone in NMO Spectrum Disorder in a Large Multicenter Cohort in French Caribbean. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200175. [PMID: 37949668 PMCID: PMC10691227 DOI: 10.1212/nxi.0000000000200175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 08/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Preventing relapses in neuromyelitis Optica spectrum disorder (NMOSD) is a primary goal. New effective molecules are often expensive and not readily available in regions with fragile health systems. Assessing the efficacy and safety of less costly therapeutic alternatives is necessary. We aim to evaluate the efficacy and safety of mitoxantrone (MiTX) in NMOSD. METHODS This is an observational, multicenter, open study of 86 NMOSD-treated patients with prospective follow-up over 30 years. The first endpoint was the first relapse at the 96-week follow-up. The secondary endpoints were to evaluate the median delay to relapse, the annualized relapse rate (ARR), and the Expanded Disability Status Scale (EDSS) at 96 weeks of follow-up and to assess risk factors of relapse and the occurrence of severe adverse effects. RESULTS At 96-week follow-up, 71% of our patients were relapse-free, and it was 87% when patients were treated with MiTX from the first attack. The ARR dropped from 0.85 (±0.55) to 0.32 (±0.63) (p < 0.001) and EDSS from 4.9 (±2.4) to 4.2 (±2.6) (p < 0.001). AQP4-IgG seropositivity (hazard ratio [HR] 12.3, 95% CI 1.64-91.6, p = 0.015), a delay between the first attack and MiTX ≥24 months (HR 2.76, 95% CI 1.23-6.17, p = 0.014), and a pretreatment ARR ≥1 (HR 2.38, 95% CI 1.05-5.39, p = 0.037) were predictors of relapse. During the entire follow-up, severe secondary adverse events occurred in 3 patients (3.5%). DISCUSSION MiTX is an effective and safe treatment for most of our patients, drastically less expensive than new molecules, and could be allowed in NMOSD Afro-descendant patients in geographical areas where access to care is difficult.
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Affiliation(s)
- Hugo Chaumont
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France.
| | - Nicolas Bérard
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Jean-Pierre Karam
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Quentin Lobjois
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Benoit Tressieres
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Aissatou Signate
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Annie Lannuzel
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
| | - Philippe Cabre
- From the Department of Neurology (H.C., N.B., J.-P.K., A.L.), University Hospital of Guadeloupe; Faculté de Médecine de l'Université des Antilles (H.C., N.B., J.-P.K., A.L., P.C.), French West Indies, Pointe-à-Pitre; Faculté de Médecine de Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, U 1127, CNRS, Unité Mixte de Recherche (UMR) 7225 (H.C., A.L.), Institut du Cerveau, ICM, Paris; Department of Neurology (Q.L., A.S., P.C.), Pierre Zobda-Quitman University Hospital; and Centre d'investigation Clinique Antilles Guyane, Inserm CIC 1424 (B.T., A.L.), University Hospital of Guadeloupe, Pointe-à-Pitre/Abymes, French West Indies, France
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Budhram A, Sechi E. Antibodies to neural cell surface and synaptic proteins in paraneoplastic neurologic syndromes. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:347-364. [PMID: 38494289 DOI: 10.1016/b978-0-12-823912-4.00006-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Among patients with paraneoplastic neurologic syndromes (PNS), emphasis has historically been placed on neural antibodies against intracellular proteins that have a strong association with malignancy. Because of the intracellular location of their antigenic targets, these antibodies are typically considered to be non-pathogenic surrogate markers of immune cell-mediated neural injury. Unfortunately, patients with these antibodies often have suboptimal response to immunotherapy and poor prognosis. Over the last two decades, however, dramatic advancements have been made in the discovery and clinical characterization of neural antibodies against extracellular targets. These antibodies are generally considered to be pathogenic, given their potential to directly alter antigen structure or function, and patients with these antibodies often respond favorably to prompt immunotherapy. These antibodies also associate with tumors and may thus occur as PNS, albeit more variably than neural antibodies against intracellular targets. The updated 2021 PNS diagnostic criteria, which classifies antibodies as high-risk, intermediate-risk, or lower-risk for an associated cancer, better clarifies how neural antibodies against extracellular targets relate to PNS. Using this recently created framework, the clinical presentations, ancillary test findings, oncologic associations, and treatment responses of syndromes associated with these antibodies are discussed.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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Seok JM, Waters P, Jeon MY, Lee HL, Baek SH, Park JS, Kang SY, Kwon O, Oh J, Kim BJ, Park KA, Oh SY, Kim BJ, Min JH. Clinical Usefulness of a Cell-based Assay for Detecting Myelin Oligodendrocyte Glycoprotein Antibodies in Central Nervous System Inflammatory Disorders. Ann Lab Med 2024; 44:56-63. [PMID: 37665286 PMCID: PMC10485852 DOI: 10.3343/alm.2024.44.1.56] [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: 02/13/2023] [Revised: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 09/05/2023] Open
Abstract
Background The clinical implications of myelin oligodendrocyte glycoprotein autoantibodies (MOG-Abs) are increasing. Establishing MOG-Ab assays is essential for effectively treating patients with MOG-Abs. We established an in-house cell-based assay (CBA) to detect MOG-Abs to identify correlations with patients' clinical characteristics. Methods We established the CBA using HEK 293 cells transiently overexpressing full-length human MOG, tested it against 166 samples from a multicenter registry of central nervous system (CNS) inflammatory disorders, and compared the results with those of the Oxford MOG-Ab-based CBA and a commercial MOG-Ab CBA kit. We recruited additional patients with MOG-Abs and compared the clinical characteristics of MOG-Ab-associated disease (MOGAD) with those of neuromyelitis optica spectrum disorder (NMOSD). Results Of 166 samples tested, 10 tested positive for MOG-Abs, with optic neuritis (ON) being the most common manifestation (4/15, 26.7%). The in-house and Oxford MOG-Ab CBAs agreed for 164/166 (98.8%) samples (κ=0.883, P<0.001); two patients (2/166, 1.2%) were only positive in our in-house CBA, and the CBA scores of the two laboratories correlated well (r=0.663, P<0.001). The commercial MOG-Ab CBA kit showed one false-negative and three false-positive results. The clinical presentation at disease onset differed between MOGAD and NMOSD; ON was the most frequent manifestation in MOGAD, and transverse myelitis was most frequent in NMOSD. Conclusions The in-house CBA for MOG-Abs demonstrated reliable results and can potentially be used to evaluate CNS inflammatory disorders. A comprehensive, long-term study with a large patient population would clarify the clinical significance of MOG-Abs.
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Affiliation(s)
- Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Mi Young Jeon
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, Korea
| | - Hye Lim Lee
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Seol-Hee Baek
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jin-Sung Park
- Department of Neurology, Kyungpook National University Chilgok Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sa-Yoon Kang
- Department of Neurology, Jeju National University School of Medicine, Jeju, Korea
| | - Ohyun Kwon
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju-Hong Min
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, Korea
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Korea
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Martin K, Srikanth P, Kanwar A, Falardeau J, Pettersson D, Yadav V. Clinical and radiographic features of a cohort of adult and pediatric subjects in the Pacific Northwest with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Mult Scler Relat Disord 2024; 81:105130. [PMID: 37979410 PMCID: PMC10842716 DOI: 10.1016/j.msard.2023.105130] [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: 06/12/2023] [Revised: 10/25/2023] [Accepted: 11/05/2023] [Indexed: 11/20/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a newly described clinical entity comprised of isolated or recurrent attacks of optic neuritis, transverse myelitis, acute disseminated encephalomyelitis (ADEM), encephalitis, or seronegative NMOSD. Prior studies report that 30-80 % of children and adults with MOGAD go on to have relapses though there are no reliable predictors. The objectives of this study were to (1) describe the demographic, clinical, and radiographic patterns of MOGAD at our center and (2) identify possible predictors of relapsing disease. METHODS Single-center retrospective cohort study of pediatric and adult subjects with MOGAD evaluated at least once at our center between January 1, 2017 and September 30, 2022. Eligible subjects had a history of positive MOG-IgG and consistent clinical syndrome comprised of an initial attack of optic neuritis (ON), transverse myelitis (TM), ADEM, cerebral cortical encephalitis, seronegative neuromyelitis optica (simultaneous ON and TM), isolated brainstem or cerebellar syndrome, or other (not fitting into another group). Relapsing subjects or those remaining monophasic at 12 months were included in the analyses of predictors of relapsing disease. Covariates included age, sex, race/ethnicity, and index event phenotype. Unadjusted and adjusted risk ratios were calculated for pediatric and adult subjects. RESULTS We describe the demographic, clinical, and radiographic characteristics of 58 subjects with MOGAD. Covariates from 48 subjects were analyzed for predictors of relapsing disease. In adults, Hispanics and non-White non-Hispanics were at increased risk of relapsing disease compared to non-Hispanic Whites [Adjusted RR 1.52 (95 % CI: 1.01, 2.30)]. There were no significant associations in the pediatric group. CONCLUSION This study is the first to describe a cohort of MOGAD in the Pacific Northwest. Our findings highlight racial and ethnic differences in risk of relapsing MOGAD in adults. Further studies on racial and ethnic differences in MOGAD are needed to confirm these findings.
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Affiliation(s)
- Kayla Martin
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Veterans Affairs MS Center of Excellence-West, Portland, OR, USA
| | - Priya Srikanth
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Anand Kanwar
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Julie Falardeau
- Department of Ophthalmology, Oregon Health & Science University, Portland, OR, USA
| | - David Pettersson
- Department of Diagnostic Radiology, Oregon Health & Science University, Portland, OR, USA
| | - Vijayshree Yadav
- Department of Neurology, Oregon Health & Science University, Portland, OR, USA; Department of Veterans Affairs MS Center of Excellence-West, Portland, OR, USA.
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Oertel FC, Hastermann M, Paul F. Delimiting MOGAD as a disease entity using translational imaging. Front Neurol 2023; 14:1216477. [PMID: 38333186 PMCID: PMC10851159 DOI: 10.3389/fneur.2023.1216477] [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: 05/03/2023] [Accepted: 08/23/2023] [Indexed: 02/10/2024] Open
Abstract
The first formal consensus diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) were recently proposed. Yet, the distinction of MOGAD-defining characteristics from characteristics of its important differential diagnoses such as multiple sclerosis (MS) and aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (NMOSD) is still obstructed. In preclinical research, MOG antibody-based animal models were used for decades to derive knowledge about MS. In clinical research, people with MOGAD have been combined into cohorts with other diagnoses. Thus, it remains unclear to which extent the generated knowledge is specifically applicable to MOGAD. Translational research can contribute to identifying MOGAD characteristic features by establishing imaging methods and outcome parameters on proven pathophysiological grounds. This article reviews suitable animal models for translational MOGAD research and the current state and prospect of translational imaging in MOGAD.
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Affiliation(s)
- Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Hastermann
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Sacco S, Virupakshaiah A, Papinutto N, Schoeps VA, Akula A, Zhao H, Arona J, Stern WA, Chong J, Hart J, Zamvil SS, Sati P, Henry RG, Waubant E. Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2023; 29:1736-1747. [PMID: 37897254 PMCID: PMC10687802 DOI: 10.1177/13524585231204414] [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: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and pediatric-onset multiple sclerosis (POMS) share clinical and magnetic resonance imaging (MRI) features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCLs) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD. METHODS T2-FLAIR and SbI (three-dimensional echoplanar imaging (3D-EPI)/susceptibility-weighted imaging (SWI) or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS-positive rate (%CVS+), and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCLs were identified using a consensual approach. RESULTS The %CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC = 1, p < 0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1±2.3, range 1-10), discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%). CONCLUSION The %CVS+ and PRLs are highly specific markers of POMS. After proper validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.
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Affiliation(s)
- Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akash Virupakshaiah
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Vinicius A Schoeps
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amit Akula
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Haojun Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Arona
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Chong
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janace Hart
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pascal Sati
- Neuroimaging Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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