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Arnett S, Chew SH, Leitner U, Hor JY, Paul F, Yeaman MR, Levy M, Weinshenker BG, Banwell BL, Fujihara K, Abboud H, Dujmovic Basuroski I, Arrambide G, Neubrand VE, Quan C, Melamed E, Palace J, Sun J, Asgari N, Broadley SA. Sex ratio and age of onset in AQP4 antibody-associated NMOSD: a review and meta-analysis. J Neurol 2024:10.1007/s00415-024-12452-8. [PMID: 38958756 DOI: 10.1007/s00415-024-12452-8] [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: 03/14/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Aquaporin-4 (AQP4) antibody-associated neuromyelitis optica spectrum disorder (NMOSD) is an antibody-mediated inflammatory disease of the central nervous system. We have undertaken a systematic review and meta-analysis to ascertain the sex ratio and mean age of onset for AQP4 antibody associated NMOSD. We have also explored factors that impact on these demographic data. METHODS A systematic search of databases was conducted according to the PRISMA guidelines. Articles reporting sex distribution and age of onset for AQP4 antibody-associated NMSOD were reviewed. An initially inclusive approach involving exploration with regression meta-analysis was followed by an analysis of just AQP4 antibody positive cases. RESULTS A total of 528 articles were screened to yield 89 articles covering 19,415 individuals from 88 population samples. The female:male sex ratio was significantly influenced by the proportion of AQP4 antibody positive cases in the samples studied (p < 0.001). For AQP4 antibody-positive cases the overall estimate of the sex ratio was 8.89 (95% CI 7.78-10.15). For paediatric populations the estimate was 5.68 (95% CI 4.01-8.03) and for late-onset cases, it was 5.48 (95% CI 4.10-7.33). The mean age of onset was significantly associated with the mean life expectancy of the population sampled (p < 0.001). The mean age of onset for AQP4 antibody-positive cases in long-lived populations was 41.7 years versus 33.3 years in the remainder. CONCLUSIONS The female:male sex ratio and the mean age of onset of AQP4 antibody-associated NMOSD are significantly higher than MS. The sex ratio increases with the proportion of cases that are positive for AQP4 antibodies and the mean age of onset increases with population life expectancy.
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Affiliation(s)
- Simon Arnett
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia.
| | - Sin Hong Chew
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Unnah Leitner
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
| | - Jyh Yung Hor
- Department of Neurology, Penang General Hospital, George Town, Penang, Malaysia
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Michael R Yeaman
- Department of Medicine, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
- Department of Medicine, Divisions of Molecular Medicine & Infectious Diseases, Harbor-UCLA Medical Center, Torrance, CA, USA
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Michael Levy
- Department of Neurology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | | - Brenda L Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University and Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Hesham Abboud
- Case Western Reserve University, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | | | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Catalonia, Spain
| | - Veronika E Neubrand
- Department of Cell Biology, Faculty of Sciences, University of Granada, Granada, Spain
| | - Chao Quan
- Department of Neurology, The National Centre for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Esther Melamed
- Dell Medical School, University of Texas, Austin, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department Clinical Neurology, John Radcliffe Hospital, Oxford, OX3 9DU, UK
| | - Jing Sun
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Institute of Integrated Intelligence and Systems, Nathan Campus, Griffith University, Nathan, QLD, Australia
- Rural Health Research Institute, Charles Sturt University, Bathurst, NSW, Australia
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Simon A Broadley
- School of Medicine and Dentistry, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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Luo W, Shi Z, Kong L, Wang X, Zhou H. Patterns of neuromyelitis optica spectrum disorder attacks in different age groups and sexes depending on the status of immunosuppressive therapy: A retrospective cohort study. Eur J Neurol 2024; 31:e16178. [PMID: 38117536 DOI: 10.1111/ene.16178] [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: 06/14/2023] [Revised: 09/27/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND AND PURPOSE The association between onset age and sex with relapse risk in neuromyelitis optica spectrum disorder (NMOSD) remains inconclusive. We aimed to describe the clinical features of patients with NMOSD in different age groups and sexes and to analyse relapse characteristics pre- and post-immunosuppressive therapy (IST). METHODS Patients with NMOSD were retrospectively reviewed from our clinical centre's database. Demographic and clinical data, attack presentation, and disease course pre- and post-IST were investigated. We also analysed the effect of onset age on the annualized relapse rate and relapse risk according to sex and IST status. Interactions on the additive scale between onset age and sex were analysed. A restricted cubic spline was used to analyse potential nonlinear correlations. Longitudinal changes in the Expanded Disability Status Scale score across NMOSD attacks were analysed using linear mixed-effect models. RESULTS In total, 533 patients experienced 1394 attacks pre-IST and 753 relapses post-IST. Older age at onset was correlated with more myelitis attacks but fewer optic neuritis attacks, with no sex-related differences in attack presentation. Pre-IST, relapse risk increased with age at onset in women, while a U-shaped correlation between onset age and relapse risk was found in men. Post-IST, an inverted U-shaped association between the predicted relapse risk and onset age was observed in women. Conversely, a negative correlation between the predicted relapse risk and onset age was found in men. Overall, a higher ratio of myelitis attacks was found post-IST. CONCLUSIONS Patients of different onset ages and sexes had different relapse patterns before and after IST.
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Affiliation(s)
- Wenqin Luo
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Ziyan Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Lingyao Kong
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Xiaofei Wang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
| | - Hongyu Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, P.R. China
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Huang Y, Luo W, Cheng X, Sun X, Wang Y, Shu Y, Lu Z, Hu X, Qiu W, Kermode A, Zhong X. Clinical and imaging features of patients with late-onset myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Relat Disord 2024; 82:105405. [PMID: 38194895 DOI: 10.1016/j.msard.2023.105405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/12/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND There is an age-dependent change in the clinical phenotype of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). However, the clinical features of late-onset MOGAD have not been well described. METHODS Clinical data of 110 MOGAD patients, including 21 late-onset patients with onset age greater than or equal to 50 years old were retrospectively analyzed. RESULTS Compared to pediatric- and younger adult-onset ones, late-onset MOGAD patients experienced milder disease onset (p < 0.001), more monophasic course (p < 0.001), fewer relapses (p = 0.007), less cerebrospinal fluid leukocytosis (p = 0.021), less longitudinally extensive transverse myelitis (onset p = 0.026, whole course p = 0.028), fewer lesions in basal ganglia (whole course p = 0.012), thalamus (whole course p = 0.040) and cerebellum (whole course p = 0.028). However, they had more cerebral symptoms (p = 0.021 onset and whole course), more lesions in white matter (onset p = 0.005, whole course p < 0.001) and periventricular area (onset p = 0.026), along with longer and delayed therapeutic intervention (p < 0.001). The main differences in clinical characteristics between late-onset patients with and without these brain involvements might be comorbidities. CONCLUSIONS Late-onset MOGAD are more likely to experience delayed diagnosis. Brain involvement may be modulated by comorbidities of the elderly, which alter the clinical manifestations of late-onset MOGAD.
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Affiliation(s)
- Yiying Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjing Luo
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Cheng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Shu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Allan Kermode
- Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia; Institute for Immunology and Infectious Disease, Murdoch University, Perth, Australia.
| | - Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Song H, Chuai Y, Yang M, Zhou H, Sun M, Xu Q, Wei S. Glial autoantibody prevalence in Chinese optic neuritis with onset after age 45: clinical factors for diagnosis. Front Immunol 2023; 14:1181908. [PMID: 37705973 PMCID: PMC10495982 DOI: 10.3389/fimmu.2023.1181908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 08/08/2023] [Indexed: 09/15/2023] Open
Abstract
Purpose As glial autoantibody testing is not yet available in some areas of the world, an alternative approach is to use clinical indicators to predict which subtypes of middle-aged and elderly-onset optic neuritis (ON) have manifested. Method This study was a single-center hospital-based retrospective cohort study. Middle-aged and elderly-onset ON patients (age > 45 years) who had experienced the first episode of ON were included in this cohort. Single- and multi-parametric diagnostic factors for middle-aged and elderly-onset myelin oligodendrocyte glycoprotein immunoglobulin-associated ON (MOG-ON) and aquaporin-4 immunoglobulin-related ON (AQP4-ON) were calculated. Results From January 2016 to January 2020, there were 81 patients with middle-aged and elderly-onset ON, including 32 (39.5%) AQP4-ON cases, 19 (23.5%) MOG-ON cases, and 30 (37.0%) Seronegative-ON cases. Bilateral involvement (47.4%, P = 0.025) was most common in the MOG-ON group. The presence of other concomitant autoimmune antibodies (65.6%, P = 0.014) and prior neurological history (37.5%, P = 0.001) were more common in the AQP4-ON group. The MOG-ON group had the best follow-up best-corrected visual acuity (BCVA) (89.5% ≤ 1.0 LogMAR, P = 0.001). The most sensitive diagnostic factors for middle-aged and elderly-onset MOG-ON were 'follow-up VA ≤ 0.1 logMAR' (sensitivity 0.89), 'bilateral involvement or follow-up VA ≤ 0.1 logMAR' (sensitivity 0.95), 'bilateral involvement or without neurological history' (sensitivity 1.00), and 'follow-up VA ≤ 0.1 logMAR or without neurological history' (sensitivity 1.00), and the most specific factor was 'bilateral involvement' (specificity 0.81). The most sensitive diagnostic factors for middle-aged and elderly-onset AQP4-ON were 'unilateral involvement' (sensitivity 0.88), 'unilateral involvement or neurological history' (sensitivity 0.91), and 'unilateral involvement or other autoimmune antibodies' (sensitivity 1.00), and the most specific factor was neurological history (specificity 0.98). Conclusion Based on our cohort study of middle-aged and elderly-onset ON, MOG-ON is less prevalent than AQP4-ON and Seronegative-ON. Using multiple combined parameters improves the sensitivity and negative predictive value for diagnosing middle-aged and elderly-onset MOG-ON and AQP4-ON. These combined parameters can help physicians identify and treat middle-aged and elderly-onset ON early when glial autoantibody status is not available.
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Affiliation(s)
- Honglu Song
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
- Department of Ophthalmology, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Yucai Chuai
- Department of Special Medical Services, Bethune International Peace Hospital, Shijiazhuang, Hebei, China
| | - Mo Yang
- Department of Neuro-ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mingming Sun
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The First Medical Center of the Chinese People's Liberation Army General Hospital, Beijing, China
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5
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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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Rojas JI, Pappolla A, Patrucco L, Cristiano E, Miguez J, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Fiol M, Leguizamon F, Luetic G, Menichini ML, Lopez PA, Pettinicchi JP, Criniti J, Caride A, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Silva B, Fernández Liguori N, Nadur D, Chercoff A, Martinez A, Steinberg J, Garcea O, Carrá A, Alonso Serena M, Carnero Contentti E. Disability outcomes in NMOSD and MOGAD patients: data from a nationwide registry in Argentina. Neurol Sci 2023; 44:281-286. [PMID: 36166174 DOI: 10.1007/s10072-022-06409-w] [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: 03/24/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
The objective was to evaluate time to reach an EDSS of 4, 6, and 7 in NMOSD and MOGAD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03,375,177). METHODS NMOSD patients diagnosed according to 2015 criteria and with MOGAD were identified. Patients with at least 3 years of follow-up and periodic clinical evaluations with EDSS outcomes were included. AQP4-antibody and MOG-antibody status was recorded, and patients were stratified as seropositive and seronegative for AQP4-antibody. EDSS of 4, 6, and 7 were defined as dependent variables. Log rank test was used to identify differences between groups. RESULTS Registry data was provided for a total of 137 patients. Of these, seventy-five presented AQP4-ab-positive NMOSD, 45 AQP4-ab-negative NMOSD, and 11 MOGAD. AQP4-ab status was determined by cell-based assay (CBA) in 72% of NMOSD patients. MOG-ab status was tested by CBA in all cases. Mean time to EDSS of 4 was 53.6 ± 24.5 vs. 63.1 ± 32.2 vs. 44.7 ± 32 months in seropositive, seronegative NMOSD, and MOGAD, respectively (p = 0.76). Mean time to EDSS of 6 was 79.2 ± 44.3 vs. 75.7 ± 48.6 vs. 54.7 ± 50 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.23), while mean time to EDSS of 7 was 86.8 ± 54 vs. 80.4 ± 51 vs. 58.5 ± 47 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.39). CONCLUSION No differences were observed between NMOSD (seropositive and seronegative) and MOGAD in survival curves.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Argentina. .,Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina. .,Centro de Esclerosis Múltiple de Buenos Aires, (CEMBA), Billinghurst 1611, CP 1181, Buenos Aires, Argentina.
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Cordoba, Argentina.,Servicio de Neurología - Hospital Córdoba, Cordoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes - Sanatorio Allende, Cordoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Sanatorio Güemes, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Débora Nadur
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina.,Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Alejandra Martinez
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
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Liu T, Li L, Guo X, Li Q, Jia D, Ma L. Clinical analysis of neuromyelitis optica spectrum disease with area postrema syndrome as the initial symptom. Eur J Med Res 2022; 27:315. [PMID: 36582004 PMCID: PMC9798654 DOI: 10.1186/s40001-022-00949-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/13/2022] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to report and discuss clinical analysis, including the diagnosis and treatment of 4 cases of neuromyelitis optica spectrum disease (NMOSD) with area postrema syndrome (APS) as the first symptom. METHODS Four patients with intractable nausea, vomiting, and confirmed NMOSD were included in the final analysis. All of these patients were initially misdiagnosed and mismanaged. RESULTS Among the 4 patients, 3 were admitted to the department of gastroenterology at the onset of the disease, and 2 were not correctly diagnosed and treated promptly due to misdiagnosis. Therefore, their symptoms worsened, and they were transferred to Intensive Care Unit (ICU) for life support. No obvious early medulla lesions were found in one patient. One patient was treated with intravenous immunoglobulin, methylprednisolone, and plasma exchange, but there was no significant clinical improvement, after which the disease relapsed during the treatment with low-dose rituximab. CONCLUSION The clinical manifestations of NMOSD are complex and diverse, and the initial symptoms, onset age of the patient, and magnetic resonance imaging (MRI) findings can influence the final diagnosis. Early identification of the APS and timely therapy can prevent visual and physical disabilities, even respiratory failure, coma, and cardiac arrest. Therefore, it is necessary to identify specific and sensitive serum and imaging markers for predicting the prognosis and recurrence of the disease.
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Affiliation(s)
- Ting Liu
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Lijuan Li
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Xiaopeng Guo
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Qifu Li
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Dandan Jia
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Lin Ma
- grid.443397.e0000 0004 0368 7493Department of Neurology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
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Hu Y, Sun Q, Yi F, Yao L, Tian Y, Tang H, Luo M, Xie N, Wang Z, Liao X, Zhou L, Xu H, Zhou Y. Age of onset correlates with clinical characteristics and prognostic outcomes in neuromyelitis optica spectrum disorder. Front Immunol 2022; 13:1056944. [PMID: 36569880 PMCID: PMC9772011 DOI: 10.3389/fimmu.2022.1056944] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 11/25/2022] [Indexed: 12/12/2022] Open
Abstract
Objective Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease preferentially affects the optic nerve and the spinal cord. The first attack usually occurs in the third or fourth decade, though patients with disease onset in the fifties or later are not uncommon. This study aimed to investigate the clinical characteristics and prognosis in patients with different age of onset and to explore the correlations between age of onset and clinical characteristics and prognostic outcomes. Method We retrospectively reviewed the medical records of 298 NMOSD patients diagnosed according to the 2015 updated version of diagnostic criteria. Patients were divided into early-onset NMOSD (EO-NMOSD) (<50 years at disease onset) and late-onset NMOSD (LO-NMOSD) (≥50 years at disease onset) based on the age of disease onset. LO-NMOSD patients were divided into two subgroups: relative-late-onset NMOSD (RLO-NMOSD) (50~70 years at disease onset) and very-late-onset NMOSD (≥70 years at disease onset). Clinical characteristics, laboratory findings, neuroimaging features, and prognostic outcomes were investigated. Results Compared to EO-NMOSD patients, patients with LO-NMOSD showed more frequent transverse myelitis (TM) (58.20% vs. 36.00%, p = 0.007) while less frequent optic neuritis (ON) (23.10% vs. 34.80%, p = 0.031) and brainstem/cerebral attacks (7.50% vs. 18.30%, p = 0.006) as the first attack. Patients with LO-NMOSD showed less frequent relapses, higher Expanded Disability Status Scale (EDSS) score at the last follow-up, fewer NMOSD-typical brain lesions, and longer segments of spinal cord lesions. Patients with older onset age showed a higher proportion of increased protein levels in cerebrospinal fluid during the acute phase of attacks. Age at disease onset positively correlated with length of spinal cord lesions at first attack and at last follow-up, negatively correlated with ARR-1 (ARR excluding the first attack, calculated from disease onset to final follow-up), irrespective of AQP4-IgG serostatus. Patients with older age at disease onset progressed to severe motor disability sooner, and age of onset positively correlated with EDSS score at the last follow-up, irrespective of AQP4-IgG serostatus. Conclusion Age of disease onset affects clinical characteristics and prognosis outcomes of patients with NMOSD.
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Affiliation(s)
- Yacen Hu
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Qiying Sun
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fang Yi
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lingyan Yao
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yun Tian
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haiyun Tang
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Mengchuan Luo
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Nina Xie
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Zhiqin Wang
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Xinxin Liao
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Lin Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hongwei Xu
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China,Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yafang Zhou
- Department of Geriatric Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China,*Correspondence: Yafang Zhou,
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Valdivia-Tangarife ER, Gamez-Nava JI, Cortés-Enríquez F, Mireles-Ramírez MA, Gonzalez-López L, Saldaña-Cruz AM, Macías-Islas MA. Risk factors associated with permanent disability in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2022; 68:104114. [PMID: 36037753 DOI: 10.1016/j.msard.2022.104114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/05/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system. In NMOSD, a relapse results in increased disability. OBJECTIVE To assess risk factors associated with permanent disability (PD) in patients with neuromyelitis optica spectrum disorders (NMOSD). METHODS We evaluated 34 cases (who developed permanent disability) and 33 controls. The assessment included the following variables: sociodemographic data and characteristics of the disease. Logistic regression analysis was performed to adjust variables associated with PD. RESULTS fifty-one percent developed PD during follow-up; 15 (22%) developed permanent visual disability, 13 (19%) developed permanent motor disability and 6 (9%) were restricted to wheelchair. Factors associated with PD in the crude analysis were: age at onset ≥ 50 years (OR 3.95, 95% IC 1.12-13.94, p= 0.032), time from onset to diagnosis ≥ 12 months (OR 3.30, 95% IC 1.13-9.64, p= 0.029), time from onset to treatment ≥ 60 months (OR 4.16, 95% IC 1.03-16.85, p= 0.045), EDSS ≥ 4.0 at the first appointment (OR 3.21, 95% IC 1.18-8.76, p= 0.022) and severe relapses during disease evolution (OR 5.72, 95% IC 1.98-16.57, p= 0.001). Factors associated with PD in the adjusted analysis were: age at onset ≥ 50 years (OR 5.82, 95% IC 1.30-26.05, p= 0.021), time from onset to diagnosis ≥ 12 months (OR 5.43, 95% IC 1.47-20.08, p= 0.011) and severe relapses during disease evolution (OR 6.65, 95% IC 1.98-22.31, p= 0.002). CONCLUSION Half of patients with NMOSD may develop PD during disease evolution. Age of onset ≥ 50 years, delay to diagnosis ≥12 months and initial EDSS ≥ 4.0 constitute the strongest risk factors for PD.
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Affiliation(s)
- Edgar R Valdivia-Tangarife
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México
| | - Jorge I Gamez-Nava
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México; Programa de Doctorado en Salud Publica, CUCS, Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México
| | - Fernando Cortés-Enríquez
- Departamento de Neurología, Hospital General Regional No 45 del Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Mario A Mireles-Ramírez
- Departamento de Neurología, Unidad de Alta Especialidad Médica, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social. Guadalajara, Jalisco, México
| | - Laura Gonzalez-López
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México; Programa de Doctorado en Salud Publica, CUCS, Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México
| | - Ana M Saldaña-Cruz
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, CUSC, Universidad de Guadalajara, Jalisco, México
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10
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Late onset neuromyelitis optica spectrum disorders (LONMOSD) from a nationwide Portuguese study: anti-AQP4 positive, anti-MOG positive and seronegative subgroups. Mult Scler Relat Disord 2022; 63:103845. [DOI: 10.1016/j.msard.2022.103845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/13/2022] [Accepted: 05/01/2022] [Indexed: 11/20/2022]
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11
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Yu J, Yan S, Niu P, Teng J. Relatively Early and Late-Onset Neuromyelitis Optica Spectrum Disorder in Central China: Clinical Characteristics and Prognostic Features. Front Neurol 2022; 13:859276. [PMID: 35493805 PMCID: PMC9046694 DOI: 10.3389/fneur.2022.859276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background We aimed to analyze the clinical characteristics and prognostic features of Chinese patients with relatively late-onset neuromyelitis optica spectrum disorder (RLO-NMOSD>40 years of age at disease onset), compared with patients with relatively early onset NMOSD (REO-NMOSD, ≤ 40 years of age at disease onset). Methods We retrospectively reviewed the medical records of patients with NMOSD in central China (with disease courses longer than 3 years) between January 2012 and January 2021. We further analyzed the clinical and prognostic differences between patients with REO-NMOSD and RLO-NMOSD. Results A total of 71 patients were included in this study. The results showed that 39 (54.9%) of the patients had RLO-NMOSD. The patients with RLO-NMOSD had higher expanded disability status scale (EDSS) scores than patients with REO-NMOSD at the initial (5.0 vs. 3.0, p = 0.01), 3-month (4.0 vs. 2.5, p = 0.001), 1-year (4.0 vs. 2.5, p = 0.003), 3rd-year (3.5 vs. 3.0, p = 0.0017), and final follow-up (4.0 vs. 2.5, P = 0.002) time points. The EDSS scores of visual function were 2.0 (1.0–3.0) in REO-NMOSD and 3.0 (2.0–3.0) in RLO-NMOSD (p = 0.038) at the final follow-up time point. The locations of spinal cord lesions at transverse myelitis (TM) onset were prone to cervical cord in patients with REO-NMOSD. There were no between-group treatment differences. The risk of requiring a cane to walk (EDSS score of 6.0) increased as the age of disease onset increased: for every 10-year increase in the age of disease onset, the risk of needing a cane to walk increased by 65% [hazard ratio (HR) = 1.65, 95% CI 1.15–2.38, p = 0.007]. Another significant predictor identified in the multivariate analysis was annualized relapse rate (ARR) (HR = 2.01, 95% CI 1.09–3.71, p = 0.025). In addition, we observed a positive correlation between age at onset and EDSS scores at the final follow-up (Spearman's r = 0.426, p < 0.0001) time point. EDSS scores at different periods were significantly different between patients with RLO-NMOSD and REO-NMOSD with anti-aquaporin-4 (AQP4) IgG positive. Conclusion The patients with RLO-NMOSD developed more severe disabilities than patients with REO-NMOSD at a variety of time periods. All of the patients may experience recurrent aggravated symptoms after their first year, with only patients with REO-NMOSD partly recovering from the 3rd year. The age at onset and ARR were the main predictors of outcomes.
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Affiliation(s)
- Jinbei Yu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Yan
- Department of Neurology, Affiliated Hospital of Hebei University, Baoding, China
| | - Pengpeng Niu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Junfang Teng
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12
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Papathanasiou A, Tanasescu R, Tench CR, Rocha MF, Bose S, Constantinescu CS, Jacob S. Age at onset predicts outcome in aquaporin-4-IgG positive neuromyelitis optica spectrum disorder from a United Kingdom population. J Neurol Sci 2021; 431:120039. [PMID: 34715481 DOI: 10.1016/j.jns.2021.120039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 09/29/2021] [Accepted: 10/19/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND There are few studies exploring the prognostic factors in patients with aquaporin-4 (AQP4)-IgG positive neuromyelitis optica spectrum disorder (NMOSD). OBJECTIVE To assess the predictors of outcome in patients with AQP4-antibody positive NMOSD from a United Kingdom (UK) population. METHODS A retrospective study of 52 patients from 2 neuroscience centres in the UK Midlands. RESULTS The most common initial presentations were acute myelitis and optic neuritis, with 22/52 cases (42.3%) each. Relapsing course was seen in 32 patients (61.5%) with mean annualised relapse rate of 0.43 (standard deviation 0.45) and a mean interval time to first relapse of 31 months (range 2-108). The median Expanded Disability Status Scale (EDSS) score at the last follow up was 4 (range 1-9). Age at onset was an independent predictor of disability in the whole cohort of patients with NMOSD. For every 10-year increase in age at disease onset, the risk of developing an EDSS score of ≥4 increased by 34%. Patients who presented initially with a longitudinally extensive transverse myelitis (LETM) showed a higher risk to develop disability, compared to other clinical presentations (median time of 4 years versus 13 years). Late onset (LO-NMOSD) patients were likely to reach an EDSS score of 4 more quickly, compared to early onset (EO-NMOSD) (median time of 7 years versus 13 years). Higher median EDSS score at last follow up was observed in LO-NMOSD compared to EO-NMOSD (6 versus 2). CONCLUSION Increasing age at onset and LETM predict disability in AQP-4-IgG positive NMOSD patients.
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Affiliation(s)
- Athanasios Papathanasiou
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK.
| | - Radu Tanasescu
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK; Division of Clinical Neuroscience, University of Nottingham, UK
| | - Chris R Tench
- Division of Clinical Neuroscience, University of Nottingham, UK
| | - Maria Francisca Rocha
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK
| | - Smriti Bose
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, UK
| | - Cris S Constantinescu
- Nottingham Centre for Multiple Sclerosis and Neuroinflammation, Department of Neurology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, UK; Division of Clinical Neuroscience, University of Nottingham, UK
| | - Saiju Jacob
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, UK; Institute of Immunology and Immunotherapy, University of Birmingham, UK
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13
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Nakahara K, Nakane S, Nagaishi A, Narita T, Matsuo H, Ando Y. Very late onset neuromyelitis optica spectrum disorders. Eur J Neurol 2021; 28:2574-2581. [PMID: 33960076 DOI: 10.1111/ene.14901] [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: 03/22/2021] [Revised: 04/24/2021] [Accepted: 04/26/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica spectrum disorder (NMOSD) often presents in the elderly with an insidious onset of symptoms and aggressive progression. There have been anecdotal cases of very late onset (VLO)-NMOSD, but case series reports are rare. The aim of this retrospective study was to clarify the clinical features of VLO-NMOSD. METHODS According to the age at onset, we classified patients with NMOSD into three subgroups: ≤49 years, early onset NMOSD (EO-NMOSD); 50-69 years, late onset NMOSD (LO-NMOSD); and ≥70 years, VLO-NMOSD. We evaluated the clinical characteristics, magnetic resonance imaging (MRI) findings, laboratory data, and immunotherapies of the groups. RESULTS Overall, 12 men and 64 women with a median (interquartile range) age at onset and duration of disease of 42.0 (29.0-55.8) years and 70.0 (16.3-143.0) months, respectively, were included. Eight (11%) patients had VLO-NMOSD, 22 (29%) had LO-NMOSD, and 46 (61%) had EO-NMOSD. Patients with EO-NMOSD had a significantly longer interval between episodes as well as time between the first symptom and diagnosis of NMOSD than did those with VLO-NMOSD and LO-NMOSD (p = 0.046). Optic neuritis and nerve lesions on MRI were significantly less frequent in patients with VLO-NMOSD than in those with LO-NMOSD and EO-NMOSD (p = 0.002 and p = 0.028, respectively). In contrast, patients with VLO-NMOSD had higher nadir Expanded Disability Status Scale and Nurick scale scores and a significantly longer spinal lesion length than did those with LO-NMOSD and EO-NMOSD (p = 0.029, p = 0.049, and p = 0.032, respectively). CONCLUSIONS Patients with VLO-NMOSD tend to develop severe myelitis with long cord lesions but not optic neuritis.
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Affiliation(s)
- Keiichi Nakahara
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Shunya Nakane
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.,Department of Molecular Neurology and Therapeutics, Kumamoto University Hospital, Kumamoto, Japan
| | - Akiko Nagaishi
- Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Tomoko Narita
- Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Hidenori Matsuo
- Department of Neurology, National Hospital Organization Nagasaki Kawatana Medical Center, Nagasaki, Japan
| | - Yukio Ando
- Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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Thongmee W, Narongkhananukul C, Padungkiatsagul T, Jindahra P, Vanikieti K. Comparison of Early- and Late-Onset NMOSD-Related Optic Neuritis in Thai Patients: Clinical Characteristics and Long-Term Visual Outcomes. Clin Ophthalmol 2021; 15:419-429. [PMID: 33574650 PMCID: PMC7871877 DOI: 10.2147/opth.s295769] [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: 12/08/2020] [Accepted: 01/14/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To compare demographic data, clinical and radiological characteristics, treatments, and long-term visual outcomes between patients with late-onset neuromyelitis optica spectrum disorder-related optic neuritis (LO-NMOSD-ON) (age at onset ≥ 50 years) and patients with early-onset neuromyelitis optica spectrum disorder-related optic neuritis (EO-NMOSD-ON) (age at onset < 50 years). Patients and Methods This retrospective study included 47 patients (69 eyes) who were diagnosed with neuromyelitis optica spectrum disorder-related optic neuritis (NMOSD-ON) over a 12-year period. There were 14 patients (21 eyes) and 33 patients (48 eyes) in the LO-NMOSD-ON and EO-NMOSD-ON groups, respectively. Results LO-NMOSD-ON–affected eyes exhibited significantly worse median nadir visual acuity (VA) at optic neuritis (ON) onset, compared with EO-NMOSD-ON–affected eyes (2.7 logMAR (range 2.6–2.9 logMAR) vs 1.95 logMAR (range 0.4–2.9 logMAR); p = 0.03). Similarly, 100% of LO-NMOSD-ON–affected eyes demonstrated a nadir VA of worse than or equal to 1.0 logMAR, compared with 62.5% of EO-NMOSD-ON–affected eyes (p = 0.03). LO-NMOSD-ON–affected eyes had a worse median final VA, compared with EO-NMOSD-ON–affected eyes (1.3 logMAR (range 0–2.9 logMAR) vs 0.3 logMAR (range 0–2.9 logMAR); adjusted p = 0.037). LO-NMOSD-ON–affected eyes more frequently exhibited a final VA of worse than or equal to 1.0 logMAR, compared with EO-NMOSD-ON–affected eyes (57.1% vs 27.0%; adjusted p = 0.039). A positive correlation was observed between age at ON onset of each eye and the final VA (logMAR) (Spearman r = 0.34, p = 0.0075). The remaining parameters did not significantly differ between the two groups. Conclusion Patients with LO-NMOSD-ON had significantly worse nadir VA at ON onset and significantly worse final VA, relative to patients with EO-NMOSD-ON. Age at ON onset of each eye was positively correlated with final VA (logMAR). Despite the difference in common age at onset, NMOSD-ON should be included in the differential diagnosis of late-onset acute to subacute optic neuropathy, along with ischemic optic neuropathy.
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Affiliation(s)
- Watcharaporn Thongmee
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Chanomporn Narongkhananukul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Panitha Jindahra
- Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Kavin Vanikieti
- Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Qin C, Tao R, Zhang SQ, Chen B, Chen M, Yu HH, Chu YH, Shang K, Wu LJ, Bu BT, Tian DS. Predictive Factors of Resistance to High-Dose Steroids Therapy in Acute Attacks of Neuromyelitis Optica Spectrum Disorder. Front Neurol 2020; 11:585471. [PMID: 33281722 PMCID: PMC7688779 DOI: 10.3389/fneur.2020.585471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022] Open
Abstract
High-dose steroids, the first-line therapy for acute attacks in neuromyelitis optica spectrum disorder (NMOSD), were ineffective in a proportion of NMOSD attacks. This study aimed to explore possible predictors of high-dose steroid resistance. Demographics and disease characteristics of acute attacks were compared between those who responded to high-dose intravenous methylprednisolone (IVMP) and those resistant to IVMP. In total, 197 attacks in 160 patients were identified in our NMOSD registry. Compared with responders, attacks resistant to high-dose steroids tended to have a higher proportion of previous history of immunosuppressive use (25.5 vs. 15.5%, p = 0.080). Significantly higher levels of proteins in the cerebrospinal fluid (CSF) were found in non-responders than in responders [485.5 (388–656) vs. 387 (291.5–532) mg/L, p = 0.006]. More active lesions were found in the brain stem of non-responders (8 attacks in 55, 14.5%), especially in the pons (7.3%) and medulla (14.5%), as opposed to responders (7 patients in 142, 4.9%). Multivariable logistic regression showed that resistance to high-dose steroid treatment was associated with previous immunosuppressant use [odds ratio (OR), 2.31; 95% confidence interval (CI) 1.002–5.34, p = 0.049], CSF protein level above 450 mg/L (OR 3.42, 95% CI 1.72–6.82, p < 0.001), and active lesions in the brainstem (OR 3.80, 95% CI 1.17–12.32, p = 0.026). In conclusion, NMOSD patients with previous use of immunosuppressants, higher levels of CSF protein, and active lesions in the brainstem are more likely to respond poorly to high-dose IVMP alone during an acute attack.
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Affiliation(s)
- Chuan Qin
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ran Tao
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Shuo-Qi Zhang
- Department of Radiology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Bo Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Man Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Hai-Han Yu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yun-Hui Chu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Shang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Long-Jun Wu
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
| | - Bi-Tao Bu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Dai-Shi Tian
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
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Cai LJ, Zhang Q, Zhang Y, Chen HX, Shi ZY, Du Q, Zhou HY. Clinical characteristics of very late-onset neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 46:102515. [PMID: 33032051 DOI: 10.1016/j.msard.2020.102515] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The typical age at onset of neuromyelitis optica spectrum disorder (NMOSD) is between 30 and 40 years. A growing awareness about the disease and advances in diagnostic techniques have led to an increase in the number of patients being diagnosed with very late-onset (VLO) NMOSD. This study compared the clinical characteristics, treatments, and prognoses between patients with VLO-NMOSD or late-onset (LO) NMOSD. METHODS Patients in our study were assigned to two groups based on age at onset of the disease: LO-NMOSD (50-70 years old at onset) and VLO-NMOSD (> 70 years old at onset). We compared clinical characteristics, magnetic resonance imaging of lesions, prognosis, and treatments between the two groups. RESULTS We collected data from 12 VLO-NMOSD patients with a median age at onset of 74.0 years (interquartile range, 72.6-75.9 years) and 104 LO-NMOSD patients with a median age at onset of 56.0 years (55.8-57.9 years). There were a high proportion of female patients in both the VLO-NMOSD group (9, 75.0%) and the LO-NMOSD group (91, 87.5%). Our study indicated that VLO-NMOSD patients had significantly higher expanded disability status scale (EDSS) scores (8.5 vs 4.0, p = 0.01), higher motor disability rates (41.7% vs 9.6%, p = 0.002), and higher mortality rates (25.0 vs 4.8%, p = 0.044) at last follow-up. However, patients with VLO-NMOSD had lower rates of immunosuppressant usage (50.0% vs 76.9%, p = 0.044). Age at onset was positively correlated with EDSS score at remission (r = 0.49, p < 0.001). CONCLUSION VLO-NMOSD was associated with higher EDSS score at remission, higher rates of mortality and motor disability, but lower rates of immunosuppressive treatment usage than LO-NMOSD. Future studies are needed to understand the effects of NMOSD on older patients, and to seek suitable treatment to improve their prognosis.
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Affiliation(s)
- L J Cai
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Q Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Y Zhang
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - H X Chen
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Z Y Shi
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Q Du
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - H Y Zhou
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Stratos K, Lee L, Dai D, Pavenski K, Zuo F, Rotstein D. Evaluation of ethnicity as a predictor of diagnostic phenotype and prognosis in neuromyelitis optica spectrum disorder in Toronto, Canada. Mult Scler Relat Disord 2020; 40:101950. [DOI: 10.1016/j.msard.2020.101950] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/23/2019] [Accepted: 01/12/2020] [Indexed: 11/17/2022]
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Late-Onset Neuromyelitis Optica Spectrum Disorder Presenting With Area Postrema Syndrome. Can J Neurol Sci 2020; 47:422-424. [PMID: 32046808 DOI: 10.1017/cjn.2020.27] [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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Carnero Contentti E, Daccach Marques V, Soto de Castillo I, Tkachuk V, Ariel B, Castillo MC, Cristiano E, Diégues Serva GB, dos Santos AC, Finkelsteyn AM, López PA, Patrucco L, Molina O, Pettinicchi JP, Toneguzzo V, Caride A, Rojas JI. Clinical features and prognosis of late-onset neuromyelitis optica spectrum disorders in a Latin American cohort. J Neurol 2020; 267:1260-1268. [DOI: 10.1007/s00415-020-09699-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 01/04/2023]
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Very late-onset recurrent myelitis in a patient diagnosed with antiphospholipid syndrome: A puzzle of autoimmunity. J Neuroimmunol 2019; 337:577051. [DOI: 10.1016/j.jneuroim.2019.577051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/23/2022]
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Sepulveda M, Delgado-García G, Blanco Y, Sola-Valls N, Martinez-Lapiscina EH, Armangué T, Montejo C, Pulido-Valdeolivas I, Martinez-Hernandez E, Ariño H, Escudero D, Ruiz-García R, Llufriu S, Dalmau J, Graus F, Saiz A. Late-onset neuromyelitis optica spectrum disorder: The importance of autoantibody serostatus. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:6/6/e607. [PMID: 31471461 PMCID: PMC6745725 DOI: 10.1212/nxi.0000000000000607] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 11/15/2022]
Abstract
Objective To describe the clinical features of late-onset (≥50 years) neuromyelitis optica spectrum disorder (LO-NMOSD), to compare the outcome with that of early-onset (EO-NMOSD), and to identify predictors of disability. Methods A retrospective, multicenter study of 238 patients with NMOSD identified by the 2015 criteria. Clinical and immunologic features of patients with LO-NMOSD were compared with those with EO-NMOSD. All patients were evaluated for aquaporin-4 (AQP4-IgG) and myelin oligodendrocyte glycoprotein (MOG-IgG) antibodies. Results Sixty-nine (29%) patients had LO-NMOSD. Demographic features, initial disease presentation, annualized relapse rate, and frequency of AQP4-IgG and MOG-IgG did not differ between patients with LO-NMOSD and EO-NMOSD. Among patients with AQP4-IgG or double seronegativity, those with LO-NMOSD had a higher risk to require a cane to walk (hazard ratio [HR], 2.10, 95% CI 1.3–3.54, p = 0.003 for AQP4-IgG, and HR, 13.0, 95% CI 2.8–59.7, p = 0.001, for double seronegative). No differences in outcome were observed between patients with MOG-IgG and LO-NMOSD or EO-NMOSD. Older age at onset (for every 10-year increase, HR 1.63, 95% CI 1.35–1.92 p < 0.001) in NMOSD, and higher disability after the first attack (HR 1.68, 95% CI 1.32–2.14, p < 0.001), and double seronegativity (HR 3.74, 95% CI 1.03–13.6, p = 0.045) in LO-NMOSD were the main independent predictors of worse outcome. Conclusions Patients with LO-NMOSD have similar clinical presentation but worse outcome than EO-NMOSD when they are double seronegative or AQP4-IgG positive. Serostatus and residual disability after first attack are the main predictors of LO-NMOSD outcome.
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Affiliation(s)
- Maria Sepulveda
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Guillermo Delgado-García
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Yolanda Blanco
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Nuria Sola-Valls
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Elena H Martinez-Lapiscina
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Thaís Armangué
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Carmen Montejo
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Irene Pulido-Valdeolivas
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Helena Ariño
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Domingo Escudero
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Raquel Ruiz-García
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Sara Llufriu
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Josep Dalmau
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Francesc Graus
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain
| | - Albert Saiz
- From the Center of Neuroimmunology (M.S., G.D.-G., Y.B., N.S.-V., E.H.M.-L., T.A., C.M., I.P.-V., E.M.-H., H.A., D.E., S.L., J.D., F.G., A.S.), Service of Neurology, Laboratory of Advanced Imaging in Neuroimmunological Diseases, Hospital Clínic of Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), and Universitat de Barcelona, Barcelona, Spain; Division of Neurology (G.D.-G.), National Institute of Neurology and Neurosurgery, Mexico City; Pediatric Neuroimmunology Unit (T.A.), Neurology Service, Sant Joan de Deu Children's Hospital, University of Barcelona, Spain; Servicio de Inmunología (R.R.-G.), Centro de Diagnóstico Biomédico, Hospital Clinic of Barcelona, Spain; Department of Neurology (J.D.), University of Pennsylvania, Philadelphia, PA; and Catalan Institution for research and Advanced Studies (ICREA) (J.D.), Barcelona, Spain.
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