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Ertürk Çetin Ö, Güngör Doğan İ, Zanapalioğlu Ü, Yadi F, Çetinkaya Tezer D, Demir S. Seizures in inflammatory demyelinating disorders of the central nervous system. Mult Scler Relat Disord 2024; 85:105535. [PMID: 38452647 DOI: 10.1016/j.msard.2024.105535] [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: 01/15/2024] [Revised: 02/10/2024] [Accepted: 03/01/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may be associated with acute symptomatic seizures and chronic epilepsy as well. The clinical features of the seizures and/or accompanying epilepsy seen in each disease group may vary. In this study, we aimed to contribute to the existing literature by describing the clinical features of seizures and epilepsy in our demyelinating patient population. METHODS We retrospectively analyzed patients who were followed up in our tertiary referral center neurology demyelinating diseases outpatient clinic between 2019 and 2024. Patients who had at least one seizure before, simultaneously, or after the diagnosis of demyelinating disease were included in the study. RESULTS Among 1735 patients with MS, 40 had experienced at least one epileptic seizure (2.3 %). Thirty patients (1.7 %) had seizures that could not be explained by another factor than MS. When secondary progressive MS (SPMS) and relapsing-remitting MS (RRMS) were compared, the interval between MS-epilepsy diagnosis was longer and seizure recurrence was more in SPMS. However, the prognosis of epilepsy was good in both subtypes. There were 21 patients followed up with antibody-positive neuromyelitis optica spectrum disorder. No patient had a seizure during the follow-up. We identified 56 patients who fulfilled the criteria for MOGAD with high antibody titers. Seizures were observed in three of them (5.4 %). All of them had status epilepticus either at the onset or during the course of the disease. CONCLUSION Even rare, seizures constitute one of the important clinical features of the inflammatory demyelinating disorders of the central nervous system. The pathophysiologic mechanism underlying seizures in MS is still not clear. Seizures may occur through different mechanisms in patients where seizures are the initial symptom or a sign of relapse and those that occur spontaneously during the progressive course of the disease. Prevalence of status epilepticus was common in MOGAD patients. Given the rarity of the seizures in CNS demyelinating disorders, it is difficult the define clinical and pathophysiological characteristics of accompanying seizures and epilepsy. Future studies conducted on large patient groups will contribute to the existing literature.
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Affiliation(s)
- Özdem Ertürk Çetin
- University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
| | - İpek Güngör Doğan
- University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Ümit Zanapalioğlu
- University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Feyzullah Yadi
- University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Damla Çetinkaya Tezer
- University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey
| | - Serkan Demir
- University of Health Sciences, Sancaktepe Training and Research Hospital, Department of Neurology, Istanbul, Turkey
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Zhou DJ, Powers AM, Cave CA, Dickas EK, Rickard MC, Rathore G, Wright RR, Zabad RK, Koh S. Perplexing Initial Presentations of MOGAD in Two Children: Intracranial Hypertension and New-Onset Seizure. Neurohospitalist 2023; 13:438-444. [PMID: 37701249 PMCID: PMC10494829 DOI: 10.1177/19418744231192159] [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: 09/14/2023] Open
Abstract
We report two distinct challenging initial presentations of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Case 1 describes a 12-year-old boy who developed headaches refractory to pain medication followed by cranial neuropathies and intracranial hypertension, confirmed by lumbar puncture with an opening pressure >36 cm H2O. Case 2 describes a 3-year-old boy who developed new-onset seizures refractory to antiseizure medications, a presentation of FLAIR-hyperintense lesions in MOG-antibody associated encephalitis with seizures (FLAMES). On repeat magnetic resonance imaging, both patients were found to have cortical T2 hyperintensities, leptomeningeal contrast enhancement, and bilateral optic nerve enhancement. In the cerebrospinal fluid, both patients had CSF pleocytosis with neutrophilic predominance. The patients were treated with intravenous immunoglobulins, plasma exchange, and high-dose corticosteroids. The first patient achieved disease remission, whereas the second patient required the addition of rituximab for management of seizures. The two cases highlight the pleomorphic clinical phenotypes of MOGAD.
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Affiliation(s)
- Daniel J. Zhou
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andria M. Powers
- Department of Radiology, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Caleb A. Cave
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | - Emily K. Dickas
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Mary C. Rickard
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Geetanjali Rathore
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Rhonda R. Wright
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
| | - Rana K. Zabad
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sookyong Koh
- Division of Neurology, Department of Pediatrics, Children’s Hospital and Medical Center, Omaha, NE, USA
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Duan Y, Zhang Z, Zhao X, Cheng H, Zhang S, Guo S, Jin B, Wu X, Aung T. Validation of different predictive scoring scales in patients with new-onset epileptic seizures or epilepsy related to neuronal surface antibody-mediated autoimmune encephalitis. Epilepsy Behav 2023; 147:109403. [PMID: 37660404 DOI: 10.1016/j.yebeh.2023.109403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/07/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
OBJECTIVE To validate the different predictive scoring scales in the Chinese population with new-onset epileptic seizures or epilepsy of unknown etiology related to neuronal surface antibody (Ab)-mediated autoimmune encephalitis (AE). METHODS We retrospectively reviewed the charts of 174 consecutive patients from October 2018 to December 2022, whose serum and cerebrospinal fluid samples were tested for neuronal surface Abs. The antibody prevalence in epilepsy and encephalopathy (APE2), antibodies contributing to focal epilepsy signs and symptoms (ACES), "obvious" indications for neural antibody testing in epilepsy or seizures (ONES) checklist, and the combinations were used to validate the predictive models of neuronal surface Ab-mediated AE. RESULTS A total of 139 patients with new-onset epileptic seizures or epilepsy of unknown etiology were enrolled. Abs were detected in 37 patients (26.6%). The APE2/ONES reflex score had the highest sensitivity (89.2%) and lowest specificity (41.7%). The ACES score had the lowest sensitivity (67.5%) and highest specificity (64.7%). Variations in the performance were observed in the different types of AE. 100% of patients with anti-γ-aminobutyric acid B-B receptor encephalitis were predicted by ONES, APE2/ONES reflex, and ACES/ONES reflex scores. Only 75% of patients with anti-N-methyl-D-aspartate receptor encephalitis were predicted by the APE2/ONES and ACES/ONES reflex scores. CONCLUSION Our study was the first to validate various predictive scoring scales in the Chinese cohort of patients with new-onset epileptic seizures or epilepsy of unknown etiology related to neuronal surface Ab-mediated AE. Based upon clinical suspicion, more than one scoring scale should be performed to predict the chance of AE in those patients.
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Affiliation(s)
- Yiqun Duan
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Zheyu Zhang
- Department of Neurology, The First Affiliated Hospital of Ningbo University, Ningbo, China
| | - Xiaoyu Zhao
- Center for Rehabilitation Medicine, Department of Neurophysiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Hui Cheng
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Sheng Zhang
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shunyuan Guo
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Bo Jin
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Xiaoyan Wu
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
| | - Thandar Aung
- Department of Neurology, Epilepsy Center, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Khoshnood MM, Santoro JD. Myelin Oligodendrocyte Glycoprotein (MOG) Associated Diseases: Updates in Pediatric Practice. Semin Pediatr Neurol 2023; 46:101056. [PMID: 37451753 DOI: 10.1016/j.spen.2023.101056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/07/2023] [Accepted: 05/07/2023] [Indexed: 07/18/2023]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) is a membrane bound protein found on the surface of oligodendrocyte cells and the outermost surface of myelin sheaths. MOG is posited to play a role as a cell surface receptor or cell adhesion molecule, though there is no definitive answer to its exact function at this time. In the last few decades, there has been a recognition of anti-MOG-antibodies (MOG-Abs) in association with a variety of neurologic conditions, though primarily demyelinating and white matter disorders. In addition, MOG associated disease (MOGAD) appears to have a predilection for pediatric populations and in some patients may have a relapsing course. There has been considerable debate as to whether MOG-Abs are truly directly pathogenic or a disease biomarker associated with neuorinflammatory disease. In this manuscript we will review the current literature surrounding MOGAD, review new clinical phenotypes, discuss treatment and prognosis, and provide insight into potential future directions that studies may focus on.
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Affiliation(s)
- Mellad M Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA; Department of Neurology, Keck School of Medicine at the University of Southern California, Los Angeles, CA.
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Patel P, Arora A, Tiwari S, Khan MA, Panda S. Nonconvulsive Status Epilepticus - A Rare Presentation of Cortical-brainstem Encephalitis Phenotype of SARS-COV-2-triggered MOGAD. Neurol India 2023; 71:594-595. [PMID: 37322777 DOI: 10.4103/0028-3886.378689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- Pratik Patel
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Anka Arora
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Sarbesh Tiwari
- Department of Diagnostic and Interventional Radiology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Md Atik Khan
- Department of Transfusion Medicine, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Samhita Panda
- Department of Neurology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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Das S, Pandit A, Ray BK, Dubey S. Sentinel seizure heralding Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2023. [DOI: 10.1186/s41983-023-00632-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Abstract
Abstract
Background
Isolated seizure as a manifestation of myelin oligodendrocyte antibody-associated disease (MOGAD) has rarely been reported previously.
Case presentation
A 16-year-old-male presented with single episode of left focal onset motor seizure with secondary generalization and impaired awareness, without any other focal neurological deficits. There was a history of right focal onset motor seizure with secondary generalized tonic–clonic seizure and impaired awareness 4 years ago. Neurological examination showed bilateral gaze evoked nystagmus. Brain imaging revealed bilateral superficial and deep white matter lesions including the corpus callosum. Anti-MOG antibody was positive. The patient received steroids and Rituximab therapy without any further recurrence of seizure or any neuro-deficits and gradual improvement in lesion burden in brain imaging.
Conclusions
This case of an adolescent boy with sole manifestation of episodes of focal seizures 4 years apart, finally diagnosed to be a case of MOGAD, not only boosts the evidence of establishing the possibility of MOG antibody-associated autoimmune epilepsy but also reinforces the importance of unexplained seizure as a clinical phenotype in MOGAD.
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Hurtubise B, Frohman EM, Galetta S, Balcer LJ, Frohman TC, Lisak RP, Newsome SD, Graves JS, Zamvil SS, Amezcua L. MOG Antibody-Associated Disease and Thymic Hyperplasia: From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200077. [PMID: 36517233 PMCID: PMC9753285 DOI: 10.1212/nxi.0000000000200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described CNS inflammatory disorder that may manifest with optic neuritis, myelitis, seizures, and/or acute disseminated encephalomyelitis. While MOG-specific antibodies in patients with MOGAD are IgG1, a T-cell-dependent antibody isotype, immunologic mechanisms of this disease are not fully understood. Thymic hyperplasia can be associated with certain autoimmune diseases. In this report we describe a case of MOGAD associated with thymic hyperplasia in a young adult.
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Affiliation(s)
- Brigitte Hurtubise
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elliot M Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Teresa C Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Robert P Lisak
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Jennifer S Graves
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco.
| | - Lilyana Amezcua
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
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Woo H, Shim Y, Chae JH, Kim KJ, Lim BC. Seizure Evolution and Outcome in Pediatric Autoimmune Encephalitis. Pediatr Neurol 2023; 139:35-42. [PMID: 36508881 DOI: 10.1016/j.pediatrneurol.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 09/05/2022] [Accepted: 11/16/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Our study aimed to characterize seizure incidence and seizure outcome of pediatric autoimmune encephalitis (AE) focusing on subgroup analysis based on antibody (Ab). METHODS Among 110 pediatric patients with AE, we compared seizure characteristics and outcomes in 68 patients with seizure, who satisfied the proposed criteria of pediatric AE. Accordingly, patients were classified into three groups, anti-myelin oligodendrocyte glycoprotein (anti-MOG) AE, anti-N-methyl-D-aspartic acid receptor (anti-NMDAR) AE, and Ab-negative AE. Univariate and multivariate analyses were performed to evaluate the risk factors for postencephalitic seizures, defined as persisting seizures six months after onset. RESULTS Seizure incidence in the anti-NMDAR (88.9%) and Ab-negative (71.1%) groups differed from anti-MOG group (37.8%). Median seizure frequency within six months was higher in the Ab-negative group (6.0, interquartile range [IQR] 3.0 to 13.0) than in the anti-NMDAR group (3.0, IQR 2.0 to 4.5) and anti-MOG group (2.0, IQR 1.0 to 5.0). Patients in the Ab-negative group tended to develop postencephalitic seizures more frequently and have a lower seizure freedom rate than those in the anti-NMDAR and anti-MOG groups. Ab-negative status, high seizure frequency within six months, and the presence of status epilepticus were associated with the development of postencephalitic seizures on univariate analysis. On multivariate analysis, Ab-negative status remained the only significant variable linked with postencephalitic seizure (odds ratio, 4.17; 95% confidence interval, 1.02 to 18.05). CONCLUSIONS We delineated the seizure incidence, evolution, and outcome of pediatric patients with Ab-positive and Ab-negative AE. Ab-negative status is predictive of higher seizure burden, more frequent development of postencephalitic seizures, and less favorable seizure outcome than anti-NMDAR and anti-MOG Ab-positive status.
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Affiliation(s)
- Hyewon Woo
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Youngkyu Shim
- Department of Pediatrics, Korea University Ansan Hospital, Ansan, Republic of Korea
| | - Jong-Hee Chae
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ki Joong Kim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byung Chan Lim
- Department of Pediatrics, Pediatric Clinical Neuroscience Center, Seoul National University Children's Hospital, Seoul, Republic of Korea; Department of Pediatrics, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Lin S, Long W, Wen J, Su Q, Liao J, Hu Z. Myelin oligodendrocyte glycoprotein antibody-associated aseptic meningitis without neurological parenchymal lesions: A novel phenotype. Mult Scler Relat Disord 2022; 68:104126. [PMID: 36115288 DOI: 10.1016/j.msard.2022.104126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibodies mediate inflammatory demyelinating diseases of the central nervous system. This study aimed to understand the clinical characteristics of MOG antibody-associated aseptic meningitis (MOGAM). METHODS Here, we report the cases of two children with MOGAM. A systematic literature review was conducted and included patients who had MOGAM only, without neurological parenchymal lesions. The clinical characteristics that may have affected the outcome were statistically analyzed. RESULTS We reviewed 12 cases of MOGAM; male: female = 9: 3. Prolonged fever lasting over 7 days (11/12) was the most frequent symptom, followed by headache (10/12), vomiting (5/12), and seizures (4/12). None of the patients had focal neurological manifestations or parenchymal lesions on imaging. Cerebrospinal fluid (CSF) leukocytosis was observed in all patients (12/12), and blood leukocytosis and elevated CSF pressure was observed in all patients who had corresponding results (9/9 and 4/4, respectively). Seizures occurrence was lower than that of MOG antibody-associated cortical encephalitis. Seven cases progressed to other MOG antibody-associated diseases (MOGADs) in the later phase of MOGAM. Patients who did not progress to other MOGADs had a shorter disease duration from onset to the initiation of intravenous methylprednisolone than those who did. All the patients achieved full recovery after steroid treatment. One patient had relapses. CONCLUSIONS MOGAM without inflammatory demyelination is a rare but distinct phenotype of MOGAD, with fewer clinical manifestations mimicking bacterial or viral meningitis/encephalomeningitis. Delayed diagnosis and treatment may induce the progression to other severe MOGADs. Early recognition of this unique autoimmune aseptic meningitis may contribute to early diagnosis, treatment, and better outcomes.
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Affiliation(s)
- Sufang Lin
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China.
| | - Weiwei Long
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Jialun Wen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Zhanqi Hu
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
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Li EC, Zheng Y, Cai MT, Lai QL, Fang GL, Du BQ, Shen CH, Zhang YX, Wu LJ, Ding MP. Seizures and epilepsy in multiple sclerosis, aquaporin 4 antibody-positive neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Epilepsia 2022; 63:2173-2191. [PMID: 35652436 DOI: 10.1111/epi.17315] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022]
Abstract
Seizure is one of the manifestations of central nervous system (CNS) inflammatory demyelinating diseases, which mainly include multiple sclerosis (MS), aquaporin 4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). "Acute symptomatic seizures secondary to MS / AQP4-NMOSD / MOGAD" occur in the acute phase of the diseases, and are more frequent in MOGAD. In contrast, recurrent non-provoked seizures, mainly attributed to "autoimmune-associated epilepsy", occur in the non-acute phase of the diseases. Seizures in MS / AQP4-NMOSD / MOGAD mostly have a focal-onset. MS patients with concomitant systemic infections, an earlier onset and a higher disease activity are more likely to have seizures, whereas factors such as higher MS severity, the presence of status epilepticus and cortical damage indicate a greater risk of developing epilepsy. In MOGAD, cerebral cortical encephalitis, acute disseminated encephalomyelitis (ADEM)-like phenotypes (predominately ADEM and multiphasic disseminated encephalomyelitis) indicate a higher seizure risk. Multiple relapses with ADEM-like phenotypes predict epilepsy in pediatrics with MOGAD. Pathophysiologically, acute symptomatic seizures in MS are associated with neuronal hyperexcitability secondary to inflammation and demyelination. Chronic epilepsy in MS is largely due to gliosis, neuronal dysfunction and synaptic abnormalities. The mainstay of treatment for seizures secondary to MS / AQP4-NMOSD / MOGAD include immunotherapy along with antiseizure medications. This critical review discusses the most-updated evidence on epidemiology, clinical correlates, and inflammatory mechanisms underlying seizures and epilepsy in MS / AQP4-NMOSD / MOGAD. Treatment cautions including drug-drug interactions and the impact of treatments on the other are outlined. We also highlight pitfalls and challenges in managing such patients and future research perspectives to address unsolved questions.
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Affiliation(s)
- Er-Chuang Li
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yang Zheng
- Department of Neurology, First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Meng-Ting Cai
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Qi-Lun Lai
- Department of Neurology, Zhejiang Hospital, Hangzhou, China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, China
| | - Bing-Qing Du
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Chun-Hong Shen
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mei-Ping Ding
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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11
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Immune Mechanism of Epileptogenesis and Related Therapeutic Strategies. Biomedicines 2022; 10:biomedicines10030716. [PMID: 35327518 PMCID: PMC8945207 DOI: 10.3390/biomedicines10030716] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/16/2022] [Accepted: 03/17/2022] [Indexed: 02/05/2023] Open
Abstract
Immunologic and neuroinflammatory pathways have been found to play a major role in the pathogenesis of many neurological disorders such as epilepsy, proposing the use of novel therapeutic strategies. In the era of personalized medicine and in the face of the exhaustion of anti-seizure therapeutic resources, it is worth looking at the current or future possibilities that neuroimmunomodulator or anti-inflammatory therapy can offer us in the management of patients with epilepsy. For this reason, we performed a narrative review on the recent advances on the basic epileptogenic mechanisms related to the activation of immunity or neuroinflammation with special attention to current and future opportunities for novel treatments in epilepsy. Neuroinflammation can be considered a universal phenomenon and occurs in structural, infectious, post-traumatic, autoimmune, or even genetically based epilepsies. The emerging research developed in recent years has allowed us to identify the main molecular pathways involved in these processes. These molecular pathways could constitute future therapeutic targets for epilepsy. Different drugs current or in development have demonstrated their capacity to inhibit or modulate molecular pathways involved in the immunologic or neuroinflammatory mechanisms described in epilepsy. Some of them should be tested in the future as possible antiepileptic drugs.
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Bartels F, Lu A, Oertel FC, Finke C, Paul F, Chien C. Clinical and neuroimaging findings in MOGAD-MRI and OCT. Clin Exp Immunol 2021; 206:266-281. [PMID: 34152000 PMCID: PMC8561692 DOI: 10.1111/cei.13641] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 06/14/2021] [Accepted: 06/17/2021] [Indexed: 12/16/2022] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) are rare in both children and adults, and have been recently suggested to be an autoimmune neuroinflammatory group of disorders that are different from aquaporin-4 autoantibody-associated neuromyelitis optica spectrum disorder and from classic multiple sclerosis. In-vivo imaging of the MOGAD patient central nervous system has shown some distinguishing features when evaluating magnetic resonance imaging of the brain, spinal cord and optic nerves, as well as retinal imaging using optical coherence tomography. In this review, we discuss key clinical and neuroimaging characteristics of paediatric and adult MOGAD. We describe how these imaging techniques may be used to study this group of disorders and discuss how image analysis methods have led to recent insights for consideration in future studies.
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Affiliation(s)
- Frederik Bartels
- Department of NeurologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Berlin School of Mind and BrainBerlin Institute of Health at Charité – Universitätsmedizin Berlin andHumboldt‐Universität zu BerlinBerlinGermany
| | - Angelo Lu
- Humboldt‐Universität zu Berlin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Experimental and Clinical Research CenterCharité –Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinBerlinGermany
- NeuroCure Clinical Research CenterCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlinGermany
| | - Frederike Cosima Oertel
- Humboldt‐Universität zu Berlin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Experimental and Clinical Research CenterCharité –Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinBerlinGermany
- NeuroCure Clinical Research CenterCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlinGermany
| | - Carsten Finke
- Department of NeurologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Berlin School of Mind and BrainBerlin Institute of Health at Charité – Universitätsmedizin Berlin andHumboldt‐Universität zu BerlinBerlinGermany
| | - Friedemann Paul
- Department of NeurologyCharité – Universitätsmedizin BerlinCorporate Member of Freie Universität Berlin and Humboldt‐Universität zu BerlinBerlinGermany
- Humboldt‐Universität zu Berlin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Experimental and Clinical Research CenterCharité –Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinBerlinGermany
- NeuroCure Clinical Research CenterCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlinGermany
| | - Claudia Chien
- Humboldt‐Universität zu Berlin and Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Experimental and Clinical Research CenterCharité –Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinBerlinGermany
- NeuroCure Clinical Research CenterCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlinGermany
- Department for Psychiatry and NeurosciencesCharité – Universitätsmedizin Berlin, Corporate Member of Freie Universität BerlinHumboldt‐Universität zu BerlinBerlinGermany
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13
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Luo W, Chen Y, Mao S, Jin J, Liu C, Zhong X, Sun X, Kermode AG, Qiu W. Serum neurofilament light chain in adult and pediatric patients with myelin oligodendrocyte glycoprotein antibody-associated disease: Correlation with relapses and seizures. J Neurochem 2021; 160:568-577. [PMID: 34839538 DOI: 10.1111/jnc.15549] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/30/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) causes major disability as a consequence of recurrent demyelinating events and neuronal loss. Biomarkers identifying different phenotypes of recurrence or tissue damage might be useful to guide individualized therapy. Herein, we evaluated serum neurofilament light chain (sNfL) as a potential biomarker in both adult and pediatric MOGAD patients. Forty-nine patients with MOGAD (37 adults, 12 children) and 71 healthy controls (HCs) (56 adults, 15 children) were enrolled prospectively from September 2019 to April 2021 at the Third Affiliated Hospital of Sun Yat-sen University and the Children's Hospital, Zhejiang University School of Medicine. sNfL levels were determined using ultrasensitive single-molecule array assay and correlated with clinical parameters. The sNfL levels in MOGAD adults in a relapsed state (median: 31.0 pg/ml) were higher than those in a remission state (8.1 pg/ml, p = 0.001) and in HC adults (10.3 pg/ml, p = 0.004). Similar results were observed in children (relapse: 46.8 pg/ml vs. remission: 13.1 pg/ml, p = 0.001; and vs. HCs: 8.2 pg/ml, p = 0.007) sNfL levels were correlated with recent relapses within 60 days (multivariate: β = 2.02, p = 0.003), seizures (multivariate: β = 2.50, p = 0.021) and brain lesions on magnetic resonance imaging (MRI) of a recent relapse (multivariate: β = 1.72, p = 0.012). Our study showed that sNfL levels are beneficial for identifying recent relapses and seizures and suggest that adult and pediatric MOGAD patients had similar sNfL levels.
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Affiliation(s)
- Wenjing Luo
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yashuang Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shanshan Mao
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianing Jin
- Department of Neurology, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunxin Liu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perth, Western Australia, Australia.,Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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14
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Wang J, Qiu Z, Li D, Yang X, Ding Y, Gao L, Liu A, Song Y, Li C, Gao R, Wang L, Wu L, Jia L, Guo D, Zhou A, Jia J, Huang L, Qu M, Gao L, Dong H, Hao J, Liu Z. Clinical and Imaging Features of Patients With Encephalitic Symptoms and Myelin Oligodendrocyte Glycoprotein Antibodies. Front Immunol 2021; 12:722404. [PMID: 34691028 PMCID: PMC8529193 DOI: 10.3389/fimmu.2021.722404] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/07/2021] [Indexed: 11/13/2022] Open
Abstract
Background Myelin oligodendrocyte glycoprotein-antibody (MOG-ab)-associated disease (MOGAD) has highly heterogenous clinical and imaging presentations, in which encephalitis is an important phenotype. In recent years, some atypical presentations in MOG-ab-associated encephalitis (MOG-E) have been increasingly reported but have not yet been described well. The aim of the study was to describe the clinical and imaging features of patients with MOG-E in our center. Atypical phenotypes would be reported, which is expected to expand the spectrum of MOGAD. Methods We reviewed medical records of 59 patients with MOGAD diagnosed in our center and identified cases who had ever experienced encephalitic symptoms. Three hundred ten patients with autoimmune encephalitis (AE) were also reviewed, and cases with positive MOG-ab were identified. Besides, patients with chronically progressive encephalitis were identified from 13 MOG-E and 310 AE patients. We collected demographic, clinical, laboratory, radiological, and outcome data to explore clinical and imaging characteristics in MOG-E, especially in the atypical phenotype of chronically progressive encephalitis. Results We identified 13 patients (7 males, 6 females) with MOG-E. The median age at onset was 33 years (range 13~62 years). Most (9/13, 69.2%) of patients showed acute or subacute onset of encephalitic symptoms. Brain MRI abnormalities were observed in all patients. The most common lesion locations on MRI were cortical/subcortical (11/13, 84.6%), deep/periventricular white matter (10/13, 76.9%) and corpus callosum (4/13, 30.8%). Brain MRI patterns were categorized into four phenotypes. The most common pattern was cortical encephalitis with leptomeningeal enhancement/brain atrophy (10/13, 76.9%). Eight (8/13, 61.5%) patients had a good response to immunotherapy. Four (4/13, 30.8%) patients with chronically progressive course were identified from MOG-E cohort. They showed leukodystrophy-like pattern, multifocal hazy lesions, or cortical encephalitis on MRI. With immunotherapy, they only showed mild or no improvement. We also identified four (4/310, 1.3%) patients with chronically progressive course from AE cohort. They had better outcomes than counterparts in MOG-E. Conclusions This study demonstrates that encephalitic presentations in MOGAD had complex clinical patterns. Chronically progressive encephalitis may be a new phenotype of MOGAD. We recommend to test MOG-ab in subacute and chronic progressive dementia with leukodystrophy-like MRI lesions.
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Affiliation(s)
- Jingsi Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zhandong Qiu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dawei Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xixi Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yan Ding
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lehong Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aihua Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yang Song
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cunjiang Li
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ran Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Lin Wang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyong Wu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Longfei Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dongmei Guo
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Aihong Zhou
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jianping Jia
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Liyuan Huang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Miao Qu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Li Gao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junwei Hao
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
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15
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Rayatpour A, Farhangi S, Verdaguer E, Olloquequi J, Ureña J, Auladell C, Javan M. The Cross Talk between Underlying Mechanisms of Multiple Sclerosis and Epilepsy May Provide New Insights for More Efficient Therapies. Pharmaceuticals (Basel) 2021; 14:ph14101031. [PMID: 34681255 PMCID: PMC8541630 DOI: 10.3390/ph14101031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 12/17/2022] Open
Abstract
Despite the significant differences in pathological background of neurodegenerative diseases, epileptic seizures are a comorbidity in many disorders such as Huntington disease (HD), Alzheimer's disease (AD), and multiple sclerosis (MS). Regarding the last one, specifically, it has been shown that the risk of developing epilepsy is three to six times higher in patients with MS compared to the general population. In this context, understanding the pathological processes underlying this connection will allow for the targeting of the common and shared pathological pathways involved in both conditions, which may provide a new avenue in the management of neurological disorders. This review provides an outlook of what is known so far about the bidirectional association between epilepsy and MS.
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Affiliation(s)
- Atefeh Rayatpour
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14117-13116, Iran; (A.R.); (S.F.)
- Institute for Brain and Cognition, Tarbiat Modares University, Tehran 14117-13116, Iran
| | - Sahar Farhangi
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14117-13116, Iran; (A.R.); (S.F.)
- Institute for Brain and Cognition, Tarbiat Modares University, Tehran 14117-13116, Iran
| | - Ester Verdaguer
- Department of Cell Biology, Physiology and Immunology, Biology Faculty, Universitat de Barcelona, 08028 Barcelona, Spain; (E.V.); (J.U.)
- Centre for Biomedical Research of Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Institute of Neuroscience, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Jordi Olloquequi
- Laboratory of Cellular and Molecular Pathology, Biomedical Sciences Institute, Health Sciences Faculty, Universidad Autónoma de Chile, Talca 3460000, Chile;
| | - Jesus Ureña
- Department of Cell Biology, Physiology and Immunology, Biology Faculty, Universitat de Barcelona, 08028 Barcelona, Spain; (E.V.); (J.U.)
- Centre for Biomedical Research of Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Institute of Neuroscience, Universitat de Barcelona, 08035 Barcelona, Spain
| | - Carme Auladell
- Department of Cell Biology, Physiology and Immunology, Biology Faculty, Universitat de Barcelona, 08028 Barcelona, Spain; (E.V.); (J.U.)
- Centre for Biomedical Research of Neurodegenerative Diseases (CIBERNED), Instituto de Salud Carlos III, 28029 Madrid, Spain
- Institute of Neuroscience, Universitat de Barcelona, 08035 Barcelona, Spain
- Correspondence: (C.A.); (M.J.)
| | - Mohammad Javan
- Department of Physiology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran 14117-13116, Iran; (A.R.); (S.F.)
- Institute for Brain and Cognition, Tarbiat Modares University, Tehran 14117-13116, Iran
- Cell Science Research Center, Department of Brain and Cognitive Sciences, Royan Institute for Stem Cell Biology and Technology, ACECR, Tehran 14117-13116, Iran
- Correspondence: (C.A.); (M.J.)
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Ferilli MAN, Valeriani M, Papi C, Papetti L, Ruscitto C, Figà Talamanca L, Ursitti F, Moavero R, Vigevano F, Iorio R. Clinical and neuroimaging characteristics of MOG autoimmunity in children with acquired demyelinating syndromes. Mult Scler Relat Disord 2021; 50:102837. [PMID: 33636614 DOI: 10.1016/j.msard.2021.102837] [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: 09/11/2020] [Revised: 12/01/2020] [Accepted: 02/06/2021] [Indexed: 12/13/2022]
Abstract
Background Myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) have been recently reevaluated as a biomarker of acquired demyelinating syndromes (ADS) of the central nervous system (CNS). Here, we describe the clinical and neuroimaging features, and the long-term outcome of children with ADS of the CNS associated with MOG-IgG. Methods All patients underwent brain and spinal cord magnetic resonance imaging (MRI), lumbar puncture for cerebrospinal fluid (CSF) analysis and MOG-IgG and aquaporin-4 IgG (AQP4-IgG) testing. Results Forty-eight pediatric patients were recruited. MOG-IgG were detected in 11/48 (25%) patients with the following clinical presentations: encephalomyelitis (EM), 8/11 (73%); optic neuritis (ON), 2/11 (18%); transverse myelitis (TM), 1/11 (9%). Patients negative for MOG-IgG were diagnosed with Multiple Sclerosis (MS) (n=15), EM (n=7), ON (n=7), neuromyelitis optica spectrum disorders (NMOSD) (n=5), TM (n=2) and encephalitis (n=1). MOG-IgG positive patients were younger at disease onset and they more frequently experienced encephalopathy and epileptic seizures compared with negative patients. EM and inflammatory lesions involving optic nerves on MRI imaging were more frequent in MOG-IgG positive patients. None of the patients with MOG-IgG became persistently seronegative during the follow-up, although a decrease in MOG-IgG titer was observed. Patients with MOG-IgG showed a good response to therapy and only two patients presented relapses during follow-up. Conclusion This study supports the distinction of MOG autoimmune oligodendrocytopathy as a unique disease entity, with clinical features different from those of MS and AQP4-IgG-positive NMOSD.
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Affiliation(s)
| | - Massimiliano Valeriani
- Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy; Center for Sensory-Motor Interaction, Aalborg University, Aalborg DK-9220, Denmark.
| | - Claudia Papi
- Neuroscience Department, Università Cattolica del Sacro Cuore, Rome 00168, Italy
| | - Laura Papetti
- Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Claudia Ruscitto
- Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome 00133, Italy
| | | | - Fabiana Ursitti
- Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Romina Moavero
- Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy; Child Neurology Unit, Systems Medicine Department, Tor Vergata University Hospital of Rome, Rome 00133, Italy
| | - Federico Vigevano
- Neuroscience Department, Bambino Gesù Children's Hospital IRCCS, Rome 00165, Italy
| | - Raffaele Iorio
- Neuroscience Department, Università Cattolica del Sacro Cuore, Rome 00168, Italy; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome 00168, Italy
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Ambrosius W, Michalak S, Kozubski W, Kalinowska A. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: Current Insights into the Disease Pathophysiology, Diagnosis and Management. Int J Mol Sci 2020; 22:E100. [PMID: 33374173 PMCID: PMC7795410 DOI: 10.3390/ijms22010100] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/18/2020] [Accepted: 12/22/2020] [Indexed: 12/16/2022] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG)-associated disease (MOGAD) is a rare, antibody-mediated inflammatory demyelinating disorder of the central nervous system (CNS) with various phenotypes starting from optic neuritis, via transverse myelitis to acute demyelinating encephalomyelitis (ADEM) and cortical encephalitis. Even though sometimes the clinical picture of this condition is similar to the presentation of neuromyelitis optica spectrum disorder (NMOSD), most experts consider MOGAD as a distinct entity with different immune system pathology. MOG is a molecule detected on the outer membrane of myelin sheaths and expressed primarily within the brain, spinal cord and also the optic nerves. Its function is not fully understood but this glycoprotein may act as a cell surface receptor or cell adhesion molecule. The specific outmost location of myelin makes it a potential target for autoimmune antibodies and cell-mediated responses in demyelinating processes. Optic neuritis seems to be the most frequent presenting phenotype in adults and ADEM in children. In adults, the disease course is multiphasic and subsequent relapses increase disability. In children ADEM usually presents as a one-time incident. Luckily, acute immunotherapy is very effective and severe disability (ambulatory and visual) is less frequent than in NMOSD. A critical element of reliable diagnosis is detection of pathogenic serum antibodies MOG with accurate, specific and sensitive methods, preferably with optimized cell-based assay (CBA). MRI imaging can also help in differentiating MOGAD from other neuro-inflammatory disorders. Reports on randomised control trials are limited, but observational open-label experience suggests a role for high-dose steroids and plasma exchange in the treatment of acute attacks, and for immunosuppressive therapies, such as steroids, oral immunosuppressants and rituximab as maintenance treatment. In this review, we present up-to-date clinical, immunological, radiographic, histopathological data concerning MOGAD and summarize the practical aspects of diagnosing and managing patients with this disease.
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Affiliation(s)
- Wojciech Ambrosius
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland;
| | - Sławomir Michalak
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (S.M.); (A.K.)
| | - Wojciech Kozubski
- Department of Neurology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland;
| | - Alicja Kalinowska
- Department of Neurology, Division of Neurochemistry and Neuropathology, Poznan University of Medical Sciences, 49 Przybyszewskiego Street, 60-355 Poznan, Poland; (S.M.); (A.K.)
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18
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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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