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Mao JH, Chen WM, Wang Y, Shao YH, Liu J, Wang XM, Tu ZC. Dynamic high-pressure microfluidization assisted with galactooligosaccharide-modified whey protein isolate: Investigating its effect on relieving intestinal barrier damage. Int J Biol Macromol 2024; 279:135322. [PMID: 39236946 DOI: 10.1016/j.ijbiomac.2024.135322] [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: 07/05/2024] [Revised: 08/15/2024] [Accepted: 09/02/2024] [Indexed: 09/07/2024]
Abstract
The study aimed to investigating the mechanisms of relieved intestinal barrier damage by dynamic high-pressure microfluidization assisted with galactooligosaccharide- glycated whey protein isolate. The modifications changed the multi-structure, and the modified whey protein isolate could promote the proliferation of IEC-6 cells and contributed to the restoration of LPS-induced occludin damage in IEC-6 cells. Also, it could repair cyclophosphamide-induced ileal villus rupture and crypt destruction in BALB/c mice, significantly altered the abundance of dominant bacteria, which were associated with propionic acid, butyric acid, isovaleric acid, and valeric acid. Ileum transcriptomics revealed that the modified whey protein isolate significantly regulate of the levels of Cstad, Cyp11a1, and Hs6st2 genes, relating to the increase of propionic acid, isovaleric acid, and valeric acid. In conclusion, galactooligosaccharide- modified whey protein isolate could regulate the level of Cstad, Cyp11a1 and Hs6st2 genes by altering the gut microbial structure and the level of SCFAs, thereby repairing the intestinal barrier.
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Affiliation(s)
- Ji-Hua Mao
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Wen-Mei Chen
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Yang Wang
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Yan-Hong Shao
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Jun Liu
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China
| | - Xu-Mei Wang
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China.
| | - Zong-Cai Tu
- National R&D Center for Freshwater Fish Processing, College of Chemistry and Materials, College of Life Science, School of Health, Jiangxi Normal University, Nanchang, Jiangxi 330022, China; State Key Laboratory of Food Science and Resources, Nanchang University, Nanchang, Jiangxi 330047, China.
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Song D, Heo JW, Kim JS, Jung J, Jang HH, Hwang IG, Shim CK, Ham JS, Park SY, Lee SH. Anti-obesity and immunomodulatory effects of Allium hookeri leaves cultivated with artificial light of different intensities on immune-depressed obese mice. Biomed Pharmacother 2024; 179:117393. [PMID: 39260326 DOI: 10.1016/j.biopha.2024.117393] [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: 05/31/2024] [Revised: 08/20/2024] [Accepted: 08/30/2024] [Indexed: 09/13/2024] Open
Abstract
This study was conducted to evaluate the effects of Allium hookeri (AH) leaves cultivated with different light-emitting diode (LED) intensities (L: low, 100 μmol/m2/s; M: medium, 150 μmol/m2/s; H: high, 200 μmol/m2/s). Alliin concentration increased as light intensity increased in AH and showed the highest level at LED-H condition. The anti-obesity and immunomodulatory properties of AH were evaluated in a cyclophosphamide (CPA)-induced immunosuppressed obese animal model. C57BL/6 J mice were randomly divided into control (CON), high-fat diet (HFD) control (CON-H), negative control (NC), positive control (PC, β-glucan, 50 mg/kg body weight (BW)), AH L, M, and H groups. The three kinds of AH extracts were orally administered to the mice at 300 mg/kg BW for 2 weeks. Except for CON and CON-H, all the other groups were intraperitoneally treated with CPA. Epididymal and abdominal fat weight decreased as LED intensity increased while spleen weight increased in the AH groups. Serum glucose decreased as LED intensity increased in the AH groups and H group showed the lowest level. Triglycerides, total, and LDL-cholesterol levels decreased while HDL-cholesterol level increased in the AH groups compared to the NC group. Moreover, AH effectively reduced serum ALT and AST levels and increased the total white blood cell count, particularly elevating lymphocyte and monocyte levels. Furthermore, NK cell activity was higher in the AH groups. These findings suggest that AH cultivated at optimal LED intensity could be used as a novel biomedicine and in pharmacotherapy to treat related diseases to improve public health without any toxicity.
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Affiliation(s)
- Doyoung Song
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Jeong-Wook Heo
- Department of Agricultural Engineering, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Ji-Su Kim
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Jieun Jung
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Hwan-Hee Jang
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - In-Guk Hwang
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Chang-Ki Shim
- Department of Agricultural Environment, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea; Division of Planning and Coordination, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Jun Sang Ham
- Department of Animal Biotechnology and Environment, National Institute of Animal Science, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Shin-Young Park
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea
| | - Sung-Hyen Lee
- Department of Agro-Food Resources, National Institute of Agricultural Sciences, Rural Development Administration, Wanju 55365, Republic of Korea.
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Banks SA, Brinjikji W, Giannini C, Syc-Mazurek SB, Xeros HK, Toledano M, Mustafa R, Carabenciov ID, Tobin WO. Intra-arterial Melphalan as Targeted Therapy for Tumefactive Multiple Sclerosis Lesions. Neurology 2024; 103:e209739. [PMID: 39106425 DOI: 10.1212/wnl.0000000000209739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2024] Open
Affiliation(s)
- Samantha A Banks
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Waleed Brinjikji
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Caterina Giannini
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Stephanie B Syc-Mazurek
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Helena K Xeros
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Michel Toledano
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Rafid Mustafa
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - Ivan D Carabenciov
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
| | - W Oliver Tobin
- From the Departments of Neurology (S.A.B., S.B.S-M., H.K.X., M.T., R.M., I.D.C., W.O.T.), Radiology (W.B.), Anatomic Pathology (C.G.), and Center for MS and Autoimmune Neurology (W.O.T.), Mayo Clinic, Rochester, MN
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Jacob A, Shatila AO, Inshasi J, Massouh J, Mir R, Noori S, Yamout B. Disease modifying treatment guidelines for multiple sclerosis in the United Arab Emirates. Mult Scler Relat Disord 2024; 88:105703. [PMID: 38924933 DOI: 10.1016/j.msard.2024.105703] [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: 01/21/2024] [Revised: 05/13/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
The newly constituted National Multiple Sclerosis (MS) Society (NMSS)of the United Arab Emirates (UAE), set up a scientific committee to create a MS disease modifying treatment (DMT) guideline for UAE. The committee considered several unique features of the MS community in UAE including large number of expatriate population, wide variations in health insurance coverage, physician and patient preferences for DMT. The overall goal of the treatment guideline is to facilitate the most appropriate DMT to the widest number of patients. To this end it has adapted recommendations from various health systems and regulatory authorities into a pragmatic amalgamation of best practices from across the world. Importantly where data is unavailable or controversial, a common sense approach is taken rather than leave physicians and patients in limbo. The committee classifies MS into subcategories and suggests appropriate treatment choices. It recommends treatment of RIS and CIS with poor prognostic factors. It largely equates the efficacy and safety of DMT with similar mechanisms of action or drug classes e.g. ocrelizumab is similar to rituximab. It allows early switching of treatment for unambiguous disease activity and those with progression independent of relapses. Autologous hematopoietic stem cell transplantation can be offered to patients who fail one high efficacy DMT. Pragmatic guidance on switching and stopping DMT, DMT choices in pregnancy, lactation and pediatric MS have been included. It is expected that these guidelines will be updated periodically as new data becomes available.
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Affiliation(s)
- Anu Jacob
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; The Walton Centre, Liverpool, United Kingdom.
| | - Ahmed Osman Shatila
- Department of Neurology, Sheikh Shakhbout Medical City Abu Dhabi, United Arab Emirates
| | - Jihad Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Joelle Massouh
- Neurology Institute and Multiple Sclerosis Centre, Harley Street Medical centre, Abu Dhabi, United Arab Emirates
| | - Ruquia Mir
- Abu Dhabi stem Cell Clinic, United Arab Emirates
| | - Suzan Noori
- University Hospital Sharjah, United Arab Emirates
| | - Bassem Yamout
- Neurology Institute and Multiple Sclerosis Centre, Harley Street Medical centre, Abu Dhabi, United Arab Emirates; American University of Beirut, Lebanon
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Brandes LE, Orme D, Bermeo-Ovalle A, Sierra Morales F. Clinical and diagnostic features of long-COVID patients presenting with neurologic symptoms in Chicago. J Neural Transm (Vienna) 2024; 131:961-969. [PMID: 38847905 DOI: 10.1007/s00702-024-02789-9] [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: 12/06/2023] [Accepted: 05/13/2024] [Indexed: 08/24/2024]
Abstract
Long COVID, a condition characterized by persistent symptoms after COVID-19 infection, is increasingly being recognized worldwide. Neurologic symptoms are frequently reported in survivors of COVID-19, making it crucial to better understand this phenomenon both on a societal scale and for the quality of life of these patients. Between January 1, 2020, and July 31, 2022, Illinois (IL) had a standardized cumulative death rate that ranked it 24th out of the 51 states in the United States (US). However, the US had one of the highest per capita COVID-19 death rates among large, high-income countries. [Bollyky T. et al. 2023] As a result of the increased number of COVID-19 infections, there was a rise in the number of patients experiencing Long COVID. At our neuro-infectious disease clinic in Chicago (IL), we observed an increasing number of patients presenting with cognitive and other neurologic symptoms after contracting COVID-19. Initially, we needed to provide these individuals with a better understanding of their condition and expected outcomes. We were thus motivated to further evaluate this group of patients for any patterns in presentation, neurologic findings, and diagnostic testing that would help us better understand this phenomenon. We aim to contribute to the growing body of research on Long COVID, including its presentation, diagnostic testing results, and outcomes to enlighten the long COVID syndrome. We hypothesize that the neurological symptoms resulting from long COVID persist for over 12 months. We conducted a retrospective analysis of clinical data from 44 patients with long-COVID. Cognitive symptoms were the most common presenting concern. Abnormalities in Montreal Cognitive Assessment, electroencephalogram, serum autoantibody testing, and cerebrospinal fluid were found in minority subsets of our cohort. At 12 months, most patients continue to experience neurologic symptoms, though more than half reported moderate or marked improvement compared to initial presentation. Although most of the patients in this study did not show a consistent occurrence of symptoms suggesting a cohesive underlying etiology, our clinical data demonstrated some features of Long COVID patients in Chicago (IL) that could lead to new research avenues, helping us better understand this syndrome that affects patients worldwide.
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Affiliation(s)
- Lauren E Brandes
- Department of Neurology, Rush University Medical Center, Chicago, USA
| | - Daniel Orme
- Department of Neurology, Rush University Medical Center, Chicago, USA
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Czeisler BM. Emergent Management of Central Nervous System Demyelinating Disorders. Continuum (Minneap Minn) 2024; 30:781-817. [PMID: 38830071 DOI: 10.1212/con.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article reviews the various conditions that can present with acute and severe central nervous system demyelination, the broad differential diagnosis of these conditions, the most appropriate diagnostic workup, and the acute treatment regimens to be administered to help achieve the best possible patient outcomes. LATEST DEVELOPMENTS The discovery of anti-aquaporin 4 (AQP4) antibodies and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in the past two decades has revolutionized our understanding of acute demyelinating disorders, their evaluation, and their management. ESSENTIAL POINTS Demyelinating disorders comprise a large category of neurologic disorders seen by practicing neurologists. In the majority of cases, patients with these conditions do not require care in an intensive care unit. However, certain disorders may cause severe demyelination that necessitates intensive care unit admission because of numerous simultaneous multifocal lesions, tumefactive lesions, or lesions in certain brain locations that lead to acute severe neurologic dysfunction. Intensive care may be necessary for the management and prevention of complications for patients who have severely altered mental status, rapidly progressive neurologic worsening, elevated intracranial pressure, severe cerebral edema, status epilepticus, or respiratory failure.
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Galetta K, Ham AS, Vishnevetsky A, Bhattacharyya S, Mateen FJ. Disease modifying therapy in the treatment of tumefactive multiple sclerosis: A retrospective cohort study. J Neuroimmunol 2024; 388:578299. [PMID: 38364529 DOI: 10.1016/j.jneuroim.2024.578299] [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: 11/15/2023] [Revised: 01/11/2024] [Accepted: 01/25/2024] [Indexed: 02/18/2024]
Abstract
Tumefactive multiple sclerosis (TMS) is characterized by large demyelinating brain lesions. This was a retrospective cohort study of 67 patients with TMS between January 2015-2023, examining different disease modifying therapy impact on expanded disability scale score change at follow-up. Median age was 36 with a female predominance. Mean EDSS was 3.3 ± 2.3 at TMS onset, 2.1 ± 1.9 at year one, and 2.1 ± 1.9 at last follow-up. A multilinear regression model found higher presentation EDSS and post-diagnosis non-B-cell high efficacy therapies were each independently associated with higher EDSS at last follow up. Further research is needed to determine the value of B-cell therapy in TMS.
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Affiliation(s)
- Kristin Galetta
- Department of Neurology, Stanford University, Palo Alto, CA, USA; Department of Neurology, Brigham and Women's Hospital, Boston, MA, USA.
| | - Andrew Siyoon Ham
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
| | | | | | - Farrah J Mateen
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.
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Fereidan‐Esfahani M, Decker PA, Weigand SD, Lopez Chiriboga AS, Flanagan EP, Tillema J, Lucchinetti CF, Eckel‐Passow JE, Tobin WO. Defining the natural history of tumefactive demyelination: A retrospective cohort of 257 patients. Ann Clin Transl Neurol 2023; 10:1544-1555. [PMID: 37443413 PMCID: PMC10502639 DOI: 10.1002/acn3.51844] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To describe demographic, clinical, and radiographic features of tumefactive demyelination (TD) and identify factors associated with severe attacks and poor outcomes. METHODS Retrospective review of TD cases seen at Mayo Clinic, 1990-2021. RESULTS Of 257 patients with TD, 183/257 (71%) fulfilled the 2017 multiple sclerosis (MS) McDonald criteria at the last follow-up, 12/257 (5%) had myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), 0 had aquaporin-4-IgG seropositive neuromyelitis optic spectrum disorders (AQP4+ NMOSD), and 62/257 (24%) were cryptogenic. Onset before age 18 was present in 18/257 (7%). Female to male ratio was 1.3:1. Cerebrospinal fluid oligoclonal (CSF) bands were present in 95/153 (62%). TD was the first demyelinating attack in 176/257 (69%). At presentation, 59/126 (47%) fulfilled Barkhof criteria for dissemination in space, 59/100 (59%) had apparent diffusion coefficient (ADC) restriction, and 57/126 (45%) had mass effect. Despite aggressive clinical presentation at onset, 181/257 (70%) of patients remained fully ambulatory (Expanded Disability Status Scale [EDSS] ≤4) after a 3.0-year median follow-up duration. Severe initial attack-related disability (EDSS ≥4) was more common in patients with motor symptoms (81/143 vs. 35/106, p < 0.0001), encephalopathy (20/143 vs. 2/106, p < 0.0001) and ADC restriction on initial MRI (42/63 vs. 15/33, p = 0.04). Poor long-term outcome (EDSS ≥4) was more common in patients with older onset age (41.9 ± 15 vs. 36.8 ± 15.6, p = 0.02) and motor symptoms at onset (49/76 vs. 66/171, p < 0.0001). INTERPRETATION Most TD patients should be considered part of the MS spectrum after excluding MOGAD and NMOSD. Motor symptoms and older age at presentation portend a poor outcome.
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Affiliation(s)
- Mahboubeh Fereidan‐Esfahani
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Dell Medical SchoolUniversity of TexasAustinTexasUSA
| | - Paul A Decker
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Stephen D. Weigand
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Eoin P Flanagan
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Laboratory Medicine and PathologyMinneapolisMinnesotaUSA
| | - Jan‐Mendelt Tillema
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Claudia F Lucchinetti
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - W. Oliver Tobin
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
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ElSaygh J, Kandinova N, Zaher A, Sunner GK, Kostanyan S. Tumefactive Multiple Sclerosis: Challenges With Treatment Modalities. Cureus 2023; 15:e41845. [PMID: 37575699 PMCID: PMC10423083 DOI: 10.7759/cureus.41845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/15/2023] Open
Abstract
Tumefactive multiple sclerosis comprises a rare subset of multiple sclerosis that often poses a diagnostic challenge to physicians. It is unique in its presentation as a solitary lesion, usually larger than 2 cm, with surrounding vasogenic edema, commonly mimicking a primary intracranial malignancy. We present a case of a 25-year-old female with no significant past medical history who presented to our institution with homonymous superior quadrantanopia. During her admission, she underwent a magnetic resonance imaging (MRI) of the brain, which revealed a large lesion in the left temporal area surrounded by marked edema. A thorough workup revealed a diagnosis of tumefactive multiple sclerosis. Subsequently, she was initiated on intravenous immunoglobulin rather than stress dose steroids, given the concern for a superimposed infection. Interestingly, the patient had a paradoxical progression of her symptoms as well as expansion of the vasogenic edema on a repeat MRI. In our case, we highlight the key differences in tumefactive multiple sclerosis diagnosis and management.
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Affiliation(s)
- Jude ElSaygh
- Internal Medicine, NewYork Presbyterian - Brooklyn Methodist Hospital, New York, USA
| | - Nicole Kandinova
- Internal Medicine, NewYork Presbyterian - Brooklyn Methodist Hospital, New York, USA
| | - Anas Zaher
- Internal Medicine, NewYork Presbyterian - Brooklyn Methodist Hospital, New York, USA
| | - Gurinder K Sunner
- Internal Medicine, NewYork Presbyterian - Brooklyn Methodist Hospital, New York, USA
| | - Sofya Kostanyan
- Internal Medicine, NewYork Presbyterian - Brooklyn Methodist Hospital, New York, USA
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Jackson-Tarlton CS, Keegan BM, Fereidan-Esfahani M, Barakat BO, Decker PA, Lucchinetti CF, Eckel-Passow J, Tobin WO. Spinal cord and brain corticospinal tract lesions are associated with motor progression in tumefactive multiple sclerosis. Mult Scler Relat Disord 2023; 73:104614. [PMID: 36948092 DOI: 10.1016/j.msard.2023.104614] [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: 01/17/2023] [Revised: 02/24/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Spinal cord lesions have been associated with progressive disease in individuals with typical relapsing remitting MS (RRMS). OBJECTIVE In the current study, we aimed to determine if progressive disease is associated with spinal cord lesions in those with tumefactive multiple sclerosis (MS). METHODS Retrospective chart review of individuals presenting to Mayo Clinic with tumefactive MS with spinal cord MRIs available (n=159). Clinical data were extracted by chart review. Brain and spinal cord MRIs were reviewed to characterize the tumefactive demyelinating lesion(s) and assess the burden of spinal cord disease. RESULTS A total of 69 (43%) had spinal cord lesions. Progressive demyelinating disease was documented in 13 (8%); the majority (11/13) with secondary progressive disease. The method of progression was myelopathic in 8/13 (62%), cognitive in 3/13 (23%), motor from a supratentorial lesion in 2/13 (16%). EDSS at last follow-up was higher in those with progression than those without (median 6.0 (2.0-10.0) vs. 2.5 (0-10.0), p = < 0.001). Progressive demyelinating disease occurred in a minority. CONCLUSIONS Patients with progression typically experienced progressive motor impairment, and this occurred exclusively in individuals with lesions in the corticospinal tracts of the brain and/or the spinal cord.
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Affiliation(s)
- Caitlin S Jackson-Tarlton
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, USA
| | - B Mark Keegan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Rochester, MN, USA
| | - Mahboubeh Fereidan-Esfahani
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Division of Neurology, Department of Medicine, Dalhousie University, Halifax, NS, USA; Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Benan O Barakat
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Rochester, MN, USA; Department of Neurology, Bon Secours Mercy Health St. Vincent Medical Center, Toledo, OH, USA
| | - Paul A Decker
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester MN, USA
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Rochester, MN, USA
| | | | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Rochester, MN, USA.
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Chopra H, Azam A, Shustorovich A. 21-Yr-Old Woman With Worsening Headache and Rapidly Progressive Hemiplegia. Am J Phys Med Rehabil 2023; 102:e41-e42. [PMID: 36075879 DOI: 10.1097/phm.0000000000002093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Harman Chopra
- From the Department of Physical Medicine & Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland (HC); Lake Erie College of Osteopathic Medicine, Bradenton, Florida (AA); and Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute, Edison, New Jersey (AS)
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12
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Boyle T, Fernando SL, Drummond J, Fontes A, Parratt J. Phenotyping variants of tumefactive demyelinating lesions according to clinical and radiological features-A case series. Front Neurol 2023; 14:1092373. [PMID: 36816572 PMCID: PMC9935935 DOI: 10.3389/fneur.2023.1092373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Background Tumefactive demyelinating lesions (TDLs) are defined as lesions >2 cm on MRI of the brain. They are identified in a range of demyelinating diseases including massive demyelination due to Marburg's acute MS, Schilder's Disease, Balo's concentric sclerosis, and Tumefactive MS. Apart from the rare demyelinating variants which are often diagnosed histologically, there are no detailed data to phenotype TDLs. Methods We describe the clinical and radiological features of four similar patients with very large TDLs (>4 cm), that are not consistent with the rare demyelinating variants and may represent a distinct phenotype. Results All patients presented with hemiplegia and apraxia. The mean age at onset was 37 years with an equal sex distribution. All patients were diagnosed with Tumefactive demyelination based on MRI and CSF analysis, precluding the need for brain biopsy. All responded to potent immunotherapy (including high dose corticosteroids, plasma exchange, rituximab, and/or cyclophosphamide). The mean lag from diagnosis to treatment was 1 day. The median EDSS at presentation was six and recovery to a median EDSS of two occurred over 6 months. Conclusion We propose that Tumefactive lesions larger than 4 cm are termed "Giant demyelinating lesions" (GDLs) not only on the basis of size, but a rapid and fulminant demyelinating presentation leading to acute, severe neurological disability that is, nonetheless, responsive to immunotherapy. Further clinical studies are required to ratify this proposed phenotype, establish the immunological profile and best treatment for such patients.
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Affiliation(s)
- Thérèse Boyle
- Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia,Immunology Laboratory, Royal North Shore Hospital, St Leonards, NSW, Australia,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,*Correspondence: Thérèse Boyle ✉
| | - Suran L. Fernando
- Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia,Immunology Laboratory, Royal North Shore Hospital, St Leonards, NSW, Australia,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - James Drummond
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neuroradiology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ariadna Fontes
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Parratt
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
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Sánchez P, Chan F, Hardy TA. Tumefactive demyelination: updated perspectives on diagnosis and management. Expert Rev Neurother 2021; 21:1005-1017. [PMID: 34424129 DOI: 10.1080/14737175.2021.1971077] [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] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Tumefactive demyelination (TD) can be a challenging scenario for clinicians due to difficulties distinguishing it from other conditions, such as neoplasm or infection; or with managing the consequences of acute lesions, and then deciding upon the most appropriate longer term treatment strategy. AREAS COVERED The authors review the literature regarding TD covering its clinic-radiological features, association with multiple sclerosis (MS), and its differential diagnosis with other neuroinflammatory and non-inflammatory mimicking disorders with an emphasis on atypical forms of demyelination including acute disseminated encephalomyelitis (ADEM), MOG antibody-associated demyelination (MOGAD) and neuromyelitis spectrum disorders (NMOSD). We also review the latest in the acute and long-term treatment of TD. EXPERT OPINION It is important that the underlying cause of TD be determined whenever possible to guide the management approach which differs between different demyelinating and other inflammatory conditions. Improved neuroimaging and advances in serum and CSF biomarkers should one day allow early and accurate diagnosis of TD leading to better outcomes for patients.
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Affiliation(s)
- Pedro Sánchez
- Department of Neurology, Alexianer St. Josefs-Krankenhaus, Potsdam, Germany
| | - Fiona Chan
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.,Brain & Mind Centre, University of Sydney, Nsw, Australia
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