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Jakuszyk P, Podlecka-Piętowska A, Kossowski B, Nojszewska M, Zakrzewska-Pniewska B, Juryńczyk M. Patterns of cerebral damage in multiple sclerosis and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders-major differences revealed by non-conventional imaging. Brain Commun 2024; 6:fcae295. [PMID: 39258257 PMCID: PMC11384145 DOI: 10.1093/braincomms/fcae295] [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: 02/16/2024] [Revised: 07/17/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
Multiple sclerosis and aquaporin-4 antibody neuromyelitis optica spectrum disorders are distinct autoimmune CNS disorders with overlapping clinical features but differing pathology. Multiple sclerosis is primarily a demyelinating disease with the presence of widespread axonal damage, while neuromyelitis optica spectrum disorders is characterized by astrocyte injury with secondary demyelination. Diagnosis is typically based on lesion characteristics observed on standard MRI imaging and antibody testing but can be challenging in patients with in-between clinical presentations. Non-conventional MRI techniques can provide valuable diagnostic information by measuring disease processes at the microstructural level. We used non-conventional MRI to measure markers of axonal loss in specific white matter tracts in multiple sclerosis and neuromyelitis optica spectrum disorders, depending on their relationship with focal lesions. Patients with relapsing-remitting multiple sclerosis (n = 20), aquaporin-4 antibody-associated neuromyelitis optica spectrum disorders (n = 20) and healthy controls (n = 20) underwent a 3T brain MRI, including T1-, T2- and diffusion-weighted sequences, quantitative susceptibility mapping and phase-sensitive inversion recovery sequence. Tractometry was used to differentiate tract fibres traversing through white matter lesions from those that did not. Neurite density index was assessed using neurite orientation dispersion and density imaging model. Cortical damage was evaluated using T1 relaxation rates. Cortical lesions and paramagnetic rim lesions were identified using phase-sensitive inversion recovery and quantitative susceptibility mapping. In tracts traversing lesions, only one out of 50 tracts showed a decreased neurite density index in multiple sclerosis compared with neuromyelitis optica spectrum disorders. Among 50 tracts not traversing lesions, six showed reduced neurite density in multiple sclerosis (including three in the cerebellum and brainstem) compared to neuromyelitis optica spectrum disorders. In multiple sclerosis, reduced neurite density was found in the majority of fibres traversing (40/50) and not traversing (37/50) white matter lesions when compared to healthy controls. A negative correlation between neurite density in lesion-free fibres and cortical lesions, but not paramagnetic rim lesions, was observed in multiple sclerosis (39/50 tracts). In neuromyelitis optica spectrum disorders compared to healthy controls, decreased neurite density was observed in a subset of fibres traversing white matter lesions, but not in lesion-free fibres. In conclusion, we identified significant differences between multiple sclerosis and neuromyelitis optica spectrum disorders corresponding to their distinct pathologies. Specifically, in multiple sclerosis, neurite density reduction was widespread across fibres, regardless of their relationship to white matter lesions, while in neuromyelitis optica spectrum disorders, this reduction was limited to fibres passing through white matter lesions. Further studies are needed to evaluate the discriminatory potential of neurite density measures in white matter tracts for differentiating multiple sclerosis from neuromyelitis optica spectrum disorders.
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Affiliation(s)
- Paweł Jakuszyk
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
| | | | - Bartosz Kossowski
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
| | - Monika Nojszewska
- Department of Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
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Wu Y, Geraldes R, Juryńczyk M, Palace J. Double-negative neuromyelitis optica spectrum disorder. Mult Scler 2023; 29:1353-1362. [PMID: 37740717 PMCID: PMC10580671 DOI: 10.1177/13524585231199819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/25/2023]
Abstract
Most patients with neuromyelitis optica spectrum disorders (NMOSD) test positive for aquaporin-4 antibody (AQP4-IgG) or myelin oligodendrocyte glycoprotein antibodies (MOG-IgG). Those who are negative are termed double-negative (DN) NMOSD and may constitute a diagnostic and therapeutic challenge. DN NMOSD is a syndrome rather than a single disease, ranging from a (postinfectious) monophasic illness to a more chronic syndrome that can be indistinguishable from AQP4-IgG+ NMOSD or develop into other mimics such as multiple sclerosis. Thus, underlying disease mechanisms are likely to be heterogeneous. This topical review aims to (1) reappraise antibody-negative NMOSD definition as it has changed over time with the development of the AQP4 and MOG-IgG assays; (2) outline clinical characteristics and the pathophysiological nature of this rare entity by contrasting its differences and similarities with antibody-positive NMOSD; (3) summarize laboratory characteristics and magnetic resonance imaging findings of DN NMOSD; and (4) discuss the current treatment for DN NMOSD.
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Affiliation(s)
- Yan Wu
- Neurology Department of First Affiliated Hospital of Kunming Medical University, Kunming, China/Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK/Neurology Department, Wexham Park hospital, Frimley Foundation Health Trust, Slough, UK
| | - Maciej Juryńczyk
- Department of Neurology, Stroke and Neurological Rehabilitation, Wolski Hospital, Warsaw, Poland
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- J Palace Department Clinical Neurology, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Kossowski B, Kong Y, Klimiec-Moskal E, Emir U, Palace J, Juryńczyk M. Relapsing antibody-negative patients with features of neuromyelitis optica spectrum disorders: Differences in N-acetylaspartate level in the cervical spinal cord indicate distinct underlying processes. Mult Scler 2022; 28:2221-2230. [PMID: 35971567 DOI: 10.1177/13524585221115304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Due to lack of biomarkers, antibody-negative patients with features of neuromyelitis optica spectrum disorders (NMOSD) are among the most challenging to diagnose and treat. Using unsupervised clustering, we recently identified 'MS-like', 'spinal MS-like', 'classic NMOSD-like' and 'NMOSD-like with brain involvement' subgroups in this cohort. OBJECTIVE We used magnetic resonance spectroscopy (MRS) to examine differences in the level of key metabolites in the spinal cord between the four identified subgroups. METHODS Twenty-five relapsing antibody-negative patients with NMOSD features classified by the unsupervised algorithm to one of the subgroups underwent a prospective cervical spinal cord MRS. Spectra from 16 patients fulfilled quality criteria and were included in the analysis. RESULTS Total N-acetylaspartate (tNAA), but not total choline (tCho) or myo-inositol (Ins), was significantly different between the four subgroups (p = 0.03). In particular, tNAA was 47.8% lower in the 'MS-like' subgroup as compared with the 'classic NMOSD-like' subgroup (p = 0.02). While we found a negative overall correlation between tNAA and disability score (r = -0.514, p = 0.04) in the whole cohort, the disability score did not differ significantly between the subgroups to explain subgroup differences in tNAA level. CONCLUSIONS Significant differences in the cervical spinal cord tNAA measurements confirm that the previously identified clinico-radiologic subgroups contain patients with distinct underlying disease processes.
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Affiliation(s)
- Bartosz Kossowski
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland
| | - Yazhuo Kong
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Uzay Emir
- Wellcome Centre for Integrative Neuroimaging, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jacqueline Palace
- Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Headley Way, OX3 9DU Oxford, UK.,Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteura 3 Street, 02-098 Warsaw, Poland.,Laboratory of Brain Imaging, Neurobiology Center, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland; Department of Clinical Neurology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Gracia F, Ramírez D, Parajeles-Vindas A, Díaz A, Díaz de la Fé A, Sánchez NER, Escobar RC, Valle LAG, Weiser R, Santos B, Candelario A, Benzadon A, Araujo P, Valderrama C, Larreategui M, Carrillo G, Gracia K, Vázquez-Céspedes J, Monterrey-Alvarez P, Carazo-Céspedes K, Sanabria-Castro A, Miranda-Loria G, Balmaceda-Meza A, Rivera LIP, Leal IO, Salinas LCR, Thompson A, Torres EL, Pereira DE, Zepeda C, López CA, Valse EAC, Urbina KZC, Urrutia MA, Van Sijtveld I, Armien B, Rivera VM. Neuromyelitis Optica Spectrum Disorder in Central America and the Caribbean: A Multinational Clinical Characterization Study. Neurol Int 2022; 14:284-293. [PMID: 35324579 PMCID: PMC8952282 DOI: 10.3390/neurolint14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023] Open
Abstract
Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0–52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren’s syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0–3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08–0.41) and 0.73/100,000 (incidence 0.02–0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region.
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Affiliation(s)
- Fernando Gracia
- Neurology Service, Hospital Santo Tomás, Panama City 0819-03752, Panama;
- School of Medicine, Universidad Interamericana de Panamá, Panama City 0830-00929, Panama;
- Correspondence: (F.G.); (B.A.)
| | - Deyanira Ramírez
- Neurology Service, Hospital Docente Padre Billini, Santo Domingo City 11102, Dominican Republic; (D.R.); (A.C.)
| | - Alexander Parajeles-Vindas
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Alejandro Díaz
- Neurology Service, Instituto Guatemalteco de Seguridad Social, Guatemala City 1010, Guatemala;
| | - Amado Díaz de la Fé
- Neurology Service, Centro Internacional de Restauración Neurológica (CIREN), La Habana 11300, Cuba;
| | | | - Romy Castro Escobar
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador 1101, El Salvador; (R.C.E.); (D.E.P.); (E.A.C.V.)
| | - Luis Alberto García Valle
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua 14285, Nicaragua; (L.A.G.V.); (K.Z.C.U.)
| | - Roberto Weiser
- Neurology Service, Hospital Horacio Oduber, Oranjestad 569, Aruba; (R.W.); (I.V.S.)
| | - Biany Santos
- Neurology Service, Hospital Cabral y Baez, Santiago City 10206, Dominican Republic;
| | - Awilda Candelario
- Neurology Service, Hospital Docente Padre Billini, Santo Domingo City 11102, Dominican Republic; (D.R.); (A.C.)
| | - Aron Benzadon
- Neurology Service, Complejo Hospitalario Dr. Arnulfo Arias Madrid CSS, Panama City 0831-01654, Panama; (A.B.); (P.A.)
| | - Pahola Araujo
- Neurology Service, Complejo Hospitalario Dr. Arnulfo Arias Madrid CSS, Panama City 0831-01654, Panama; (A.B.); (P.A.)
| | - Carlos Valderrama
- Neurology Service, Hospital Regional Rafael Hernández CSS, David City 0816-06808, Panama;
| | - Mario Larreategui
- Neurology Service, Hospital Regional Anita Moreno MINSA, La Villa de Los Santos 0819-11380, Panama;
| | - Gabriela Carrillo
- Neurology Service, Hospital Santo Tomás, Panama City 0819-03752, Panama;
| | - Karla Gracia
- School of Medicine, Universidad Interamericana de Panamá, Panama City 0830-00929, Panama;
| | - Johana Vázquez-Céspedes
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Priscilla Monterrey-Alvarez
- Neurology Service, Hospital San Rafael de Alajuela CCSS, Alajuela 1481-2100, Costa Rica; (P.M.-A.); (G.M.-L.)
| | - Kenneth Carazo-Céspedes
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Alfredo Sanabria-Castro
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Gustavo Miranda-Loria
- Neurology Service, Hospital San Rafael de Alajuela CCSS, Alajuela 1481-2100, Costa Rica; (P.M.-A.); (G.M.-L.)
| | - Andrea Balmaceda-Meza
- Neurology Service, Centro de Desarrollo Estratégico e Información de Salud y Seguridad Social (CENDEISSSS CCSS), San Jose 1475-1000, Costa Rica;
| | | | - Irma Olivera Leal
- Neurology Service, Hospital Hermanos Almejeira, La Habana 10200, Cuba;
| | | | - Arnold Thompson
- Neurology Service, Hospital Dr. Mario Catarino Rivas, San Pedro Sula 21104, Honduras; (N.E.R.S.); (A.T.)
| | - Ericka López Torres
- Neurology Service, Hospital Nacional Rosales, San Salvador 1101, El Salvador; (E.L.T.); (C.Z.); (C.A.L.)
| | - Daniel Enrique Pereira
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador 1101, El Salvador; (R.C.E.); (D.E.P.); (E.A.C.V.)
| | - Carolina Zepeda
- Neurology Service, Hospital Nacional Rosales, San Salvador 1101, El Salvador; (E.L.T.); (C.Z.); (C.A.L.)
| | - César Abdón López
- Neurology Service, Hospital Nacional Rosales, San Salvador 1101, El Salvador; (E.L.T.); (C.Z.); (C.A.L.)
| | - Ernesto Arturo Cornejo Valse
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador 1101, El Salvador; (R.C.E.); (D.E.P.); (E.A.C.V.)
| | - Karla Zinica Corea Urbina
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua 14285, Nicaragua; (L.A.G.V.); (K.Z.C.U.)
- Neurology Service, Hospital Carlos Roberto Huembes—Policía Nacional, Managua 14203, Nicaragua
| | - Marco Antonio Urrutia
- Neurology Service, Hospital Infantil de Nicaragua Manuel de Jesús Rivera La Mascota, Managua 12001, Nicaragua;
| | - Ivonne Van Sijtveld
- Neurology Service, Hospital Horacio Oduber, Oranjestad 569, Aruba; (R.W.); (I.V.S.)
| | - Blas Armien
- Dirección de Investigación, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City 0816-02593, Panama
- National Research System (SNI), National Secretary of Research Technology and Innovation (SENACYT), Panama City 0816-02852, Panama
- Correspondence: (F.G.); (B.A.)
| | - Victor M. Rivera
- Neurology Department, Baylor College of Medicine, Houston, TX 77025, USA;
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