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Greco G, Colombo E, Gastaldi M, Ahmad L, Tavazzi E, Bergamaschi R, Rigoni E. Beyond Myelin Oligodendrocyte Glycoprotein and Aquaporin-4 Antibodies: Alternative Causes of Optic Neuritis. Int J Mol Sci 2023; 24:15986. [PMID: 37958968 PMCID: PMC10649355 DOI: 10.3390/ijms242115986] [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: 10/02/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Optic neuritis (ON) is the most common cause of vision loss in young adults. It manifests as acute or subacute vision loss, often accompanied by retrobulbar discomfort or pain during eye movements. Typical ON is associated with Multiple Sclerosis (MS) and is generally mild and steroid-responsive. Atypical forms are characterized by unusual features, such as prominent optic disc edema, poor treatment response, and bilateral involvement, and they are often associated with autoantibodies against aquaporin-4 (AQP4) or Myelin Oligodendrocyte Glycoprotein (MOG). However, in some cases, AQP4 and MOG antibodies will return as negative, plunging the clinician into a diagnostic conundrum. AQP4- and MOG-seronegative ON warrants a broad differential diagnosis, including autoantibody-associated, granulomatous, and systemic disorders. These rare forms need to be identified promptly, as their management and prognosis are greatly different. The aim of this review is to describe the possible rarer etiologies of non-MS-related and AQP4- and MOG-IgG-seronegative inflammatory ON and discuss their diagnoses and treatments.
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Affiliation(s)
- Giacomo Greco
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Matteo Gastaldi
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Lara Ahmad
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Eleonora Tavazzi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Eleonora Rigoni
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
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Chidobem IJ, Alrobaian MA, Wang Y, Vizcaino MA, Saidha S, Henderson AD. Recurrent Optic Neuritis Associated With Sarcoma. J Neuroophthalmol 2022; 42:e297-e299. [PMID: 34001738 DOI: 10.1097/wno.0000000000001268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ikechukwu J Chidobem
- Division of Neuroimmunology (IJC, YW, SS), Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Neuro-Ophthalmology (MA, ADH), Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland; Division of Ophthalmology (MA), King Abdulaziz Medical City, Riyadh, Saudi Arabia ; and Department of Pathology (MAV), Johns Hopkins University School of Medicine, Baltimore, Maryland
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3
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Naides SJ. The role of the laboratory in the expanding field of neuroimmunology: Autoantibodies to neural targets. J Immunol Methods 2018; 463:1-20. [PMID: 30300607 DOI: 10.1016/j.jim.2018.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Accepted: 04/12/2018] [Indexed: 12/15/2022]
Abstract
Accelerated identification of autoantibodies associated with previously idiopathic neurological disease has provided insights into disease mechanisms, enhanced understanding of neurological function, and opportunities for improved therapeutic interventions. The role of the laboratory in the expanding field of neuroimmunology is critical as specific autoantibody identification provides guidance to clinicians in diagnosis, prognosis, tumor search strategies, and therapeutic interventions. The number of specific autoantibodies identified continues to increase and newer testing strategies increase efficiencies in the laboratory and availability to clinicians. The need for broadly targeted efficient testing is underscored by the variability in clinical presentation and tumor associations attributable to a specific autoantibody, and conversely the various autoantibody specificities that can be the cause of a given clinical presentation. While many of the antineural antibodies were first recognized in the setting of neoplastic disease, idiopathic autoimmune neurological disease in the absence of underlying tumor is increasingly recognized. Appropriation of therapeutic modalities used to treat autoimmune disease to treat these autoantibody mediated neurological diseases has improved patient outcomes. Interaction between clinicians and laboratorians is critical to our understanding of these diseases and optimization of the clinical benefits of our increasing knowledge in neuroimmunology.
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Affiliation(s)
- Stanley J Naides
- Immunology R&D, Quest Diagnostics Nichols Institute, 33608 Ortega Highway, San Juan Capistrano, CA 92675, USA.
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Bentea G, Sculier C, Grigoriu B, Meert AP, Durieux V, Berghmans T, Sculier JP. Autoimmune paraneoplastic syndromes associated to lung cancer: A systematic review of the literature: Part 3: Neurological paraneoplastic syndromes, involving the central nervous system. Lung Cancer 2017; 106:83-92. [PMID: 28285700 DOI: 10.1016/j.lungcan.2017.01.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The development of new immune treatment in oncology and particularly for lung cancer may induce new complications, particularly activation or reactivation of auto-immune diseases. In this context, a systematic review on the auto-immune paraneoplastic syndromes that can complicate lung cancer appears useful. This article is the third of a series of five and deals mainly with neurological paraneoplastic syndromes involving the central nervous system.
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Affiliation(s)
- Georgiana Bentea
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Claudine Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Bogdan Grigoriu
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium
| | - Anne-Pascale Meert
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Valérie Durieux
- Bibliothèque des Sciences de la Santé, Université libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Thierry Berghmans
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium
| | - Jean-Paul Sculier
- Service des Soins Intensifs et Urgences Oncologiques & Thoracic Oncology, Institut Jules Bordet, Centre des Tumeurs de l'Université Libre de Bruxelles (ULB), Belgium; Laboratoire facultaire de Médecine factuelle (ULB), Belgium.
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Igarashi N, Sawamura H, Kaburaki T, Aihara M. Anti-Collapsing Response-Mediating Protein-5 Antibody-Positive Paraneoplastic Perioptic Neuritis without Typical Neurological Symptoms. Neuroophthalmology 2016; 41:24-29. [PMID: 28228834 DOI: 10.1080/01658107.2016.1241283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 09/20/2016] [Accepted: 09/22/2016] [Indexed: 01/26/2023] Open
Abstract
A 68-year-old male presented with blurred vision in both eyes. Ophthalmoscopy revealed bilateral prominent disc swelling and vitritis. No systematic neurological symptoms were observed. Magnetic resonance imaging revealed bilateral meningeal enhancement of the optic nerve. Small cell carcinoma was found, and antibodies against collapsing response-mediating protein-5 (CRMP-5) were detected in the serum. Ophthalmological manifestations disappeared during a decrease in tumour size with treatment for the malignancy. This case report describes this rare case of anti-CRMP-5 antibody-positive paraneoplastic perioptic neuritis without neurological symptoms, showing that prompt diagnosis and timely treatment of the underlying tumour are crucial to prevent increased levels of autoantibodies and irreversible damage to the nervous system.
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Affiliation(s)
- Nozomi Igarashi
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Hiromasa Sawamura
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Toshikatsu Kaburaki
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
| | - Makoto Aihara
- Department of Ophthalmology, Graduate School of Medicine, The University of Tokyo , Tokyo, Japan
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Gaier ED, Boudreault K, Rizzo JF, Falardeau J, Cestari DM. Atypical Optic Neuritis. Curr Neurol Neurosci Rep 2015; 15:76. [DOI: 10.1007/s11910-015-0598-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Paraneoplastic optic neuropathy and retinopathy associated with colon adenocarcinoma. Can J Ophthalmol 2013; 48:e116-20. [PMID: 24093201 DOI: 10.1016/j.jcjo.2013.03.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Revised: 03/09/2013] [Accepted: 03/11/2013] [Indexed: 11/22/2022]
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8
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Slamovits TL, Posner JB, Reidy DL, Thirkill CE, Keltner JL. Pancreatic neuroendocrine paraneoplastic optic neuropathy: confirmation with antibody to optic nerve and hepatic metastasis. J Neuroophthalmol 2012; 33:21-5. [PMID: 22926698 DOI: 10.1097/wno.0b013e3182699b2a] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 68-year-old woman presented with bilateral visual loss as the only clinical manifestation of an occult pancreatic nonsecretory neuroendocrine tumor (NET). The suspected diagnosis of paraneoplastic optic neuropathy was confirmed using immunofluorescence assays to demonstrate the presence of antibodies in the patient's serum that reacted with antigen(s) in the optic nerve and in the pancreatic NET hepatic metastasis. Treatment of the underlying cancer was followed by marked improvement in visual function.
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Affiliation(s)
- Thomas L Slamovits
- Department of Ophthalmology, Neurology and Neurosurgery, Albert Einstein College of Medicine, Bronx, NY, USA.
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Syndrome neurologique paranéoplasique à anticorps anti-CV2/CRMP5 révélateur d’un cancer bronchique à petites cellules. Efficacité du traitement du cancer bronchique. Rev Neurol (Paris) 2012; 168:371-4. [DOI: 10.1016/j.neurol.2011.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 06/27/2011] [Accepted: 07/05/2011] [Indexed: 11/17/2022]
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Saloustros E, Zaganas I, Mavridis M, Vamvakas L, Plaitakis A, Georgoulias V, Mavroudis D. Anti-CV2 associated cerebellar degeneration after complete response to chemoradiation of head and neck carcinoma. J Neurooncol 2009; 97:291-4. [PMID: 19798470 DOI: 10.1007/s11060-009-0022-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 09/21/2009] [Indexed: 12/11/2022]
Abstract
Paraneoplastic cerebellar degeneration is a rare neurological disorder that frequently precedes the detection of malignancy. Here, we report the case of a 60 year-old woman with locally advanced squamous cell carcinoma of the tongue who developed a subacute cerebellar syndrome associated with the presence of anti-CV2/CRMP5 antibodies in the cerebrospinal fluid, after achieving complete remission of the primary tumor and the involved cervical lymph nodes by chemoradiation. The patient's symptoms on presentation were dizziness and gait unsteadiness. On examination she showed dysarthria, nystagmus and limb and gait ataxia. The diagnosis of paraneoplastic cerebellar syndrome was made on the basis of the clinical findings and immunological testing that revealed the presence of anti-CV2/CRMP5 antibodies in the patient's cerebrospinal fluid. This syndrome, which is very rare in association with head and neck cancer, commonly precedes the detection of malignancy by a year or more and has been documented in only a few cases after completion of anticancer treatment.
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Affiliation(s)
- Emmanouel Saloustros
- Department of Medical Oncology, University Hospital of Heraklion, Voutes, 71110, Heraklion, Crete, Greece
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High-Titer Collapsin Response-Mediating Protein-Associated (CRMP-5) Paraneoplastic Optic Neuropathy and Vitritis as the Only Clinical Manifestations in a Patient With Small Cell Lung Carcinoma. J Neuroophthalmol 2008; 28:17-22. [DOI: 10.1097/wno.0b013e3181675479] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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