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Saballegue JCD, Tiongson MLGP. Rituximab Therapy for Double Seronegative Neuromyelitis Optica Spectrum Disease. Cureus 2024; 16:e60004. [PMID: 38854188 PMCID: PMC11162507 DOI: 10.7759/cureus.60004] [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: 05/09/2024] [Indexed: 06/11/2024] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system disease presenting as optic neuritis, myelitis, and brainstem syndromes. It may be aquaporin-4 seropositive, anti-myelin oligodendrocyte glycoprotein (MOG) antibody seropositive, or double seronegative. Double-seronegative NMOSD can pose a diagnostic and therapeutic challenge. Treatment typically aims to decrease the incidence of relapse, for which high-dose intravenous methylprednisolone is the first-line agent. Non-steroid treatments include azathioprine, mycophenolate mofetil, and rituximab. This case describes a 45-year-old female presenting with left arm numbness and weakness for three months. She had been previously diagnosed with optic neuritis in 2013 but was lost to follow-up. Progression of weakness warranted admission to the neurology department. Diagnostic work and imaging were suggestive of neuromyelitis optica. Tests for aquaporin-4, anti-MOG, immunoglobulin G, and immunoglobulin M in the cerebrospinal fluid were all negative. Initial treatment comprised methylprednisolone; however, due to the progression of symptoms, she was given two cycles of rituximab. Rituximab targets the CD20 antigen in B cells and is thought to reduce the risk of relapse and the severity of NMOSD. The patient's Barthel index score, expanded disability status scale score, and motor examination improved after two cycles of rituximab.
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Marignier R, Laplaud D, Zéphir H, Papeix C, Leray E, Amri E, Piotaix M, de Sèze J. Real-life study to assess effectiveness and safety of eculizumab in patients with neuromyelitis optica spectrum disorders in France: protocol for ECUP4, an observational study. Front Neurol 2024; 14:1303874. [PMID: 38318238 PMCID: PMC10839895 DOI: 10.3389/fneur.2023.1303874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 11/20/2023] [Indexed: 02/07/2024] Open
Abstract
Background Eculizumab, a humanized monoclonal antibody targeting the C5 complement protein, has been approved for the treatment of neuromyelitis optica spectrum disorders (NMOSD) in adult patients who are anti-aquaporin-4 (AQP4) antibody positive (Ab+). The aim of this study is to evaluate the long-term effectiveness and safety of eculizumab in French adults with NMOSD and to describe patients' characteristics, disability, and quality of life using data collected in a real-world setting. Methods This is the protocol for ECUP4, an ongoing prospective, observational, non-comparative, multicenter study conducted in 32 reference centers in France. Eligible patients must also be enrolled in NOMADMUS, a nested cohort of the French national multiple sclerosis registry (OFSEP). The primary endpoint is the annualized relapse rate. Secondary endpoints include the long-term safety of eculizumab, as well as patients' characteristics, treatment outcomes, disability, pain, visual acuity, and quality of life. Visits and treatments follow routine clinical practice. The case report forms (CRF) comprise data recorded in the context of the NOMADMUS cohort, collected during routine visits. The inclusion period is planned for 3 years, with no limitation on the number of patients enrolled. The maximum follow-up duration will be 5.5 years. Conclusion The efficacy and safety of eculizumab in patients with AQP4+ NMOSD have been demonstrated in randomized clinical trials that showed a significant reduction in the risk of relapse, with a safety profile consistent with other indications. This study will provide clinical and patient-reported evidence of the benefits of eculizumab, using data from a real-world setting in France. Trial registration number This study is registered at the French public repertory Health data Hub, N° F20211228123801. All information can be accessed at: https://www.health-data-hub.fr/.
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Affiliation(s)
- Romain Marignier
- Service de Neurologie, SEP Neuroinflammation et Pathologies de la Myéline, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM) - Hôpital Pierre Wertheimer, Bron, France
| | - David Laplaud
- Service de Neurologie du CHU de Nantes, CR2TI-Inserm U1064, CRC-SEP Pays de la Loire, Nantes Université, Nantes, France
| | - Hélène Zéphir
- Service de Neurologie du CHU Hôpital Roger Salengro, Lille, France
| | - Caroline Papeix
- Service de Neurologie, Hôpital Fondation A. de Rothshchild, Paris, France
| | - Emmanuelle Leray
- Univ Rennes, EHESP, CNRS, Inserm, ARENES UMR 6051, RSMS U 1309, Rennes, France
| | - Ekbel Amri
- Alexion, AstraZeneca Rare Disease, Levallois Perret, France
| | | | - Jérôme de Sèze
- Service de Neurologie du Centre Hospitalier Universitaire de Strasbourg, Strasbourg, France
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Jain K, Anita M, Netravathi M. Double hit - A case in point for dual seropositivity to AQP4 and MOG antibodies. J Neuroimmunol 2023; 383:578198. [PMID: 37716133 DOI: 10.1016/j.jneuroim.2023.578198] [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: 08/08/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
AQP4-IgG NMOSD (anti-aquaporin-4 neuromyelitis optica spectrum disorder) and MOGAD (myelin oligodendrocyte glycoprotein antibody associated disease) are unique disorders among themselves, with rare reports of dual seropositivity being described. Evaluation with cell-based assays reduces the incidence of false positivity. The clinical features of these cases may either have a dominant phenotype or may evolve into one subsequently. We describe a young girl aged 18-year-old who presented with longitudinally extensive transverse myelitis and dual seropositivity to both AQP4 and MOG antibodies.
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Affiliation(s)
- Kshiteeja Jain
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - M Anita
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
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Solmaz I, Öncel IH, Konuşkan B, Erol I, Orgun LT, Yılmaz Ü, Ünalp A, Atasoy E, Aksoy E, Yılmaz D, Öztürk M, Karaca NB, Yılmaz S, Yiş U, Dündar NO, Parlak Ş, Vural A, Günbey C, Anlar B. Role of serostatus in pediatric neuromyelitis optica spectrum disorders: A nationwide multicentric study. Mult Scler Relat Disord 2023; 77:104847. [PMID: 37393803 DOI: 10.1016/j.msard.2023.104847] [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: 04/23/2023] [Accepted: 06/19/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are immune-mediated inflammatory disorders of the central nervous system (CNS) mostly presenting as optic neuritis and acute myelitis. NMOSD can be associated with seropositivity for aquaporin 4 antibody (AQP4 IgG), myelin oligodendrocyte glycoprotein antibody (MOG IgG), or can be seronegative for both. In this study, we retrospectively examined our seropositive and seronegative pediatric NMOSD patients. METHOD Data were collected from all participating centres nationwide. Patients diagnosed with NMOSD were divided into three subgroups according to serology: AQP4 IgG NMOSD, MOG IgG NMOSD, and double seronegative (DN) NMOSD. Patients with at least six months of follow-up were compared statistically. RESULTS The study included 45 patients, 29 female and 16 male (ratio:1.8), mean age 15.16 ± 4.93 (range 5.5-27) years. Age at onset, clinical manifestations, and cerebrospinal fluid findings were similar between AQP4 IgG NMOSD (n = 17), MOG IgG NMOSD (n = 10), and DN NMOSD (n = 18) groups. A polyphasic course was more frequent in the AQP4 IgG and MOG IgG NMOSD groups than DN NMOSD (p = 0.007). The annualized relapse rate and rate of disability were similar between groups. Most common types of disability were related to optic pathway and spinal cord involvement. Rituximab in AQP4 IgG NMOSD, intravenous immunoglobulin in MOG IgG NMOSD, and azathioprine in DN NMOSD were usually preferred for maintenance treatment. CONCLUSION In our series with a considerable number of double seronegatives, the three major serological groups of NMOSD were indistinguishable based on clinical and laboratory findings at initial presentation. Their outcome is similar in terms of disability, but seropositive patients should be more closely followed-up for relapses.
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Affiliation(s)
- Ismail Solmaz
- Etlik City Hospital, Department of Pediatric Neurology, Ankara, Turkey.
| | - Ibrahim Halil Öncel
- Hacettepe University, Faculty of Medicine, Departmanet of Pediatric Neurology, Ankara, Turkey
| | - Bahadır Konuşkan
- Dr Sami Ulus Child Health and Diseases Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey
| | - Ilknur Erol
- Baskent University Faculty of Medicine, Department of Pediatric Neurology, Adana, Turkey
| | - Leman Tekin Orgun
- Baskent University Faculty of Medicine, Department of Pediatric Neurology, Adana, Turkey
| | - Ünsal Yılmaz
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Aycan Ünalp
- University of Health Sciences, Izmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatric Neurology, Izmir, Turkey
| | - Ergin Atasoy
- Etlik City Hospital, Department of Pediatric Neurology, Ankara, Turkey
| | - Erhan Aksoy
- Dr Sami Ulus Child Health and Diseases Training and Research Hospital, Department of Pediatric Neurology, Ankara, Turkey
| | - Deniz Yılmaz
- Bilkent City Hospital, Department of Pediatric Neurology, Ankara, Turkey
| | - Merve Öztürk
- Kocaeli University, Faculty of Medicine, Department of Pediatric Neurology, Kocaeli, Turkey
| | - Nazlı Balcan Karaca
- Gazi University, Faculty of Medicine, Department of Pediatric Neurology, Ankara, Turkey
| | - Sanem Yılmaz
- Ege University Faculty of Medicine, Department of Pediatric Neurology, Izmir, Turkey
| | - Uluç Yiş
- Dokuz Eylül University Faculty of Medicine, Department of Pediatric Neurology, Izmir, Turkey
| | - Nihal Olgaç Dündar
- Izmir Katip Celebi University Faculty of Medicine, Department of Pediatric Neurology, Izmir, Turkey
| | - Şafak Parlak
- Hacettepe University, Faculty of Medicine, Department of Radiology, Ankara, Turkey
| | - Atay Vural
- Koç University, Department of Neurology, Istanbul, Turkey
| | - Ceren Günbey
- Hacettepe University, Faculty of Medicine, Departmanet of Pediatric Neurology, Ankara, Turkey
| | - Banu Anlar
- Hacettepe University, Faculty of Medicine, Departmanet of Pediatric Neurology, Ankara, Turkey
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Antonescu Ghelmez D, Moraru A, Antonescu F, Chelmambet AS, Bucur AI, Tuţǎ S. Double seropositive neuromyelitis optica associated with COVID-19: A case report. Front Neurol 2022; 13:1004132. [PMID: 36341113 PMCID: PMC9629861 DOI: 10.3389/fneur.2022.1004132] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
Neuromyelitis optica spectrum disorders are characterized by severe demyelination and axonal damage with autoimmune mechanisms, predominantly targeting the optic nerves and the spinal cord. Patients often test positive for anti-AQP4 antibodies, while some have anti-MOG antibodies. Double seropositivity has been described, with a variable prevalence (0 to 26%) dependent on the testing method. The clinical significance of double seropositivity remains unclear. We present the case of a 65-year-old patient, admitted to our clinic with optical neuritis, followed up approximately 10 days later by cervical myelitis, who tested positive for both anti-AQP4 and anti-MOG antibodies. The clinical onset coincided with a mild form of SARS-CoV-2 infection. The neurological symptoms were initially relatively subdued, which delayed the diagnosis. The patient was not vaccinated against SARS-CoV-2. The clinical picture was compatible with an anti-AQP4 phenotype. The patient was started on corticosteroid therapy, under which the clinical response was good. Our case reinforces the idea that SARS-CoV-2 can precipitate autoimmune demyelinating diseases since SARS-CoV-2 infection has already been demonstrated as a risk factor for NMOSD relapses. To the best of our knowledge, this is the first reported case of double seropositive neuromyelitis optica associated with COVID-19. We expect that in the near future, as the true burden of COVID becomes clearer, we shall encounter other cases which can trace their apparent clinical onset to a SARS-CoV-2 infection. Careful attention should be paid to the apparent minor neurological symptoms of COVID-19.
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Affiliation(s)
- Dana Antonescu Ghelmez
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases Bucharest, Bucharest, Romania
| | - Adriana Moraru
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases Bucharest, Bucharest, Romania
- *Correspondence: Adriana Moraru
| | - Florian Antonescu
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases Bucharest, Bucharest, Romania
| | - Altay Sercan Chelmambet
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases Bucharest, Bucharest, Romania
| | - Amanda Ioana Bucur
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases Bucharest, Bucharest, Romania
| | - Sorin Tuţǎ
- Department of Neurology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurology, National Institute of Neurology and Neurovascular Diseases Bucharest, Bucharest, Romania
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The Prevalence, Demographics, Clinical Features, Neuroimaging, and Interethnic Differences of MOG Disease in Malaysia with Global Perspectives. Mult Scler Relat Disord 2022; 67:104168. [DOI: 10.1016/j.msard.2022.104168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 08/20/2022] [Accepted: 09/08/2022] [Indexed: 11/19/2022]
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Chaara T, Gilardin L, Nielly H, Le Burel S, Bousquet A, Beaucreux C, Kearns K, Salvadori A, Piljan M, Sollier M, Mayaux J, Rohaut B, Le Guennec L, Vanquaethem H, Michon A. Le croiseur était coulé. Rev Med Interne 2022. [DOI: 10.1016/j.revmed.2022.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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8
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Rapid Discrimination of Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis Using Machine Learning on Infrared Spectra of Sera. Int J Mol Sci 2022; 23:ijms23052791. [PMID: 35269934 PMCID: PMC8911153 DOI: 10.3390/ijms23052791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/24/2022] [Accepted: 03/01/2022] [Indexed: 12/13/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are both autoimmune inflammatory and demyelinating diseases of the central nervous system. NMOSD is a highly disabling disease and rapid introduction of the appropriate treatment at the acute phase is crucial to prevent sequelae. Specific criteria were established in 2015 and provide keys to distinguish NMOSD and MS. One of the most reliable criteria for NMOSD diagnosis is detection in patient’s serum of an antibody that attacks the water channel aquaporin-4 (AQP-4). Another target in NMOSD is myelin oligodendrocyte glycoprotein (MOG), delineating a new spectrum of diseases called MOG-associated diseases. Lastly, patients with NMOSD can be negative for both AQP-4 and MOG antibodies. At disease onset, NMOSD symptoms are very similar to MS symptoms from a clinical and radiological perspective. Thus, at first episode, given the urgency of starting the anti-inflammatory treatment, there is an unmet need to differentiate NMOSD subtypes from MS. Here, we used Fourier transform infrared spectroscopy in combination with a machine learning algorithm with the aim of distinguishing the infrared signatures of sera of a first episode of NMOSD from those of a first episode of relapsing-remitting MS, as well as from those of healthy subjects and patients with chronic inflammatory demyelinating polyneuropathy. Our results showed that NMOSD patients were distinguished from MS patients and healthy subjects with a sensitivity of 100% and a specificity of 100%. We also discuss the distinction between the different NMOSD serostatuses. The coupling of infrared spectroscopy of sera to machine learning is a promising cost-effective, rapid and reliable differential diagnosis tool capable of helping to gain valuable time in patients’ treatment.
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Pandit L, Malli C, D'Cunha A, Sudhir A. Overcoming the challenges in diagnosis of AQP4-IgG positive neuromyelitis optica spectrum disorders in resource poor settings using an indigenized and cost effective cell based assay. J Neuroimmunol 2021; 360:577706. [PMID: 34507014 DOI: 10.1016/j.jneuroim.2021.577706] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Diagnosis of neuromyelitis optica spectrum disorders (NMOSD) in India is hindered by limited access to cost effective and sensitive assays for detection of aquaporin-4 antibody (AQP4-IgG) in India. OBJECTIVE To develop a cost effective, sensitive, cell based assay (CBA) for detection of AQP4-IgG and to evaluate the serological status in patients with NMOSD diagnosed by 2015 diagnostic criteria. METHOD Stably transfected Chinese hamster ovary (CHO) cell line expressing aquaporin M23 isomer was established. A fixed CBA was developed and validated in 381 samples including clinically definite NMOSD (n = 87), high risk NMOSD (n = 51), other demyelinating disorders (n = 92), other neurological disorders (n = 51) and healthy volunteers (n = 100). We tested the same samples again using a commercially available CBA and compared the results. All assays were performed by 2 independent investigators blinded to clinical and serological status. RESULTS Our "in house"(Mangalore) assay showed sensitivity of 81.6% (95% CI 71.86-89.11%) for clinically definite NMOSD and 29.41% (95% CI 17.50-43.8%) for high risk NMOSD. Specificity was 100% for both groups. Both assays showed similar results for 67/ 87 (77.01%) patients with definite NMOSD while 4 samples tested positive by our assay alone (Cohen's kappa coefficient [K] - 0.86). Among the high risk group 14/51 (27.5%) samples showed similar results, one patient additionally was positive by the Mangalore assay (K - 0.95).
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Affiliation(s)
- Lekha Pandit
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India.
| | - Chaithra Malli
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India
| | - Anitha D'Cunha
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India
| | - Akshatha Sudhir
- Center for Advanced Neurological Research, KS Hegde Medical Academy, Nitte University, Mangalore, India
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Gudkova VV, Kimelfeld EI, Paderina VP, Koshurnikov DS, Ulianov DI, Ermakov DS, Maliutina NA. Opticoneuromyelitis associated with melanoma. Case report. CONSILIUM MEDICUM 2021. [DOI: 10.26442/20751753.2021.11.201159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This article presents a clinical review of a patient with an extremely rare assotiation of opticoneuromyelitis and skin melanoma. The paper noted the typical clinical and neuroimaging signs of opticoneuromyelitis and the rare manifestations of myelitic syndrome such as segmental muscle hypertonicity and hand hyperkinesis. The question remains open as to whether these two processes in a patient are linked by a single pathogenesis in the form of a paraneoplastic neurological syndrome or whether two independent diseases are represent there. Two observations of a combination of melanoma and opticoneuromyelitis as a manifestation of the paraneoplastic syndrome have been analysed in the literature. The article highlights the difficulties in the treatment of this patient, as the immunomodulatory therapy used for both diseases has a different vectorial focus. Immunosuppression is recommended for the treatment of opticoneuromyelitis, while immune activation is recommended for melanoma.
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11
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Kini S, Bhat YR, Karegowda LH. Torticollis as an Initial Manifestation of a Seronegative Demyelinating Disorder in a Child: A Case Report. JOURNAL OF PEDIATRIC NEUROLOGY 2021. [DOI: 10.1055/s-0041-1736599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractTorticollis refers to a condition in which the head is persistently tilted to one side, sometimes associated with pain. Torticollis in a child can be congenital or acquired. Torticollis as an initial manifestation of an underlying demyelinating syndrome is quite rare in children. Here, we report a 7-year-old girl who presented with persistent torticollis. Neuroimaging of the brain revealed features of a demyelinating disease. Further studies did not show any evidence of multiple sclerosis. Cerebrospinal fluid was negative for antiaquaporin-4 antibodies, antimyelin oligodendrocyte glycoprotein antibodies, and oligoclonal bands. A seronegative demyelinating disorder was considered. She was treated with pulsed methylprednisolone therapy. She responded well to steroids with no progression of illness during follow-up. Torticollis was partially improved.
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Affiliation(s)
- Sandesh Kini
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Yellanthoor Ramesh Bhat
- Department of Paediatrics, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Lakshmikanth Halegubbi Karegowda
- Department of Radiodiagnosis and Imaging, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India
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12
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Lin TY, Chien C, Lu A, Paul F, Zimmermann HG. Retinal optical coherence tomography and magnetic resonance imaging in neuromyelitis optica spectrum disorders and MOG-antibody associated disorders: an updated review. Expert Rev Neurother 2021; 21:1101-1123. [PMID: 34551653 DOI: 10.1080/14737175.2021.1982697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein IgG antibody-associated disorders (MOGAD) comprise two groups of rare neuroinflammatory diseases that cause attack-related damage to the central nervous system (CNS). Clinical attacks are often characterized by optic neuritis, transverse myelitis, and to a lesser extent, brainstem encephalitis/area postrema syndrome. Retinal optical coherence tomography (OCT) is a non-invasive technique that allows for in vivo thickness quantification of the retinal layers. Apart from OCT, magnetic resonance imaging (MRI) plays an increasingly important role in NMOSD and MOGAD diagnosis based on the current international diagnostic criteria. Retinal OCT and brain/spinal cord/optic nerve MRI can help to distinguish NMOSD and MOGAD from other neuroinflammatory diseases, particularly from multiple sclerosis, and to monitor disease-associated CNS-damage. AREAS COVERED This article summarizes the current status of imaging research in NMOSD and MOGAD, and reviews the clinical relevance of OCT, MRI and other relevant imaging techniques for differential diagnosis, screening and monitoring of the disease course. EXPERT OPINION Retinal OCT and MRI can visualize and quantify CNS damage in vivo, improving our understanding of NMOSD and MOGAD pathology. Further efforts on the standardization of these imaging techniques are essential for implementation into clinical practice and as outcome parameters in clinical trials.
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Affiliation(s)
- Ting-Yi Lin
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Angelo Lu
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Cacciaguerra L, Storelli L, Radaelli M, Mesaros S, Moiola L, Drulovic J, Filippi M, Rocca MA. Application of deep-learning to the seronegative side of the NMO spectrum. J Neurol 2021; 269:1546-1556. [PMID: 34328544 DOI: 10.1007/s00415-021-10727-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/19/2021] [Accepted: 07/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To apply a deep-learning algorithm to brain MRIs of seronegative patients with neuromyelitis optica spectrum disorders (NMOSD) and NMOSD-like manifestations and assess whether their structural features are similar to aquaporin-4-seropositive NMOSD or multiple sclerosis (MS) patients. PATIENTS AND METHODS We analyzed 228 T2- and T1-weighted brain MRIs acquired from aquaporin-4-seropositive NMOSD (n = 85), MS (n = 95), aquaporin-4-seronegative NMOSD [n = 11, three with anti-myelin oligodendrocyte glycoprotein antibodies (MOG)], and aquaporin-4-seronegative patients with NMOSD-like manifestations (idiopathic recurrent optic neuritis and myelitis, n = 37), who were recruited from February 2010 to December 2019. Seventy-three percent of aquaporin-4-seronegative patients with NMOSD-like manifestations also had a clinical follow-up (median duration of 4 years). The deep-learning neural network architecture was based on four 3D convolutional layers. It was trained and validated on MRI scans of aquaporin-4-seropositive NMOSD and MS patients and was then applied to aquaporin-4-seronegative NMOSD and NMOSD-like manifestations. Assignment of unclassified aquaporin-4-seronegative patients was compared with their clinical follow-up. RESULTS The final algorithm differentiated aquaporin-4-seropositive NMOSD and MS patients with an accuracy of 0.95. All aquaporin-4-seronegative NMOSD and 36/37 aquaporin-4-seronegative patients with NMOSD-like manifestations were classified as NMOSD. Anti-MOG patients had a similar probability of being NMOSD or MS. At clinical follow-up, one unclassified aquaporin-4-seronegative patient evolved to MS, three developed NMOSD, and the others did not change phenotype. CONCLUSIONS Our findings support the inclusion of aquaporin4-seronegative patients into NMOSD and suggest a possible expansion to aquaporin-4-seronegative unclassified patients with NMOSD-like manifestations. Anti-MOG patients are likely to have intermediate brain features between NMOSD and MS.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Loredana Storelli
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marta Radaelli
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy. .,Vita-Salute San Raffaele University, Milan, Italy. .,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Iorio R, Papi C. Neuromyelitis optica, aquaporin-4 antibodies, and neuroendocrine disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:173-186. [PMID: 34238456 DOI: 10.1016/b978-0-12-820683-6.00013-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system that preferentially affects the optic nerve and the spinal cord. In around 80% of NMO patients, autoantibodies binding to aquaporin-4 (AQP4) are detected. AQP4-IgG unifies a spectrum of disorders (NMOSD) that include not only optic neuritis, longitudinally extensive transverse myelitis but also syndromes caused by lesion of the diencephalic region and the circumventricular organs (CVOs). The distinctive immunopathological characteristics of NMOSD lesions, occurring in regions where AQP4 is highly expressed, supports a central role for AQP4-IgG in disease pathogenesis. AQP4 expression is concentrated in CVOs and in the hypothalamus, mainly in the dorsal hypothalamic area, dorsomedial hypothalamic nucleus and suprachiasmatic nucleus. Several neuroendocrine disorders caused by inflammatory lesions involving the diencephalic region have been described in patients with NMOSD, including syndrome of inappropriate antidiuresis, sleep disorders, and other endocrinopathies caused by hypothalamic injury. Focus of this chapter is the involvement of hypothalamus and CVOs in AQP4 autoimmunity.
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Affiliation(s)
- Raffaele Iorio
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Papi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
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Waliszewska-Prosół M, Chojdak-Łukasiewicz J, Budrewicz S, Pokryszko-Dragan A. Neuromyelitis Optica Spectrum Disorder Treatment-Current and Future Prospects. Int J Mol Sci 2021; 22:ijms22062801. [PMID: 33802046 PMCID: PMC7998461 DOI: 10.3390/ijms22062801] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/16/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated demyelinative disorder of the central nervous system affecting mainly the optical nerves and the spinal cord. The recurrent course of the disease, with exacerbations and incomplete remissions, causes accumulating disability, which has a profound impact upon patients’ quality of life. The discovery of antibodies against aquaporin 4 (AQP4) and their leading role in NMO etiology and the formulation of diagnostic criteria have improved appropriate recognition of the disease. In recent years, there has been rapid progress in understanding the background of NMO, leading to an increasing range of treatment options. On the basis of a review of the relevant literature, the authors present currently available therapeutic strategies for NMO as well as ongoing research in this field, with reference to key points of immune-mediated processes involved in the background of the disease.
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Collongues N, Alves Do Rego C, Bourre B, Biotti D, Marignier R, da Silva AM, Santos E, Maillart E, Papeix C, Palace J, Leite MIS, De Seze J. Pregnancy in Patients With AQP4-Ab, MOG-Ab, or Double-Negative Neuromyelitis Optica Disorder. Neurology 2021; 96:e2006-e2015. [PMID: 33627499 DOI: 10.1212/wnl.0000000000011744] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the effects of pregnancy on neuromyelitis optica spectrum disorder (NMOSD) according to patients' serostatus and immunosuppressive therapy (IST). METHODS We performed a retrospective multicenter international study on patients with NMOSD. Patients were tested for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies (Ab). Informative pregnancies were reported when NMOSD onset occurred before or during pregnancy or up to 12 months postpartum. The mean annualized relapse rate (ARR) was calculated for the 12 months before conception, for each trimester of pregnancy, and postpartum. Events such as miscarriage, abortion, and preeclampsia were reported. IST was considered if taken in the 3 months before or during pregnancy. RESULTS We included 89 pregnancies (46 with AQP4-Ab, 30 with MOG-Ab, and 13 without either Ab) in 58 patients with NMOSD. Compared to the prepregnancy period, the ARR was lower during pregnancy in each serostatus group and higher during the postpartum period in patients with AQP4-Ab (p < 0.01). Forty-eight percent (n = 31) of pregnancies occurred during IST and these patients presented fewer relapses during pregnancy and the 12 months postpartum than untreated patients (26% vs 53%, p = 0.04). Miscarriages occurred in 10 (11%) pregnancies, and were mainly in patients with AQP4-Ab (with or without IST) and a previous history of miscarriage. Preeclampsia was reported in 2 (2%) patients who were AQP4-Ab-positive. CONCLUSION We found a rebound in the ARR during the first postpartum trimester that was higher than the prepregnancy period only in AQP4-Ab-positive patients. Taking IST just before or during pregnancy reduces the risk of relapses in these conditions.
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Affiliation(s)
- Nicolas Collongues
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK.
| | - Cecilia Alves Do Rego
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Bertrand Bourre
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Damien Biotti
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Romain Marignier
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Ana Martins da Silva
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Ernestina Santos
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Elisabeth Maillart
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Caroline Papeix
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Jacqueline Palace
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Maria Isabel S Leite
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Jerome De Seze
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
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Houen G, Trier NH, Frederiksen JL. Epstein-Barr Virus and Multiple Sclerosis. Front Immunol 2020; 11:587078. [PMID: 33391262 PMCID: PMC7773893 DOI: 10.3389/fimmu.2020.587078] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/18/2020] [Indexed: 12/11/2022] Open
Abstract
Multiple sclerosis (MS) is a neurologic disease affecting myelinated nerves in the central nervous system (CNS). The disease often debuts as a clinically isolated syndrome, e.g., optic neuritis (ON), which later develops into relapsing-remitting (RR) MS, with temporal attacks or primary progressive (PP) MS. Characteristic features of MS are inflammatory foci in the CNS and intrathecal synthesis of immunoglobulins (Igs), measured as an IgG index, oligoclonal bands (OCBs), or specific antibody indexes. Major predisposing factors for MS are certain tissue types (e.g., HLA DRB1*15:01), vitamin D deficiency, smoking, obesity, and infection with Epstein-Barr virus (EBV). Many of the clinical signs of MS described above can be explained by chronic/recurrent EBV infection and current models of EBV involvement suggest that RRMS may be caused by repeated entry of EBV-transformed B cells to the CNS in connection with attacks, while PPMS may be caused by more chronic activity of EBV-transformed B cells in the CNS. In line with the model of EBV's role in MS, new treatments based on monoclonal antibodies (MAbs) targeting B cells have shown good efficacy in clinical trials both for RRMS and PPMS, while MAbs inhibiting B cell mobilization and entry to the CNS have shown efficacy in RRMS. Thus, these agents, which are now first line therapy in many patients, may be hypothesized to function by counteracting a chronic EBV infection.
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Affiliation(s)
- Gunnar Houen
- Institute of Biochemistry and Molecular Biology, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
| | | | - Jette Lautrup Frederiksen
- Department of Neurology, Rigshospitalet, Glostrup, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Gao Y, Zhang B, Yang J. Satralizumab for the Treatment of Neuromyelitis Optica Spectrum Disorders. Ann Pharmacother 2020; 55:1167-1171. [PMID: 33246373 DOI: 10.1177/1060028020976669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To review the pharmacological characteristics, clinical evidence, and place in therapy of satralizumab for the treatment of neuromyelitis optica spectrum disorders (NMOSDs). DATA SOURCES A comprehensive literature search was conducted in PubMed (January 2000 to October 15, 2020). Key search terms included satralizumab and neuromyelitis optica spectrum disorders. Other sources were derived from product labeling and ClinicalTrials.gov. STUDY SELECTION AND DATA EXTRACTION All English-language articles identified from the data sources were reviewed and evaluated. Phase I, II, and III clinical trials were included. DATA SYNTHESIS NMOSD is an autoimmune disease characterized by inflammatory lesions in the optic nerves and spinal cord. Interleukin-6 is involved in the pathogenesis of the disorder. Satralizumab is a humanized monoclonal antibody targeting the interleukin-6 receptor. Phase III trials showed that protocol-defined relapse was 30% for satralizumab and 50% for placebo (P = 0.018) when patients with NMOSD were treated with satralizumab monotherapy; protocol-defined relapse was 20% for satralizumab and 43% for placebo (P = 0.02) when satralizumab was added to immunosuppressant treatment. Satralizumab is generally well tolerated, with common adverse effects including injection-related reaction. RELEVANCE TO PATIENT CARE AND CLINICAL PRACTICE Satralizumab has the potential to become a valuable treatment option for patients with NMOSD. CONCLUSION Satralizumab appears to be safe and effective as monotherapy or in combination with an immunosuppressant for patients with NMOSD and has the potential to become a valuable treatment option for these patients.
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Affiliation(s)
- Yanli Gao
- Linyi Central Hospital, Linyi, Shandong, China
| | - Baoqi Zhang
- Linyi Central Hospital, Linyi, Shandong, China
| | - Junyi Yang
- Linyi Central Hospital, Linyi, Shandong, China
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Boziki M, Sintila SA, Ioannidis P, Grigoriadis N. Biomarkers in Rare Demyelinating Disease of the Central Nervous System. Int J Mol Sci 2020; 21:ijms21218409. [PMID: 33182495 PMCID: PMC7665127 DOI: 10.3390/ijms21218409] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 11/06/2020] [Accepted: 11/07/2020] [Indexed: 12/29/2022] Open
Abstract
Rare neurological diseases are a heterogeneous group corresponding approximately to 50% of all rare diseases. Neurologists are among the main specialists involved in their diagnostic investigation. At the moment, a consensus guideline on which neurologists may base clinical suspicion is not available. Moreover, neurologists need guidance with respect to screening investigations that may be performed. In this respect, biomarker research has emerged as a particularly active field due to its potential applications in clinical practice. With respect to autoimmune demyelinating diseases of the Central Nervous System (CNS), although these diseases occur in the frame of organ-specific autoimmunity, pathology of the disease itself is orchestrated among several anatomical and functional compartments. The differential diagnosis is broad and includes, but is not limited to, rare neurological diseases. Multiple Sclerosis (MS) needs to be differentially diagnosed from rare MS variants, Acute Disseminated Encephalomyelitis (ADEM), the range of Neuromyelitis Optica Spectrum Disorders (NMOSDs), Myelin Oligodendrocyte Glycoprotein (MOG) antibody disease and other systemic inflammatory diseases. Diagnostic biomarkers may facilitate timely diagnosis and proper disease management, preventing disease exacerbation due to misdiagnosis and false treatment. In this review, we will describe advances in biomarker research with respect to rare neuroinflammatory disease of the CNS.
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Osswald D, De Seze J, Collongues N, Speeg-Schatz C. Comparaison clinico-épidémiologique des pathologies du spectre des neuromyélites optiques. J Fr Ophtalmol 2020; 43:598-603. [DOI: 10.1016/j.jfo.2019.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/16/2019] [Accepted: 11/06/2019] [Indexed: 10/23/2022]
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Server Alonso A, Sakinis T, Pfeiffer HCV, Sandvig I, Barlinn J, Marthinsen PB. Understanding Pediatric Neuroimmune Disorder Conflicts: A Neuroradiologic Approach in the Molecular Era. Radiographics 2020; 40:1395-1411. [PMID: 32735475 DOI: 10.1148/rg.2020200032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroimmune disorders in children are a complex group of inflammatory conditions of the central nervous system with diverse pathophysiologic mechanisms and clinical manifestations. Improvements in antibody analysis, genetics, neuroradiology, and different clinical phenotyping have expanded knowledge of the different neuroimmune disorders. The authors focus on pediatric-onset myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease, which is a new entity in the spectrum of inflammatory demyelinating diseases, distinct from both multiple sclerosis (MS) and anti-aquaporin-4 (AQP4) antibody neuromyelitis optica spectrum disorders (NMOSDs). The authors review the importance of an optimized antibody-detection assay, the frequency of MOG antibodies in children with acquired demyelinating syndrome (ADS), the disease course, the clinical spectrum, proposed diagnostic criteria, and neuroimaging of MOG antibody-associated disease. Also, they outline differential diagnosis from other neuroimmune disorders in children according to the putative primary immune mechanism. Finally, they recommend a diagnostic algorithm for the first manifestation of ADS or relapsing ADS that leads to four demyelinating syndromes: MOG antibody-associated disease, AQP4 antibody NMOSDs, MS, and seronegative relapsing ADS. This diagnostic approach provides a framework for the strategic role of neuroradiology in diagnosis of ADS and decision making, to optimize patient care and treatment outcome in concert with clinicians. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Andres Server Alonso
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Tomas Sakinis
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Helle Cecilie V Pfeiffer
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Inger Sandvig
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Jon Barlinn
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Pål B Marthinsen
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
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Monoclonal Antibody-Based Treatments for Neuromyelitis Optica Spectrum Disorders: From Bench to Bedside. Neurosci Bull 2020; 36:1213-1224. [PMID: 32533450 DOI: 10.1007/s12264-020-00525-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/10/2020] [Indexed: 12/20/2022] Open
Abstract
Neuromyelitis optica (NMO)/NMO spectrum disorder (NMOSD) is a chronic, recurrent, antibody-mediated, inflammatory demyelinating disease of the central nervous system, characterized by optic neuritis and transverse myelitis. The binding of NMO-IgG with astrocytic aquaporin-4 (AQP4) functions directly in the pathogenesis of >60% of NMOSD patients, and causes astrocyte loss, secondary inflammatory infiltration, demyelination, and neuron death, potentially leading to paralysis and blindness. Current treatment options, including immunosuppressive agents, plasma exchange, and B-cell depletion, are based on small retrospective case series and open-label studies. It is noteworthy that monoclonal antibody (mAb) therapy is a better option for autoimmune diseases due to its high efficacy and tolerability. Although the pathophysiological mechanisms of NMOSD remain unknown, increasingly, therapeutic studies have focused on mAbs, which target B cell depletion, complement and inflammation cascade inactivation, blood-brain-barrier protection, and blockade of NMO-IgG-AQP4 binding. Here, we review the targets, characteristics, mechanisms of action, development, and potential efficacy of mAb trials in NMOSD, including preclinical and experimental investigations.
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Abstract
Neuromyelitis optica (NMO) is a rare and chronic disabling autoimmune astrocytopathy of the central nervous system. Current advances regarding aquaporin-4 antibody function facilitate the understanding of clinical manifestations and imaging findings beyond optic neuritis and transverse myelitis. The current definition of NMO spectrum disorder (NMOSD) includes both aquaporin-4-IgG seropositive and seronegative patients who present with characteristic findings. This review will briefly summarize the pathophysiology and the latest NMOSD diagnostic criteria and focus on the NMOSD imaging findings and its differential diagnosis.
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Affiliation(s)
- Sheng-Che Hung
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC; Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC.
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Rabasté S, Cobo-Calvo A, Nistiriuc-Muntean V, Vukusic S, Marignier R, Cotton F. Diagnostic value of bright spotty lesions on MRI after a first episode of acute myelopathy. J Neuroradiol 2020; 48:28-36. [PMID: 32407908 DOI: 10.1016/j.neurad.2020.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND PURPOSE To determine the diagnostic value of bright spotty lesions (BSLs) for aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSDAQP4+), the predictive value of axial-BSLs for AQP4-IgG seropositivity, and the radio-clinical differences in NMOSDAQP4+ patients with and without axial-BSLs. MATERIALS AND METHODS Retrospective study that included patients aged≥16 years, with a first acute spinal cord syndrome between 2005 and 2018 and abnormal spinal cord MRI with axial and sagittal T2 sequences. Patients with MRI findings consistent with compressive myelopathy were excluded. All spinal cord MRI were retrospectively evaluated for the presence of BSLs by 2 radiologists blinded to the diagnosis of acute myelopathy. RESULTS A total of 82 patients were included; 15 aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder patients (NMOSDAQP4+), and 67 other patients, considered as the other causes of myelopathy (OM) group. The specificity of axial-BSLs for NMOSDAQP4+ patients was 94.0% (95% CI [85.6 to 97.7]). The sensitivity was 40.0% (95% CI [19.8 to 64.3]). In the multivariable analysis, the only MRI characteristic associated with AQP4-IgG positivity was the presence of axial-BSLs (OR: 9.2, 95% CI [1.2 to 72.9]; P=0.022). In NMOSDAQP4+ patients, the median of cord expansion ratio was higher with axial-BSL (1.2, IQR [1.1-1.3]) than without axial-BSL (1.1, IQR [1.0-1.2]; P=0.046). CONCLUSION After a first acute spinal cord syndrome, the presence of axial-BSLs on spinal cord MRI seems very specific for NMOSDAQP4+ and seems to be a predictor radiological marker of AQP4-IgG positivity.
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Affiliation(s)
- Sylvain Rabasté
- Service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - Alvaro Cobo-Calvo
- Service de neurologie-sclérose en plaques, pathologies de la myéline et neuroinflammation, centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 69500 Bron, France; Inserm U1028, CNRS UMR5292, centre de recherche en neuroscience de Lyon, université Lyon-1, 69008 Lyon, France
| | - Veronica Nistiriuc-Muntean
- Service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France
| | - Sandra Vukusic
- Service de neurologie-sclérose en plaques, pathologies de la myéline et neuroinflammation, centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 69500 Bron, France; Inserm U1028, CNRS UMR5292, centre de recherche en neuroscience de Lyon, université Lyon-1, 69008 Lyon, France
| | - Romain Marignier
- Service de neurologie-sclérose en plaques, pathologies de la myéline et neuroinflammation, centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), hospices civils de Lyon, hôpital neurologique Pierre-Wertheimer, 69500 Bron, France; Inserm U1028, CNRS UMR5292, centre de recherche en neuroscience de Lyon, université Lyon-1, 69008 Lyon, France
| | - François Cotton
- Service de radiologie, centre hospitalier Lyon-Sud, hospices civils de Lyon, 69310 Pierre-Bénite, France; Inserm U1044, CNRS UMR 5220, CREATIS, université Lyon-1, 69100 Villeurbanne, France.
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Ong ZM, Schee JP, Viswanathan S. Therapeutic Plasma Exchange in Neuromyelitis Optica Spectrum Disorders and Related Disorders in Resource‐Limited Settings: Outcomes in a Multiethnic Single‐Center Population. Ther Apher Dial 2019; 24:312-323. [DOI: 10.1111/1744-9987.13446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 09/04/2019] [Accepted: 10/24/2019] [Indexed: 01/31/2023]
Affiliation(s)
- Zhi Miin Ong
- Department of Neurology Kuala Lumpur Hospital, Ministry of Health Kuala Lumpur Malaysia
| | - Jie Ping Schee
- Department of Neurology Kuala Lumpur Hospital, Ministry of Health Kuala Lumpur Malaysia
| | - Shanthi Viswanathan
- Department of Neurology Kuala Lumpur Hospital, Ministry of Health Kuala Lumpur Malaysia
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Pharmacotherapy for Neuromyelitis Optica Spectrum Disorders: Current Management and Future Options. Drugs 2019; 79:125-142. [PMID: 30623348 DOI: 10.1007/s40265-018-1039-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Neuromyelitis optica (NMO) is an inflammatory and demyelinating disease of the central nervous system. Although the prevalence of NMO is low, the rapid and severe impairment observed in patients has led to extensive development of research in the fields of diagnostic criteria and therapy in the past 15 years. With improved understanding of the pathophysiology of NMO and the role of aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein antibodies, numerous therapeutic approaches have been proposed and are currently undergoing evaluation. In this review, we describe the rationale for existing therapeutics and their benefit/risk ratio. We also discuss the pharmacological and clinical interest of future approaches targeting, among others, B or T cells, the blood-central nervous system barrier, complement, polynuclear cells, AQP4-antibody linkage and AQP4 activity. The numerous agents under development are the result of a major collaborative effort all over the world. After the considerable progress on diagnosis, we are now close to class I evidence for a therapeutic effect of several drugs in NMO spectrum disorders, most notably with the anti-interleukin-6 receptor antibody (satralizumab) and anti-complement-5 antibody (eculizumab).
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Camacho J, Zuleta S, Alba MP, Hernandez A, Navas C. Neuromyelitis optica spectrum disorder in pediatrics. Case report. CASE REPORTS 2019. [DOI: 10.15446/cr.v5n1.74943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Introduction: Neuromyelitis optica is an inflammatory disorder of the central nervous system that accounts for 5% of demyelinating diseases in pediatrics. Its clinical presentation is variable and associated to the involved area of the central nervous system.Case presentation: This is the case of a 15-year-old patient who consulted several times for nonspecific neurological symptoms. During his last visit to the Clínica Universitaria Colombia in Bogotá, he presented with bilateral optic neuritis, associated with frontal and parietal headache. Immunophenotyping studies were carried out, reporting positive IgG anti-aquaporin 4 antibodies (anti-AQP4 antibody), thus leading to a diagnosis of seropositive neuromyelitis optica spectrum disorder (NMOSD). Management with methylprednisolone pulses was initiated with subsequent outpatient management with rituximab that allowed stabilizing the disease.Discussion: This is an interesting case due to its insidious and uncertain onset in a pediatric patient. It was possible to evaluate clinical and diagnostic differences in relation to its presentation in adults. NMOSD mediated by anti-AQP4 is rare; brain and bone marrow MRI are essential for diagnosis. The treatment of choice for acute conditions consists of high doses of methylprednisolone.Conclusion: This disorder may result in irreversible neurological damage; for this reason, high suspicion is required for early diagnosis and timely treatment.
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Lambert J, Mejia S, Vojdani A. Plant and human aquaporins: pathogenesis from gut to brain. Immunol Res 2018; 67:12-20. [DOI: 10.1007/s12026-018-9046-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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