1
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Arnett S, Chew SH, Leitner U, Hor JY, Paul F, Yeaman MR, Levy M, Weinshenker BG, Banwell BL, Fujihara K, Abboud H, Dujmovic Basuroski I, Arrambide G, Neubrand VE, Quan C, Melamed E, Palace J, Sun J, Asgari N, Broadley SA. Sex ratio and age of onset in AQP4 antibody-associated NMOSD: a review and meta-analysis. J Neurol 2024; 271:4794-4812. [PMID: 38958756 PMCID: PMC11319503 DOI: 10.1007/s00415-024-12452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Aquaporin-4 (AQP4) antibody-associated neuromyelitis optica spectrum disorder (NMOSD) is an antibody-mediated inflammatory disease of the central nervous system. We have undertaken a systematic review and meta-analysis to ascertain the sex ratio and mean age of onset for AQP4 antibody associated NMOSD. We have also explored factors that impact on these demographic data. METHODS A systematic search of databases was conducted according to the PRISMA guidelines. Articles reporting sex distribution and age of onset for AQP4 antibody-associated NMSOD were reviewed. An initially inclusive approach involving exploration with regression meta-analysis was followed by an analysis of just AQP4 antibody positive cases. RESULTS A total of 528 articles were screened to yield 89 articles covering 19,415 individuals from 88 population samples. The female:male sex ratio was significantly influenced by the proportion of AQP4 antibody positive cases in the samples studied (p < 0.001). For AQP4 antibody-positive cases the overall estimate of the sex ratio was 8.89 (95% CI 7.78-10.15). For paediatric populations the estimate was 5.68 (95% CI 4.01-8.03) and for late-onset cases, it was 5.48 (95% CI 4.10-7.33). The mean age of onset was significantly associated with the mean life expectancy of the population sampled (p < 0.001). The mean age of onset for AQP4 antibody-positive cases in long-lived populations was 41.7 years versus 33.3 years in the remainder. CONCLUSIONS The female:male sex ratio and the mean age of onset of AQP4 antibody-associated NMOSD are significantly higher than MS. The sex ratio increases with the proportion of cases that are positive for AQP4 antibodies and the mean age of onset increases with population life expectancy.
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Affiliation(s)
- Simon Arnett
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia.
| | - Sin Hong Chew
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Unnah Leitner
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Jyh Yung Hor
- Department of Neurology, Penang General Hospital, George Town, Penang, Malaysia
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael R Yeaman
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Department of Medicine, Divisions of Molecular Medicine & Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, USA
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Brenda L Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University and Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Hesham Abboud
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Veronika E Neubrand
- Department of Cell Biology, Faculty of Sciences, University of Granada, Granada, Spain
| | - Chao Quan
- Department of Neurology, The National Centre for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Esther Melamed
- Dell Medical School, University of Texas, Austin, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department Clinical Neurology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Jing Sun
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Institute of Integrated Intelligence and Systems, Nathan Campus, Griffith University, Nathan, QLD, Australia
- Rural Health Research Institute, Charles Sturt University, Bathurst, NSW, Australia
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Simon A Broadley
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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2
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Darvishi L, Shaygannejad V, Mansourian M, Saneei P, Mirmosayyeb O, Safavi SM. The association between dietary inflammatory index and risk of neuromyelitis optica spectrum disorder: a case-control study. Nutr Neurosci 2024:1-8. [PMID: 38870095 DOI: 10.1080/1028415x.2024.2342154] [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: 06/15/2024]
Abstract
BACKGROUND AND AIM Neuromyelitis optica spectrum disorder (NMOSD) is a severe and rare inflammatory disease affecting the central nervous system through optic neuritis and transverse myelitis. Present study aimed to investigate the association between dietary inflammatory index (DII) and risk of NMOSD. METHODS In this case-control study, 30 NMOSD cases and 90 aged matched healthy individuals were recruited. Habitual dietary intakes were assessed by a validated 168-item food frequency questionnaire to calculate the DII score. A multiple adjusted regression was used to determine the odd ratio (OR) of NMOSD across DII tertiles. The Residual method was applied to adjust the energy intake. RESULTS Participants in the top of DII tertile were more likely to have NMOSD in the crude model compared to those with the lowest one (OR: 4.18; 95%CI: 1.43-12.21). It was the case when multivariable confounders were considered in adjustment model I (OR: 3.98; 95%CI: 1.34-11.82) and II (OR: 4.43; 95%CI: 1.36-14.38), such that, individuals with a greater DII score had 3.98 and 4.43-time higher risk of NMOSD in model I and II, respectively. CONCLUSION The Present study suggests that greater adherence to a pro-inflammatory diet may be associated with an increased risk of NMOSD.
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Affiliation(s)
- Leila Darvishi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Department of Epidemiology and Biostatistics, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parvane Saneei
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sayyed Morteza Safavi
- Department of Community Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
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3
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Sechi E, Puci M, Pateri MI, Zara P, Othmani S, Sotgiu S, Saddi MV, Leoni S, Fenu G, Melis M, Sotgiu G, Solla P, Cocco E, Frau J. Epidemiology of aquaporin-4-IgG-positive NMOSD in Sardinia. Mult Scler Relat Disord 2024; 85:105522. [PMID: 38461730 DOI: 10.1016/j.msard.2024.105522] [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: 11/08/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The Italian Island of Sardinia (population, 1,578,146) is recognized for the high risk of multiple sclerosis (MS) but the epidemiological burden of other less common demyelinating diseases of the central nervous system (CNS), such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), is unknown. In this study, we determined the incidence and prevalence of AQP4-IgG+NMOSD in Sardinia over a ten-year study period (2013-2022). METHODS Patients with a diagnosis of AQP4-IgG+NMOSD (per 2015 IPND diagnostic criteria) were retrospectively identified using two sources: (1) Archives of the reference and only laboratory for AQP4-IgG testing in Sardinia; and (2) medical records of the four MS units in the island. Incidence (January 2013-December 2022) and prevalence (December 31, 2022) were calculated. RESULTS A total of 45 cases were included: incident, 31; prevalent, 41. The median age (range) at disease presentation was 51 (6-78) years; female/male ratio was 9:1. The crude (95 % CI) incidence and prevalence were 1.9 (1.3-2.7) per million and 2.6 (1.9-3.5) per 100,000, respectively. Prevalence increased from 2013 (1.1 per 100,000) to 2022 (2.6 per 100,000); p = 0.002. After age-standardization to the world, incidence and prevalence (95 % CI) decreased to 1.3 (0.7-2) per million and 1.8 (1.3-2.3) per 100,000, respectively. Coexisting immune-mediated disorders, mostly autoimmune thyroiditis, were reported in 50 % of patients. CONCLUSIONS The epidemiology of AQP4-IgG+NMOSD in Sardinia is overall in line with other Caucasian populations. The high MS risk in the island seems disease-specific and not associated with an increased risk of other CNS demyelinating disorders, confirming different pathophysiology.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, University Hospital of Sassari, Sassari, Italy.
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Maria Ida Pateri
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Pietro Zara
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Sabrine Othmani
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, University Hospital of Sassari, Sassari, Italy
| | | | - Stefania Leoni
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Giuseppe Fenu
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Paolo Solla
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
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Taheri N, Sarrand J, Soyfoo MS. Neuromyelitis Optica: Pathogenesis Overlap with Other Autoimmune Diseases. Curr Allergy Asthma Rep 2023; 23:647-654. [PMID: 37889429 DOI: 10.1007/s11882-023-01112-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW Neuromyelitis optica (NMO) is an auto-immune disease essentially depicted by optic neuritis and transverse myelitis. Per se, NMO was initially believed to be a sub-type of multiple sclerosis with typical demyelinating cerebral lesions and optic nerve inflammation. More recently, corroborating lignes of evidence have strengthened the concept of the spectrum of diseases associated with NMO and more specifically with the role of anti-aquaporin-4 antibodies in the pathogenesis of disease. RECENT FINDINGS In this article, we review the recent pathogenic findings in NMO and more interestingly the newly discovered role of anti-aquaporin-4 antibodies as key players in triggering cerebral lesions. The concept of spectrum of diseases associated with NMO is also discussed. These recent findings have paved in the further understanding of the pathogenesis underlying NMO and new treatments are currently being developed targeting anti-aquaporin-4 antibodies.
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Affiliation(s)
- Nadim Taheri
- Department of Rheumatology, Hopital Universitaire de Bruxelles, HUB, ULB, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Julie Sarrand
- Department of Rheumatology, Hopital Universitaire de Bruxelles, HUB, ULB, 808 Route de Lennik, 1070, Brussels, Belgium
| | - Muhammad S Soyfoo
- Department of Rheumatology, Hopital Universitaire de Bruxelles, HUB, ULB, 808 Route de Lennik, 1070, Brussels, Belgium.
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5
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Liu J, Zhang X, Zhong Y, Liu X. The prevalence of depression, anxiety, and sleep disturbances in patients with neuromyelitis optica spectrum disorders (NMOSD): A systematic review and meta-analysis. Mult Scler Relat Disord 2023; 79:105007. [PMID: 37717305 DOI: 10.1016/j.msard.2023.105007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 09/02/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023]
Abstract
OBJECTIVE To estimate pooled prevalence of depression, anxiety, and sleep disturbances in neuromyelitis optica spectrum disorders (NMOSD) cases. METHODS Electronic database of PubMed (MEDLINE), the Cochrane Central Register of Controlled Trials (CENTRAL), Embase and Web of Science ware systematically searched to identify relevant studies published not later than June 10, 2022. Specifically, original articles that reported the prevalence of depression, anxiety and sleep disturbances were selected. All pooled prevalence and 95 % confidence intervals (CIs) were calculated using a random-effects model. Publication bias was examined using funnel plots, and sensitivity analysis was used to explore the stability of the pooled results. RESULTS A total of 31 studies involving 4213 participants were included in this review. The pooled prevalence of depression was 40 % (95 % CI: 32-49 %), the pooled prevalence of anxiety was 45 % (95 % CI: 24-66 %), and the pooled prevalence of sleeping disturbances was 55 % (95 % CI: 46-64 %). The depression and anxiety prevalence estimates varied based on different screening tools. CONCLUSIONS There is a high prevalence of depression, anxiety, and sleep disturbances among NMOSD. These findings underscore the importance of regular monitoring of psychological status in NMOSD as well as the need for preventive approaches, early diagnosis, and intervention to improve medical and psychosocial outcomes.
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Affiliation(s)
- Jianyi Liu
- The First People's Hospital of Changde City, Changde, China.
| | - Xiaobo Zhang
- The First People's Hospital of Changde City, Changde, China
| | - Yi Zhong
- The First People's Hospital of Changde City, Changde, China
| | - Xianglin Liu
- The First People's Hospital of Changde City, Changde, China.
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6
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Shi L, Li D, Zhang Y, Wang J, Fu J, Liu X, Wang P. Factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorders. Eur J Med Res 2023; 28:426. [PMID: 37821922 PMCID: PMC10568753 DOI: 10.1186/s40001-023-01404-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 09/28/2023] [Indexed: 10/13/2023] Open
Abstract
OBJECTIVE To investigate the factors influencing the degree of disability in patients with neuromyelitis optica spectrum disorder (NMOSD) and provide evidence for disease monitoring and clinical intervention. METHODS Eighty-four patients with NMOSD at Xuanwu Hospital Capital Medical University were enrolled in this retrospective study. Before treatment, blood was collected from all patients, and their expanded disability status scores were assessed. RESULTS Of the 84 patients assessed, 66 (78.57%) had an expanded disability status scale score < 7, and 18 (21.43%) had scores ≥ 7. The univariate analysis showed that the total bilirubin (TBil), cerebrospinal fluid albumin (CSF ALB), cerebrospinal fluid immunoglobulin G (CSF IgG), QALB, and QIgG levels in the group with scores ≥ 7 were significantly different from those with scores < 7 (P < 0.05). In addition, Spearman's correlation analysis showed a significant correlation between ALB and expanded disability status scores in patients with NMOSD (P < 0.05), and the multivariate logistic regression analysis showed that TBil was an independent factor influencing the degree of disability in patients with NMOSD (P < 0.05). The receiver operating characteristic curve was constructed using TBil values; the area under the curve of TBil was 0.729 (P < 0.01), and the best cut-off value was 11.015 g/L. Its sensitivity in predicting the severity of disability in NMOSD patients was 51.5% while its specificity was 88.9%. CONCLUSION TBil is an independent factor that influences the severity of disability in patients with NMOSD. In addition, ALB is closely related to NMOSD severity, and some factors associated with the BBB are significantly increased in severely disabled NMOSD patients.
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Affiliation(s)
- Lili Shi
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dawei Li
- Neurology of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yunxiu Zhang
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jinling Wang
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingxuan Fu
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xia Liu
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Peichang Wang
- Clinical Laboratory of Xuanwu Hospital, Capital Medical University, Beijing, China.
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7
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Shen X. Research progress on pathogenesis and clinical treatment of neuromyelitis optica spectrum disorders (NMOSDs). Clin Neurol Neurosurg 2023; 231:107850. [PMID: 37390569 DOI: 10.1016/j.clineuro.2023.107850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are characteristically referred to as various central nervous system (CNS)-based inflammatory and astrocytopathic disorders, often manifested by the axonal damage and immune-mediated demyelination targeting optic nerves and the spinal cord. This review article presents a detailed view of the etiology, pathogenesis, and prescribed treatment options for NMOSD therapy. Initially, we present the epidemiology of NMOSDs, highlighting the geographical and ethnical differences in the incidence and prevalence rates of NMOSDs. Further, the etiology and pathogenesis of NMOSDs are emphasized, providing discussions relevant to various genetic, environmental, and immune-related factors. Finally, the applied treatment strategies for curing NMOSD are discussed, exploring the perspectives for developing emergent innovative treatment strategies.
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Affiliation(s)
- Xinyu Shen
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200000, PR China.
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8
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Wang S, Pan L, Wu R, Shao Y, Xue M, Zhu H, Min W, Zheng X, Liang Y, Zhu M. Oily fish and raw vegetable consumption can decrease the risk of AQP4-positive neuromyelitis optica spectrum disorders: a Mendelian-randomization study. Sci Rep 2023; 13:9372. [PMID: 37296187 PMCID: PMC10256733 DOI: 10.1038/s41598-023-36372-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are severe inflammatory disorders of the central nervous system targeting aquaporin-4 (AQP4). The risk factors for NMOSD remain to be determined, though they may be related to diet and nutrition. This study aimed to explore the possibility of a causal relationship between specific food intake and AQP4-positive NMOSD risk. The study followed a two-sample Mendelian randomization (MR) design. Genetic instruments and self-reported information on the intake of 29 types of food were obtained from a genome-wide association study (GWAS) on 445,779 UK Biobank participants. A total of 132 individuals with AQP4-positive NMOSD and 784 controls from this GWAS were included in our study. The associations were evaluated using inverse-variance-weighted meta-analysis, weighted-median analysis, and MR-Egger regression. A high consumption of oily fish and raw vegetables was associated with a decreased risk of AQP4-positive NMOSD (odds ratio [OR] = 1.78 × 10-16, 95% confidence interval [CI] = 2.60 × 10-25-1.22 × 10-7, p = 0.001; OR = 5.28 × 10-6, 95% CI = 4.67 × 10-11-0.598, p = 0.041, respectively). The results were consistent in the sensitivity analyses, and no evidence of directional pleiotropy was observed. Our study provides useful implications for the development of AQP4-positive NMOSD prevention strategies. Further research is needed to determine the exact causal relationship and mechanisms underlying the association between specific food intake and AQP4-positive NMOSD.
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Affiliation(s)
- Shengnan Wang
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Lin Pan
- Clinical College, Jilin University, Changchun, China
| | - Rui Wu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yanqing Shao
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Mengru Xue
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Hao Zhu
- Department of Hepatology, The First Hospital of Jilin University, Changchun, China
| | - Wanwan Min
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Xiangyu Zheng
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Yekun Liang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Mingqin Zhu
- Department of Neurology, Neuroscience Center, The First Hospital of Jilin University, Changchun, China.
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9
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Rotstein DL, Wolfson C, Carruthers R, Freedman MS, Morrow SA, Lee L, Burton JM, Nisenbaum R, Konig A, Magalhaes S, Marrie RA. A national case-control study investigating demographic and environmental factors associated with NMOSD. Mult Scler 2023; 29:521-529. [PMID: 36803237 PMCID: PMC10152218 DOI: 10.1177/13524585231151953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
BACKGROUND Risk factors for aquaporin-4 (AQP4+) antibody neuromyelitis optica spectrum disorder (NMOSD) are not well-established. OBJECTIVE To investigate demographic and environmental factors associated with NMOSD using a validated questionnaire and case-control design. METHODS We enrolled patients with AQP4 + NMOSD through six Canadian Multiple Sclerosis Clinics. Participants completed the validated Environmental Risk Factors in Multiple Sclerosis Study (EnvIMS) questionnaire. Their responses were compared to those of 956 unaffected controls from the Canadian arm of EnvIMS. We calculated odds ratios (ORs) for the association between each variable and NMOSD using logistic regression and Firth's procedure for rare events. RESULTS In 122 participants (87.7% female) with NMOSD, odds of NMOSD in East Asian and Black participants were ⩾8 times that observed in White participants. Birthplace outside Canada was associated with an increased risk of NMOSD (OR = 5.5, 95% confidence interval (CI) = 3.6-8.3) as were concomitant autoimmune diseases (OR = 2.7, 95% CI = 1.4-5.0). No association was observed with reproductive history or age at menarche. CONCLUSION In this case-control study, risk of NMOSD in East Asian and Black versus White individuals was greater than that observed in many previous studies. Despite the preponderance of affected women, we did not observe any association with hormonal factors such as reproductive history or age at menarche.
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Affiliation(s)
- Dalia L Rotstein
- DL Rotstein MS Clinic, St. Michael’s
Hospital, 30 Bond St., Toronto, ON M5B 1W8, Canada.
| | - Christina Wolfson
- Departments of Epidemiology, Biostatistics and
Occupational Health and Medicine, Faculty of Medicine and Health Sciences,
McGill University, Montreal, QC, Canada/Research Institute of the McGill
University Health Centre, Montreal, QC, Canada
| | - Robert Carruthers
- Division of Neurology, Faculty of Medicine,
University of British Columbia, Vancouver, BC, Canada
| | - Mark S Freedman
- Department of Medicine, University of Ottawa,
Ottawa, ON, Canada/Ottawa Hospital Research Institute, Ottawa, ON,
Canada
| | - Sarah A Morrow
- Western University, London, ON, Canada/London
Health Sciences Centre, London, ON, Canada
| | - Liesly Lee
- Department of Medicine, University of Toronto,
Toronto, ON, Canada/Sunnybrook Health Sciences Centre, University of
Toronto, Toronto, ON, Canada
| | - Jodie M Burton
- Departments of Clinical Neurosciences and
Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Rosane Nisenbaum
- St. Michael’s Hospital, Toronto, ON,
Canada/Applied Health Research Centre and MAP Centre for Urban Health
Solutions, Li Ka Shing Knowledge Institute, St Michael’s Hospital, Unity
Health Toronto, Toronto, ON, Canada/Division of Biostatistics, Dalla Lana
School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Sandra Magalhaes
- Department of Sociology, University of New
Brunswick, Fredericton, NB, Canada
| | - Ruth Ann Marrie
- Departments of Medicine and Community Health
Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences,
University of Manitoba, Winnipeg, MB, Canada
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10
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The description of neuromyelitis optica spectrum disorder: Patient registry in Yangtze River Delta area of China. Mult Scler Relat Disord 2022; 66:104023. [PMID: 35843144 DOI: 10.1016/j.msard.2022.104023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical features of neuromyelitis optica spectrum disorder (NMOSD) through patient registry in Yangtze River Delta area of China. METHODS A total of 502 consecutive patients diagnosed with aquaporin-4 antibody (AQP4-ab)-positive NMOSD were registered between December 2018 to January 2021 in multiple tertiary referral centers within the framework of Yangtze River Delta of China. Their baseline data were reviewed, and follow-up clinical information were collected prospectively. RESULTS The mean age at onset was 37.3 (range 3-80 years) years and the female-to-male ratio was 8.1:1. The median disease duration was 47 months (interquartile range [IQR] 25-84 months). A total of 1372 attacks of the 502 patients were recorded till the last follow-up, with a median annualized relapse rate of 0.4 (IQR 0.3-0.6). Nearly one-fourth (24.5%, 336/1372) of the attacks had prodromic events, including upper respiratory tract infection (36.3%, 122/336), fever (20.2%, 68/336) and pregnancy-related issues (17.9%, 60/336), etc. Myelitis was the most common attack type throughout the disease course (51.4%, 705/1372), followed by optic neuritis (ON, 43.1%, 592/1372). As for onset phenotype, ON (37.3%, 187/502) prevailed over myelitis (28.3%, 142/502). The median time to first relapse was 12 months (IQR 5-25 months). Patients with brainstem encephalitis at onset were more likely to have other anatomical region involved in subsequent attacks (p < 0.001), compared to other onset type. The median serum AQP4-ab titer measured by cell-based assays was 1:100 (IQR 1:32-1:320, range 1:10-1:10,000). The baseline AQP4-ab titer in cerebrospinal fluid (r = 0.542, p <0.001), overall ARR (r = 0.232, p< 0.001) and the EDSS scores at last follow-up (r = 0.119, p = 0.022) significantly correlated with baseline serum AQP4-ab titer. Antinuclear antibodies (48.4%), thyroid peroxidase antibodies (30.7%), and anti-SSA antibodies (26.2%) represented the most frequent concomitant antibodies, while autoimmune thyroid disorders (13.1%, 66/502) and Sjogren's syndrome (10.8%, 54/502) were the most common accompanying autoimmune diseases. Till the last follow-up, 403 patients received preventive treatments. Azathioprine represented the most common initial treatment, mycophenolate mofetil and rituximab was the most common second and third-line treatment, respectively. The EDSS score at the last follow-up ranged from 0 to 8.5 with a median of 2 (IQR 1-3). CONCLUSIONS A comprehensive clinical picture of patients with AQP4-ab-positive NMOSD in Yangtze River Delta area of China was presented. More information on disease tragedy and predictive prognostic factors could be generated through long-term observations.
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Ghadiri F, Eskandarieh S, Sahraian MA, Azimi A, Moghadasi AN. Late-onset neuromyelitis optica spectrum disorder: A case series from Iran. Rev Neurol (Paris) 2021; 178:249-252. [PMID: 34776261 DOI: 10.1016/j.neurol.2021.08.006] [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: 05/30/2021] [Revised: 07/17/2021] [Accepted: 08/27/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a disabling autoimmune disease of the central nervous system that can start at ages of 50 or more, when it is called late-onset NMOSD (LO-NMOSD). Data on this disorder are sparse. In this cross-sectional study, patient characteristics of the disease were studied. LO-NMOSD patients of a tertiary center in Tehran were studied from 2016 to 2020. CASE REPORTS Eight patients were identified, half of whom were men. The diagnostic delay was from no time-lapse to three years (mean: 0.62, SD: 1.06), which was significantly shorter than in early-onset patients. Seven patients (87.5%) tested positive for AQP4-IgG which was significantly higher compared to early-onset patients (p-value=0.01). Four patients (50%) had both transverse myelitis and optic neuritis as presenting symptoms, while three (38%) had just myelitis and only one (12%) had optic neuritis. CONCLUSION There is discrepancy regarding different aspects of LO-NMOSD. Further studies are needed to clarify the subject in order to enhance diagnosis and treatment.
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Affiliation(s)
- F Ghadiri
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - S Eskandarieh
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - M A Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - A Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran
| | - A N Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Sciences, Hasan Abad Sq, Tehran, Iran.
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Rezaeimanesh N, Jahromi SR, Sahraian MA, Rafiee P, Moghadasi AN. The association between dietary total antioxidant capacity and NMO-IgG seropositivity in patients with neuromyelitis optica spectrum disorder. Clin Neurol Neurosurg 2021; 209:106903. [PMID: 34461362 DOI: 10.1016/j.clineuro.2021.106903] [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: 02/28/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES There is growing evidence highlighting the role of environmental risk factors of NMO-IgG seropositivity in patients with neuromyelitis optica spectrum disorder (NMOSD). The present study investigated the possible association between dietary total antioxidant capacity (TAC) and NMO-IgG seropositivity in NMOSD patients. METHODS Fifty-six patients with a definite diagnosis of NMOSD were included in the study. Data on patients' age, gender, height, weight, cigarette smoking status, and alcohol consumption were collected and recorded. Body mass index (BMI) was also calculated. In addition, dietary habits of patients were evaluated using an adjusted semi-quantitative food frequency questionnaire (FFQ) that consists of 168 food items. Dietary TAC was calculated using the oxygen radical absorption capacity (ORAC) method. Enzyme-linked immunosorbent assay (ELISA) method was used to determine the NMO-IgG serum status. The association between dietary TAC and odds of NMO-IgG seropositivity was measured using the logistic regression analysis. RESULTS The mean of dietary TAC was 8362.8 (μmolTE/1000 kcal) in seronegative patients and 6609.9 (μmolTE/1000 kcal) in seropositive patients and had a significant difference between the mentioned groups of patients (P: 0.02). An inverse association was found between dietary TAC and odds of NMO-IgG seropositivity in all three regression models. The higher dietary intake of antioxidant resulted in significant findings as follows: 92% (95% CI: 0.01-0.53), 97% (95% CI: 0.00-0.34), and 97% (95% CI: 0.00-0.32) lower odds of NMO-IgG seropositivity in the fourth quartiles of the first, the second, and the third regression model, respectively. Moreover, the inverse association between fruit intake and odds of NMO-IgG seropositivity was significant in the third quartile (OR:0.10; 95%CI: 0.01-0.97). CONCLUSION The present study indicated a significant inverse association between dietary TAC and NMO-IgG seropositivity of NMOSD patients. As no definite treatment can be offered for NMOSD and nutrition is a modifiable factor in this regard, specification of dietary factors affecting the risk of NMOSD is of great value.
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Affiliation(s)
- Nasim Rezaeimanesh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Rafiee
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Dietary risk factors of primary progressive multiple sclerosis: A population-based case-control study. Mult Scler Relat Disord 2021; 56:103233. [PMID: 34488182 DOI: 10.1016/j.msard.2021.103233] [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: 04/17/2021] [Revised: 07/14/2021] [Accepted: 08/29/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES There are growing evidences on the role of nutritional factors in multiple sclerosis (MS) occurrence. But dietary data are limited in primary progressive type of MS (PPMS). We assessed the role of dietary factors during adolescence in PPMS risk. METHODS An incident case-control study on 143 PPMS cases with definite diagnosis and 400 controls were conducted in Sina hospital, Tehran, Iran. Demographic data were collected. Data on nutritional habits during adolescence were obtained using questionnaire designed for multinational case-control studies of environmental risk factors for multiple sclerosis (EnvIMS-Q). Logistic regression models were run to evaluate the role of diet in PPMS risk. RESULTS A significant association was founded between higher intake of dairy, seafood, red meat, poultry, vegetable, fruit and nut and lower risk of PPMS (P< 00.5). This association was dose dependent for all mentioned food groups except fruit. In the fully adjusted model, more intake of dairy (OR: 0.27; 95%CI: 0.14-0.53), seafood (OR: 0.21; 95%CI: 0.10-0.44), red meat (OR:0.44; 95%CI: 0.22-0.90), vegetable (OR: 0.19; 95%CI: 0.09-0.39), fruit (OR: 0.47; 95%CI: 0.22-0.99) and nut (OR: 0.29; 95%CI: 0.15-0.56) in the third tertiles resulted in significant reduction in PPMS risk. In case of poultry consumption, the association was meaningful just in the third tertile of crude model (OR: 0.54; 95%CI: 0.30-0.95). Nutrient supplementation with calcium, iron, folic acid, vitamin B12 and C were also related with more than 84% lower risk of PPMS. CONCLUSION Our data proposed that adequate intake of food groups and nutrient supplementation during adolescence may be effective in reducing adult-onset PPMS risk.
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Th17-Related Cytokines as Potential Discriminatory Markers between Neuromyelitis Optica (Devic's Disease) and Multiple Sclerosis-A Review. Int J Mol Sci 2021; 22:ijms22168946. [PMID: 34445668 PMCID: PMC8396435 DOI: 10.3390/ijms22168946] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 08/15/2021] [Accepted: 08/17/2021] [Indexed: 02/06/2023] Open
Abstract
Multiple sclerosis (MS) and Devic’s disease (NMO; neuromyelitis optica) are autoimmune, inflammatory diseases of the central nervous system (CNS), the etiology of which remains unclear. It is a serious limitation in the treatment of these diseases. The resemblance of the clinical pictures of these two conditions generates a partial possibility of introducing similar treatment, but on the other hand, a high risk of misdiagnosis. Therefore, a better understanding and comparative characterization of the immunopathogenic mechanisms of each of these diseases are essential to improve their discriminatory diagnosis and more effective treatment. In this review, special attention is given to Th17 cells and Th17-related cytokines in the context of their potential usefulness as discriminatory markers for MS and NMO. The discussed results emphasize the role of Th17 immune response in both MS and NMO pathogenesis, which, however, cannot be considered without taking into account the broader perspective of immune response mechanisms.
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Soares-Dos-Reis R, Tsz-Ching JL, Kim SH, Jacob A, Whittam D, Berthelot E, Paul F, Nakashima I, Tye JSN, De Seze J, Jitprapaikulsan J, Tan K, Yang L, Elsone L, Leite MI, Mealy MA, Levy M, Fan M, Siebert N, Asgari N, Cabre P, Siritho S, Pittock SJ, Wing-Ho SC, Senger T, Yeo T, Takai Y, Pandit L, Kim HJ, Palace J. Asian and African/Caribbean AQP4-NMOSD patient outcomes according to self-identified race and place of residence. Mult Scler Relat Disord 2021; 53:103080. [PMID: 34171683 DOI: 10.1016/j.msard.2021.103080] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/11/2021] [Accepted: 06/07/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy characterized by aquaporin-4 antibodies, whose prognosis is influenced by onset age, race, environmental exposures and immunosuppression. Distinguishing the contribution of environment from genetics is challenging. We aimed to compare neuromyelitis optica spectrum disorder (NMOSD) patient outcomes according to self-identified racial group and place of residence. METHODS This retrospective analysis of prospectively collected data included non-white anti-aquaporin-4 antibody positive NMOSD patients under follow-up from 15 centers [United Kingdom, France, Germany, Denmark, Martinique, United States of America, Japan, South Korea, Singapore, Thailand, China (including Hong Kong) and India]. Racial groups were designated: African/Caribbean; South Asian; East Asian (including Southeast Asia). Patients from these racial groups residing outside Africa/Caribbean or Asia were compared with those living in the Caribbean or the Asian areas. Kaplan-Meier survival curves and Cox models were generated using time to sustained Expanded Disability Status Scale≥6.0 or death; time to sustained Kurtzke Visual Function Score≥3.0 or a composite endpoint of all three. RESULTS Among 821 patients, African/Caribbean patients (n = 206) had the shortest time to immunosuppression and higher visual disability at onset. South Asian patients (n = 65) were younger, had lower visual disability at onset and higher mortality rate. East Asians (n = 550) had the lowest relapse rate and lowest accrued motor disability. Survival analysis of African/Caribbean outside Africa/Caribbean vs those in the Caribbean showed a significant difference in the composite endpoint (p = 0.024,log-rank test), not apparently related to treatment differences. No significant differences between native and those residing outside Asia were found for other racial groups. CONCLUSION This NMOSD study reports the effects of place of residence on the outcomes in different races. Place of residence may not be a significant driver of disability among Asian patients, while it may influence African/Caribbean patient outcomes. Validating these findings could help distinguish between genetic causes and potentially modifiable environmental factors.
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Affiliation(s)
- Ricardo Soares-Dos-Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Porto, Portugal; Department of Clinical Neurosciences and Mental Health, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | | | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
| | - Anu Jacob
- Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
| | - Daniel Whittam
- Walton Center NHS Foundation Trust, Liverpool, United Kingdom.
| | - Emeline Berthelot
- Service de Neurologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique.
| | - Friedemann Paul
- NeuroCure Clinical Research, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany; Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | | | - Jerôme De Seze
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France.
| | | | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore.
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Liene Elsone
- Walton Center NHS Foundation Trust, Liverpool, United Kingdom.
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, United Kingdom.
| | - Maureen A Mealy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, United States.
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, United States.
| | - Moli Fan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Nadja Siebert
- Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany; Max-Delbrück-Center for Molecular Medicine, Berlin, Germany.
| | - Nasrin Asgari
- Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; Department of Neurology, Slagelse Hospital, Institute of Regional Health Research, Slagelse, Denmark.
| | - Philippe Cabre
- Service de Neurologie, Hôpital Pierre Zobda-Quitman, Fort-de-France, Martinique.
| | - Sasitorn Siritho
- Siriraj Neuroimmunology Center, Siriraj Hospital, Mahidol University, Thailand; Bumrungrad International Hospital, Thailand
| | - Sean J Pittock
- Departments of Laboratory Medicine and Pathology and Neurology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States.
| | | | - Thomas Senger
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France.
| | - Tianrong Yeo
- Department of Pharmacology, Experimental Neuropathology Group, University of Oxford, Mansfield Road OX1 3QT, United Kingdom; Department of Neurology, National Neuroscience Institute, Singapore.
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Lekha Pandit
- Center for Advanced Neurological Research, Nitte University, Mangalore, India
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea.
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, West Wing, John Radcliffe Hospital, Oxford University Hospitals, Oxford OX3 9DU, United Kingdom.
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Akaishi T, Himori N, Takeshita T, Fujihara K, Misu T, Takahashi T, Fujimori J, Ishii T, Aoki M, Nakazawa T, Nakashima I. Optic neuritis after ocular trauma in anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder. Brain Behav 2021; 11:e02083. [PMID: 33591639 PMCID: PMC8119803 DOI: 10.1002/brb3.2083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 01/20/2021] [Accepted: 01/31/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to report the possible association between minor trauma to the eyes and the subsequent occurrence of optic neuritis in patients with serum anti-aquaporin-4 (AQP4) antibody-positive neuromyelitis optica spectrum disorder (NMOSD). METHODS Herein, we present three patients who developed acute optic neuritis with visual disturbances after accidental minor trauma to their eyes, without any fundus abnormality or orbital floor fractures present. RESULTS Two of the three patients had a preceding history of neurological disturbances compatible with NMOSD (e.g., myelitis, area postrema syndrome) before the occurrence of trauma. One patient was rapidly treated with steroid pulse therapy and plasmapheresis, and he fully recovered visual acuity. The other two, who were left untreated in the acute phase, had sequelae of severe visual disturbances in the affected eyes. CONCLUSIONS These cases suggest possible association between minor trauma to the eyes and the subsequent occurrence of optic neuritis in patients with serum anti-AQP4 antibodies. Avoiding ocular trauma and early administration of steroid pulse therapy in response to optic neuritis after trauma are desired in such cases.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Noriko Himori
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takayuki Takeshita
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Toru Nakazawa
- Department of Ophthalmology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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Impact of comorbid Sjögren syndrome in anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders. J Neurol 2021; 268:1938-1944. [PMID: 33416998 DOI: 10.1007/s00415-020-10377-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 12/18/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune neurological diseases of the central nervous system, which are characterized by the presence of serum anti-aquaporin-4 autoantibodies (AQP4-IgG). An association between Sjögren syndrome (SjS) and AQP4-IgG-positive NMOSD has been proposed, but the rate of coexistence has not been determined. METHODS In this study, 4,447 patients suspected of having NMOSD with acute neurological episodes were evaluated for the positivity of serum AQP4-IgG, serum SS-A/Ro antibody, and the presence of SjS-related symptoms (dry eye, dry mouth). RESULTS Of the 4,447 patients, 1,651 were positive for serum AQP4-IgG, and the remaining 2,796 were negative. A significantly higher proportion of AQP4-IgG-positive patients were positive for serum anti-SSA/Ro antibody (26.3 vs. 4.5%; p < 0.0001) and anti-SSB/La antibody (7.2 vs. 1.2%; p < 0.0001) and had dry eye (9.1 vs .4.9%; p < 0.0001) and dry mouth symptoms (8.9 vs. 3.7%; p < 0.0001). More than 80% of the patients with SjS with acute neurological events such as myelitis or optic neuritis were AQP4-IgG positive. AQ4-IgG-positive patients with comorbid SjS showed a higher female rate (97.1 vs. 89.0%; p = 0.0062), a higher positivity rate for oligoclonal bands (15.4 vs. 7.5%; p = 0.029), and a higher relapse frequency (p = 0.027) than AQP4-IgG-positive patients without comorbid SjS. CONCLUSIONS The prevalence of SjS is higher among AQP4-IgG-positive than AQP4-IgG-negative patients, with the potential prevalence of 10-20% at the diagnosis of AQP4-IgG-positive NMOSD. Comorbid SjS is more prevalent in females, and it has a higher relapse frequency among AQP4-IgG-positive patients.
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Tfaily MAH, Titanji B, Schniederjan MJ, Goodman A, Lava NS, Pouch SM, Collins MH, Adelman MW. Neuromyelitis Optica Presenting as Infectious Meningoencephalitis: Case Report and Literature Review. Am J Med Sci 2020; 361:534-541. [PMID: 33342552 DOI: 10.1016/j.amjms.2020.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 11/20/2020] [Accepted: 12/11/2020] [Indexed: 11/16/2022]
Abstract
In this patient-focused review, we present a 34-year-old previously healthy man admitted for fever and headache two weeks after a motor vehicle accident. On admission, his workup was concerning for meningoencephalitis based on elevated cerebrospinal fluid (CSF) white blood cell count and elevated CSF protein. He was admitted for management of meningoencephalitis. During his course, no causative infectious agent was identified despite an extensive workup. He additionally underwent an autoimmune and paraneoplastic workup that was negative. During his hospitalization, he developed acute transverse myelitis manifested by bilateral lower extremity paralysis. After four weeks marked by persistent clinical deterioration, brain biopsy was performed. Pathologic examination was consistent with neuromyelitis optica spectrum disorder (NMOSD). In this case report and literature review, we explore the presentations of NMOSD that mimic an infection. Clinicians should be aware of the possibility of NMOSD masquerading as infectious meningoencephalitis or acute transverse myelitis.
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Affiliation(s)
| | - Boghuma Titanji
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew J Schniederjan
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Abigail Goodman
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Neil S Lava
- Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Matthew H Collins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Max W Adelman
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Rafiee F, Tarjoman T, Moghadasi AN, Sahraian MA, Azimi A, Rezaeimanesh N, Eskandarieh S. Stressful life events, socioeconomic status, and the risk of neuromyelitis optica spectrum disorder: A population-based case-control study. Mult Scler Relat Disord 2020; 46:102544. [DOI: 10.1016/j.msard.2020.102544] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/27/2020] [Accepted: 09/28/2020] [Indexed: 12/20/2022]
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20
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Akaishi T, Fujimori J, Takahashi T, Misu T, Takai Y, Nishiyama S, Kaneko K, Ogawa R, Abe M, Ishii T, Aoki M, Fujihara K, Nakashima I. Seasonal variation of onset in patients with anti-aquaporin-4 antibodies and anti-myelin oligodendrocyte glycoprotein antibody. J Neuroimmunol 2020; 349:577431. [PMID: 33147540 DOI: 10.1016/j.jneuroim.2020.577431] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 02/06/2023]
Abstract
This study aimed to determine the seasonal impact on the clinical onset of inflammatory neurological diseases of the central nervous system by analyzing the onset month with information on clinical manifestations in Japanese patients. As a result, patients with anti-aquaporin-4 antibodies (AQP4-IgG)-positive neuromyelitis optica spectrum disorders (NMOSD) showed spring-summer predominance of the clinical onset. Conversely, patients with anti-myelin oligodendrocyte glycoprotein antibody (MOG-IgG)-associated disease showed autumn-winter predominance of the clinical onset. Both seasonal variations were irrespective of the clinical manifestation. Environmental factors with seasonal variation influence the development of neurological conditions related to AQP4-IgG and MOG-IgG.
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Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan.
| | - Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Neurology, National Hospital Organization Yonezawa National Hospital, Yonezawa, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kimihiko Kaneko
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ryo Ogawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Abe
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Tadashi Ishii
- Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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21
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Jarius S, Paul F, Weinshenker BG, Levy M, Kim HJ, Wildemann B. Neuromyelitis optica. Nat Rev Dis Primers 2020; 6:85. [PMID: 33093467 DOI: 10.1038/s41572-020-0214-9] [Citation(s) in RCA: 227] [Impact Index Per Article: 56.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica (NMO; also known as Devic syndrome) is a clinical syndrome characterized by attacks of acute optic neuritis and transverse myelitis. In most patients, NMO is caused by pathogenetic serum IgG autoantibodies to aquaporin 4 (AQP4), the most abundant water-channel protein in the central nervous system. In a subset of patients negative for AQP4-IgG, pathogenetic serum IgG antibodies to myelin oligodendrocyte glycoprotein, an antigen in the outer myelin sheath of central nervous system neurons, are present. Other causes of NMO (such as paraneoplastic disorders and neurosarcoidosis) are rare. NMO was previously associated with a poor prognosis; however, treatment with steroids and plasma exchange for acute attacks and with immunosuppressants (in particular, B cell-depleting agents) for attack prevention has greatly improved the long-term outcomes. Recently, a number of randomized controlled trials have been completed and the first drugs, all therapeutic monoclonal antibodies, have been approved for the treatment of AQP4-IgG-positive NMO and its formes frustes.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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22
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Rezaeimanesh N, Jahromi SR, Ghorbani Z, Moghadasi AN, Hekmatdoost A, Moghadam NB, Sahraian MA. Low carbohydrate diet score and odds of neuromyelitis optica spectrum disorder: A case-control study. INT J VITAM NUTR RES 2020; 92:321-330. [PMID: 32795169 DOI: 10.1024/0300-9831/a000677] [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: 11/19/2022]
Abstract
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is a demyelinating inflammatory disease of The Central nervous system. We aimed to investigate the association between low carbohydrate diet (LCD) and NMOSD odds. Method: Seventy NMOSD patients with definite diagnosis and 164 hospital-based controls were enrolled in this case-control study. Dietary data was obtained using a validated 168-item food frequency questionnaire. To determine the LCD score, participants were stratified into 11 groups according to carbohydrate, protein, fat, animal fat, animal protein, vegetable fat and vegetable protein intakes. Higher intake of protein and fat, and lower intake of carbohydrate received a higher score between 0-10. Macronutrients scores were summed together and LCD scores calculated. The association between LCD scores and likelihood of being assigned to NMOSD group was investigated using multiple regression models. Results: Total LCD scores increased from the median of 21.00 in the first decile to 53.00 in the tenth decile of LCD score. After adjustment for confounding factors including age, gender, BMI, energy intake, cigarette smoking and alcohol consumption, an inverse association was detected between LCD scores and odds of NMOSD. The odds of suffering from NMOSD declined significantly about 78% (OR: 0.22; 95% CI: 0.05-0.87) and 76% (OR: 0.24; 95% CI: 0.06-0.93) in the fifth and sixth deciles of LCD score compared to the first decile. Conclusion: From the obtained results it can be speculated that higher carbohydrate and lower protein and fat intakes may be associate with the increased odds of NMOSD. However, further studies are needed to confirm these results.
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Affiliation(s)
- Nasim Rezaeimanesh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran, Student Research Committee, Department and Faculty of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Beladi Moghadam
- Department of neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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23
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The possible beneficial effects of higher vitamin B6 intake from diet on cognitive function of patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 42:102132. [DOI: 10.1016/j.msard.2020.102132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
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24
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Rezaeimanesh N, Sahraian MA, Moghadasi AN, Eskandarieh S. Epidemiology of neuromyelitis optica spectrum disorder in Tehran, Iran: the prevalence, baseline characteristics, and clinical aspects. Neurol Sci 2020; 41:2647-2648. [DOI: 10.1007/s10072-020-04393-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 04/01/2020] [Indexed: 11/29/2022]
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25
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Naser Moghadasi A. Environmental and genetic risk factors in the development of neuromyelitis optica. EXPERT REVIEW OF OPHTHALMOLOGY 2020. [DOI: 10.1080/17469899.2020.1723416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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26
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Shi Z, Qiu Y, Wang J, Fang Y, Zhang Y, Chen H, Du Q, Zhao Z, Yan C, Yang M, Zhou H. Dysbiosis of gut microbiota in patients with neuromyelitis optica spectrum disorders: A cross sectional study. J Neuroimmunol 2020; 339:577126. [DOI: 10.1016/j.jneuroim.2019.577126] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 02/06/2023]
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27
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Ramakrishnan P, Nagarajan D. Neuromyelitis optica spectrum disorder: an overview. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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28
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Wu K, Wen L, Duan R, Li Y, Yao Y, Jing L, Jia Y, Teng J, He Q. Triglyceride Level Is an Independent Risk Factor in First-Attacked Neuromyelitis Optica Spectrum Disorders Patients. Front Neurol 2019; 10:1230. [PMID: 31824407 PMCID: PMC6881454 DOI: 10.3389/fneur.2019.01230] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: To investigate prospective associations between triglyceride (TG) level and prognosis of first-attacked patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: This retrospective study included 196 patients newly diagnosed with NMOSD from June 2014 to December 2018. Data of clinical parameters, including age of onset, sex, BMI, blood lipid levels, anti-aquaporin-4 status, serum glucose level, therapy regimens, comorbidities, initial Expanded Disability Status Scale (EDSS), relapses, and outcomes were collected. We used logistic regression models to examine the associations among relevant clinical factors and outcomes, and statistical analyses were performed using the SPSS 23.0 software. Results: Compared with the high TG group, residual EDSS was relatively lower in the normal TG group (median 1.0 vs. 2.0, P = 0.002). In the univariate analysis, TG level was positively correlated with outcomes (OR 1.75, 95% CI 1.18-2.60, P = 0.005) and relapses (OR 1.57, 95% CI 1.07-2.31, P = 0.02). Our stratified analysis suggested that patients with normal BMI (OR 4.90, 95% CI 2.10-11.44, P = 0.001) were closely correlated with poor recovery owing to increased TG level. In the multivariate analysis, a statistically significant association still existed between TG level and outcomes (OR 3.44, 95% CI 1.02-11.64; P = 0.040) after adjusting for various variables. Conclusions: In first-attacked NMOSD patients, TG level was positively associated with poor recovery. Early monitoring and treatment of elevated TG level in NMOSD patients are important.
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Affiliation(s)
- Kaimin Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - LuLu Wen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Jing
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianyi He
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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29
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Rezaeimanesh N, Razeghi Jahromi S, Ghorbani Z, Beladi Moghadam N, Hekmatdoost A, Naser Moghadasi A, Azimi AR, Sahraian MA. The association between dietary sugar intake and neuromyelitis optica spectrum disorder: A case-control study. Mult Scler Relat Disord 2019; 31:112-117. [PMID: 30978652 DOI: 10.1016/j.msard.2019.03.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/04/2019] [Accepted: 03/31/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon autoimmune disease of the central nerves system (CNS) by inflammatory nature. The effects of high dietary sugar intake on inflammation and dysbiosis have been received more attention in recent years. The aim of the present study was to investigate the association between various types of dietary sugar intake and NMOSD odds and clinical features. METHOD The current case-control study was conducted among 70 patients with definite NMOSD diagnosis based on 2015 international consensus criteria and 164 hospital-based controls. Demographic and anthropometric information in all participants and disease characteristics just in case group were obtained. Dietary data during the past year of study attendance was collected by a validated 168-item food frequency questionnaire. Participants were stratified into 3 tertiles according to each type of sugar intake and the third tertile considered as reference in multivariate regression models. The correlation between dietary sugar and disease features were analyzed using Pearson correlation test. RESULTS The mean ± SD of total sugar intake increased from 80.73 ± 17.71 to 208.71 ± 57.93 g/day across tertiles of total sugar intake. In fully adjusted model, lower intake of sugar was associates with decreased odds of NMOSD in the first tertile vs third tertile by ORs of: 0.02(CI:0.00-0.08; p-for-trend:0.00), 0.02(CI:0.00-0.10; p-for-trend:0.00), 0.23(CI:0.08-0.61; p-for-trend:0.00), 0.19(CI:0.06-0.58; p-for-trend:0.00) and 0.16(CI:0.05-0.51; p-for-trend:0.00) for glucose, fructose, galactose, lactose and sucrose, respectively. The odds of NMOSD had a 1.72-fold (CI: 1.43-2.03; p-for-trend:0.00) significant raise per every 10 g increase for total sugar intake. There was no significant correlation between various types of dietary sugar intakes and relapse rate or patients' disability. CONCLUSION The present study proposes a possible direct association between high intake of various sugar types and odds of suffering from NMOSD. More investigations are needed to prove this results.
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Affiliation(s)
- Nasim Rezaeimanesh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran; School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Nahid Beladi Moghadam
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Azita Hekmatdoost
- Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Reza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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