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Ju YH, Cho J, Park JY, Kim H, Hong EB, Park KD, Lee CJ, Chung E, Kim HI, Nam MH. Tonic excitation by astrocytic GABA causes neuropathic pain by augmenting neuronal activity and glucose metabolism. Exp Mol Med 2024; 56:1193-1205. [PMID: 38760512 PMCID: PMC11148027 DOI: 10.1038/s12276-024-01232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 05/19/2024] Open
Abstract
Neuropathic pain is a debilitating condition caused by the hyperexcitability of spinal dorsal horn neurons and is often characterized by allodynia. Although neuron-independent mechanisms of hyperexcitability have been investigated, the contribution of astrocyte-neuron interactions remains unclear. Here, we show evidence of reactive astrocytes and their excessive GABA release in the spinal dorsal horn, which paradoxically leads to the tonic excitation of neighboring neurons in a neuropathic pain model. Using multiple electrophysiological methods, we demonstrated that neuronal hyperexcitability is attributed to both increased astrocytic GABA synthesis via monoamine oxidase B (MAOB) and the depolarized reversal potential of GABA-mediated currents (EGABA) via the downregulation of the neuronal K+/Cl- cotransporter KCC2. Furthermore, longitudinal 2-deoxy-2-[18F]-fluoro-D-glucose microPET imaging demonstrated increased regional glucose metabolism in the ipsilateral dorsal horn, reflecting neuronal hyperexcitability. Importantly, inhibiting MAOB restored the entire astrocytic GABA-mediated cascade and abrogated the increased glucose metabolism and mechanical allodynia. Overall, astrocytic GABA-mediated tonic excitation is critical for neuronal hyperexcitability, leading to mechanical allodynia and neuropathic pain.
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Affiliation(s)
- Yeon Ha Ju
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
| | - Jongwook Cho
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Ji-Young Park
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Hyunjin Kim
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
| | - Eun-Bin Hong
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
| | - Ki Duk Park
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea
| | - C Justin Lee
- Center for Cognition and Sociality, Institute for Basic Science, Daejeon, 34126, Republic of Korea
| | - Euiheon Chung
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea
| | - Hyoung-Ihl Kim
- Department of Biomedical Science and Engineering, Gwangju Institute of Science and Technology (GIST), Gwangju, 61005, Republic of Korea.
- Department of Neurosurgery, Presbyterian Medical Center, Jeonju, 54987, Republic of Korea.
| | - Min-Ho Nam
- Brain Science Institute, Korea Institute of Science and Technology (KIST), Seoul, 02792, Republic of Korea.
- Department of KHU-KIST Convergence Science and Technology, Kyung Hee University, Seoul, 02447, Republic of Korea.
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2
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Rosner J, de Andrade DC, Davis KD, Gustin SM, Kramer JLK, Seal RP, Finnerup NB. Central neuropathic pain. Nat Rev Dis Primers 2023; 9:73. [PMID: 38129427 PMCID: PMC11329872 DOI: 10.1038/s41572-023-00484-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023]
Abstract
Central neuropathic pain arises from a lesion or disease of the central somatosensory nervous system such as brain injury, spinal cord injury, stroke, multiple sclerosis or related neuroinflammatory conditions. The incidence of central neuropathic pain differs based on its underlying cause. Individuals with spinal cord injury are at the highest risk; however, central post-stroke pain is the most prevalent form of central neuropathic pain worldwide. The mechanisms that underlie central neuropathic pain are not fully understood, but the pathophysiology likely involves intricate interactions and maladaptive plasticity within spinal circuits and brain circuits associated with nociception and antinociception coupled with neuronal hyperexcitability. Modulation of neuronal activity, neuron-glia and neuro-immune interactions and targeting pain-related alterations in brain connectivity, represent potential therapeutic approaches. Current evidence-based pharmacological treatments include antidepressants and gabapentinoids as first-line options. Non-pharmacological pain management options include self-management strategies, exercise and neuromodulation. A comprehensive pain history and clinical examination form the foundation of central neuropathic pain classification, identification of potential risk factors and stratification of patients for clinical trials. Advanced neurophysiological and neuroimaging techniques hold promise to improve the understanding of mechanisms that underlie central neuropathic pain and as predictive biomarkers of treatment outcome.
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Affiliation(s)
- Jan Rosner
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- Department of Neurology, University Hospital Bern, Inselspital, University of Bern, Bern, Switzerland
| | - Daniel C de Andrade
- Center for Neuroplasticity and Pain (CNAP), Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Karen D Davis
- Division of Brain, Imaging and Behaviour, Krembil Brain Institute, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Department of Surgery and Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Sylvia M Gustin
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, New South Wales, Australia
- NeuroRecovery Research Hub, School of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - John L K Kramer
- International Collaboration on Repair Discoveries, ICORD, University of British Columbia, Vancouver, Canada
- Department of Anaesthesiology, Pharmacology & Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Rebecca P Seal
- Pittsburgh Center for Pain Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Departments of Neurobiology and Otolaryngology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Nanna B Finnerup
- Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.
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3
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmun Rev 2023; 22:103465. [PMID: 37852514 DOI: 10.1016/j.autrev.2023.103465] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing neuroinflammatory autoimmune astrocytopathy, with a predilection for the optic nerves and spinal cord. Most cases are characterised by aquaporin-4-antibody positivity and have a relapsing disease course, which is associated with accrual of disability. Although the prognosis in NMOSD has improved markedly over the past few years owing to advances in diagnosis and therapeutics, it remains a severe disease. In this article, we review the evolution of our understanding of NMOSD, its pathogenesis, clinical features, disease course, treatment options and associated symptoms. We also address the gaps in knowledge and areas for future research focus.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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4
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Yang Y, Li J, Li T, Li Z, Zhuo Z, Han X, Duan Y, Cao G, Zheng F, Tian D, Wang X, Zhang X, Li K, Zhou F, Huang M, Li Y, Li H, Li Y, Zeng C, Zhang N, Sun J, Yu C, Shi F, Asgher U, Muhlert N, Liu Y, Wang J. Cerebellar connectome alterations and associated genetic signatures in multiple sclerosis and neuromyelitis optica spectrum disorder. J Transl Med 2023; 21:352. [PMID: 37245044 DOI: 10.1186/s12967-023-04164-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/26/2023] [Indexed: 05/29/2023] Open
Abstract
BACKGROUND The cerebellum plays key roles in the pathology of multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD), but the way in which these conditions affect how the cerebellum communicates with the rest of the brain (its connectome) and associated genetic correlates remains largely unknown. METHODS Combining multimodal MRI data from 208 MS patients, 200 NMOSD patients and 228 healthy controls and brain-wide transcriptional data, this study characterized convergent and divergent alterations in within-cerebellar and cerebello-cerebral morphological and functional connectivity in MS and NMOSD, and further explored the association between the connectivity alterations and gene expression profiles. RESULTS Despite numerous common alterations in the two conditions, diagnosis-specific increases in cerebellar morphological connectivity were found in MS within the cerebellar secondary motor module, and in NMOSD between cerebellar primary motor module and cerebral motor- and sensory-related areas. Both diseases also exhibited decreased functional connectivity between cerebellar motor modules and cerebral association cortices with MS-specific decreases within cerebellar secondary motor module and NMOSD-specific decreases between cerebellar motor modules and cerebral limbic and default-mode regions. Transcriptional data explained > 37.5% variance of the cerebellar functional alterations in MS with the most correlated genes enriched in signaling and ion transport-related processes and preferentially located in excitatory and inhibitory neurons. For NMOSD, similar results were found but with the most correlated genes also preferentially located in astrocytes and microglia. Finally, we showed that cerebellar connectivity can help distinguish the three groups from each other with morphological connectivity as predominant features for differentiating the patients from controls while functional connectivity for discriminating the two diseases. CONCLUSIONS We demonstrate convergent and divergent cerebellar connectome alterations and associated transcriptomic signatures between MS and NMOSD, providing insight into shared and unique neurobiological mechanisms underlying these two diseases.
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Affiliation(s)
- Yuping Yang
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Junle Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
| | - Ting Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
| | - Zhen Li
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China
| | - Zhizheng Zhuo
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Xuemei Han
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, 130031, Jilin, China
| | - Yunyun Duan
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Guanmei Cao
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Fenglian Zheng
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China
| | - Decai Tian
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Xinli Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xinghu Zhang
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Kuncheng Li
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Fuqing Zhou
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, 330006, Jiangxi, China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, Jiangxi, China
| | - Muhua Huang
- Department of Radiology, The First Affiliated Hospital, Nanchang University, Nanchang, 330006, Jiangxi, China
- Neuroimaging Lab, Jiangxi Province Medical Imaging Research Institute, Nanchang, 330006, Jiangxi, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, 200040, China
| | - Yongmei Li
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Chun Zeng
- Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Ningnannan Zhang
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jie Sun
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Chunshui Yu
- Department of Radiology and Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Fudong Shi
- Center for Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
- China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Umer Asgher
- School of Mechanical and Manufacturing Engineering (SMME), National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Nils Muhlert
- School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PT, UK
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119, The West Southern 4th Ring Road, Fengtai District, Beijing, 100070, China.
| | - Jinhui Wang
- Institute for Brain Research and Rehabilitation, South China Normal University, Zhongshan Avenue West 55, Tianhe District, Guangzhou, 510631, China.
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Guangzhou, 510631, China.
- Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, 510631, China.
- Center for Studies of Psychological Application, South China Normal University, Guangzhou, 510631, China.
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5
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Jarius S, Aktas O, Ayzenberg I, Bellmann-Strobl J, Berthele A, Giglhuber K, Häußler V, Havla J, Hellwig K, Hümmert MW, Kleiter I, Klotz L, Krumbholz M, Kümpfel T, Paul F, Ringelstein M, Ruprecht K, Senel M, Stellmann JP, Bergh FT, Tumani H, Wildemann B, Trebst C. Update on the diagnosis and treatment of neuromyelits optica spectrum disorders (NMOSD) - revised recommendations of the Neuromyelitis Optica Study Group (NEMOS). Part I: Diagnosis and differential diagnosis. J Neurol 2023:10.1007/s00415-023-11634-0. [PMID: 37022481 DOI: 10.1007/s00415-023-11634-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 02/17/2023] [Accepted: 02/18/2023] [Indexed: 04/07/2023]
Abstract
The term 'neuromyelitis optica spectrum disorders' (NMOSD) is used as an umbrella term that refers to aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica (NMO) and its formes frustes and to a number of closely related clinical syndromes without AQP4-IgG. NMOSD were originally considered subvariants of multiple sclerosis (MS) but are now widely recognized as disorders in their own right that are distinct from MS with regard to immunopathogenesis, clinical presentation, optimum treatment, and prognosis. In part 1 of this two-part article series, which ties in with our 2014 recommendations, the neuromyelitis optica study group (NEMOS) gives updated recommendations on the diagnosis and differential diagnosis of NMOSD. A key focus is on differentiating NMOSD from MS and from myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD), which shares significant similarity with NMOSD with regard to clinical and, partly, radiological presentation, but is a pathogenetically distinct disease. In part 2, we provide updated recommendations on the treatment of NMOSD, covering all newly approved drugs as well as established treatment options.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Judith Bellmann-Strobl
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Achim Berthele
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Katrin Giglhuber
- Department of Neurology, School of Medicine, Technical University Munich, Klinikum rechts der Isar, Munich, Germany
| | - Vivien Häußler
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
- Data Integration for Future Medicine (DIFUTURE) Consortium, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef Hospital, Ruhr University Bochum, Bochum, Germany
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University of Münster, Münster, Germany
| | - Markus Krumbholz
- Department of Neurology and Pain Treatment, Immanuel Klinik Rüdersdorf, University Hospital of the Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Rüdersdorf bei Berlin, Germany
- Department of Neurology and Stroke, University Hospital of Tübingen, Tübingen, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, LMU Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Friedemann Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Experimental and Clinical Research Center, a Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité-Universitätsmedizin Berlin, Berlin, Germany
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- NeuroCure Clinical Research Center, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan-Patrick Stellmann
- Department of Neurology and Institute of Neuroimmunology and MS (INIMS), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- APHM, Hopital de la Timone, CEMEREM, Marseille, France
- Aix Marseille Univ, CNRS, CRMBM, Marseille, France
| | | | | | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany.
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6
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Zhang Y, Feng J, Ou C, Zhou X, Liao Y. AQP4 mitigates chronic neuropathic pain-induced cognitive impairment in mice. Behav Brain Res 2023; 440:114282. [PMID: 36596395 DOI: 10.1016/j.bbr.2022.114282] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 11/29/2022] [Accepted: 12/30/2022] [Indexed: 01/01/2023]
Abstract
Neuropathic pain is a risk factor for cognitive defects. The ubiquitous expression of AQP4 in astrocytes throughout the central nervous system is altered in the neurodegenerative disease. However, the exact role of AQP4 in cognitive impairment induced by chronic neuropathic pain remains unclear. In this study, we discovered that AQP4 protein and mRNA expression decreased time-dependently in the model of chronic neuropathic pain-induced cognitive disorder. AQP4 overexpression recovered mice from cognitive impairment. Furthermore, the concentration of Aβ1-42 in the serum and hippocampus reduced in mice with AQP4 overexpression adeno-associated virus injection. In conclusion, AQP4 in astrocytes is important in mitigating cognitive impairment caused by chronic neuropathic pain.
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Affiliation(s)
- Yue Zhang
- Department of Histology, Embryology and Neurobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China; Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Jianguo Feng
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Laboratory of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Cehua Ou
- Department of Pain Management, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Xue Zhou
- Department of Histology, Embryology and Neurobiology, West China School of Basic Medical Sciences & Forensic Medicine, Sichuan University, Chengdu, China.
| | - Yonghong Liao
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China; Laboratory of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China.
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7
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Min W, Zhang L, Wang S, Xue M, Guo C, Zhu M. Clinical characteristics of late-onset neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2023; 70:104517. [PMID: 36708681 DOI: 10.1016/j.msard.2023.104517] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 01/11/2023] [Accepted: 01/13/2023] [Indexed: 01/16/2023]
Abstract
BACKGROUND Anti-aquaporin-4 (AQP-4) immunoglobulin G (IgG) is a major autoimmune antibody that contributes to the pathogenesis of neuromyelitis optica spectrum disorder (NMOSD). NMOSD often presents as disability, severe sensory impairment, and sleep disorders, which can cause anxiety and depression and further affect the quality of life. The age of onset is a key factor influencing the prognosis of NMOSD. However, this result was based on studies involving only anti-aquaporin-4 (AQP4) immunoglobulin G (IgG)-seropositive NMOSD patients or studies using the 2006 NMOSD diagnosis criteria. Therefore, further study of the age of onset of NMOSD is valuable. This study aimed to describe the clinical and magnetic resonance imaging (MRI) differences between early-onset neuromyelitis optica spectrum disorder (EO-NMOSD) and late-onset (LO)-NMOSD patients. METHODS Fifty patients were enrolled, their anti-AQP4-IgG titers were measured, and brain and spinal cord MRIs were obtained. Additionally, several questionnaires related to disease severity, anxiety, depression, cognition, sleep, pain, and fatigue were collected. RESULTS Higher AQP4-IgG seropositivity, higher AQP4-IgG titer, frequency of thoracic myelitis, and white matter hyperintensities (WMH), as well as greater severity of disability, greater severity of sleep disorders, higher anxiety, poorer cognitive function, and higher clinical dementia rating (CDR)-community affairs scores were observed in late-onset (LO)-NMOSD patients than those in early-onset (EO)-NMOSD. AQP4-IgG titer positively correlated with age, annual relapse rate, Expanded Disability Status Scale (EDSS) sensory scores, Activity of Daily Living Scale (ADL) scores, and Pittsburgh Sleep Quality Index (PSQI) scores. The EDSS-sensory scores positively correlated with age, relapse time, Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, PSQI, ADL, and CDR. WMH was positively correlated with age, EDSS-sensory scores, PSQI scores, and CDR scores and negatively correlated with the California Verbal Learning Test scores. CONCLUSION LO-NMOSD patients have worse prognoses than those of EO-NMOSD patients. Higher AQP4-IgG titers, more WMHs, thoracic myelitis, and severe sensory symptoms are associated with cognition, depression, anxiety, and sleep disorders.
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Affiliation(s)
- Wanwan Min
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Li Zhang
- Department of Radiology, The First Hospital of Jilin University, Changchun, China
| | - Shengnan Wang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Mengru Xue
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Chunjie Guo
- Department of Radiology, The First Hospital of Jilin University, Changchun, China.
| | - Mingqin Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China.
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8
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Yang F, Lin L, Xia Y, Wu C. Ultrasound-guided pulsed radiofrequency for neuromyelitis optica spectrum disorder-associated neuropathic pain: A case report. Medicine (Baltimore) 2022; 101:e32417. [PMID: 36595742 PMCID: PMC9794213 DOI: 10.1097/md.0000000000032417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Neuropathic pain (NP) is one of the most prevalent and troublesome symptoms of neuromyelitis optica spectrum disorder (NMOSD), seriously affecting the patient's life. At present, effective treatment for NP induced by NMOSD does not exist. Pulsed radiofrequency (PRF), an emerging microinvasive therapy, alleviates pain and is widely used to treat various types of NP. This is the first report describing a patient with NMOSD-associated NP treated with PRF on the left cervical 6 nerve root. METHODS A 49-year-old female with NMOSD-associated severe NP in the left upper limb and left shoulder tried several medications, but none were effective. She was diagnosed with NP caused by NMOSD.To alleviate severe pain, we performed PRF on the left cervical nerve root under the guidance of ultrasound. This treatment was repeated 3 times. RESULTS The patient's pain was significantly relieved, with a visual analog scale score decreasing from 7-8/10 to 2-3/10, which was maintained during the 3-month follow-up period, without complications. CONCLUSION PRF might be effective for the management of intractable neuropathic pain caused by NMOSD.
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Affiliation(s)
- Fei Yang
- Department of Pain, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Liheng Lin
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yu Xia
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Changxue Wu
- Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- * Correspondence: Changxue Wu, Department of Anesthesiology, The Affiliated Hospital of Southwest Medical University, No.25 Taiping Street, Luzhou, Sichuan Province 646000, China. (e-mail: )
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9
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Munera M, Buendía E, Sanchez A, Viasus D, Sanchez J. AQP4 as a vintage autoantigen: what do we know till now? Heliyon 2022; 8:e12132. [PMID: 36506380 PMCID: PMC9730132 DOI: 10.1016/j.heliyon.2022.e12132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/09/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- M. Munera
- Medical Research Group (GINUMED), Universitary Corporation Rafael Nuñez, Colombia,Corresponding author.
| | - E. Buendía
- Faculty of Medicine, University of Cartagena, Cartagena, Colombia,Department of Internal Medicine, Centro Hospitalario Serena del Mar, Cartagena, Colombia,Clinical and Biomedical Research Group, Faculty of Medicine, University of Cartagena, Colombia
| | - A. Sanchez
- Faculty of Medicine, University of Cartagena, Cartagena, Colombia,Clinical and Biomedical Research Group, Faculty of Medicine, University of Cartagena, Colombia
| | - D. Viasus
- Division of Health Sciences, Universidad del Norte, Barranquilla, Colombia
| | - J. Sanchez
- Group of Clinical and Experimental Allergy (GACE), IPS Universitaria, University of Antioquia, Medellín, Colombia
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10
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Pique J, Nicolas P, Marignier R. Neuromielite ottica acuta (malattia di Devic). Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Xue H, Yang W, Zhao Y, Wang L, Wang G, Zhang M, Zhang H. Pain in neuromyelitis optic spectrum disorder. Mult Scler Relat Disord 2022; 68:104192. [PMID: 36244188 DOI: 10.1016/j.msard.2022.104192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 09/03/2022] [Accepted: 09/22/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pain is a common symptom of neuromyelitis optica spectrum disorder (NMOSD), but there are relatively few studies on NMOSD pain. METHODS We retrospectively reviewed the medical records of 145 patients with NMOSD admitted to our hospital between July 2016 and June 2019. RESULTS The clinical characteristics of pain and factors related to NMOSD were analyzed, revealing that the incidence of pain in NMOSD is high and can be used for disease localization. CONCLUSION Different types of pain occur at different stages of the disease, and serum aquaporin-4 antibody (AQP4-ab) positivity is an independent risk factor for NMOSD pain. Hormones and biological immune agents may also be effective in some cases.
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Affiliation(s)
- Huiru Xue
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China
| | - Wen Yang
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China
| | - Yunfei Zhao
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China
| | - Li Wang
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China
| | - Guilian Wang
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China
| | - Meini Zhang
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China.
| | - Hui Zhang
- First Hospital of Shanxi Medical University, Taiyuan, Shanxi province, China.
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12
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Factors correlated with neuropathic pain in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2022; 68:104213. [PMID: 36223704 DOI: 10.1016/j.msard.2022.104213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 09/01/2022] [Accepted: 10/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Neuropathic pain in neuromyelitis optica spectrum disorder (NMOSD) is common but has always been overlooked. This study was conducted to explore factors correlated with neuropathic pain in NMOSD and to evaluate associations between pain and quality of life. METHODS In this cross-sectional study, NMOSD patients were interviewed face-to-face. The Brief Pain Inventory, Douleur Neuropathique 4, and Neuropathic Pain Symptom Inventory scales were used to evaluate pain. Patients completed the Beck Depression Inventory-II and Social Functioning-36 tests to evaluate depression and quality of life. RESULTS A total of 122 NMOSD patients were enrolled. Eighty-one (66.4%; 95% CI, 39.9% to 92.9%) had current pain, of which 35 (28.7%; 95% CI, 20.7% to 36.7%) had neuropathic pain. Forty-nine (40.2%; 95% CI, 31.5% to 48.9%) patients experienced depression, which was moderate to severe in 22 patients. Multinomial logistic regression showed that significantly more patients with neuropathic pain had depression than those with other pain (OR, 4.15; 95% CI, 1.40 to 12.35; P=0.010) or no pain (OR, 5.65; 95% CI, 1.74 to 18.18; P=0.004). Significantly more patients with neuropathic pain had initial spinal cord involvement than those in the no-pain group (OR, 15.78; 95% CI, 1.37 to 182.15; P=0.027). Quality of life was severely affected in NMOSD patients with neuropathic pain. Only 29.6% were treated with analgesics, and none were prescribed antidepressants. CONCLUSION Depression was correlated with neuropathic pain and was often overlooked. Initial spinal cord involvement might indicate a higher risk for neuropathic pain. Neuropathic pain in NMOSD patients requires scrutiny.
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13
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Li X, Xu H, Zheng Z, Ouyang H, Chen G, Lou Z, Chen H, Zhang J, Zhan Y, Mao H, Zhang C, Zhao M, Zhao Y. The risk factors of neuropathic pain in neuromyelitis optica spectrum disorder: a retrospective case-cohort study. BMC Neurol 2022; 22:304. [PMID: 35986246 PMCID: PMC9389678 DOI: 10.1186/s12883-022-02841-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Neuropathic pain is a common complication in neuromyelitis optica spectrum disorder (NMOSD), which seriously affects the quality of life of NMOSD patients, with no satisfactory treatment. And risk factors of neuropathic pain are still uncertain. Objective To investigate the risk factors of neuropathic pain in a NMOSD cohort. Materials and methods Our study was a retrospective case-cohort study, the patients diagnosed with NMOSD in the Department of Neurology from the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2011 to October 2021 were screened. Inclusion criteria were: (1) patients diagnosed as NMOSD according to the International Panel for NMO Diagnosis (IPND) criteria, (2) the aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) test was performed. Patients without AQP4-IgG antibody were excluded. Clinical data, including sex, age of the first onset, symptoms of the first episode including neuropathic pain and attack types, localization of lesions of the first episode on Magnetic Resonance Imaging (MRI), Extended disability status Scale (EDSS) of the first onset, treatment of immunosuppression in the first acute phase, disease modifying therapy (DMT), treatment of neuropathic pain and APQ4-IgG status were collected from the hospital system database. Neuropathic pain was defined according to the International Association for the Study of Pain criteria and was described as “pain arising as a direct consequence of a lesion or disease affecting the somatosensory system”. Results One hundred nineteen patients were screened and finally 86 patients fulfilling the inclusion and exclusion criteria were enrolled in our study. The prevalence of neuropathic pain in patients with NMOSD was 43.0%. Univariate analysis showed that the factors associated with neuropathic pain were the age at the onset, the attack type of optic neuritis, the attack type of myelitis, length of spinal cord involvement, localization of thoracic lesion, optic lesion, upper thoracic lesions, lower thoracic lesions, extended spinal cord lesions (≥ 3 spinal lesions), extended thoracic lesions (≥ 4 thoracic lesions), intravenous immunoglobulin and mycophenolate mofetil. Multivariate regression analysis showed that extended thoracic lesions (OR 20.21 [1.18–346.05], P = 0.038) and age (OR 1.35 (1–1.81) P = 0.050) were independently associated with neuropathic pain among NMOSD patients and that gender (OR 12.11 (0.97–151.64) P = 0.053) might be associated with neuropathic pain among NMOSD patients. Conclusion Extended thoracic lesions (≥ 4 thoracic lesions), age and gender might be independent risk factors of neuropathic pain among patients with NMOSD. However, with a small sample size and predominantly female, caution must be applied and these results need validating in further cohorts.
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Szewczyk AK, Papuć E, Mitosek-Szewczyk K, Woś M, Rejdak K. NMOSD-Diagnostic Dilemmas Leading towards Final Diagnosis. Brain Sci 2022; 12:885. [PMID: 35884693 PMCID: PMC9313254 DOI: 10.3390/brainsci12070885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The emergence of white matter lesions in the central nervous system (CNS) can lead to diagnostic dilemmas. They are a common radiological symptom and their patterns may overlap CNS or systemic diseases and provoke underdiagnosis or misdiagnosis. The aim of the study was to assess factors influencing the underdiagnosis of neuromyelitis optica spectrum disorder (NMOSD) as well as to estimate NMOSD epidemiology in Lubelskie voivodeship, Poland. (2) Methods: This retrospective study included 1112 patients, who were made a tentative or an established diagnosis of acute or subacute onset of neurological deficits. The evaluation was based on medical history, neurological examination, laboratory and radiographic results and fulfilment of diagnosis criteria. (3) Results: Up to 1.62 percent of patients diagnosed with white matter lesions and up to 2.2% of the patients previously diagnosed with MS may suffer from NMOSD. The duration of delayed diagnosis is longer for males, despite the earlier age of onset. Seropositive cases for antibodies against aquaporin-4 have worse prognosis for degree of disability. (4) Conclusions: Underdiagnosis or misdiagnosis in NMOSD still remains a problem in clinical practice and has important implications for patients. The incorrect diagnosis is caused by atypical presentation or NMOSD-mimics; however, covariates such as gender, onset and diagnosis age may also have an influence.
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Affiliation(s)
- Anna K. Szewczyk
- Doctoral School, Medical University of Lublin, ul. Chodźki 7, 20-093 Lublin, Poland
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Ewa Papuć
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland;
| | - Krystyna Mitosek-Szewczyk
- Department of Child Neurology, Medical University of Lublin, ul. Profesora Antoniego Gebali 6, 20-093 Lublin, Poland;
| | - Michał Woś
- Department of Medical Informatics and Statistics with E-Learning Lab, ul. Jaczewskiego 4, 20-090 Lublin, Poland;
| | - Konrad Rejdak
- Department of Neurology, Medical University of Lublin, ul. Jaczewskiego 8, 20-954 Lublin, Poland;
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Kang H, Qiu H, Hu X, Wei S, Tao Y. Differences in Neuropathic Pain and Radiological Features Between AQP4-ON, MOG-ON, and IDON. FRONTIERS IN PAIN RESEARCH 2022; 3:870211. [PMID: 35615385 PMCID: PMC9124930 DOI: 10.3389/fpain.2022.870211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose The purpose of this study was to investigate pain and radiological features of different types of first-episode demyelinating optic neuritis (ON). Methods Eighty-three patients presenting with first-episode aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n = 28), myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n = 26) and idiopathic demyelinating optic neuritis (IDON, n = 29) were included in this retrospective case-control study. We assessed optic nerve lesions on magnetic resonance imaging (MRI), acute pain associated with onset of optic neuritis and clinical characteristics of those ON patients with different serum autoantibody status. Results 24 AQP4-ON patients (85.75%), 23 MOG-ON patients (88.5%) and 24 IDON patients (82.8%) suffered from ON-associated pain. MOG-ON had mostly retro-orbital pain; AQP4-ON and IDON had mostly neuropathic pain. In addition, pain was more severe in AQP4ON patients than in other ON patients. In MRI, bilateral involvement was more common in AQP4-ON than IDON (26.9 and 3.7%); radiological optic nerve head swelling was more common in MOG-ON than in AQP4-ON and IDON (68.0 vs. 23.1 vs. 25.9%). MRI lesion in peri-optic nerve sheath was more common in AQP4-ON (53.8 vs. 16.0 vs. 3.7%). In 70 patients with ON-associated pain, gadolinium enhancement of orbital optic nerve was most common in MOG-ON patients (82.4 vs. 55.0 vs. 33.3%, P = 0.018), and enhancement of optic chiasma was most common in AQP4-ON patients (40.0 vs. 5.9 vs. 6.7%, P = 0.015). Perineural and orbital enhancement was observed only in patients with MOG-ON (P < 0.001). The length of enhancement was longer in AQP4-ON patients than in MOG-ON and IDON patients. Conclusion Pain is a common symptom in patients with all types of demyelinating ON. AQP4-ON is frequently associated with severe ON-associated pain and longitudinally extensive optic nerve inflammatory lesions. Intra-orbital and peri-optic inflammation were more frequently observed in patients with MOG-ON, which was closely related to optic disc swelling and retro-orbital pain provoked by eye movements.
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Affiliation(s)
- Hao Kang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Huaiyu Qiu
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiaofeng Hu
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Shihui Wei
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
- Shihui Wei
| | - Yong Tao
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- *Correspondence: Yong Tao
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16
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Sexual Dysfunction in Women with Neuromyelitis Optica Spectrum Disorders and Multiple Sclerosis. SEXUALITY AND DISABILITY 2022. [DOI: 10.1007/s11195-022-09731-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Tan PH, Ji J, Yeh CC, Ji RR. Interferons in Pain and Infections: Emerging Roles in Neuro-Immune and Neuro-Glial Interactions. Front Immunol 2021; 12:783725. [PMID: 34804074 PMCID: PMC8602180 DOI: 10.3389/fimmu.2021.783725] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/19/2021] [Indexed: 12/24/2022] Open
Abstract
Interferons (IFNs) are cytokines that possess antiviral, antiproliferative, and immunomodulatory actions. IFN-α and IFN-β are two major family members of type-I IFNs and are used to treat diseases, including hepatitis and multiple sclerosis. Emerging evidence suggests that type-I IFN receptors (IFNARs) are also expressed by microglia, astrocytes, and neurons in the central and peripheral nervous systems. Apart from canonical transcriptional regulations, IFN-α and IFN-β can rapidly suppress neuronal activity and synaptic transmission via non-genomic regulation, leading to potent analgesia. IFN-γ is the only member of the type-II IFN family and induces central sensitization and microglia activation in persistent pain. We discuss how type-I and type-II IFNs regulate pain and infection via neuro-immune modulations, with special focus on neuroinflammation and neuro-glial interactions. We also highlight distinct roles of type-I IFNs in the peripheral and central nervous system. Insights into IFN signaling in nociceptors and their distinct actions in physiological vs. pathological and acute vs. chronic conditions will improve our treatments of pain after surgeries, traumas, and infections.
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Affiliation(s)
- Ping-Heng Tan
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City, Taiwan
| | - Jasmine Ji
- Neuroscience Department, Wellesley College, Wellesley, Massachusetts, MA, United States
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
| | - Chun-Chang Yeh
- Department of Anesthesiology of Tri-Service General Hospital & National Defense Medical Center, Taipei City, Taiwan
| | - Ru-Rong Ji
- Center for Translational Pain Medicine, Department of Anesthesiology, Duke University Medical Center, Durham, NC, United States
- Department of Neurobiology, Duke University Medical Center, Durham, NC, United States
- Department of Cell Biology, Duke University Medical Center, Durham, NC, United States
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Serizawa K, Tomizawa-Shinohara H, Miyake S, Yogo K, Matsumoto Y. Interleukin-6: evolving role in the management of neuropathic pain in neuroimmunological disorders. Inflamm Regen 2021; 41:34. [PMID: 34724990 PMCID: PMC8561956 DOI: 10.1186/s41232-021-00184-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/03/2021] [Indexed: 12/27/2022] Open
Abstract
Background Neuropathic pain in neuroimmunological disorders refers to pain caused by a lesion or disease of the somatosensory system such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). MS and NMOSD are autoimmune disorders of the central nervous system, and ≥ 50% of patients with these disorders experience chronic neuropathic pain. The currently available medications for the management of neuropathic pain have limited effectiveness in patients with MS and NMOSD, and there is an unmet medical need to identify novel therapies for the management of chronic neuropathic pain in these patients. In this review article, we summarize the role of interleukin-6 (IL-6) in the pathogenesis of MS and NMOSD and the ameliorative effects of anti–IL-6 therapies in mouse models of experimental autoimmune encephalomyelitis (EAE). Main body Intraperitoneal injection of MR16-1, an anti–IL-6 receptor (IL-6R) antibody, reduced mechanical allodynia and spontaneous pain in EAE mice, which was attributed to a reduction in microglial activation and inhibition of the descending pain inhibitory system. The effect of anti–IL-6 therapies in ameliorating neuropathic pain in the clinical setting is controversial; a reduction in pain intensity has been reported with an anti–IL-6 antibody in four studies, namely a case report, a pilot study, a retrospective observational study, and a case series. Pain intensity was evaluated using a numerical rating scale (NRS), with a lower score indicating lesser pain. A reduction in the NRS score was reported in all four studies. However, in two randomized controlled trials of another anti–IL-6R antibody, the change in the visual analog scale pain score was not statistically significantly different when compared with placebo. This was attributed to the low mean pain score at baseline in both the trials and the concomitant use of medications for pain in one of the trials, which may have masked the effects of the anti–IL-6R antibody on neuropathic pain. Conclusion Thus, anti–IL-6 therapies might have a potential to reduce neuropathic pain, but further investigations are warranted to clarify the effect of inhibition of IL-6 signaling on neuropathic pain associated with MS and NMOSD.
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Affiliation(s)
- Kenichi Serizawa
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200, Kajiwara, Kamakura, Kanagawa, 247-8530, Japan.
| | - Haruna Tomizawa-Shinohara
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200, Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Shota Miyake
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200, Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
| | - Kenji Yogo
- Research Planning Department, Chugai Pharmaceutical Co., Ltd., -135, Komakado, Gotemba, Shizuoka, 412-8513, Japan
| | - Yoshihiro Matsumoto
- Product Research Department, Chugai Pharmaceutical Co., Ltd., 200, Kajiwara, Kamakura, Kanagawa, 247-8530, Japan
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Abboud H, Salazar-Camelo A, George N, Planchon SM, Matiello M, Mealy MA, Goodman A. Symptomatic and restorative therapies in neuromyelitis optica spectrum disorders. J Neurol 2021; 269:1786-1801. [PMID: 34482456 PMCID: PMC8940781 DOI: 10.1007/s00415-021-10783-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/27/2021] [Accepted: 08/28/2021] [Indexed: 02/06/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are a group of autoimmune inflammatory conditions that primarily target the optic nerves, spinal cord, brainstem, and occasionally the cerebrum. NMOSD is characterized by recurrent attacks of visual, motor, and/or sensory dysfunction that often result in severe neurological deficits. In recent years, there has been a significant progress in relapse treatment and prevention but the residual disability per attack remains high. Although symptomatic and restorative research has been limited in NMOSD, some therapeutic approaches can be inferred from published case series and evidence from multiple sclerosis literature. In this review, we will discuss established and emerging therapeutic options for symptomatic treatment and restoration of function in NMOSD. We highlight NMOSD-specific considerations and identify potential areas for future research. The review covers pharmacologic, non-pharmacologic, and neuromodulatory approaches to neuropathic pain, tonic spasms, muscle tone abnormalities, sphincter dysfunction, motor and visual impairment, fatigue, sleep disorders, and neuropsychological symptoms. In addition, we briefly discuss remyelinating agents and mesenchymal stem cell transplantation in NMOSD.
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Affiliation(s)
- Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, Parkinson's and Movement Disorders Center, University Hospitals of Cleveland, Case Western Reserve University, Bolwell, 5th floor, 11100 Euclid Avenue, Cleveland, OH, 44106, USA.
| | - Andrea Salazar-Camelo
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Naveen George
- Multiple Sclerosis and Neuroimmunology Program, Parkinson's and Movement Disorders Center, University Hospitals of Cleveland, Case Western Reserve University, Bolwell, 5th floor, 11100 Euclid Avenue, Cleveland, OH, 44106, USA
| | - Sarah M Planchon
- The Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
| | - Marcelo Matiello
- Neurology Department, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maureen A Mealy
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Horizon Therapeutics Plc, Deerfield, IL, USA
| | - Andrew Goodman
- Neuroimmunology Division, Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
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20
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Ishikura T, Kinoshita M, Shimizu M, Yasumizu Y, Motooka D, Okuzaki D, Yamashita K, Murata H, Beppu S, Koda T, Tada S, Shiraishi N, Sugiyama Y, Miyamoto K, Kusunoki S, Sugimoto T, Kumanogoh A, Okuno T, Mochizuki H. Anti-AQP4 autoantibodies promote ATP release from astrocytes and induce mechanical pain in rats. J Neuroinflammation 2021; 18:181. [PMID: 34419102 PMCID: PMC8380350 DOI: 10.1186/s12974-021-02232-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/04/2021] [Indexed: 12/23/2022] Open
Abstract
Background Intractable neuropathic pain is a common symptom of neuromyelitis optica spectrum disorder (NMOSD). However, the underlying mechanism of NMOSD pain remains to be elucidated. In this study, we focused on ATP, which is one of the damage-associated molecular patterns, and also a well-recognized molecule involved in peripheral neuropathic pain. Methods We assessed the development of pain symptoms by injecting anti-AQP4 recombinant autoantibodies (rAQP4 IgG) into rat spinal cords. We incubated HEK293 cells expressing AQP4 (HEK-AQP4) and rat astrocytes with rAQP4 IgG and assessed the level of ATP in the supernatant. We performed transcriptome analysis of the spinal cords injected with rAQP4 IgG. Pharmacological inhibition was also applied to investigate the involvement of ATP in the development of neuropathic pain in our rat model. The ATP concentration within the cerebrospinal fluid was examined in patients with NMOSD and other neurological diseases. Results Development of mechanical allodynia was confirmed in rAQP4 IgG–treated rats. AQP4-Ab–mediated extracellular ATP release from astrocytes was observed in vitro, and pharmacological inhibition of ATP receptor reversed mechanical allodynia in the rAQP4 IgG–treated rats. Furthermore, transcriptome analysis revealed elevation of gene expressions related to several ATP receptors including P2rx4 and IL1B in the spinal cord of rAQP4 IgG–treated rats. In patients, CSF ATP concentration was significantly higher in the acute and remission phase of NMOSD than in multiple sclerosis or other neurological disorders. Conclusion Anti-AQP4 antibody was shown to induce the release of extracellular ATP from astrocytes. The ATP-mediated development of mechanical allodynia was also suggested in rats treated with anti-AQP4 antibody. Our study indicates the pivotal role of ATP in the pain mechanism of NMOSD. Supplementary Information The online version contains supplementary material available at 10.1186/s12974-021-02232-w.
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Affiliation(s)
- Teruyuki Ishikura
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Makoto Kinoshita
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Mikito Shimizu
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshiaki Yasumizu
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Daisuke Motooka
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Daisuke Okuzaki
- Genome Information Research Center, Research Institute for Microbial Diseases, Osaka University, Suita, Osaka, Japan
| | - Kazuya Yamashita
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hisashi Murata
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shohei Beppu
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Koda
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoru Tada
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Naoyuki Shiraishi
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yasuko Sugiyama
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Katsuichi Miyamoto
- Department of Neurology, Kindai University Faculty of Medicine, Sayama, Osaka, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University Faculty of Medicine, Sayama, Osaka, Japan
| | - Tomoyuki Sugimoto
- Graduate School of Data Science, Shiga University, Hikone, Shiga, Japan
| | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tatsusada Okuno
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Patient-reported burden of symptoms in neuromyelitis optica: A secondary analysis on pain and quality of life. J Neurol Sci 2021; 428:117546. [PMID: 34252701 DOI: 10.1016/j.jns.2021.117546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Relapses of neuromyelitis optica spectrum disorder (NMOSD) result in cumulative neurologic disabilities, are unpredictable, and are interspersed with remissions. Pain in NMOSD is often severe and intractable, with a significant impact on patient quality of life (QoL). We performed a more detailed analysis of previously published survey data on the association of pain and QoL, comparing patients who were seropositive and seronegative for antibodies against aquaporin-4 (AQP4-IgG). METHODS We conducted a secondary analysis of questionnaire data from 193 NMOSD patients across North America. The study population was predominantly female (88.6%) and aged 19-76 years. Results were reported for three groups: AQP4-IgG-seropositive (61.1%), AQP4-IgG-seronegative and the total cohort including patients with unknown serostatus. We measured the strength of associations and interactions between pain and variables including QoL, patient satisfaction, frequency of hospital visits, and number of relapses versus other symptoms. RESULTS Pain severity was the strongest negative predictor of QoL. In the total and AQP4-IgG-seropositive groups, pain was the most common symptom that patients wanted their physician to be concerned about; in the AQP4-IgG-seronegative group, this was fatigue. For all patients, frequent hospital visits and relapses were associated with more severe pain, but not frequency of NMOSD specialist visits. Patients without recent relapse still commonly reported moderate or severe pain (>25%). CONCLUSION This study confirms the heavy burden of pain on NMOSD patients and its effect on QoL and healthcare utilization. Prevention or early treatment of relapses and more effective pain management may reduce this burden.
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Chen H, Lian Z, Liu J, Shi Z, Du Q, Feng H, Zhang Q, Yang M, Wu X, Zhou H. Brain changes correlate with neuropathic pain in patients with neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2021; 53:103048. [PMID: 34090129 DOI: 10.1016/j.msard.2021.103048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/23/2021] [Accepted: 05/17/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Neuropathic pain (NP) is a highly disturbing sensory experience in patients with neuromyelitis optica spectrum disorders (NMOSD). However, the brain changes in NMOSD patients with NP have rarely been studied. OBJECTIVE The aim of the cross-sectional and follow-up longitudinal study was to investigate the brain changes in NMOSD patients with NP. METHODS In the cross-sectional study, comparisons were performed between groups with NP (W-NP) and without NP (Wo-NP), and age, sex and years of education were adjusted. We compared the voxel-wise whole-brain gray matter (GM) volume, cortical thickness (CT), cortical surface area (CSA) and local gyrification index (LGI). Probabilistic tractography started from regions with significant between-group differences in GM volume, CT, CSA and LGI. We also compared fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD) and axial diffusivity (AD) of the white matter (WM) skeleton using Tract-Based Spatial Statistics (TBSS). In the longitudinal study, the patients were followed for 2.0±0.0 years and underwent the same imaging scanning as the cross-sectional study. Changes of the CT, CSA, LGI and WM were obtained. RESULTS Patients in the W-NP group were older than those in the Wo-NP group and showed significantly reduced LGI of the left temporal lobe and adjacent regions(regions of interest, ROIs), which participated in neuropathic pain processing, possibly by emotion and attention control. Probabilistic tractography started from ROIs, and the generated WM tracts showed decreased MD and RD in the W-NP group compared to the Wo-NP group. Using TBSS, both MD and RD decreased in extensive WM skeleton in the right hemisphere of the patients in the W-NP group. Additionally, in the follow-up longitudinal study, compared with patients in the Wo-NP group, patients in the W-NP group showed lower mean reduction rates of LGI of ROIs, and less increase of FA and more increases of MD, AD and RD in the extensive WM skeleton. CONCLUSIONS These findings support the hypothesis that brain changes might correlate with NP in NMOSD patients and predict the changes related to NP over time.
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Affiliation(s)
- Hongxi Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhiyun Lian
- Department of Neurology, Chongqing City Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Ju Liu
- Department of Neurology, the first Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qin Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huiru Feng
- Department of Internal Medicine, Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region, Chengdu, Sichuan, China
| | - Qin Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Mu Yang
- Sichuan Cancer Hospital and research Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Xi Wu
- Department of Computer Science, Chengdu University of Information Technology.
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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23
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Pellkofer HL, Kümpfel T. [Pain in multiple sclerosis and neuromyelitis optica spectrum disorders]. Schmerz 2021; 35:211-222. [PMID: 34032887 DOI: 10.1007/s00482-021-00554-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2021] [Indexed: 12/15/2022]
Abstract
Multiple sclerosis and neuromyelitis optica spectrum disorders are autoimmune inflammatory diseases of the central nervous system, which can lead to a multitude of neurological complaints and pain syndromes. Pain may be an acute symptom during disease exacerbation as well as a chronic symptom, whereby the latter sometimes substantially reduces the quality of life. The etiology of pain is very heterogeneous but the rapid differential diagnostic classification is decisive in order to be able to initiate a differentiated treatment strategy. Chronic pain must be differentiated from pain as a possible (early) symptom of an acute disease exacerbation, classified in more detail and individually treated. These include central neuropathic pain, pain associated with spasticity, musculoskeletal pain due to excess loading and pain as a side effect of immunotherapy and in the context of comorbidities. The treatment strategies are often insufficiently evidence-based due to the lack of data.
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Affiliation(s)
- Hannah L Pellkofer
- Institut für Klinische Neuroimmunologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland.
| | - Tania Kümpfel
- Institut für Klinische Neuroimmunologie, LMU Klinikum, Marchioninistr. 15, 81377, München, Deutschland
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24
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Ayzenberg I, Richter D, Henke E, Asseyer S, Paul F, Trebst C, Hümmert MW, Havla J, Kümpfel T, Ringelstein M, Aktas O, Wildemann B, Jarius S, Häußler V, Stellmann JP, Senel M, Klotz L, Pellkofer HL, Weber MS, Pawlitzki M, Rommer PS, Berthele A, Wernecke KD, Hellwig K, Gold R, Kleiter I. Pain, Depression, and Quality of Life in Neuromyelitis Optica Spectrum Disorder: A Cross-Sectional Study of 166 AQP4 Antibody-Seropositive Patients. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2021; 8:8/3/e985. [PMID: 34108267 PMCID: PMC8058953 DOI: 10.1212/nxi.0000000000000985] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
Objectives To evaluate prevalence, clinical characteristics, and predictors of pain,
depression, and their impact on the quality of life (QoL) in a large
neuromyelitis optica spectrum disorder (NMOSD) cohort. Methods We included 166 patients with aquaporin-4–seropositive NMOSD from 13
tertiary referral centers. Patients received questionnaires on demographic
and clinical characteristics, PainDetect, short form of Brief Pain
Inventory, Beck Depression Inventory–II, and Short Form 36 Health
Survey. Results One hundred twenty-five (75.3%) patients suffered from chronic
NMOSD-associated pain. Of these, 65.9% had neuropathic pain, 68.8% reported
spasticity-associated pain and 26.4% painful tonic spasms. Number of
previous myelitis attacks (OR = 1.27, p = 0.018)
and involved upper thoracic segments (OR = 1.31, p
= 0.018) were the only predictive factors for chronic pain. The latter
was specifically associated with spasticity-associated pain (OR = 1.36,
p = 0.002). More than a third (39.8%) suffered
from depression, which was moderate to severe in 51.5%. Pain severity (OR
= 1.81, p < 0.001) and especially neuropathic
character (OR = 3.44, p < 0.001) were associated
with depression. Pain severity and walking impairment explained 53.9% of the
physical QoL variability, while depression and walking impairment 39.7% of
the mental QoL variability. No specific medication was given to 70.6% of
patients with moderate or severe depression and 42.5% of those with
neuropathic pain. Two-thirds (64.2%) of patients with symptomatic treatment
still reported moderate to severe pain. Conclusions Myelitis episodes involving upper thoracic segments are main drivers of pain
in NMOSD. Although pain intensity was lower than in previous studies, pain
and depression remain undertreated and strongly affect QoL. Interventional
studies on targeted treatment strategies for pain are urgently needed in
NMOSD.
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Affiliation(s)
- Ilya Ayzenberg
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Daniel Richter
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Eugenia Henke
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Susanna Asseyer
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Friedemann Paul
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Corinna Trebst
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Martin W Hümmert
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Joachim Havla
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Tania Kümpfel
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Marius Ringelstein
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Orhan Aktas
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Brigitte Wildemann
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Sven Jarius
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Vivien Häußler
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Jan-Patrick Stellmann
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Makbule Senel
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Luisa Klotz
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Hannah L Pellkofer
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Martin S Weber
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Marc Pawlitzki
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Paulus S Rommer
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Achim Berthele
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Klaus-Dieter Wernecke
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Kerstin Hellwig
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Ralf Gold
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Ingo Kleiter
- From the Department of Neurology (I.A., D.R., E.H., K.H., R.G., I.K.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Neurology (I.A.), Sechenov First Moscow State Medical University, Russia; NeuroCure Clinical Research Center (S.A., F.P.), Charité Universitätsmedizin Berlin, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Germany; Department of Neurology (C.T., M.W.H.), Hannover Medical School, Germany; Institute of Clinical Neuroimmunology (J.H., T.K., H.L.P.), University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Germany; Department of Neurology (M.R., O.A.), Medical Faculty, Heinrich Heine University Düsseldorf, Germany; Department of Neurology (M.R.), Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Germany; Molecular Neuroimmunology Group (B.W., S.J.), Department of Neurology, University of Heidelberg, Germany; Institut für Neuroimmunologie und Multiple Sklerose (INIMS) (V.H., J.-P.S.), Zentrum für Molekulare Neurobiologie, Hamburg, Germany; Klinik und Poliklinik für Neurologie (V.H., J.-P.S.), Universitätsklinikum Hamburg-Eppendorf, Germany; APHM (J.-P.S.), Hopital de la Timone, CEMEREM, Marseille, France; Aix Marseille Université (J.-P.S.), CRMBM, CNRS UMR 7339, Marseille, France; Department of Neurology (M.S.), University of Ulm, Germany; Münster Department of Neurology with Institute of Translational Neurology (L.K., M.P.), University Hospital Münster, Germany; Department of Neurology (H.L.P., M.S.W.), University Medical Center, Göttingen, Germany; Department of Neurology (M.P.), Otto-von-Guericke University, Magdeburg, Germany; Department of Neurology (P.S.R.), Medical University of Vienna, Austria; Neuroimmunology Section (P.S.R.), Department of Neurology, University of Rostock, Germany; Department of Neurology (A.B.), School of Medicine, Technical University of Munich, Germany; Charité-Universitätsmedizin Berlin, CRO SOSTANA GmbH Berlin (K.-D.W.), Germany; and Marianne-Strauß-Klinik (I.K.), Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany.
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Aktas O, Kümpfel T. [From neuromyelitis optica to neuromyelitis optica spectrum disorder: from clinical syndrome to diagnistic classification]. DER NERVENARZT 2021; 92:307-316. [PMID: 33728474 DOI: 10.1007/s00115-021-01098-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2021] [Indexed: 12/30/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD), derived from NMO or Devic's disease, is considered as a distinct disease since the discovery of a novel and pathogenic serum autoantibody targeting aquaporin‑4 (AQP4-IgG) and is distinguished from classical multiple sclerosis (MS). With the continuous extension of knowledge on the clinical manifestations, the previously narrow diagnostic term NMO became NMOSD, which has also been used in the diagnostic criteria since 2015. The current diagnostic criteria enable the early diagnosis of NMOSD in patients with and without AQP4-IgG. Typical clinical manifestations include involvement of the spinal cord, optic nerve and brainstem. Typically patients with the disease also present with neuropathic pain, painful tonic spasms and also other unusual manifestations in NMOSD. Especially in AQP4-IgG positive NMOSD patients, the coexistence with other autoimmune diseases is frequently observed. In most cases NMOSD follows a relapsing course with exacerbation-free periods sometimes lasting years and can be manifested first in advanced adulthood. A subset of AQP4-IgG negative NMOSD patients have been found to harbor autoantibodies targeting myelin oligodendrocyte glycoprotein (MOG), which is considered as a distinct disease entity: these MOG antibody-associated disorders (MOGAD) can present with clinical syndromes resembling both NMOSD and MS and are currently the subject of intensive research.
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Affiliation(s)
- Orhan Aktas
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Deutschland
| | - Tania Kümpfel
- Institut für klinische Neuroimmunologie, LMU Klinikum, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
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Asseyer S, Henke E, Trebst C, Hümmert MW, Wildemann B, Jarius S, Ringelstein M, Aktas O, Pawlitzki M, Korsen M, Klotz L, Siebert N, Ruprecht K, Bellmann-Strobl J, Wernecke KD, Häußler V, Havla J, Gahlen A, Gold R, Paul F, Kleiter I, Ayzenberg I. Pain, depression, and quality of life in adults with MOG-antibody-associated disease. Eur J Neurol 2021; 28:1645-1658. [PMID: 33423336 DOI: 10.1111/ene.14729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/23/2020] [Accepted: 12/30/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) is an inflammatory autoimmune condition of the central nervous system. However, data on pain and depression have remained scarce. The aim of this study was to assess features of chronic pain and depression as well as their impact on health-related quality of life (hr-QoL) in MOGAD. METHODS Patients with MOGAD were identified in the Neuromyelitis Optica Study Group registry. Data were acquired by a questionnaire, including clinical, demographic, pain (PainDetect, Brief Pain Inventory-Short Form, McGill Pain Questionnaire-Short Form), depression (Beck Depression Inventory-II), and hr-QoL (Short Form-36 Health Survey) items. RESULTS Twenty-two of 43 patients suffered from MOGAD-related pain (11 nociceptive, eight definite neuropathic, three possible neuropathic) and 18 from depression. Patients with neuropathic pain had the highest pain intensity and most profound activities of daily living (ADL) impairment. Fifteen patients reported spasticity-associated pain, including four with short-lasting painful tonic spasms. Later disease onset, profound physical impairment, and depression were associated with chronic pain. Physical QoL was more affected in pain sufferers (p < 0.001) than in pain-free patients, being most severely reduced by neuropathic pain (p = 0.016). Pain severity, visual impairment, and gait impairment independently predicted lower physical QoL. Depression was the only factor reducing mental QoL. Twelve patients still suffering from moderate pain (pain severity 4.6 ± 2.3) received pain medication. Only four out of 10 patients with moderate to severe depression took antidepressants. CONCLUSIONS Being highly prevalent, pain and depression strongly affect QoL and ADL in MOGAD. Both conditions remain insufficiently controlled in real-life clinical practice.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Eugenia Henke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Corinna Trebst
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Martin W Hümmert
- Department of Neurology, Hannover Medical School, Hannover, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum Düsseldorf, Düsseldorf, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marc Pawlitzki
- Department of Neurology, Otto-von-Guericke University, Magdeburg, Germany.,Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Melanie Korsen
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Luisa Klotz
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Münster, Germany
| | - Nadja Siebert
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klaus-Dieter Wernecke
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,CRO Sostana GmbH, Berlin, Germany
| | - Vivien Häußler
- Institute of Neuroimmunology and Multiple Sclerosis, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Havla
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians University, Munich, Germany
| | - Anna Gahlen
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ingo Kleiter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke gGmbH, Berg, Germany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.,Department of Neurology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
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27
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Myelin Oligodendrocyte Glycoprotein Antibody-Associated Myelitis Presenting with Headache. Can J Neurol Sci 2021; 48:879-881. [PMID: 33568250 DOI: 10.1017/cjn.2021.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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28
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Li W, Liu J, Tan W, Zhou Y. The role and mechanisms of Microglia in Neuromyelitis Optica Spectrum Disorders. Int J Med Sci 2021; 18:3059-3065. [PMID: 34400876 PMCID: PMC8364446 DOI: 10.7150/ijms.61153] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune neurological disease that can cause blindness and disability. As the major mediators in the central nervous system, microglia plays key roles in immunological regulation in neuroinflammatory diseases, including NMOSD. Microglia can be activated by interleukin (IL)-6 and type I interferons (IFN-Is) during NMOSD, leading to signal transducer and activator of transcription (STAT) activation. Moreover, complement C3a secreted from activated astrocytes may induce the secretion of complement C1q, inflammatory cytokines and progranulin (PGRN) by microglia, facilitating injury to microglia, neurons, astrocytes and oligodendrocytes in an autocrine or paracrine manner. These processes involving activated microglia ultimately promote the pathological course of NMOSD. In this review, recent research progress on the roles of microglia in NMOSD pathogenesis is summarized, and the mechanisms of microglial activation and microglial-mediated inflammation, and the potential research prospects associated with microglial activation are also discussed.
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Affiliation(s)
- Wenqun Li
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China
| | - Jiaqin Liu
- Department of Pharmacy, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan, China.,Institute of Clinical Pharmacy, Central South University, Changsha, 410011, Hunan, China
| | - Wei Tan
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan 410011, China
| | - Yedi Zhou
- Department of Ophthalmology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China.,Hunan Clinical Research Center of Ophthalmic Disease, Changsha, Hunan 410011, China
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29
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Xie Q, Sun M, Sun J, Zheng T, Wang M. New progress in the treatment of neuromyelitis optica spectrum disorder with monoclonal antibodies (Review). Exp Ther Med 2020; 21:148. [PMID: 33456515 DOI: 10.3892/etm.2020.9579] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 11/27/2020] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a group of immune-mediated inflammatory demyelinating diseases mainly affecting the central nervous system. It is characterized by high risk of relapse and progression to disability. The frequent recurrences of neuromyelitis optica spectrum disorder often exacerbate the neurological dysfunction and severely affect the patient's quality of life. Conventional treatments for neuromyelitis optica spectrum disorder, including acute treatment and sequential therapy, aim to decrease the degree of disability and recurrences. In recent years, new monoclonal antibodies have yielded encouraging results. The present review discusses the research status and recent progress in the treatment of NMOSD with monoclonal antibodies.
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Affiliation(s)
- Qinfang Xie
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, P.R. China
| | - Mengjiao Sun
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, P.R. China
| | - Jing Sun
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, P.R. China
| | - Ting Zheng
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, P.R. China
| | - Manxia Wang
- Department of Neurology, Lanzhou University Second Hospital, Lanzhou, Gansu 730030, P.R. China
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30
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Asseyer S, Kuchling J, Gaetano L, Komnenić D, Siebert N, Chien C, Scheel M, Oertel FC, Ruprecht K, Bellmann-Strobl J, Finke C, Chakravarty MM, Magon S, Wuerfel J, Paul F, Papadopoulou A, Brandt AU. Ventral posterior nucleus volume is associated with neuropathic pain intensity in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2020; 46:102579. [DOI: 10.1016/j.msard.2020.102579] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 09/27/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
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31
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Jarius S, Paul F, Weinshenker BG, Levy M, Kim HJ, Wildemann B. Neuromyelitis optica. Nat Rev Dis Primers 2020; 6:85. [PMID: 33093467 DOI: 10.1038/s41572-020-0214-9] [Citation(s) in RCA: 241] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica (NMO; also known as Devic syndrome) is a clinical syndrome characterized by attacks of acute optic neuritis and transverse myelitis. In most patients, NMO is caused by pathogenetic serum IgG autoantibodies to aquaporin 4 (AQP4), the most abundant water-channel protein in the central nervous system. In a subset of patients negative for AQP4-IgG, pathogenetic serum IgG antibodies to myelin oligodendrocyte glycoprotein, an antigen in the outer myelin sheath of central nervous system neurons, are present. Other causes of NMO (such as paraneoplastic disorders and neurosarcoidosis) are rare. NMO was previously associated with a poor prognosis; however, treatment with steroids and plasma exchange for acute attacks and with immunosuppressants (in particular, B cell-depleting agents) for attack prevention has greatly improved the long-term outcomes. Recently, a number of randomized controlled trials have been completed and the first drugs, all therapeutic monoclonal antibodies, have been approved for the treatment of AQP4-IgG-positive NMO and its formes frustes.
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Affiliation(s)
- Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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32
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Asseyer S, Cooper G, Paul F. Pain in NMOSD and MOGAD: A Systematic Literature Review of Pathophysiology, Symptoms, and Current Treatment Strategies. Front Neurol 2020; 11:778. [PMID: 33473247 PMCID: PMC7812141 DOI: 10.3389/fneur.2020.00778] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) are autoimmune inflammatory disorders of the central nervous system (CNS). Pain is highly prevalent and debilitating in NMOSD and MOGAD with a severe impact on quality of life, and there is a critical need for further studies to successfully treat and manage pain in these rare disorders. In NMOSD, pain has a prevalence of over 80%, and pain syndromes include neuropathic, nociceptive, and mixed pain, which can emerge in acute relapse or become chronic during the disease course. The impact of pain in MOGAD has only recently received increased attention, with an estimated prevalence of over 70%. These patients typically experience not only severe headache, retrobulbar pain, and/or pain on eye movement in optic neuritis but also neuropathic and nociceptive pain. Given the high relevance of pain in MOGAD and NMOSD, this article provides a systematic review of the current literature pertaining to pain in both disorders, focusing on the etiology of their respective pain syndromes and their pathophysiological background. Acknowledging the challenge and complexity of diagnosing pain, we also provide a mechanism-based classification of NMOSD- and MOGAD-related pain syndromes and summarize current treatment strategies.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
| | - Graham Cooper
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, 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, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
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33
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Neuromyelitis optica and myotonic dystrophy type 2: a rare association with diagnostic implications. J Neurol 2020; 267:2744-2746. [DOI: 10.1007/s00415-020-10049-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/01/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
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34
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Rosso M, Saxena S, Chitnis T. Targeting IL-6 receptor in the treatment of neuromyelitis optica spectrum: a review of emerging treatment options. Expert Rev Neurother 2020; 20:509-516. [PMID: 32306778 DOI: 10.1080/14737175.2020.1757434] [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] [Indexed: 12/23/2022]
Abstract
Introduction: Recent research has shown that IL-6 receptor (IL-6 R) inhibitors like tocilizumab and satralizumab are effective in reducing the relapse rate in patients with NMOSD.Areas covered: This review article explores current concepts in NMOSD management and focuses on IL-6 R as a therapeutic target. The authors delve into the biological and immunological role of IL-6 in the pathogenesis of NMOSD. Further, the authors summarize the most recent findings on the use of anti-IL-6 R monoclonal antibodies, tocilizumab and satralizumab, in the treatment of NMOSD.Expert opinion: A better understanding of the role of cytokines in NMOSD may provide the neurologist with novel therapies for this disease. IL-6 R appears to be a central hub to NMOSD pathogenesis and a relevant therapeutic target.
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Affiliation(s)
- Mattia Rosso
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, USA
| | - Shrishti Saxena
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.,Ann Romney Center for Neurologic Disease, Harvard Medical School, Boston, Massachusetts, USA.,Department of Neurology, Partners Multiple Sclerosis Center, Brigham and Women's Hospital, Boston, Massachusetts, USA
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35
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Wang C, Wu Q, Wang Z, Hu L, Marshall C, Xiao M. Aquaporin 4 knockout increases complete freund's adjuvant-induced spinal central sensitization. Brain Res Bull 2020; 156:58-66. [DOI: 10.1016/j.brainresbull.2020.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 12/30/2019] [Accepted: 01/03/2020] [Indexed: 01/07/2023]
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36
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Xu M, Bennett DLH, Querol LA, Wu LJ, Irani SR, Watson JC, Pittock SJ, Klein CJ. Pain and the immune system: emerging concepts of IgG-mediated autoimmune pain and immunotherapies. J Neurol Neurosurg Psychiatry 2020; 91:177-188. [PMID: 30224548 DOI: 10.1136/jnnp-2018-318556] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 07/18/2018] [Accepted: 07/30/2018] [Indexed: 12/30/2022]
Abstract
The immune system has long been recognised important in pain regulation through inflammatory cytokine modulation of peripheral nociceptive fibres. Recently, cytokine interactions in brain and spinal cord glia as well as dorsal root ganglia satellite glia have been identified important- in pain modulation. The result of these interactions is central and peripheral sensitisation of nociceptive processing. Additionally, new insights and the term 'autoimmune pain' have emerged through discovery of specific IgGs targeting the extracellular domains of antigens at nodal and synaptic structures, causing pain directly without inflammation by enhancing neuronal excitability. Other discovered IgGs heighten pain indirectly by T-cell-mediated inflammation or destruction of targets within the nociceptive pathways. Notable identified IgGs in pain include those against the components of channels and receptors involved in inhibitory or excitatory somatosensory synapses or their pathways: nodal and paranodal proteins (LGI1, CASPR1, CASPR2); glutamate detection (AMPA-R); GABA regulation and release (GAD65, amphiphysin); glycine receptors (GLY-R); water channels (AQP4). These disorders have other neurological manifestations of central/peripheral hyperexcitabability including seizures, encephalopathy, myoclonus, tremor and spasticity, with immunotherapy responsiveness. Other pain disorders, like complex regional pain disorder, have been associated with IgGs against β2-adrenergic receptor, muscarinic-2 receptors, AChR-nicotinic ganglionic α-3 receptors and calcium channels (N and P/Q types), but less consistently with immune treatment response. Here, we outline how the immune system contributes to development and regulation of pain, review specific IgG-mediated pain disorders and summarise recent development in therapy approaches. Biological agents to treat pain (anti-calcitonin gene-related peptide and anti-nerve growth factor) are also discussed.
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Affiliation(s)
- Min Xu
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Neurology, Xuan wu Hospital Capital Medical University, Beijing, China
| | - David L H Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Luis Antonio Querol
- Neuromuscular Diseases Unit-Neuromuscular Lab Neurology Department, Universitat Autònoma de Barcelona, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - James C Watson
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Department of Pain Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.,Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA .,Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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37
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Hyun JW, Jang H, Yu J, Park NY, Kim SH, Huh SY, Kim W, Park MS, Oh J, Park KD, Kim HJ. Comparison of Neuropathic Pain in Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis. J Clin Neurol 2020; 16:124-130. [PMID: 31942768 PMCID: PMC6974826 DOI: 10.3988/jcn.2020.16.1.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 10/02/2019] [Accepted: 10/04/2019] [Indexed: 12/19/2022] Open
Abstract
Background and Purpose To compare the characteristics of neuropathic pain in neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). Methods From 2016 to 2018, 500 patients with NMOSD and MS from 6 referral hospitals in Korea underwent pain investigation. After the patients with current pain were matched for sex ratio and disease duration as confounding factors, PainDETECT questionnaires were assessed in 99 NMOSD and 58 MS patients to investigate neuropathic pain. The short form of the Brief Pain Inventory from 74 patients with neuropathic pain component was also analysed. Results According to the PainDETECT questionnaire, mechanical allodynia (p=0.014) and thermal hyperalgesia (p=0.011) were more severe in NMOSD patients than in MS patients. Strong involvements (score >3) of the pain in domains of tingling/prickling sensation (p=0.024), mechanical allodynia (p=0.027), sudden pain attacks (p=0.018), and thermal hyperalgesia (p=0.002) were significantly more frequent in NMOSD compared to MS patients. Among the patients experiencing pain with a neuropathic component, total pain-related interference (p=0.045) scores were significantly higher in NMOSD patients than in MS patients. In daily life, pain interfered with normal work (p=0.045) and relationships with other people (p=0.039) more often in NMOSD patients than in MS patients. Although pain medication was prescribed more frequently in NMOSD patients, the percentage of patients experiencing medication-related pain relief was lower in those patients. Conclusions The severity of neuropathic pain and the pain-related interference in daily life were greater in NMOSD patients than in MS patients. Individualized analgesic management should be considered based on a comprehensive understanding of neuropathic pain in these patients.
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Affiliation(s)
- Jae Won Hyun
- Department of Neurology, National Cancer Center, Goyang, Korea
| | - Hyunmin Jang
- Department of Neurology, National Cancer Center, Goyang, Korea
| | - JaeBin Yu
- Department of Neurology, National Cancer Center, Goyang, Korea
| | - Na Young Park
- Department of Neurology, National Cancer Center, Goyang, Korea
| | - Su Hyun Kim
- Department of Neurology, National Cancer Center, Goyang, Korea
| | - So Young Huh
- Department of Neurology, Kosin University College of Medicine, Busan, Korea
| | - Woojun Kim
- Department of Neurology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Su Park
- Department of Neurology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University School of Medicine, Seoul, Korea
| | - Kee Duk Park
- Department of Neurology, Ewha Womans University School of Medicine, Ewha Medical Research Institute, Seoul, Korea
| | - Ho Jin Kim
- Department of Neurology, National Cancer Center, Goyang, Korea.
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38
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Ramakrishnan P, Nagarajan D. Neuromyelitis optica spectrum disorder: an overview. Acta Neurobiol Exp (Wars) 2020. [DOI: 10.21307/ane-2020-023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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39
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Abstract
Astrocytes are critical for maintaining the homeostasis of the CNS. Increasing evidence suggests that a number of neurological and neuropsychiatric disorders, including chronic pain, may result from astrocyte 'gliopathy'. Indeed, in recent years there has been substantial progress in our understanding of how astrocytes can regulate nociceptive synaptic transmission via neuronal-glial and glial-glial cell interactions, as well as the involvement of spinal and supraspinal astrocytes in the modulation of pain signalling and the maintenance of neuropathic pain. A role of astrocytes in the pathogenesis of chronic itch is also emerging. These developments suggest that targeting the specific pathways that are responsible for astrogliopathy may represent a novel approach to develop therapies for chronic pain and chronic itch.
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40
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Vierck C. Mechanisms of Below-Level Pain Following Spinal Cord Injury (SCI). THE JOURNAL OF PAIN 2019; 21:262-280. [PMID: 31493490 DOI: 10.1016/j.jpain.2019.08.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 07/05/2019] [Accepted: 08/07/2019] [Indexed: 12/18/2022]
Abstract
Mechanisms of below-level pain are discoverable as neural adaptations rostral to spinal injury. Accordingly, the strategy of investigations summarized here has been to characterize behavioral and neural responses to below-level stimulation over time following selective lesions of spinal gray and/or white matter. Assessments of human pain and the pain sensitivity of humans and laboratory animals following spinal injury have revealed common disruptions of pain processing. Interruption of the spinothalamic pathway partially deafferents nocireceptive cerebral neurons, rendering them spontaneously active and hypersensitive to remaining inputs. The spontaneous activity among these neurons is disorganized and unlikely to generate pain. However, activation of these neurons by their remaining inputs can result in pain. Also, injury to spinal gray matter results in a cascade of secondary events, including excitotoxicity, with rostral propagation of excitatory influences that contribute to chronic pain. Establishment and maintenance of below-level pain results from combined influences of injured and spared axons in the spinal white matter and injured neurons in spinal gray matter on processing of nociception by hyperexcitable cerebral neurons that are partially deafferented. A model of spinal stenosis suggests that ischemic injury to the core spinal region can generate below-level pain. Additional questions are raised about demyelination, epileptic discharge, autonomic activation, prolonged activity of C nocireceptive neurons, and thalamocortical plasticity in the generation of below-level pain. PERSPECTIVE: An understanding of mechanisms can direct therapeutic approaches to prevent development of below-level pain or arrest it following spinal cord injury. Among the possibilities covered here are surgical and other means of attenuating gray matter excitotoxicity and ascending propagation of excitatory influences from spinal lesions to thalamocortical systems involved in pain encoding and arousal.
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Affiliation(s)
- Chuck Vierck
- Department of Neuroscience, University of Florida College of Medicine and McKnight Brain Institute, Gainesville, Florida.
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41
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Mealy MA, Kozachik SL, Levy M. Review of Treatment for Central Spinal Neuropathic Pain and Its Effect on Quality of Life: Implications for Neuromyelitis Optica Spectrum Disorder. Pain Manag Nurs 2019; 20:580-591. [PMID: 31103517 DOI: 10.1016/j.pmn.2019.03.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 03/10/2019] [Accepted: 03/15/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) causes disabling and persistent central neuropathic pain (NP). Because the pain syndrome in NMOSD is severe and often intractable to analgesic treatment, it interferes with quality of life in patients. No interventional trials have been published looking at response to interventions for pain in NMOSD. This is a synthesis of the literature surveying the impact on quality of life of interventions in all mechanisms of central spinal NP. This review has important implications for management of pain in NMOSD. METHODS AND DATA SOURCES A systematic database search was conducted using PubMed, Embase, and CINAHL Plus with keywords including "spinal cord," "quality of life," and "neuropathic pain" in an attempt to identify original research that targeted spinal NP treatment and used quality of life as an outcome measure. Both pharmacologic and nonpharmacologic treatments were sought out. RESULTS Twenty-one studies meeting our eligibility criteria were identified and evaluated, 13 using pharmacologic treatments and 8 using nonpharmacologic interventions. Overall, sample sizes were modest, and effects on decreasing pain and/or improving quality of life were suboptimal. CONCLUSIONS This review provides researchers with a foundation from which to start a more thorough and thoughtful investigation into the management of NP in NMOSD and underscores the importance of including quality of life as a clinically meaningful outcome measure.
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Affiliation(s)
- Maureen A Mealy
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, Maryland; Johns Hopkins University, School of Nursing, Baltimore, Maryland.
| | | | - Michael Levy
- Department of Neurology, Johns Hopkins University, School of Medicine, Baltimore, Maryland
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42
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Hillebrand S, Schanda K, Nigritinou M, Tsymala I, Böhm D, Peschl P, Takai Y, Fujihara K, Nakashima I, Misu T, Reindl M, Lassmann H, Bradl M. Circulating AQP4-specific auto-antibodies alone can induce neuromyelitis optica spectrum disorder in the rat. Acta Neuropathol 2019; 137:467-485. [PMID: 30564980 PMCID: PMC6514074 DOI: 10.1007/s00401-018-1950-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/12/2018] [Accepted: 12/12/2018] [Indexed: 12/22/2022]
Abstract
It is well established that the binding of pathogenic aquaporin-4 (AQP4)-specific autoantibodies to astrocytes may initiate a cascade of events culminating in the destruction of these cells and in the formation of large tissue-destructive lesions typical for patients with neuromyelitis optica spectrum disorders (NMOSD). To date, not a single experimental study has shown that the systemic presence of the antibody alone can induce any damage to the central nervous system (CNS), while pathological studies on brains of NMOSD patients suggested that there might be ways for antibody entry and subsequent tissue damage. Here, we systemically applied a highly pathogenic, monoclonal antibody with high affinity to AQP4 over prolonged period of time to rats, and show that AQP4-abs can enter the CNS on their own, via circumventricular organs and meningeal or parenchymal blood vessels, that these antibodies initiate the formation of radically different lesions with AQP4 loss, depending on their mode and site of entry, and that lesion formation is much more efficient in the presence of encephalitogenic T-cell responses. We further demonstrate that the established tissue-destructive lesions trigger the formation of additional lesions by short and far reaching effects on blood vessels and their branches, and that AQP4-abs have profound effects on the AQP4 expression in peripheral tissues which counter-act possible titer loss by antibody absorption outside the CNS. Cumulatively, these data indicate that directly induced pathological changes caused by AQP4-abs inside and outside the CNS are efficient drivers of disease evolution in seropositive organisms.
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Affiliation(s)
- Sophie Hillebrand
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria
| | - Kathrin Schanda
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Magdalini Nigritinou
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria
| | - Irina Tsymala
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria
| | - Denise Böhm
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria
| | - Patrick Peschl
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Markus Reindl
- Clinical Department of Neurology, Innsbruck Medical University, Innsbruck, Austria
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria
| | - Monika Bradl
- Department of Neuroimmunology, Center for Brain Research, Medical University Vienna, Spitalgasse 4, 1090, Vienna, Austria.
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Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
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Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
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Araki M. Blockade of IL-6 signaling in neuromyelitis optica. Neurochem Int 2018; 130:104315. [PMID: 30342072 DOI: 10.1016/j.neuint.2018.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 10/04/2018] [Accepted: 10/17/2018] [Indexed: 01/14/2023]
Abstract
Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorder (NMOSD) are autoimmune diseases associated with a disease-specific autoantibody directed against the water channel protein aquaporin-4. Standard immunotherapy, immunosuppressive agents, and corticosteroids can prevent acute attacks and maintain remission in most patients with NMOSD. However, there is a strong need for additional options for patients who are refractory to standard treatments. Emerging therapies targeting specific molecules related to the pathogenicity of NMOSD are currently being developed. The review focuses on improving preventive treatments for NMOSD, including ongoing randomized clinical trials using biological drugs targeting CD19 and CD20 on B cells, interleukin-6, and complement protein C5. The anti-IL-6 receptor monoclonal antibody tocilizumab (TCZ), which can block IL-6 signaling, was shown to be highly effective for refractory patients with NMOSD. Notably, TCZ has marked effects on chronic neuropathic pain and general fatigue in patients refractory to standard medications. TCZ is a promising drug for preventing acute attacks in patients with NMOSD.
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Affiliation(s)
- Manabu Araki
- Multiple Sclerosis Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan.
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Asseyer S, Schmidt F, Chien C, Scheel M, Ruprecht K, Bellmann-Strobl J, Brandt AU, Paul F. Pain in AQP4-IgG-positive and MOG-IgG-positive neuromyelitis optica spectrum disorders. Mult Scler J Exp Transl Clin 2018; 4:2055217318796684. [PMID: 30186620 PMCID: PMC6117869 DOI: 10.1177/2055217318796684] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/21/2018] [Accepted: 07/17/2018] [Indexed: 12/21/2022] Open
Abstract
Background Pain is a frequent symptom in aquaporin-4-immunoglobulin-G-positive neuromyelitis optica spectrum disorders (AQP4-IgG-pos. NMOSD). Data on pain in myelin-oligodendrocyte-glycoprotein-immunoglobulin-G autoimmunity with a clinical NMOSD phenotype (MOG-IgG-pos. NMOSD) are scarce. Objective The objective of this paper is to investigate pain in MOG-IgG-pos. NMOSD, AQP4-IgG-pos. NMOSD and NMOSD without AQP4/MOG-IgG detection (AQP4/MOG-IgG-neg. NMOSD). Methods Forty-nine MOG-IgG-pos. (n = 14), AQP4-IgG-pos. (n = 29) and AQP4/MOG-IgG-neg. (n = 6) NMOSD patients were included in this cross-sectional baseline analysis from an ongoing observational study. We identified spinal cord lesions on magnetic resonance imaging, assessed pain by the painDETECT and McGill Pain questionnaires, quality of life by Short Form Health Survey, and depression by Beck Depression Inventory. Results Twelve MOG-IgG-pos. NMOSD patients (86%), 24 AQP4-IgG-pos. NMOSD patients (83%), and all AQP4/MOG-IgG-neg. NMOSD patients (100%) suffered from pain. MOG-IgG-pos. NMOSD patients had mostly neuropathic pain and headache; AQP4-IgG-pos. and AQP4/MOG-IgG-neg. NMOSD patients had mostly neuropathic pain. A history of myelitis was less frequent in MOG-IgG-pos. NMOSD than in AQP4-IgG-pos. NMOSD patients. Pain influenced quality of life in all patients. Thirty-six percent of patients with pain received pain medication; none of them were free of pain. Conclusions Pain is a frequent symptom of patients with MOG-IgG-pos. NMOSD and is as important as in AQP4-IgG-pos. and AQP4/MOG-IgG-neg. NMOSD. Despite its impact on quality of life, pain is insufficiently alleviated by medication.
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Affiliation(s)
- Susanna Asseyer
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Felix Schmidt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Claudia Chien
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Germany.,A.U.B. and F.P. contributed equally as senior authors of this work
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Abstract
PURPOSE OF REVIEW This article provides a practical approach for providers caring for patients with neuromyelitis optica (NMO) spectrum disorders. Clinical and imaging features, diagnostic criteria, treatment of acute exacerbations, chronic preventive therapy, and symptom management in NMO spectrum disorders are discussed. RECENT FINDINGS The rapid pace of research in NMO spectrum disorders has led to many recent advances. A broader understanding of the clinical spectrum of the disease as well as improvements in anti-aquaporin-4 antibody assays have led to recent revision of the diagnostic criteria. Several recent studies have expanded the knowledge base regarding the efficacy and safety of current therapies for NMO spectrum disorders. SUMMARY An NMO spectrum disorder is an inflammatory disorder affecting the central nervous system, previously thought to be closely related to multiple sclerosis but more recently demonstrated to represent a distinct clinical and pathophysiologic entity. As NMO spectrum disorders carry significant morbidity and, at times, mortality, prompt and accurate diagnosis followed by swift initiation of therapy for both treatment of acute exacerbations and prevention of further relapses is critical. This article provides a practical approach to the diagnosis and management of NMO spectrum disorders.
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Eaneff S, Wang V, Hanger M, Levy M, Mealy MA, Brandt AU, Eek D, Ratchford JN, Nyberg F, Goodall J, Wicks P. Patient perspectives on neuromyelitis optica spectrum disorders: Data from the PatientsLikeMe online community. Mult Scler Relat Disord 2017; 17:116-122. [PMID: 29055439 DOI: 10.1016/j.msard.2017.07.014] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Few studies have evaluated patient perspectives on neuromyelitis optica (NMO) and NMO spectrum disorder (NMOSD). OBJECTIVE Describe patient-reported clinical and treatment experience in NMOSD and compare disease characteristics of NMOSD with those of multiple sclerosis (MS). METHODS This retrospective, observational study included 522 members with NMO or NMOSD (hereafter collectively referred to as NMOSD) from PatientsLikeMe (PLM), an online patient community. Data describing member demographics, symptoms, and treatments were collected, analysed descriptively, and compared with data from PLM members with MS. RESULTS Fatigue, pain, and stiffness/spasticity were each rated as moderate to severe by more than half of NMOSD members, and 59% reported that their health limited the type of work or other activities they could perform all or most of the time. Overall, symptom severity and disability levels were comparable between NMOSD and MS members; however, NMOSD members were more likely than MS members to attribute disability to vision-related symptoms and were less likely to report moderate to severe cognitive and emotional symptoms, including brain fog, depressed or anxious mood, and emotional lability. CONCLUSION This analysis underscores the challenges of living with fatigue, pain, stiffness/spasticity, and visual difficulties, prevalent NMOSD symptoms among members of the PLM community.
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Affiliation(s)
| | - Victor Wang
- PatientsLikeMe Inc., 160 s Street, Cambridge, MA 02142, USA.
| | - Morgan Hanger
- PatientsLikeMe Inc., 160 s Street, Cambridge, MA 02142, USA.
| | - Michael Levy
- Department of Neurology, Johns Hopkins Hospital, 600N. Wolfe St., Baltimore, MD 21287, USA.
| | - Maureen A Mealy
- Department of Neurology, Johns Hopkins Hospital, 600N. Wolfe St., Baltimore, MD 21287, USA.
| | | | - Daniel Eek
- AstraZeneca, Pepparedsleden 1, Gothenburg, Sweden.
| | | | | | | | - Paul Wicks
- PatientsLikeMe Inc., 160 s Street, Cambridge, MA 02142, USA.
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Araki M, Yamamura T. Neuromyelitis optica spectrum disorders: Emerging therapies. ACTA ACUST UNITED AC 2017. [DOI: 10.1111/cen3.12394] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Manabu Araki
- Multiple Sclerosis Center; National Institute of Neuroscience; National Center of Neurology and Psychiatry; Tokyo Japan
- Department of Immunology; National Institute of Neuroscience; National Center of Neurology and Psychiatry; Tokyo Japan
| | - Takashi Yamamura
- Multiple Sclerosis Center; National Institute of Neuroscience; National Center of Neurology and Psychiatry; Tokyo Japan
- Department of Immunology; National Institute of Neuroscience; National Center of Neurology and Psychiatry; Tokyo Japan
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Ashtari F, Safaei A, Shaygannejad V, Najafi MA, Vesal S. Neuromyelitis optica spectrum disease characteristics in Isfahan, Iran: A cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2017; 22:41. [PMID: 28465700 PMCID: PMC5393101 DOI: 10.4103/1735-1995.202142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/13/2016] [Accepted: 12/02/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disease (NMOSD) is a severe autoimmune demyelinating disorder of the central nervous system that throughout epidemiological data, it has not been completely determined. The aim of this study was to assess characteristics of NMOSD patients in Isfahan as one of the most prevalent cities for multiple sclerosis in Iran. MATERIALS AND METHODS Forty-five patients diagnosed as neuromyelitis optica (NMO) disease through 5 years enrolled in this study. Demographics and characteristics of disease such as Expanded Disability Status Scale (EDSS) score, disease duration, clinical symptoms, laboratory data, and magnetic resonance imaging findings (including T1, T2, and flair protocols) were recorded. NMO-immunoglobulin G serology assay was done in all of the patients by ELISA test. RESULTS Female to male ratio was 5.4:1. The mean age of disease onset was 29.8 ± 11.2 years. NMO antibody was positive in 24.4% of patients. The presenting symptoms were optic neuritis (55.5%), transverse myelitis (40%), and brainstem symptoms (4.5%). The interval between the first and second attack was 19.28 ± 31.27 months (range: 1 month to 17 years). The mean EDSS score of the patients was 2.8 ± 2.25. Frequency of long-extending cervical plaque was higher among men than women (85.7% vs. 57.9%). CONCLUSION Based on this study, the mean age of NMOSD onset among Isfahan population was considerably lower than other studies, and there was higher frequency of long-extending cervical lesion among male patients which needs more consideration in further studies.
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Affiliation(s)
- Fereshte Ashtari
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Safaei
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Student of Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Amin Najafi
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Student of Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vesal
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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