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Clarke L, Arnett S, Bukhari W, Khalilidehkordi E, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy DA, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw CP, Spies JM, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AGK, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12:722237. [PMID: 34566866 PMCID: PMC8458658 DOI: 10.3389/fneur.2021.722237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Cella Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Cameron P Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith M Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Allan G K Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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Abbatemarco JR, Galli JR, Sweeney ML, Carlson NG, Samara VC, Davis H, Rodenbeck S, Wong KH, Paz Soldan MM, Greenlee JE, Rose JW, Delic A, Clardy SL. Modern Look at Transverse Myelitis and Inflammatory Myelopathy: Epidemiology of the National Veterans Health Administration Population. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/6/e1071. [PMID: 34465615 PMCID: PMC8409131 DOI: 10.1212/nxi.0000000000001071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/22/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVES To characterize population-level data associated with transverse myelitis (TM) within the US Veterans Health Administration (VHA). METHODS This retrospective review used VHA electronic medical record from 1999 to 2015. We analyzed prevalence, disease characteristics, modified Rankin Scale (mRS) scores, and mortality data in patients with TM based on the 2002 Diagnostic Criteria. RESULTS We identified 4,084 patients with an International Classification of Diseases (ICD) code consistent with TM and confirmed the diagnosis in 1,001 individuals (90.7% males, median age 64.2, 67.7% Caucasian, and 31.4% smokers). The point prevalence was 7.86 cases per 100,000 people. Less than half of the cohort underwent a lumbar puncture, whereas only 31.8% had a final, disease-associated TM diagnosis. The median mRS score at symptom onset was 3 (interquartile range 2-4), which remained unchanged at follow-up, although less than half (43.2%) of the patients received corticosteroids, IVIg, or plasma exchange. Approximately one-quarter of patients (24.3%) had longitudinal extensive TM, which was associated with poorer outcomes (p = 0.002). A total of 108 patients (10.8%) died during our review (94.4% males, median age 66.5%, and 70.4% Caucasian). Mortality was associated with a higher mRS score at follow-up (OR 1.94, 95% CI, 1.57-2.40) and tobacco use (OR 1.87, 95% CI, 1.17-2.99). DISCUSSION This national TM review highlights the relatively high prevalence of TM in a modern cohort. It also underscores the importance of a precise and thorough workup in this disabling disorder to ensure diagnostic precision and ensure optimal management for patients with TM in the future.
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Affiliation(s)
- Justin R Abbatemarco
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Jonathan R Galli
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Michael L Sweeney
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Noel G Carlson
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Verena C Samara
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Haley Davis
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Stefanie Rodenbeck
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Ka-Ho Wong
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - M Mateo Paz Soldan
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - John E Greenlee
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - John W Rose
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Alen Delic
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC
| | - Stacey L Clardy
- From the Department of Neurology (J.R.A., J.R.G., M.L.S., N.G.C., S.R., K.-H.W., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), University of Utah, Salt Lake City; George E. Wahlen Veterans Affairs Medical Center (J.R.G., N.G.C., M.M.P.S., J.E.G., J.W.R., A.D., S.L.C.), Salt Lake City, UT; Department of Neurobiology (N.G.C.), University of Utah, Salt Lake City; PeaceHealth Neurology (V.C.S.), Springfield, OR; and Department of Pathology (H.D.), Duke University Hospital, Durham, NC.
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Clarke L, Arnett S, Lilley K, Liao J, Bhuta S, Broadley SA. Magnetic resonance imaging in neuromyelitis optica spectrum disorder. Clin Exp Immunol 2021; 206:251-265. [PMID: 34080180 DOI: 10.1111/cei.13630] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system (CNS) associated with antibodies to aquaporin-4 (AQP4), which has distinct clinical, radiological and pathological features, but also has some overlap with multiple sclerosis and myelin oligodendrocyte glycoprotein (MOG) antibody associated disease. Early recognition of NMOSD is important because of differing responses to both acute and preventive therapy. Magnetic resonance (MR) imaging has proved essential in this process. Key MR imaging clues to the diagnosis of NMOSD are longitudinally extensive lesions of the optic nerve (more than half the length) and spinal cord (three or more vertebral segments), bilateral optic nerve lesions and lesions of the optic chiasm, area postrema, floor of the IV ventricle, periaqueductal grey matter, hypothalamus and walls of the III ventricle. Other NMOSD-specific lesions are denoted by their unique morphology: heterogeneous lesions of the corpus callosum, 'cloud-like' gadolinium (Gd)-enhancing white matter lesions and 'bright spotty' lesions of the spinal cord. Other lesions described in NMOSD, including linear periventricular peri-ependymal lesions and patch subcortical white matter lesions, may be less specific. The use of advanced MR imaging techniques is yielding further useful information regarding focal degeneration of the thalamus and optic radiation in NMOSD and suggests that paramagnetic rim patterns and changes in normal appearing white matter are specific to MS. MR imaging is crucial in the early recognition of NMOSD and in directing testing for AQP4 antibodies and guiding immediate acute treatment decisions. Increasingly, MR imaging is playing a role in diagnosing seronegative cases of NMOSD.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Kate Lilley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Jacky Liao
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Radiology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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Murphy OC, Mukharesh L, Salazar-Camelo A, Pardo CA, Newsome SD. Early factors associated with later conversion to multiple sclerosis in patients presenting with isolated myelitis. J Neurol Neurosurg Psychiatry 2021; 92:jnnp-2020-325274. [PMID: 33687973 DOI: 10.1136/jnnp-2020-325274] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 02/09/2021] [Accepted: 02/10/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To identify early clinical and paraclinical factors that may help predict later conversion to multiple sclerosis (MS) in patients presenting with isolated myelitis (ie, 'transverse myelitis' without clinical or radiological evidence of inflammation/demyelination elsewhere in the central nervous system). METHODS In this retrospective cohort study, we included patients with isolated myelitis who were followed clinically and radiologically at our specialised myelopathy clinic. We excluded patients with MS at the onset, aquaporin-4-IgG seropositivity, myelin oligodendrocyte glycoprotein-IgG seropositivity or other identified aetiology. Logistic regression was used to identify factors predictive of conversion to MS (defined by the 2017 McDonald criteria). RESULTS We included 100 patients, followed for a median of 4.3 years. Conversion to MS occurred in 25 of 77 patients (32%) with short-segment myelitis (longest lesion spanning <3 vertebral segments on MRI) as compared with 0 of 23 patients (0%) with longitudinally extensive myelitis (p=0.002). Among patients with short-segment myelitis, factors identified as highly predictive of conversion to MS using multivariate logistic regression included cerebrospinal fluid (CSF)-restricted oligoclonal bands (OCB) (OR (OR) 9.2, 95% CI 2.1 to 41.0, p=0.004), younger age (OR 1.1 for each year younger, 95% CI 1.0 to 1.1, p=0.04) and longer follow-up (OR 1.3 for each year longer, 95% CI 1.0 to 1.6, p=0.04). Conversion to MS occurred at a median of 2.8 years after myelitis onset. CONCLUSIONS Short-segment MRI cord lesion(s), CSF-restricted OCB, younger age and longer follow-up are all factors predictive of conversion to MS in patients presenting with isolated myelitis.
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Affiliation(s)
- Olwen C Murphy
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Loulwah Mukharesh
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Andrea Salazar-Camelo
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Carlos A Pardo
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
| | - Scott D Newsome
- Johns Hopkins Myelitis and Myelopathy Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
- Johns Hopkins Multiple Sclerosis Center, Department of Neurology, Johns Hopkins Hospital, Baltimore, MD, USA
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Liang J, Liu J, Gu M, Zhu C, Xu X, Fan R, Peng F, Jiang Y. Clinical Characteristics of Chinese Male Patients with Aquaporin-4 Antibody-Positive Late-Onset Neuromyelitis Optica Spectrum Disorder. Neuroimmunomodulation 2021; 28:61-67. [PMID: 33946074 DOI: 10.1159/000515555] [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: 10/29/2020] [Accepted: 02/23/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Limited studies are available for male patients with anti-aquaporin-4 antibody (AQP4-Ab)-positive late-onset neuromyelitis optica spectrum disease (LONMOSD). The aim of this study was to investigate the clinical characteristics of Chinese male patients with AQP4-Ab-positive LONMOSD. METHODS We retrospectively reviewed the medical records of 12 male patients with LONMOSD, 16 male patients with early-onset NMOSD (EONMOSD), and 64 female patients with LONMOSD. These enrolled patients were classified according to the age of onset: LONMOSD (≥50 years of age at onset) versus EONMOSD (<50 years of age at onset). Clinical characteristics and magnetic resonance imaging (MRI) findings were collected. All included patients were positive for AQP4 antibody. RESULTS Compared with female LONMOSD patients, male LONMOSD patients had less frequent transverse myelitis (TM) at onset (8.33 vs. 53.13%, p = 0.004) and lower Expanded Disability Status Scale (EDSS) scores (median 1 vs. 4, p = 0.036). Compared with male EONMOSD patients, male LONMOSD patients had a shorter time from onset to diagnosis (0.85 months vs. 6.00 months, p = 0.04). CONCLUSION Less common TM at onset, less disease severity, and shorter time from onset to diagnosis probably occur in male LONMOSD patients.
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Affiliation(s)
- Jie Liang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jia Liu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Meifeng Gu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Cansheng Zhu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiaofeng Xu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Rong Fan
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Fuhua Peng
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ying Jiang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Butryn M, Neumann J, Rolfes L, Bartels C, Wattjes MP, Mahmoudi N, Seeliger T, Konen FF, Thiele T, Witte T, Meuth SG, Skripuletz T, Pawlitzki M. Clinical, Radiological, and Laboratory Features of Spinal Cord Involvement in Primary Sjögren's Syndrome. J Clin Med 2020; 9:jcm9051482. [PMID: 32423153 PMCID: PMC7290729 DOI: 10.3390/jcm9051482] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/10/2020] [Accepted: 05/12/2020] [Indexed: 01/21/2023] Open
Abstract
Objective: To identify radiological and laboratory hallmarks in patients with primary Sjögren’s syndrome (pSS) presenting with spinal cord involvement. Methods: Clinical and laboratory routine parameters were analyzed in a retrospective multicenter case series of four patients who developed myelitis associated with pSS. Serological and cerebrospinal fluid (CSF) measurements of pSS associated anti-SSA(Ro)-antibodies were initiated, and CSF neurofilament light chain (NFL) levels were assessed. NFL values were compared with results from 15 sex- and age-matched healthy controls. Radiological assessment was performed using multi-sequence spinal cord magnetic resonance imaging. Results: Three of the four patients initially developed neurological signs suggestive of myelitis and were subsequently diagnosed with pSS. All patients presented a longitudinal spinal T2-hyperintense lesion in the cervical spinal cord, whereas only two patients showed pleocytosis and oligoclonal bands in the CSF. Median (range) CSF-NFL levels were significantly elevated in patients compared to controls (6672 pg/mL (621–50,000) vs. 585 pg/mL (357–729), p = 0.009). One patient showed sustained, highly increased NFL levels (50,000 pg/mL) in the initial assessment when radiological signs of axonal injury were still absent. Anti-SSA(Ro)-antibodies were found in the serum of three patients, while two patients additionally presented intrathecal anti-SSA(Ro)-antibody production. Elevated CSF-NFL levels and intrathecal synthesis of anti-SSA(Ro)-antibodies were associated with a relapsing and treatment-resistant disease course. Conclusion: Inflammatory spinal cord lesions associated with pSS are a rare but serious disease leading to severe disability. NFL and anti-SSA(Ro)-antibodies in CSF might serve as prognostic biomarkers and should be routinely assessed in patients with pSS.
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Affiliation(s)
- Michaela Butryn
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.B.); (J.N.); (C.B.)
| | - Jens Neumann
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.B.); (J.N.); (C.B.)
| | - Leoni Rolfes
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, 41849 Münster, Germany; (L.R.); (S.G.M.)
| | - Claudius Bartels
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.B.); (J.N.); (C.B.)
| | - Mike P. Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany; (M.P.W.); (N.M.)
| | - Nima Mahmoudi
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, 30625 Hannover, Germany; (M.P.W.); (N.M.)
| | - Tabea Seeliger
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.S.); (F.F.K.)
| | - Franz F. Konen
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.S.); (F.F.K.)
| | - Thea Thiele
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (T.T.); (T.W.)
| | - Torsten Witte
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, 30625 Hannover, Germany; (T.T.); (T.W.)
| | - Sven G. Meuth
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, 41849 Münster, Germany; (L.R.); (S.G.M.)
| | - Thomas Skripuletz
- Department of Neurology, Hannover Medical School, 30625 Hannover, Germany; (T.S.); (F.F.K.)
- Correspondence: (T.S.); (M.P.)
| | - Marc Pawlitzki
- Department of Neurology, Otto-von-Guericke University, 39120 Magdeburg, Germany; (M.B.); (J.N.); (C.B.)
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, 41849 Münster, Germany; (L.R.); (S.G.M.)
- Correspondence: (T.S.); (M.P.)
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Hu SJ, Lu PR. Retinal ganglion cell-inner plexiform and nerve fiber layers in neuromyelitis optica. Int J Ophthalmol 2018; 11:89-93. [PMID: 29375997 DOI: 10.18240/ijo.2018.01.16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/11/2017] [Indexed: 11/23/2022] Open
Abstract
AIM To determine the thickness of the retinal ganglion cell-inner plexiform layer (GCIPL) and the retinal nerve fiber layer (RNFL) in patients with neuromyelitis optica (NMO). METHODS We conducted a cross-sectional study that included 30 NMO patients with a total of 60 eyes. Based on the presence or absence of optic neuritis (ON), subjects were divided into either the NMO-ON group (30 eyes) or the NMO-ON contra group (10 eyes). A detailed ophthalmologic examination was performed for each group; subsequently, the GCIPL and the RNFL were measured using high-definition optical coherence tomography (OCT). RESULTS In the NMO-ON group, the mean GCIPL thickness was 69.28±21.12 µm, the minimum GCIPL thickness was 66.02±10.02 µm, and the RNFL thickness were 109.33±11.23, 110.47±3.10, 64.92±12.71 and 71.21±50.22 µm in the superior, inferior, temporal and nasal quadrants, respectively. In the NMO-ON contra group, the mean GCIPL thickness was 85.12±17.09 µm, the minimum GCIPL thickness was 25.39±25.1 µm, and the RNFL thicknesses were 148.33±23.22, 126.36±23.45, 82.21±22.30 and 83.36±31.28 µm in the superior, inferior, temporal and nasal quadrants, respectively. In the control group, the mean GCIPL thickness was 86.98±22.37 µm, the minimum GCIPL thickness was 85.28±10.75 µm, and the RNFL thicknesses were 150.22±22.73, 154.79±60.23, 82.33±7.01 and 85.62±13.81 µm in the superior, inferior, temporal and nasal quadrants, respectively. The GCIPL and RNFL were thinner in the NMO-ON contra group than in the control group (P<0.05); additionally, the RNFL was thinner in the inferior quadrant in the NMO-ON group than in the control group (P<0.05). Significant correlations were observed between the GCIPL and RNFL thickness measurements as well as between thickness measurements and the two visual field parameters of mean deviation (MD) and corrected pattern standard deviation (PSD) in the NMO-ON group (P<0.05). CONCLUSION The thickness of the GCIPL and RNFL, as measured using OCT, may indicate optic nerve damage in patients with NMO.
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Affiliation(s)
- Sai-Jing Hu
- Department of Ophthalmology, the First Affiliated Hospital of Suzhou University, Suzhou 215000, Jiangsu Province, China.,Department of Ophthalmology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Pei-Rong Lu
- Department of Ophthalmology, the First Affiliated Hospital of Suzhou University, Suzhou 215000, Jiangsu Province, China
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Thyroid hormone level is associated with the frequency and severity of acute transverse myelitis. Neuroreport 2017; 28:292-297. [PMID: 28240719 DOI: 10.1097/wnr.0000000000000753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute transverse myelitis (ATM) is a progressive and autoimmune disease with inflammatory cell infiltrates into the spinal cord, and thyroid hormone (TH) level is associated with the oxidative and antioxidant status. Variations in oxidative stress and antioxidant levels are related to the pathogenesis of autoimmune and inflammatory diseases. Our study aimed to investigate the possible correlation between ATM and TH levels of thyroid-stimulating hormone (TSH), free thyroxine (FT4), free triiodothyronine (FT3), and FT4/FT3. We measured serum concentrations of TSH, FT4, and FT3 in 205 individuals, including 42 ATM patients, 49 multiple sclerosis patients, and 114 healthy controls. Our findings show that ATM patients had lower levels of TSH and FT3 and higher levels of FT4 and FT4/FT3 compared with healthy controls, whether male or female. Moreover, levels of TSH and FT3 in patients with ATM were inversely correlated with disease severity measured by the Expanded Disability Status Scale. Variations in TH level may represent the oxidative status and are surrogate biomarkers of the incidence and severity of ATM.
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Shan Y, Tan S, Zhang L, Huang J, Sun X, Wang Y, Cai W, Qiu W, Hu X, Lu Z. Serum 25-hydroxyvitamin D 3 is associated with disease status in patients with neuromyelitis optica spectrum disorders in south China. J Neuroimmunol 2016; 299:118-123. [PMID: 27725109 DOI: 10.1016/j.jneuroim.2016.09.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/22/2016] [Accepted: 09/12/2016] [Indexed: 01/20/2023]
Abstract
Here, we investigated the relationship between serum 25-hydroxyvitamin D3 (25[OH]D3) levels and neuromyelitis optica spectrum disorder (NMOSD). Patients with NMOSD had lower 25(OH)D3 levels than healthy people, with lower levels in patients in the acute phase than those in remission. An inverse correlation was found between 25(OH)D3 and Expanded Disability Status Scale scores of patients during attacks. Higher serum 25(OH)D3 levels were associated with greater amelioration of symptoms during corticosteroid therapy. These results indicate that decreased vitamin D may be involved in NMOSD pathogenesis, and that 25(OH)D3 serum levels may reflect the severity of NMOSD in the acute phase.
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Affiliation(s)
- Yilong Shan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Sha Tan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Lei Zhang
- Department of Neurology, The Fifth Affiliated Hospital of Sun Yat-sen University, No 52 Meihuadong Road, Zhuhai City, China
| | - Jianhua Huang
- Department of Clinical Laboratory, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Wei Cai
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou City, China.
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Mao Z, Yin J, Zhong X, Zhao Z, Qiu W, Lu Z, Hu X. Late-onset neuromyelitis optica spectrum disorder in AQP4-seropositivepatients in a Chinese population. BMC Neurol 2015; 15:160. [PMID: 26337073 PMCID: PMC4558842 DOI: 10.1186/s12883-015-0417-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/28/2015] [Indexed: 01/06/2023] Open
Abstract
Background Increasing rates of AQP4-seropositive neuromyelitis optica spectrum disorder (NMOSD) have been reported in late-onset patients (LONMOSD). However, the full range of clinical differences between early-onset and late-onset variants remain unclear. We describe the clinical features and outcomes of AQP4-seropositive LONMOSD patients in a Chinese population. Methods This was a retrospective analysis of medical records in a cohort study of AQP4-seropositive NMOSD patients with early-onset (≤49 years) and late-onset (≥50 years) variants between January 2006 and February 2014. Demographic, clinical, neuroimaging and cerebrospinal fluid (CSF) findings and prognosis data were analyzed. Results We identified thirty AQP4-seropositive LONMOSD patients (86.7 % women). The median age at onset was 57.5 years (range 50–70). There were similar onset frequencies between optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM). Longer interval between (first) ON and LETM (median 13 vs. 4 months; p < 0.05), time from first symptoms to diagnosis of NMO (median 17 vs. 7 months, p < 0.05), higher comorbidities (66.7 vs. 26.7 %; p < 0.05), and more hypertension (26.7 vs.3.3 %; p < 0.05) were prevalent. NMO-like lesions were less common (10.7 vs. 41.6 %; p < 0.05), while the rate of non-specific lesions tended to be higher (53.6 vs. 29 %; p = 0.067). These patients displayed more severe Expanded Disability Status Scale (EDSS) in nadir (median 6.75vs.5; p < 0.05). Attacks often resulted in EDSS 4 within a short period (median 8 vs. 13.5 months; p < 0.05). At last follow-up, the EDSS score was more severe in these patients (median 5.25 vs. 4; p < 0.05). No significant predictors were identified. Conclusions This study provides an overview of the clinical and paraclinical features of AQP4-seropositive LONMOSD patients in China and demonstrates a number of distinct disease characteristics in early vs. late onset. Older patients are more susceptible to disability in short course. However, these patients do not always display NMO-like lesions in the brain. Initial LETM may not necessarily be predominant as the initial symptom, contrary to previous reports. The higher comorbidities may warrant a modified approach of treatment.
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Affiliation(s)
- Zhifeng Mao
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
| | - Junjie Yin
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
| | - Xiaonan Zhong
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
| | - Zhihua Zhao
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
| | - Wei Qiu
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
| | - Zhengqi Lu
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
| | - Xueqiang Hu
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, China.
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Abstract
Objective:To compare the clinical features of our sero-negative and sero-positive neuromyelitis optica (NMO) patients.Methods:Thirty-nine patients with NMO were recruited and analyzed retrospectively. Serum aquaporin 4 (AQP4) antibody status was determined by a cell-based assay. For the sero-negative patients, cerebrospinal fluid (CSF) and serum samples were re-tested using the cell-based assay and an indirect immunofluorescence assay.Results:By the cell-based assay, 30 patients (76.92%, 30/39), were positive for AQP4 antibodies in serum and 37 patients (94.9%, 37/39), had a CSF-positive antibody status. Seven NMO patients (17.9%, 7/39) were sero-negative by the cell-based assay but demonstrated positive CSF results. By indirect immunofluorescence, the remaining two patients, who had no AQP4 antibodies in serum or CSF by the cell-based assay, were positive for IgG antibodies in serum, which selectively targeted the central nervous system microvessels, pia, subpia, Virchow-Robin space, kidney, and stomach. There were no significant differences between the sero-positive and sero-negative NMO groups among their demographic and clinical data.Conclusions:Repeating the test using a different assay or CSF is helpful to clarify whether sero-negative NMO patients do in fact carry AQP4 antibodies.
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12
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Hyun JW, Kim SH, Huh SY, Kim W, Yun J, Joung A, Sato DK, Fujihara K, Kim HJ. Idiopathic aquaporin-4 antibody negative longitudinally extensive transverse myelitis. Mult Scler 2014; 21:710-7. [DOI: 10.1177/1352458514551454] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 08/13/2014] [Indexed: 12/27/2022]
Abstract
Background: Longitudinally extensive transverse myelitis (LETM) is a characteristic manifestation of neuromyelitis optica (NMO). However, not all patients with LETM are positive for aquaporin-4 (AQP4) antibodies. We evaluated the characteristics of idiopathic isolated LETM negative for AQP4 antibodies. Methods: From the National Cancer Center registry of inflammatory diseases of the central nervous system, patients with LETM as an initial manifestation and follow-up for at least two years were enrolled. Their medical records and MRIs were reviewed retrospectively. AQP4 antibody was confirmed by three different validated methods at least three times. Cerebrospinal fluid (CSF) glial fibrillary acidic protein (GFAP) levels were measured to investigate astrocyte damage. Results: Among 108 patients with first-ever LETM, 55 were positive for AQP4 antibodies (P-LETM) and 53 were consistently negative. Of them, seven were later diagnosed with seronegative NMO, and four were positive for MOG antibodies. The remaining 42 patients (N-LETM) showed several features distinct from P-LETM: male predominance, older age of onset, milder clinical presentation, spinal cord confinement and absence of combined autoimmunity. CSF GFAP levels were not increased in N-LETM but were markedly elevated in P-LETM. Conclusions: Idiopathic isolated N-LETM is not that rare among first-ever LETM, and has many features distinct from P-LETM where astrocytic damage is evident.
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Affiliation(s)
- Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - So-Young Huh
- Kosin University School of Medicine, Busan, Korea
| | - Woojun Kim
- Catholic University School of Medicine, Seoul, Korea
| | - Junglim Yun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - AeRan Joung
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Douglas Kazutoshi Sato
- Department of Neurology and Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Neurology and Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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Serum thyroid-stimulating hormone and anti-thyroglobulin antibody are independently associated with lesions in spinal cord in central nervous system demyelinating diseases. PLoS One 2014; 9:e100672. [PMID: 25093326 PMCID: PMC4122347 DOI: 10.1371/journal.pone.0100672] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 05/30/2014] [Indexed: 12/26/2022] Open
Abstract
Transverse myelitis (TM) is associated with neuromyelitis optica (NMO) and multiple sclerosis (MS). Early recognition of useful parameters may be helpful to distinguish their difference. This retrospective study analyzed thyroid parameters from 243 serum samples (relapse = 128; remission = 115) of 178 patients with demyelinating diseases (NMO, n = 25; TM, n = 48; MS, n = 105). The relationship between thyroid and clinical parameters was analyzed. Patients with NMO and TM had a higher frequency of abnormal thyroid-stimulating hormone (TSH), anti-thyroglobulin antibodies (TG-Ab), and antithyroid peroxidase antibody (TPO-Ab) than MS patients (p<0.05). The level of TSH and TG-Ab returned to normal levels after administration of high-dose intravenous methylprednisolone (p<0.05). In 96 patients (NMO, n = 19; TM, n = 25; MS, n = 52) without treatment, serum levels of TSH, TG-Ab and TPO-Ab were significantly different between patients with and without myelitis (p<0.01). Patients positive for aquaporin-4 (AQP4) antibodies showed higher abnormalities of TSH (p = 0.001), TG-Ab (p = 0.004) and TPO-Ab (p<0.0001) levels than AQP4 antibodies negative patients. Logistic regression analyses revealed independent relationships between TSH (odds ratio [OR] = 33.994; p<0.0001), TG-Ab (OR = 7.703; p = 0.017) and myelitis occurrence in 96 patients at the active stage. In 52 MS patients experiencing their first attack, MS patients with myelitis were associated with TSH abnormalities (OR = 42.778; p<0.0001). This study showed increased abnormalities of thyroid parameters in patients with NMO and TM than in MS patients. MS patients with myelitis also had greater TSH abnormality than in MS patients without myelitis. Abnormal TSH and TG-Ab were independently associated with myelitis occurrence in central nervous system demyelinating disorders.
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Li R, Zhong X, Qiu W, Wu A, Dai Y, Lu Z, Hu X. Association between neuromyelitis optica and tuberculosis in a Chinese population. BMC Neurol 2014; 14:33. [PMID: 24555792 PMCID: PMC3938476 DOI: 10.1186/1471-2377-14-33] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 02/18/2014] [Indexed: 12/20/2022] Open
Abstract
Background A number of reports have described the presence of tuberculosis (TB) in neuromyelitis optica (NMO) patients. However, a definite association between the two conditions has not been conclusively demonstrated. Methods To investigate the association between NMO and TB in a Chinese population, we performed a retrospective review of hospital records of NMO patients, control patients and tuberculosis meningitis (TBM) patients from January 1, 1995 to December 31, 2011. Results The frequency of preceding/simultaneous active pulmonary TB (PTB) was not significantly different between NMO patients (1.1%) and control groups (2.3% in myasthenia gravis, 1.1% in polymyositis or dermatomyositis, zero in idiopathic facial palsy and viral meningitis/meningoencephalitis). NMO cases differed from TBM cases in terms of demographics, course (recurrent or monophasic), cerebrospinal fluid analysis and magnetic resonance images. Two TBM patients shared partial clinical features with NMO (one of the TBM patients had a longitudinal extensive spinal cord lesion involving the holocord, and the other had optic neuritis before anti-tuberculosis treatment). NMO antibodies were only detected in NMO patients and not in TBM patients with myelitis or optic neuritis. Conclusions We could not confirm previous suggestions of the association between PTB and NMO. Direct infection of the central nervous system by TB may mimic NMO in some respects, but whether NMO-like symptoms that develop during the course of TB should be considered and diagnosed as NMO is open to discussion.
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Affiliation(s)
| | | | | | | | | | | | - Xueqiang Hu
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, No, 600 Tianhe Road, Guangzhou, Guangdong Province 510630, China.
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Zhong YH, Liu J, Li M, Wang X, Yuan Y, Zhong XF, Peng FH. Distinct serum apolipoprotein A-I levels in neuromyelitis optica and acute transverse myelitis. Lipids Health Dis 2013; 12:150. [PMID: 24148653 PMCID: PMC3819004 DOI: 10.1186/1476-511x-12-150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/18/2013] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE NMO and ATM are intertwined both clinically and pathologically. Apolipoprotein (apo) A-I, the main apolipoprotein of HDL, plays an important role in lipid metabolism in the cerebrospinal fluid and is known to suppress pro-inflammatory cytokines generated by activated T cells in some autoimmune diseases as an immune regulator. However, the differences in the levels of serum apoA-I between NMO and ATM patients are unclear. METHODS In the present study, serum apo A-I levels were measured in 53 NMO patients, 45 ATM patients and 49 healthy subjects. We tested serum apoA-I levels in all participants and investigated EDSS scores of patients with NMO and ATM. Statistical analyses were performed by using SPSS statistical software. RESULT We found that serum apoA-I levels in patients with NMO were significantly lower in comparison to those with ATM. We also found that serum levels of apoA-I was lower in male subjects in comparison to the female subjects in all groups although these differences were not statistically significant in patients with NMO or ATM. It is also shown in our study that serum apoA-I levels in patients with NMO were significantly elevated after receiving a high dosage of intravenous corticosteroids over a period of one week. However, we did not find any correlation between the apoA-I levels and disease disability. CONCLUSION From this study, we concluded that serum levels of apoA-I were lower in NMO patients compared to patients with ATM. Serum apoA-I studies might provide some useful clues to differentiate NMO cases from ATM cases.
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Affiliation(s)
| | | | | | | | | | - Xiu-Feng Zhong
- Multiple Sclerosis Center, Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, Guangdong Province 510630, China.
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16
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Cobo Calvo A, Mañé Martínez MA, Alentorn-Palau A, Bruna Escuer J, Romero Pinel L, Martínez-Yélamos S. Idiopathic acute transverse myelitis: outcome and conversion to multiple sclerosis in a large series. BMC Neurol 2013; 13:135. [PMID: 24090445 PMCID: PMC3856522 DOI: 10.1186/1471-2377-13-135] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 09/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2002, the Transverse Myelitis Consortium Working Group (TMCWG) proposed the diagnostic criteria for idiopathic acute transverse myelitis (IATM) to delimit and unify this group of patients. This study aimed to describe the conversion rate to multiple sclerosis (MS) and variables associated with conversion, and to analyze functional outcome and prognostic factors associated with functional recovery in patients who fulfilled the current TMCWG criteria for definite and possible IATM. METHODS Eighty-seven patients diagnosed with IATM between 1989 and 2011 were retrospectively reviewed. Two patients with positive neuromyelitis optica IgG serum antibodies were excluded. Epidemiological, clinical, laboratory, magnetic resonance imaging (MRI) data and outcome of 85 patients were analyzed. RESULTS Eleven (13%) patients converted to MS after a median follow-up of 2.9 years (interquartile range 1.0-4.8). Early-age onset of symptoms was related to conversion to MS. Only 9.4% of patients with IATM were unable to walk unassisted at the end of follow-up. Urinary sphincter dysfunction (odds ratio [OR] 3.37, 95% confidence interval [CI] 1.04-10.92) and longitudinally extensive transverse myelitis (LETM) on MRI (OR 12.34, 95% CI 3.38-45.00) were associated with a poorer outcome (Rankin ≥ 2). CONCLUSIONS At least 13% of patients who fulfill the TMCWG criteria for definite and possible IATM will convert to MS. Functional recovery in IATM is poorer in patients with urinary sphincter dysfunction at admission or LETM on MRI.
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Affiliation(s)
- Alvaro Cobo Calvo
- Multiple Sclerosis Unit, Neurology Department, Hospital Universitari de Bellvitge - IDIBELL, Feixa Llarga s/n L'Hospitalet de Llobregat, Barcelona 08907, Spain.
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17
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Lu Z, Zhang B, Qiu W, Kang Z, Shen L, Long Y, Huang J, Hu X. Comparative brain stem lesions on MRI of acute disseminated encephalomyelitis, neuromyelitis optica, and multiple sclerosis. PLoS One 2011; 6:e22766. [PMID: 21853047 PMCID: PMC3154259 DOI: 10.1371/journal.pone.0022766] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Accepted: 06/29/2011] [Indexed: 12/19/2022] Open
Abstract
Background Brain stem lesions are common in patients with acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), and multiple sclerosis (MS). Objectives To investigate comparative brain stem lesions on magnetic resonance imaging (MRI) among adult patients with ADEM, NMO, and MS. Methods Sixty-five adult patients with ADEM (n = 17), NMO (n = 23), and MS (n = 25) who had brain stem lesions on MRI were enrolled. Morphological features of brain stem lesions among these diseases were assessed. Results Patients with ADEM had a higher frequency of midbrain lesions than did patients with NMO (94.1% vs. 17.4%, P<0.001) and MS (94.1% vs. 40.0%, P<0.001); patients with NMO had a lower frequency of pons lesions than did patients with MS (34.8% vs. 84.0%, P<0.001) and ADEM (34.8% vs. 70.6%, P = 0.025); and patients with NMO had a higher frequency of medulla oblongata lesions than did patients with ADEM (91.3% vs. 35.3%, P<0.001) and MS (91.3% vs. 36.0%, P<0.001). On the axial section of the brain stem, the majority (82.4%) of patients with ADEM showed lesions on the ventral part; the brain stem lesions in patients with NMO were typically located in the dorsal part (91.3%); and lesions in patients with MS were found in both the ventral (44.0%) and dorsal (56.0%) parts. The lesions in patients with ADEM (100%) and NMO (91.3%) had poorly defined margins, while lesions of patients with MS (76.0%) had well defined margins. Brain stem lesions in patients with ADEM were usually bilateral and symmetrical (82.4%), while lesions in patients with NMO (87.0%) and MS (92.0%) were asymmetrical or unilateral. Conclusions Brain stem lesions showed various morphological features among adult patients with ADEM, NMO, and MS. The different lesion locations may be helpful in distinguishing these diseases.
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Affiliation(s)
- Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Bingjun Zhang
- 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
| | - Zhuang Kang
- Department of Radiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Liping Shen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Youming Long
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Junqi Huang
- Key Laboratory of Tropical Diseases Control, Ministry of Education and Department of Immunology/Institute of Immunology, Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
- * E-mail: (XH); (JH)
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
- * E-mail: (XH); (JH)
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