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Geraldes R, Arrambide G, Banwell B, Rovira À, Cortese R, Lassmann H, Messina S, Rocca MA, Waters P, Chard D, Gasperini C, Hacohen Y, Mariano R, Paul F, DeLuca GC, Enzinger C, Kappos L, Leite MI, Sastre-Garriga J, Yousry T, Ciccarelli O, Filippi M, Barkhof F, Palace J. The influence of MOGAD on diagnosis of multiple sclerosis using MRI. Nat Rev Neurol 2024:10.1038/s41582-024-01005-2. [PMID: 39227463 DOI: 10.1038/s41582-024-01005-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2024] [Indexed: 09/05/2024]
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated demyelinating disease that is challenging to differentiate from multiple sclerosis (MS), as the clinical phenotypes overlap, and people with MOGAD can fulfil the current MRI-based diagnostic criteria for MS. In addition, the MOG antibody assays that are an essential component of MOGAD diagnosis are not standardized. Accurate diagnosis of MOGAD is crucial because the treatments and long-term prognosis differ from those for MS. This Expert Recommendation summarizes the outcomes from a Magnetic Resonance Imaging in MS workshop held in Oxford, UK in May 2022, in which MS and MOGAD experts reflected on the pathology and clinical features of these disorders, the contributions of MRI to their diagnosis and the clinical use of the MOG antibody assay. We also critically reviewed the literature to assess the validity of distinctive imaging features in the current MS and MOGAD criteria. We conclude that dedicated orbital and spinal cord imaging (with axial slices) can inform MOGAD diagnosis and also illuminate differential diagnoses. We provide practical guidance to neurologists and neuroradiologists on how to navigate the current MOGAD and MS criteria. We suggest a strategy that includes useful imaging discriminators on standard clinical MRI and discuss imaging features detected by non-conventional MRI sequences that demonstrate promise in differentiating these two disorders.
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Affiliation(s)
- Ruth Geraldes
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK.
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
- Wexham Park Hospital, Frimley Health Foundation Trust, Slough, UK
| | - Mara Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Declan Chard
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- National Institute for Health Research (NIHR) University College London Hospitals (CLH) Biomedical Research Centre, London, UK
| | - Claudio Gasperini
- Multiple Sclerosis Centre, Department of Neurosciences, San Camillo-Forlanini Hospital, Rome, Italy
| | - Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Gabriele C DeLuca
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Christian Enzinger
- Department of Neurology, Medical University of Graz, Graz, Austria
- Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, Graz, Austria
| | - Ludwig Kappos
- Research Center for Clinical Neuroimmunology and Neuroscience, University Hospital and University, Basel, Switzerland
| | - M Isabel Leite
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Centre of Catalonia (Cemcat), Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Tarek Yousry
- NMR Research Unit, Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, London, UK
- University College London Hospitals (UCLH) National Institute for Health and Research (NIHR) Biomedical Research Centre (BRC), London, UK
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands
- Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - Jacqueline Palace
- NMO Service, Department of Neurology, Oxford University Hospitals, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
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Manzano GS, Levy M, Salky R, Mateen FJ, Klawiter EC, Chitnis T, Vasileiou ES, Sotirchos ES, Gibbons E, Huda S, Jacob A, Matiello M. Assessment of international MOGAD diagnostic criteria in patients with overlapping MOG-associated disease and multiple sclerosis phenotypes. J Neurol 2024; 271:6160-6171. [PMID: 39066792 DOI: 10.1007/s00415-024-12585-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 07/11/2024] [Accepted: 07/13/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND The clinical spectrum and diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has evolved in the setting of an optimized anti-MOG-IgG cell-based assay and expert consensus. The McDonald criteria for MS have been revised multiple times to improve the accuracy and specificity of diagnosis on a framework based on clinical presentation, MRI findings, and CSF results. While the uses of MS and MOGAD diagnostic criteria are helpful for typical cases, such utility for patients with overlapping clinical, laboratorial, and imaging features is unknown, posing diagnostic and management uncertainties. OBJECTIVES To report a multicenter cohort of patients with overlapping phenotypic features of MOGAD and MS and evaluate the application of new MOGAD diagnostic criteria. METHODS A collaborative retrospective cohort study was performed to identify patients with both positive serum anti-MOG-IgG and fulfillment of the MS revised 2017 McDonald criteria. Clinical and radiographic features of patients fulfilling inclusion criteria were reviewed longitudinally, including relapses, repeated MRI, and MOG-IgG testing in detail to allow the panel of expert opinion to assign to each case. The International MOGAD Panel proposed criteria were applied at onset and last follow-up to each case and compared to the expert author diagnosis assignment based on presentation, clinical and imaging features, and response to treatment. RESULTS Ten of 225 (4%) MOG-IgG seropositive cases met study inclusion criteria [seven of 10 were female; age at initial event: eight adults (mean age 26.8 years), two adolescents (mean age 14.5 years)]. AQP4-IgG was negative for all. Apart from serum titers of MOG-IgG, distinguishing clinical and radiographic features [i.e., clinical severity of the initial demyelinating event, radiographic features (optic nerve/spine/brain), and presence/absence of lesion normalization on serial scans] led to consensus of three separate classifications differing by degrees of shared features of MOGAD and MS. Patients were classified by expert panel into (1) Classic MOGAD even with MS-like, well-defined brain lesions, when severe events and most T2 lesions normalized (n = 5; MOG-IgG titers 1:100, 1:20, 1:160, 1:40, 1:200); (2) Classic RRMS included cases thought to have likely false positive or clinically irrelevant MOG-IgG, due to mild clinical events and no radiographic normalization of well-defined MS-like lesions (n = 3; MOG titers 1:20, 1:100, 1:40); (3) MOGAD and MS overlapping phenotype was defined by those with a combination of mild and severe clinical events, partial T2 lesion normalization, both well- and ill-defined lesions (n = 2; MOG titers 1:20, 1:100). The application of the International MOGAD Panel criteria categorized five patients (50%) in agreement with expert assignment. One additional patient was classified in agreement to assignment when MOGAD criteria were applied after serial MOG-IgG titers testing. DISCUSSION While the International MOGAD Panel diagnostic criteria have helped with accuracy for the diagnosis of this condition, in a group of patients seropositive for MOG-IgG with overlapping clinical and imaging features of RRMS criteria review may lead to increased accuracy. Serial serologies, repeated imaging, close attention to clinical course, and response to therapy are possible variables to consider for further refinement of MOGAD diagnostic criteria.
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Affiliation(s)
- Giovanna S Manzano
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Michael Levy
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA
| | - Rebecca Salky
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA
| | - Farrah J Mateen
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA
| | - Eric C Klawiter
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA
| | - Tanuja Chitnis
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA
- Department of Neurology, Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - Eleni S Vasileiou
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Elias S Sotirchos
- Department of Neurology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Saif Huda
- Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Anu Jacob
- Section of Multiple Sclerosis and Autoimmune Neurology, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Marcelo Matiello
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, 15 Parkman Street, Wang 8-835, Boston, MA, 02114, USA.
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Sun FY, Shen J, Ding L, Zhu B, Gu N, Liu Z, Di Z, Jia XT. Bilateral pontine brachium lesions in one autoantibodies directed against MOG positive patient: A case report. Medicine (Baltimore) 2024; 103:e39278. [PMID: 39121314 PMCID: PMC11315575 DOI: 10.1097/md.0000000000039278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/23/2024] [Indexed: 08/11/2024] Open
Abstract
RATIONALE Myelin oligodendrocyte glycoprotein (MOG) antibody-related disease is a relatively recent entity in inflammatory demyelinating disease. Its clinical presentation varies in severity and the lack of specific imaging features makes it easy to misdiagnose. We now report the case of a MOG antibody-positive patient who presented with diplopia and dizziness, and whose brain magnetic resonance imaging (MRI) showed abnormal signals in the bilateral pontine brachium. PATIENT CONCERNS A previously healthy 52-year-old woman presented with diplopia and dizziness, and was hospitalized 4 days after onset. DIAGNOSES Brain MRI demonstrated abnormal hyperintense signals in the bilateral pontine brachium on T2-weighted fluid attenuated inversion recovery imaging. MRI enhancement showed abnormal enhancement foci in bilateral pontine brachium and pons. Cerebrospinal fluid examination showed Oligoclonal IgG bands were negative. The IgG index was normal, and serum aquaporin-4 antibody was negative, while serum MOG-Ab was positive (1:100). In conjunction with a positive serum MOG antibody and exclusion of other diseases, diagnosis of MOG antibody-related disease was made. INTERVENTIONS Intravenous methylprednisolone followed by oral corticosteroids. OUTCOMES Symptoms resolved completely. At 4-month follow-up. Follow-up after 4 months showed disappearance of the abnormal signal in the left pontine brachium and diminution of abnormal high signal in the right compared to the previous one, and there was no recurrence 1 year after the onset of the disease. LESSONS If brain MRI indicating bilateral, multiple, and diffuse abnormal signals in the pontine brachium, and a discrepancy between the clinical symptoms and the imaging severity, a diagnosis of demyelinating disease should be considered highly probable. In such cases, anti-MOG antibody testing is essential for further defining the etiology. The clinical phenotype and imaging manifestations of MOG antibody-positive brainstem encephalitis may lack sufficient specificity to be readily identifiable. Timely diagnosis and early glucocorticoid therapy are beneficial in improving prognosis and preventing recurrence.
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Affiliation(s)
- Fan-Ya Sun
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Jia Shen
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Le Ding
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Bo Zhu
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Naibing Gu
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Zhiqin Liu
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Zhengli Di
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
| | - Xiao-Tao Jia
- Department of Neurology, The Affiliated Xi’an Central Hospital of Xi’an Jiaotong University College of Medicine, Xi’an, Shaanxi, People’s Republic of China
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Schneider R, Kogel A, Ladopoulos T, Siems N, Krieger B, Bellenberg B, Gold R, Ayzenberg I, Lukas C. Cortical atrophy patterns in myelin oligodendrocyte glycoprotein antibody-associated disease. Ann Clin Transl Neurol 2024; 11:2166-2175. [PMID: 39054631 PMCID: PMC11330211 DOI: 10.1002/acn3.52137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 06/07/2024] [Accepted: 06/09/2024] [Indexed: 07/27/2024] Open
Abstract
OBJECTIVES Global brain volume changes in patients with myelin oligodendrocyte glycoprotein antibody-associated disease compared with healthy controls (HC) could be revealed by magnetic resonance imaging, but specific atrophy patterns of cortical structures and relation to cognitive impairment are not yet comprehensively known. Thus, we aimed to investigate cortical thickness differences in patients with myelin oligodendrocyte glycoprotein antibody-associated disease compared with HC. METHODS 3-Tesla brain magnetic resonance imaging was performed in 23 patients with myelin oligodendrocyte glycoprotein antibody-associated disease and 49 HC for voxel-wise group comparisons and neuropsychological testing in patients. Surface-based morphometry with region of interest-based surface analysis and region of interest-based extraction of cortical thickness was performed in patients compared with HC and in patient subgroups with and without cognitive impairment. RESULTS Comparing patients with myelin oligodendrocyte glycoprotein antibody-associated disease with HC, exploratory surface-based morphometry demonstrated cortical volume reduction in pericalcarine and lingual cortical regions. Region of interest-based surface analysis specified reduced cortical thickness in the adjacent pericalcarine and orbitofrontal regions in myelin oligodendrocyte glycoprotein antibody-associated disease, as well as reduced temporal cortical thickness in patients with cognitive impairment (n = 10). Patients without cognitive impairment (n = 13) showed only circumscribed cortical brain volume loss compared with HC in the pericalcarine region. INTERPRETATION In conclusion, cortical atrophy in myelin oligodendrocyte glycoprotein antibody-associated disease was characterized by cortical thickness reduction in the adjacent pericalcarine and orbitofrontal regions, with a tendency of temporal thickness reduction in cognitively impaired patients.
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Affiliation(s)
- Ruth Schneider
- Department of Neurology, St. Josef HospitalRuhr University BochumBochumGermany
- Institute of Neuroradiology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Ann‐Kathrin Kogel
- Department of Neurology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Theodoros Ladopoulos
- Department of Neurology, St. Josef HospitalRuhr University BochumBochumGermany
- Institute of Neuroradiology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Nadine Siems
- Department of Neurology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Britta Krieger
- Institute of Neuroradiology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Barbara Bellenberg
- Institute of Neuroradiology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Ralf Gold
- Department of Neurology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef HospitalRuhr University BochumBochumGermany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef HospitalRuhr University BochumBochumGermany
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Cejvanovic S, Sheikh Z, Hamann S, Subramanian PS. Imaging the brain: diagnosis aided by structural features on neuroimaging studies. Eye (Lond) 2024; 38:2380-2391. [PMID: 38783084 PMCID: PMC11306573 DOI: 10.1038/s41433-024-03142-w] [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: 01/23/2024] [Revised: 04/29/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
The use of neuroimaging allows the ophthalmologist to identify structural lesions in the orbit or along the neuroaxis that allow for more accurate diagnosis and treatment of patients with neuro-ophthalmic diseases. The primary imaging tools include computed tomography (CT) and magnetic resonance imaging (MRI), both of which can be used to evaluate the brain, spinal cord and canal, and orbits. Neurovascular structures, both arterial and venous, also can be imaged in high resolution with modern CT and MR angiography and CT and MR venography. In many cases, invasive procedures such as catheter angiography can be avoided with these studies, and angiography is often reserved for confirmation of vascular lesions combined with endovascular treatment. In this article, we illustrate how the evaluation of patients presenting with neuro-ophthalmic diseases involving the afferent and efferent visual pathways can be optimized with the use of appropriate diagnostic imaging studies. The complementary value of ophthalmic imaging is also demonstrated, and the advantages and disadvantages of both CT and MRI as well as their use in longitudinal patient follow up is demonstrated.
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Affiliation(s)
| | - Zahir Sheikh
- Department of Neurology, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Prem S Subramanian
- Department of Neurology, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA.
- Department of Ophthalmology, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA.
- Department of Neurosurgery, Sue Anschutz-Rodgers University of Colorado Eye Center and University of Colorado School of Medicine, Aurora, Colorado, USA.
- Department of Surgery (Division of Ophthalmology), Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
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Filippi M, Preziosa P, Margoni M, Rocca MA. Diagnostic Criteria for Multiple Sclerosis, Neuromyelitis Optica Spectrum Disorders, and Myelin Oligodendrocyte Glycoprotein-immunoglobulin G-associated Disease. Neuroimaging Clin N Am 2024; 34:293-316. [PMID: 38942518 DOI: 10.1016/j.nic.2024.03.001] [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] [Indexed: 06/30/2024]
Abstract
The diagnostic workup of multiple sclerosis (MS) has evolved considerably. The 2017 revision of the McDonald criteria shows high sensitivity and accuracy in predicting clinically definite MS in patients with a typical clinically isolated syndrome and allows an earlier MS diagnosis. Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein-immunoglobulin G-associated disease (MOGAD) are recognized as separate conditions from MS, with specific diagnostic criteria. New MR imaging markers may improve diagnostic specificity for these conditions, thus reducing the risk of misdiagnosis. This study summarizes the most recent updates regarding the application of MR imaging for the diagnosis of MS, NMOSD, and MOGAD.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Rechtman A, Freidman-Korn T, Zveik O, Shweiki L, Hoichman G, Vaknin-Dembinsky A. Assessing the applicability of the 2023 international MOGAD panel criteria in real-world clinical settings. J Neurol 2024; 271:5102-5108. [PMID: 38809270 PMCID: PMC11319595 DOI: 10.1007/s00415-024-12438-6] [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: 04/17/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
INTRODUCTION Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified demyelinating disorder with a diverse clinical spectrum. Diagnosing MOGAD traditionally relies on clinical judgment, highlighting the necessity for precise diagnostic criteria. Banwell et al. proposed criteria, aiming to refine the diagnostic spectrum. This study evaluates these criteria in a real-life cohort, comparing their performance with clinical judgment and describe the cohort of MOGAD patients. METHODS This retrospective study, conducted at Hadassah Medical Center, included 88 patients with MOG-IgG antibodies. Patients with a positive or borderline MOG-IgG antibodies by cell-based assay were included. Demographics, clinical and MRI data were recorded. Cases were divided into definite MOGAD and Non-MOGAD groups as determined by the treating physician. We assessed the sensitivity and specificity of the new criteria in comparison to treating physicians' evaluations. Additionally, we examined clinical differences between the MOGAD and Non-MOGAD groups. RESULTS We observed a strong concordance (98%) between the new MOGAD criteria and treating physicians' diagnoses. Clinical disparities between MOGAD and Non-MOGAD groups included lower EDSS scores, normal MRI scans, preserved brain volume, negative OCB results, and distinct relapse patterns. Also, compared to relapsing patients, monophasic MOGAD patients have greater brain volume and a lower age at onset. CONCLUSION The study demonstrates robust accuracy of new MOGAD criteria, emphasizing their potential to enhance diagnostic precision. Treatment response integration into the MOGAD diagnosis is crucial, as it could aid in distinguishing MOGAD from other demyelinating disorders. Distinct clinical profiles highlight the importance of informed decisions in managing MOGAD and similar disorders.
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Affiliation(s)
- Ariel Rechtman
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Germany
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Freidman-Korn
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Germany
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Omri Zveik
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Germany
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lyne Shweiki
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Germany
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Garrick Hoichman
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Germany
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Military Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adi Vaknin-Dembinsky
- Department of Neurology and Laboratory of Neuroimmunology and the Agnes-Ginges Center for Neurogenetics, Hadassah-Hebrew University Medical Center, Ein-Kerem, Germany.
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
- Neurology Department, Multiple Sclerosis and Immunobiology Research, Hadassah Medical Center, Ein-Kerem, POB 12000, 91120, Jerusalem, Israel.
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Virupakshaiah A, Schoeps VA, Race J, Waltz M, Sharayah S, Nasr Z, Moseley CE, Zamvil SS, Gaudioso C, Schuette A, Casper TC, Rose J, Flanagan EP, Rodriguez M, Tillema JM, Chitnis T, Gorman MP, Graves JS, Benson LA, Rensel M, Abrams A, Krupp L, Lotze TE, Aaen G, Wheeler Y, Schreiner T, Waldman A, Chong J, Mar S, Waubant E. Predictors of a relapsing course in myelin oligodendrocyte glycoprotein antibody-associated disease. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333464. [PMID: 38964848 DOI: 10.1136/jnnp-2024-333464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/23/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described demyelinating disorder, and children represent about 50% of all cases. Almost half of the patients experience relapses, but very few studies have evaluated predictors of relapse risk, challenging clinical management. The study aimed to identify predictors at MOGAD onset that are associated with a relapsing course. METHODS Prospectively collected data from paediatric patients with MOGAD seen by the US Network of Paediatric MS Centres were leveraged. Univariable and adjusted multivariable models were used to predict recurrent disease. RESULTS We identified 326 MOGAD cases (mean age at first event 8.9 years [SD 4.3], 57% female, 77% white and 74% non-Hispanic) and 46% relapsed during a mean follow-up of 3.9 years (SD 4.1). In the adjusted multivariable model, female sex (HR 1.66, 95% CI 1.17 to 2.36, p=0.004) and Hispanic/Latino ethnicity (HR 1.77, 95% CI 1.19 to 2.64, p=0.005) were associated with a higher risk of relapsing MOGAD. Maintenance treatment initiated before a second event with rituximab (HR 0.25, 95% CI 0.07 to 0.92, p=0.037) or intravenous immunoglobulin (IVIG) (HR 0.35, 95% CI 0.14 to 0.88, p=0.026) was associated with lower risk of a second event in multivariable analyses. Conversely, maintenance steroids were associated with a higher estimated relapse risk (HR 1.76, 95% CI 0.90 to 3.45, p=0.097). CONCLUSION Sex and ethnicity are associated with relapsing MOGAD. Use of rituximab or IVIG therapy shortly after onset is associated with a lower risk of the second event. Preventive treatment after a first event could be considered for those with a higher relapse risk.
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Affiliation(s)
- Akash Virupakshaiah
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Vinicius A Schoeps
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | | | | | - Siefaddeen Sharayah
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Zahra Nasr
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Carson E Moseley
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Scott S Zamvil
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
- Program in Immunology, UCSF, San Francisco, California, USA
| | - Cristina Gaudioso
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | | | | | - John Rose
- The University of Utah, Salt Lake City, Utah, USA
| | | | | | | | - Tanuja Chitnis
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Mark P Gorman
- Boston Children's Hospital, Boston, Massachusetts, USA
| | - Jennifer S Graves
- Department of Neurology, University of California San Diego, La Jolla, California, USA
| | | | | | | | - Lauren Krupp
- Pediatric MS Center, NYU Langone Health, New York, New York, USA
| | | | - Gregory Aaen
- Loma Linda University Medical Center, Loma Linda, California, USA
| | - Yolanda Wheeler
- University of Alabama at Birmingham, Birmingham, Alabama, USA
| | | | - Amy Waldman
- The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Janet Chong
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
| | - Soe Mar
- Department of Neurology, Washington University in St Louis, St Louis, Missouri, USA
| | - Emmanuelle Waubant
- Neurology, UCSF Weill Institute for Neurosciences, San Francisco, California, USA
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9
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Luo X, Li H, Xia W, Quan C, ZhangBao J, Tan H, Wang N, Bao Y, Geng D, Li Y, Yang L. Joint radiomics and spatial distribution model for MRI-based discrimination of multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin-oligodendrocyte-glycoprotein-IgG-associated disorder. Eur Radiol 2024; 34:4364-4375. [PMID: 38127076 DOI: 10.1007/s00330-023-10529-y] [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: 03/01/2023] [Revised: 10/26/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE To develop a discrimination pipeline concerning both radiomics and spatial distribution features of brain lesions for discrimination of multiple sclerosis (MS), aquaporin-4-IgG-seropositive neuromyelitis optica spectrum disorder (NMOSD), and myelin-oligodendrocyte-glycoprotein-IgG-associated disorder (MOGAD). METHODS Hyperintensity T2 lesions were delineated in 212 brain MRI scans of MS (n = 63), NMOSD (n = 87), and MOGAD (n = 45) patients. To avoid the effect of fixed training/test dataset sampling when developing machine learning models, patients were allocated into 4 sub-groups for cross-validation. For each scan, 351 radiomics and 27 spatial distribution features were extracted. Three models, i.e., multi-lesion radiomics, spatial distribution, and joint models, were constructed using random forest and logistic regression algorithms for differentiating: MS from the others (MS models) and MOGAD from NMOSD (MOG-NMO models), respectively. Then, the joint models were combined with demographic characteristics (i.e., age and sex) to create MS and MOG-NMO discriminators, respectively, based on which a three-disease discrimination pipeline was generated and compared with radiologists. RESULTS For classification of both MS-others and MOG-NMO, the joint models performed better than radiomics or spatial distribution model solely. The MS discriminator achieved AUC = 0.909 ± 0.027 and bias-corrected C-index = 0.909 ± 0.027, and the MOG-NMO discriminator achieved AUC = 0.880 ± 0.064 and bias-corrected C-index = 0.883 ± 0.068. The three-disease discrimination pipeline differentiated MS, NMOSD, and MOGAD patients with 75.0% accuracy, prominently outperforming the three radiologists (47.6%, 56.6%, and 66.0%). CONCLUSIONS The proposed pipeline integrating multi-lesion radiomics and spatial distribution features could effectively differentiate MS, NMOSD, and MOGAD. CLINICAL RELEVANCE STATEMENT The discrimination pipeline merging both radiomics and spatial distribution features of brain lesions may facilitate the differential diagnoses of multiple sclerosis, neuromyelitis optica spectrum disorder, and myelin-oligodendrocyte-glycoprotein-IgG-associated disorder. KEY POINTS • Our study introduces an approach by combining radiomics and spatial distribution models. • The joint model exhibited superior performance in distinguishing multiple sclerosis from aquaporin-4-IgG-seropositive neuromyelitis optica spectrum disorder and myelin-oligodendrocyte-glycoprotein-IgG-associated disorder as well as discriminating the latter two diseases. • The three-disease discrimination pipeline showcased remarkable accuracy, surpassing the performance of experienced radiologists, highlighting its potential as a valuable diagnostic tool.
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Affiliation(s)
- Xiao Luo
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Haiqing Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Wei Xia
- Academy for Engineering and Technology, Fudan University, Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Hongmei Tan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Na Wang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Yifang Bao
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
| | - Daoying Geng
- Academy for Engineering and Technology, Fudan University, Shanghai, China
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China
| | - Yuxin Li
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
| | - Liqin Yang
- Department of Radiology, Huashan Hospital, Fudan University, 12 Wulumuqi Middle Road, Shanghai, 200040, China.
- Institute of Functional and Molecular Medical Imaging, Fudan University, Shanghai, China.
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10
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Chen Y, Zhangbao J, Xu J, Zhou L, Zhou Z, Quan C. The distinction of area postrema syndrome between MOGAD and NMOSD. Heliyon 2024; 10:e30633. [PMID: 38779012 PMCID: PMC11108817 DOI: 10.1016/j.heliyon.2024.e30633] [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: 09/26/2023] [Revised: 04/30/2024] [Accepted: 05/01/2024] [Indexed: 05/25/2024] Open
Abstract
Background and objectives Both myelin oligodendrocyte glycoprotein-IgG associated disorders (MOGAD) and neuromyelitis optica spectrum disorder (NMOSD) are demyelinating diseases of the central nervous system. They present similar clinical manifestations such as optica neuritis, myelitis and area postrema syndrome (APS). The distinctions of optica neuritis (ON) and myelitis between them have been elaborated to great length while their differences in APS remain to be elucidated. We aim to report the frequency of APS in patients with MOGAD as well as NNOSD patients, and to compare the characteristics of APS between patients with MOGAD and those with NMOSD. Methods Seven MOG-IgG positive APS patients were retrospectively identified between 2017 and 2022. APS phenotypes have been previously described. The similarities and differences between MOGAD and NMOSD patients with APS was compared, including the frequency and duration of APS between the two diseases, and their incidences of accompanied subtentorial lesions have also been described and compared. Results We reviewed a cohort of 218 MOG-IgG-positive patients, and 396 patients with NMOSD. 200 MOGAD patients and 332 NMOSD patients were included in this study. In the cohort, seven patients with MOG-IgG-positive antibody presented with APS were analyzed, four of whom had disease onset with APS. Of the 332 patients with NMOSD, 47 had APS attacks while 31 had APS at disease onset. In patients with MOGAD, 2 had nausea, 3 had vomiting, 5 had hiccups, and 1 patient presented with all three symptoms above. In patients with NMOSD, 70.2 % had nausea, vomiting and hiccups at the same time during APS attacks. Apart from the medulla oblongata, other subtentorial regions were also affected in 6/7 MOGAD patients while 14/47 NMOSD patients had other subtentorial regions involved. During an APS attack, the incidence of concomitant lesions in the brainstem and other regions was significantly greater in MOGAD than in the NMOSD cohort (P = 0.008*). Conclusion APS is a rare, but not isolated clinical manifestation of MOGAD. APS happened more frequently with other supratentorial and subtentorial lesions in MOGAD. The symptoms of NVH (nausea, vomiting, hiccups) tended to happen respectively in MOGAD compared with NMOSD. The phenotype or mechanism of APS in MOGAD may differ from that in NMOSD.
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Affiliation(s)
- Ying Chen
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Jingzi Zhangbao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Junfeng Xu
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Zhiming Zhou
- Department of Neurology, The First Affiliated Hospital of Wannan Medical College, Wuhu, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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11
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Gklinos P, Dobson R. Myelin Oligodendrocyte Glycoprotein-Antibody Associated Disease: An Updated Review of the Clinical Spectrum, Pathogenetic Mechanisms and Therapeutic Management. Antibodies (Basel) 2024; 13:43. [PMID: 38804311 PMCID: PMC11130828 DOI: 10.3390/antib13020043] [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: 03/16/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
Clinical syndromes associated with antibodies against myelin oligodendrocyte glycoprotein (MOG) are now recognized as a distinct neurological disease entity, and are gaining increasing attention. The pathogenic mechanisms underlying MOG-antibody disease (MOGAD) remain incompletely understood. Case series, facilitated by registries, and observational studies over the past few years have shed increasing light on the clinical aspects and therapeutic approaches of MOGAD. MOGAD may manifest with a variety of clinical syndromes, including acute disseminated encephalomyelitis (ADEM), autoimmune encephalitis, optic neuritis (ON) and transverse myelitis (TM). MOGAD can be either monophasic or relapsing. This review aims to provide a comprehensive updated description of the clinical spectrum, paraclinical features, and prognosis of MOG-antibody disease, as well as summarize its therapeutic considerations. Randomized clinical trials, standardized diagnostic criteria and treatment guidelines are the steps forward.
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Affiliation(s)
- Panagiotis Gklinos
- First Neurology Department, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK;
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12
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Nowacka B, Lubiński W, Kaźmierczak B. Myelin Oligodendrocyte Glycoprotein (MOG) Antibody-Associated Optic Neuritis - A Case Report and Literature Review. Int Med Case Rep J 2024; 17:391-399. [PMID: 38708316 PMCID: PMC11069371 DOI: 10.2147/imcrj.s459799] [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: 02/02/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Background Myelin oligodendrocyte glycoprotein (MOG)-IgG-associated optic neuritis (ON) is a new subset of demyelinating optic neuropathy. Case Report This study presents a case of a 49-year-old woman with MOG-IgG-positive ON, who reported to the ophthalmic emergency room with decreased visual acuity, retrobulbar pain and red color desaturation in her left eye. Abnormalities in the ophthalmological examination were: decreased Snellen's distance best-corrected visual acuity (DBCVA) to 0.04 in her left eye, slightly elevated optic nerve disc in the left eye confirmed by increased peripapillary retinal nerve fiber layer (RNFL) thickness in SD-OCT, abnormalities in pattern visual evoked potentials in both eyes. The preliminary diagnosis was demyelinating optic neuritis left for observation. However, two weeks after the first symptoms, treatment with intravenous methylprednisolone was initiated due to a decrease in DBCVA to no light perception. Intravenous steroids were followed by oral prednisone and later also by mycophenolate mofetil. The patient experienced slow but gradual improvement. One year after the occurrence of the initial symptoms, DBCVA was 0.5 in the left eye, however partial atrophy of the optic nerve developed, confirmed by macular ganglion cell layer (GCL) thickness and RNFL atrophy in SD-OCT, while visual pathway function improved. Conclusion All atypical cases of ON should be primarily considered for cell-based assays. MOG-IgG-positive ON usually responds well to steroid drugs and delaying immunosuppressive treatment may cause irreversible damage to the optic nerve.
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Affiliation(s)
- Barbara Nowacka
- 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Lubiński
- 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Beata Kaźmierczak
- 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
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13
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Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [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] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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14
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Amin M, Al-Iedani O, Lea RA, Brilot F, Maltby VE, Lechner-Scott J. A longitudinal analysis of brain volume changes in myelin oligodendrocyte glycoprotein antibody-associated disease. J Neuroimaging 2024; 34:78-85. [PMID: 38018386 DOI: 10.1111/jon.13175] [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: 08/15/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND AND PURPOSE Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a relapsing demyelinating condition. There are several cross-sectional studies showing evidence of brain atrophy in people with MOGAD (pwMOGAD), but longitudinal brain volumetric assessment is still an unmet need. Current recommendations do not include monitoring with MRI and assume distinct attacks. Evidence of ongoing axon loss will have diagnostic and therapeutic implications. In this study, we assessed brain volume changes in pwMOGAD over a mean follow-up period of 2 years and compared this to changes in people with multiple sclerosis (pwMS). METHODS This is a retrospective single-center study over a 7-year period from 2014 to 2021. MRI brain scans at the time of diagnosis and follow-up in remission were collected from 14 Caucasian pwMOGAD, confirmed by serum myelin oligodendrocyte glycoprotein immunoglobulin G antibody presence, detected by live cell-based assays. Total brain volume (TBV), white matter (WM), gray matter (GM), and demyelinating lesion volumes were assessed automatically using the Statistical Parametric Mapping and FMRIB automated segmentation tools. MRI brain scans at diagnosis and follow-up on remission were collected from 32-matched pwMS for comparison. Statistical analysis was done using analysis of variance. RESULTS There is evidence of TBV loss, affecting particularly GM, over an approximately 2-year follow-up period in pwMOGAD (p < .05), comparable to pwMS. WM and lesion volume change over the same period were not statistically significant (p > .1). CONCLUSION We found evidence of loss of GM and TBV over time in pwMOGAD, similar to pwMS, although the WM and lesion volumes were unchanged.
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Affiliation(s)
- Mohammad Amin
- Nepean Hospital, Kingswood, New South Wales, Australia
- Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Oun Al-Iedani
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
- Immune Health Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
| | - Rodney A Lea
- Immune Health Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- Institute of Health and Biomedical Innovation, School of Biomedical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Fabienne Brilot
- Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, New South Wales, Australia
- Brain and Mind Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Medical Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Vicki E Maltby
- Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- Immune Health Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- Immune Health Program, Hunter Medical Research Institute, New Lambton, New South Wales, Australia
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia
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15
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Oertel FC, Hastermann M, Paul F. Delimiting MOGAD as a disease entity using translational imaging. Front Neurol 2023; 14:1216477. [PMID: 38333186 PMCID: PMC10851159 DOI: 10.3389/fneur.2023.1216477] [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: 05/03/2023] [Accepted: 08/23/2023] [Indexed: 02/10/2024] Open
Abstract
The first formal consensus diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) were recently proposed. Yet, the distinction of MOGAD-defining characteristics from characteristics of its important differential diagnoses such as multiple sclerosis (MS) and aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (NMOSD) is still obstructed. In preclinical research, MOG antibody-based animal models were used for decades to derive knowledge about MS. In clinical research, people with MOGAD have been combined into cohorts with other diagnoses. Thus, it remains unclear to which extent the generated knowledge is specifically applicable to MOGAD. Translational research can contribute to identifying MOGAD characteristic features by establishing imaging methods and outcome parameters on proven pathophysiological grounds. This article reviews suitable animal models for translational MOGAD research and the current state and prospect of translational imaging in MOGAD.
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Affiliation(s)
- Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Maria Hastermann
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Freie Universität Berlin and Humboldt-Universität zu Berlin, Charité – Universitätsmedizin Berlin, Berlin, Germany
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16
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Sacco S, Virupakshaiah A, Papinutto N, Schoeps VA, Akula A, Zhao H, Arona J, Stern WA, Chong J, Hart J, Zamvil SS, Sati P, Henry RG, Waubant E. Susceptibility-based imaging aids accurate distinction of pediatric-onset MS from myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler 2023; 29:1736-1747. [PMID: 37897254 PMCID: PMC10687802 DOI: 10.1177/13524585231204414] [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: 06/30/2023] [Revised: 09/07/2023] [Accepted: 09/13/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) and pediatric-onset multiple sclerosis (POMS) share clinical and magnetic resonance imaging (MRI) features but differ in prognosis and management. Early POMS diagnosis is essential to avoid disability accumulation. Central vein sign (CVS), paramagnetic rim lesions (PRLs), and central core lesions (CCLs) are susceptibility-based imaging (SbI)-related signs understudied in pediatric populations that may help discerning POMS from MOGAD. METHODS T2-FLAIR and SbI (three-dimensional echoplanar imaging (3D-EPI)/susceptibility-weighted imaging (SWI) or similar) were acquired on 1.5T/3T scanners. Two readers assessed CVS-positive rate (%CVS+), and their average score was used to build a receiver operator curve (ROC) assessing the ability to discriminate disease type. PRLs and CCLs were identified using a consensual approach. RESULTS The %CVS+ distinguished 26 POMS cases (mean age 13.7 years, 63% females, median EDSS 1.5) from 14 MOGAD cases (10.8 years, 35% females, EDSS 1.0) with ROC = 1, p < 0.0001, (cutoff 41%). PRLs were only detectable in POMS participants (mean 2.1±2.3, range 1-10), discriminating the two conditions with a sensitivity of 69% and a specificity of 100%. CCLs were more sensitive (81%) but less specific (71.43%). CONCLUSION The %CVS+ and PRLs are highly specific markers of POMS. After proper validation on larger multicenter cohorts, consideration should be given to including such imaging markers for diagnosing POMS at disease onset.
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Affiliation(s)
- Simone Sacco
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Akash Virupakshaiah
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Nico Papinutto
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Vinicius A Schoeps
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amit Akula
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Haojun Zhao
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Jennifer Arona
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - William A Stern
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Chong
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janace Hart
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Scott S Zamvil
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Pascal Sati
- Neuroimaging Program, Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Roland G Henry
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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17
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Quack L, Glatter S, Wegener-Panzer A, Cleaveland R, Bertolini A, Endmayr V, Seidl R, Breu M, Wendel E, Schimmel M, Baumann M, Rauchenzauner M, Pritsch M, Boy N, Muralter T, Kluger G, Makoswski C, Kraus V, Leiz S, Loehr-Nilles C, Kreth JH, Braig S, Schilling S, Kern J, Blank C, Tro Baumann B, Vieth S, Wallot M, Reindl M, Ringl H, Wandinger KP, Leypoldt F, Höftberger R, Rostásy K. Autoantibody status, neuroradiological and clinical findings in children with acute cerebellitis. Eur J Paediatr Neurol 2023; 47:118-130. [PMID: 38284996 DOI: 10.1016/j.ejpn.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Acute cerebellitis (AC) in children and adolescents is an inflammatory disease of the cerebellum due to viral or bacterial infections but also autoimmune-mediated processes. OBJECTIVE To investigate the frequency of autoantibodies in serum and CSF as well as the neuroradiological features in children with AC. MATERIAL AND METHODS Children presenting with symptoms suggestive of AC defined as acute/subacute onset of cerebellar symptoms and MRI evidence of cerebellar inflammation or additional CSF pleocytosis, positive oligoclonal bands (OCBs), and/or presence of autoantibodies in case of negative cerebellar MRI. Children fulfilling the above-mentioned criteria and a complete data set including clinical presentation, CSF studies, testing for neuronal/cerebellar and MOG antibodies as well as MRI scans performed at disease onset were eligible for this retrospective multicenter study. RESULTS 36 patients fulfilled the inclusion criteria for AC (f:m = 14:22, median age 5.5 years). Ataxia was the most common cerebellar symptom present in 30/36 (83 %) in addition to dysmetria (15/36) or dysarthria (13/36). A substantial number of children (21/36) also had signs of encephalitis such as somnolence or seizures. In 10/36 (28 %) children the following autoantibodies (abs) were found: MOG-abs (n = 5) in serum, GFAPα-abs (n = 1) in CSF, GlyR-abs (n = 1) in CSF, mGluR1-abs (n = 1) in CSF and serum. In two further children, antibodies were detected only in serum (GlyR-abs, n = 1; GFAPα-abs, n = 1). MRI signal alterations in cerebellum were found in 30/36 children (83 %). Additional supra- and/or infratentorial lesions were present in 12/36 children, including all five children with MOG-abs. Outcome after a median follow-up of 3 months (range: 1 a 75) was favorable with an mRS ≤2 in 24/36 (67 %) after therapy. Antibody (ab)-positive children were significantly more likely to have a better outcome than ab-negative children (p = .022). CONCLUSION In nearly 30 % of children in our study with AC, a range of abs was found, underscoring that autoantibody testing in serum and CSF should be included in the work-up of a child with suspected AC. The detection of MOG-abs in AC does expand the MOGAD spectrum.
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Affiliation(s)
- L Quack
- Department of Pediatric Neurology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - S Glatter
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria; Comprehensive Center for Pediatrics, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - A Wegener-Panzer
- Department of Pediatric Radiology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - R Cleaveland
- Department of Pediatric Radiology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - A Bertolini
- Department of Pediatric Neurology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany
| | - V Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria
| | - R Seidl
- Department of Pediatrics, Bethanien Hospital, Moers, Germany
| | - M Breu
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - E Wendel
- Division of Pediatric Neurology, Department of Pediatrics, Olgahospital, Stuttgart, Germany
| | - M Schimmel
- Division of Pediatric Neurology, Clinic of Pediatrics, Augsburg University Hospital, University of Augsburg, Augsburg, Germany
| | - M Baumann
- Department of Pediatric I, Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - M Rauchenzauner
- Department of Pediatric I, Pediatric Neurology, Medical University of Innsbruck, Innsbruck, Austria; Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Hospital for Neuropediatrics and Neurological Rehabilitation, Vogtareuth, Germany
| | - M Pritsch
- Department of Neuropediatrics, Children's Hospital DRK Siegen, Siegen, Germany
| | - N Boy
- Centre for Child and Adolescent Medicine, Department of General Pediatrics, Division of Neuropediatrics and Metabolic Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - T Muralter
- Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Hospital for Neuropediatrics and Neurological Rehabilitation, Vogtareuth, Germany
| | - G Kluger
- Centre of Epilepsy for Children and Adolescents, Schoen Klinik Vogtareuth, Hospital for Neuropediatrics and Neurological Rehabilitation, Vogtareuth, Germany; Research Institute for Rehabilitation, Transition, and Palliation, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - C Makoswski
- Pediatric Neurology, Department of Pediatrics, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, Germany
| | - V Kraus
- Pediatric Neurology, Department of Pediatrics, Kinderklinik München Schwabing, School of Medicine, Technical University of Munich, Germany; Social Pediatrics, Department of Pediatrics, Technical University of Munich, Munich, Germany
| | - S Leiz
- Department of Pediatrics and Adolescent Medicine, Hospital Dritter Orden, Munich, Germany
| | - C Loehr-Nilles
- Department of Neuropediatrics, Klinikum Mutterhaus der Borromäerinnen, Trier, Germany
| | - J H Kreth
- Department of Neuropediatrics, Social Pediatric Center, Klinikum Leverkusen, Leverkusen, Germany
| | - S Braig
- Department of Pediatrics, Klinikum Bayreuth, Bayreuth, Germany
| | - S Schilling
- Department of Neuropediatrics, Clinic of Pediatrics, Barmherzige Brüder St. Hedwig Hospital, Regensburg, Germany
| | - J Kern
- Department of Pediatric Neurology and Developmental Medicine, University Children's Hospital Tübingen, Germany
| | - C Blank
- Department of Pediatric Neurology, Children's Hospital St. Marien, Landshut, Germany
| | - B Tro Baumann
- Department of Neuropediatrics, Children's Hospital DRK Siegen, Siegen, Germany
| | - S Vieth
- Department of Pediatrics, University Medical Center Schleswig Holstein, Kiel, Germany
| | - M Wallot
- Department of Pediatrics, Bethanien Hospital, Moers, Germany
| | - M Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Austria
| | - H Ringl
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Austria; Department of Radiology, Klinik Donaustadt, Vienna, Austria
| | - K P Wandinger
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany
| | - F Leypoldt
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel/Lübeck, Germany; Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - R Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Austria; Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria.
| | - K Rostásy
- Department of Pediatric Neurology, Childreńs Hospital Datteln, University Witten/Herdecke, Datteln, Germany.
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18
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Zeng W, Yu L, Wu J, Wang F, Liu X, Ren S, Zhang D, Lian B, Hu M, Cao L. Clinical characteristics and long-term follow-up outcomes of myelin oligodendrocyte glycoprotein antibody-associated disease in Han Chinese participants. Medicine (Baltimore) 2023; 102:e35391. [PMID: 37800805 PMCID: PMC10553075 DOI: 10.1097/md.0000000000035391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/05/2023] [Indexed: 10/07/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an immune-mediated inflammatory demyelinating disease of the central nervous system. This study aimed to delineate the clinical manifestations, imaging features, and long-term outcomes in Chinese patients with MOGAD and analyze the recurrence-associated factors. The phenotypic and neuroimaging characteristics of 15 Han Chinese patients with MOGAD were retrospectively analyzed. Demyelinating attacks, MOG antibodies in the cerebrospinal fluid/serum, response to immunotherapy, follow-up outcomes, and recurrence-associated factors were recorded. The median age at disease onset was 34 years (range, 4-65 years). The most common initial presentations included vision loss (10/15, 66.7%) and seizures (5/15, 33.3%). Serum MOG-Ab titers in 14/15 cases were higher than those in the cerebrospinal fluid and were detected in 3/6 relapsed patients. Brain magnetic resonance imaging during acute attacks showed lesions in 10/15 patients (66.7%), mostly in the cortex/subcortical white matter (5/15, 33.3%). Recurrence occurred in 6/15 patients (40.0%); in 4 patients, recurrence occurred shortly after immunotherapy discontinuation. Residual neurological deficits were present in 5/15 patients (33.3%), including visual impairment, incapacitation, cognitive impairment, and speech reduction. Optic neuritis was the most common clinical manifestation of MOGAD. magnetic resonance imaging findings were heterogeneous and the cerebral cortex/subcortical white matter was the most susceptible brain region. Although patients in the acute phase responded well to methylprednisolone pulse therapy, the long-term recurrence rate was high. Consistently detected serum MOG antibodies and inappropriate maintenance immunotherapy may be associated with recurrence, and residual neurological deficits should not be ignored.
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Affiliation(s)
- Wei Zeng
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, China
| | - Lu Yu
- Department of Neurology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jiarui Wu
- The First School of Clinical Medicine, Guangdong Medical University, Zhanjiang, China
| | - Fang Wang
- Department of Neurology, Liuzhou People’s Hospital, Liuzhou, China
| | - Xudong Liu
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
| | - Shuqun Ren
- School of Nursing, Guangxi University of Chinese Medicine, Nanning, China
| | - Daxue Zhang
- School of Nursing, Anhui Medical University, Hefei, China
| | - Baorong Lian
- Shantou University Medical College, Shantou University, Shantou, China
| | - Minghua Hu
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
| | - Liming Cao
- Department of Neurology, The First Affiliated Hospital of Shenzhen University, Shenzhen, China
- Hunan Provincial Key Laboratory of the Research and Development of Novel Pharmaceutical Preparations, Changsha Medical University, Changsha, China
- Clinical College of the Shenzhen Second People’s Hospital, Anhui Medical University, Shenzhen, China
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19
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Wu Y, Geraldes R, Juryńczyk M, Palace J. Double-negative neuromyelitis optica spectrum disorder. Mult Scler 2023; 29:1353-1362. [PMID: 37740717 PMCID: PMC10580671 DOI: 10.1177/13524585231199819] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 08/02/2023] [Accepted: 08/21/2023] [Indexed: 09/25/2023]
Abstract
Most patients with neuromyelitis optica spectrum disorders (NMOSD) test positive for aquaporin-4 antibody (AQP4-IgG) or myelin oligodendrocyte glycoprotein antibodies (MOG-IgG). Those who are negative are termed double-negative (DN) NMOSD and may constitute a diagnostic and therapeutic challenge. DN NMOSD is a syndrome rather than a single disease, ranging from a (postinfectious) monophasic illness to a more chronic syndrome that can be indistinguishable from AQP4-IgG+ NMOSD or develop into other mimics such as multiple sclerosis. Thus, underlying disease mechanisms are likely to be heterogeneous. This topical review aims to (1) reappraise antibody-negative NMOSD definition as it has changed over time with the development of the AQP4 and MOG-IgG assays; (2) outline clinical characteristics and the pathophysiological nature of this rare entity by contrasting its differences and similarities with antibody-positive NMOSD; (3) summarize laboratory characteristics and magnetic resonance imaging findings of DN NMOSD; and (4) discuss the current treatment for DN NMOSD.
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Affiliation(s)
- Yan Wu
- Neurology Department of First Affiliated Hospital of Kunming Medical University, Kunming, China/Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK/Neurology Department, Wexham Park hospital, Frimley Foundation Health Trust, Slough, UK
| | - Maciej Juryńczyk
- Department of Neurology, Stroke and Neurological Rehabilitation, Wolski Hospital, Warsaw, Poland
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- J Palace Department Clinical Neurology, John Radcliffe Hospital, Oxford OX3 9DU, UK
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20
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Carnero Contentti E, Okuda DT, Rojas JI, Chien C, Paul F, Alonso R. MRI to differentiate multiple sclerosis, neuromyelitis optica, and myelin oligodendrocyte glycoprotein antibody disease. J Neuroimaging 2023; 33:688-702. [PMID: 37322542 DOI: 10.1111/jon.13137] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
Differentiating multiple sclerosis (MS) from other relapsing inflammatory autoimmune diseases of the central nervous system such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is crucial in clinical practice. The differential diagnosis may be challenging but making the correct ultimate diagnosis is critical, since prognosis and treatments differ, and inappropriate therapy may promote disability. In the last two decades, significant advances have been made in MS, NMOSD, and MOGAD including new diagnostic criteria with better characterization of typical clinical symptoms and suggestive imaging (magnetic resonance imaging [MRI]) lesions. MRI is invaluable in making the ultimate diagnosis. An increasing amount of new evidence with respect to the specificity of observed lesions as well as the associated dynamic changes in the acute and follow-up phase in each condition has been reported in distinct studies recently published. Additionally, differences in brain (including the optic nerve) and spinal cord lesion patterns between MS, aquaporin4-antibody-positive NMOSD, and MOGAD have been described. We therefore present a narrative review on the most relevant findings in brain, spinal cord, and optic nerve lesions on conventional MRI for distinguishing adult patients with MS from NMOSD and MOGAD in clinical practice. In this context, cortical and central vein sign lesions, brain and spinal cord lesions characteristic of MS, NMOSD, and MOGAD, optic nerve involvement, role of MRI at follow-up, and new proposed diagnostic criteria to differentiate MS from NMOSD and MOGAD were discussed.
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Affiliation(s)
| | - Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Chien
- 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
| | - Friedemman 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
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital Ramos Mejía, Buenos Aires, Argentina
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21
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Berhanu D, Leal Rato M, Messina S, Leite MI, Geraldes R, Palace J. The effect of smoking on MRI lesion resolution in NMOSD-AQP4 and MOGAD. Mult Scler 2023; 29:1250-1256. [PMID: 37528605 PMCID: PMC10503243 DOI: 10.1177/13524585231188485] [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: 03/16/2023] [Revised: 06/13/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND The effect of smoking on the resolution of magnetic resonance imaging (MRI) lesions in patients with neuromyelitis optica spectrum disorders with aquaporin-4 positive antibody (NMOSD-AQP4) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) has not been studied before. OBJECTIVE We aimed to determine the effect of smoking on lesion resolution in MRI and assess its correlation with clinical recovery after a relapse. METHODS We conducted a cohort study including NMOSD-AQP4 and MOGAD patients with acute and follow-up MRI scans. We collected demographic, clinical, imaging and smoking data. Logistic regression models were fitted to predict the effect of smoking on lesion resolution and to assess whether clinical recovery was associated with MRI lesion resolution. RESULTS A total of 105 patients were included (57 with NMOSD-AQP4 and 48 with MOGAD). Current and past smoking was associated with a higher risk of persistent lesions in NMOSD-AQP4 and MOGAD (risk ratio (RR) = 3.4, 95% confidence interval (CI) = 2.5-4.7, p < 0.001). Additionally, the presence of lesion resolution was associated with better clinical recovery (RR = 1.9, 95% CI = 1.7-2.2, p < 0.001). CONCLUSION Smoking is associated with worse MRI lesion resolution in patients with NMOSD-AQP4 and MOGAD, and lesion resolution correlates with clinical recovery. Our findings suggest a detrimental effect of smoking in inflammatory central nervous system (CNS) diseases.
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Affiliation(s)
- David Berhanu
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Miguel Leal Rato
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Serviço de Imagiologia Neurológica, Centro Hospitalar Universitário Lisboa Norte, EPE, Lisboa, Portugal
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Neurology, Frimley Health NHS Foundation Trust, Frimley, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Clinical Neurology, John Radcliffe Hospital, Oxford University Hospitals Trust, Oxford, UK
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22
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Pandit L, D’Cunha A, Malli C, Sudhir A. Comparison of live and fixed cell-based assay performance: implications for the diagnosis of MOGAD in a low-middle income country. Front Immunol 2023; 14:1252650. [PMID: 37705970 PMCID: PMC10495565 DOI: 10.3389/fimmu.2023.1252650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/07/2023] [Indexed: 09/15/2023] Open
Abstract
Background Though considered optimal, live cell-based assay (LCBA) is often unavailable for the diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disorders (MOGAD) in resource-poor regions. This study was undertaken to determine the agreement between LCBA and the widely available fixed cell-based assay (FCBA), for recommending testing guidelines within our region. Method All consecutive patients in our registry with a MOGAD phenotype were tested. The results from a commercially available FCBA (Euroimmun, Germany) were compared with a validated "in-house" LCBA. Clinical and MRI data were available for correlation. Results Among the 257 patient samples tested, 118 (45.9%) were positive by FCBA titre ≥1: 10 and or LCBA titres ≥1: 160 titre and 139 samples were negative. There was robust agreement between the two assays (agreement 98.8%, Cohen's kappa 0.98 [95% CI- 0.95-1.00], Spearman correlation 0.97 (p < 0.0001). Among five discordant samples, four had clinical and or MRI data which supported an alternate diagnosis. There was a modest correlation between assay titres, particularly for samples with titres ≥ 1:100 in FCBA (Spearman's Rho 0.26, p 0.005). Thirty samples were positive by FCBA at < 1:100 titre and included 1:80 (20),1:40(7) and 1:10 (3) titres. Among them, 80% had clear positive titres when tested by LCBA. Conclusion The FCBA tested with serum dilutions of 1:10 was highly predictive of MOGAD in our study and compared well with our "in-house" LCBA. The current recommendations for testing at higher dilutions need to be re-examined in light of our findings. The results of our study should ideally be replicated in a larger dataset but at the same time provide some guidance for the accurate diagnosis of MOGAD in resource-poor settings.
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Affiliation(s)
- Lekha Pandit
- Center for Advanced Neurological Research, Nitte University, Mangalore, India
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23
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Huda S, Palace J. It's not multiple sclerosis, what is it?! Pract Neurol 2023; 23:270-272. [PMID: 37100592 DOI: 10.1136/pn-2022-003677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 04/28/2023]
Affiliation(s)
- Saif Huda
- Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, UK
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24
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Takai Y, Misu T, Fujihara K, Aoki M. Pathology of myelin oligodendrocyte glycoprotein antibody-associated disease: a comparison with multiple sclerosis and aquaporin 4 antibody-positive neuromyelitis optica spectrum disorders. Front Neurol 2023; 14:1209749. [PMID: 37545724 PMCID: PMC10400774 DOI: 10.3389/fneur.2023.1209749] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/20/2023] [Indexed: 08/08/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) is expressed on the outermost layer of the myelin sheath in the central nervous system. Recently, the clinical concept of MOG antibody-associated disease (MOGAD) was established based on the results of human MOG-transfected cell-based assays which can detect conformation-sensitive antibodies against MOG. In this review, we summarized the pathological findings of MOGAD and discussed the issues that remain unresolved. MOGAD pathology is principally inflammatory demyelination without astrocyte destruction, characterized by perivenous demyelination previously reported in acute disseminated encephalomyelitis and by its fusion pattern localized in both the white and gray matter, but not by radially expanding confluent demyelination typically seen in multiple sclerosis (MS). Some of demyelinating lesions in MOGAD show severe loss of MOG staining compared with those of other myelin proteins, suggesting a MOG-targeted pathology in the disease. Perivascular cuffings mainly consist of macrophages and T cells with CD4-dominancy, which is also different from CD8+ T-cell-dominant inflammation in MS. Compared to aquaporin 4 (AQP4) antibody-positive neuromyelitis optica spectrum disorders (NMOSD), perivenous complement deposition is less common, but can be seen on myelinated fibers and on myelin degradation products within macrophages, resembling MS Pattern II pathology. Thus, the pathogenetic contribution of complements in MOGAD is still debatable. Together, these pathological features in MOGAD are clearly different from those of MS and AQP4 antibody-positive NMOSD, suggesting that MOGAD is an independent autoimmune demyelinating disease entity. Further research is needed to clarify the exact pathomechanisms of demyelination and how the pathophysiology relates to the clinical phenotype and symptoms leading to disability in MOGAD patients.
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Affiliation(s)
- Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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25
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Ishido H, Chiba S, Takahashi H, Isa M, Ogawa Y, Kubota H, Imanishi A, Omori Y, Ono T, Tsutsui K, Han G, Kondo H, Tsuji H, Nakamagoe K, Ishii A, Tanaka K, Tamaoka A, Shimizu T, Nishino S, Miyamoto T, Kanbayashi T. Characteristics of hypersomnia due to inflammatory demyelinating diseases of the central nervous system. BMJ Neurol Open 2023; 5:e000428. [PMID: 37396796 PMCID: PMC10314432 DOI: 10.1136/bmjno-2023-000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/06/2023] [Indexed: 07/04/2023] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) diagnostic criteria for inflammatory demyelinating central nervous system diseases included symptomatic narcolepsy; however, no relevant case-control studies exist. We aimed to examine the relationship among cerebrospinal fluid orexin-A (CSF-OX) levels, cataplexy and diencephalic syndrome; determine risk factors for low-and-intermediate CSF-OX levels (≤200 pg/mL) and quantify hypothalamic intensity using MRI. Methods This ancillary retrospective case-control study included 50 patients with hypersomnia and 68 controls (among 3000 patients) from Akita University, the University of Tsukuba and community hospitals (200 facilities). Outcomes were CSF-OX level and MRI hypothalamus-to-caudate-nucleus-intensity ratio. Risk factors were age, sex, hypersomnolence and MRI hypothalamus-to-caudate-nucleus-intensity ratio >130%. Logistic regression was performed for the association between the risk factors and CSF-OX levels ≤200 pg/mL. Results The hypersomnia group (n=50) had significantly more cases of NMOSD (p<0.001), diencephalic syndrome (p=0.006), corticosteroid use (p=0.011), hypothalamic lesions (p<0.023) and early treatment (p<0.001). No cataplexy occurred. In the hypersomnia group, the median CSF-OX level was 160.5 (IQR 108.4-236.5) pg/mL and median MRI hypothalamus-to-caudate-nucleus-intensity ratio was 127.6% (IQR 115.3-149.1). Significant risk factors were hypersomnolence (adjusted OR (AOR) 6.95; 95% CI 2.64 to 18.29; p<0.001) and MRI hypothalamus-to-caudate-nucleus-intensity ratio >130% (AOR 6.33; 95% CI 1.18 to 34.09; p=0.032). The latter was less sensitive in predicting CSF-OX levels ≤200 pg/mL. Cases with MRI hypothalamus-to-caudate-nucleus-intensity ratio >130% had a higher rate of diencephalic syndrome (p<0.001, V=0.59). Conclusions Considering orexin as reflected by CSF-OX levels and MRI hypothalamus-to-caudate-nucleus-intensity ratio may help diagnose hypersomnia with diencephalic syndrome.
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Affiliation(s)
- Hideaki Ishido
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
- Neurology, Dokkyo Ika Daigaku Saitama Iryo Center, Koshigaya, Saitama, Japan
- Neurology, Hakusuikai Hatsuishi Hospital, Kashiwa, Chiba, Japan
| | - Shigeru Chiba
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
- Psychiatry, Ibaraki Prefectural Medical Center of Psychiatry, Kasama, Ibaraki, Japan
- Psychiatry, Minamisaitama Hospital, Koshigaya, Saitama, Japan
| | - Hana Takahashi
- Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Megumi Isa
- Neurology, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Yasuhiro Ogawa
- General Medicine, Ibaraki Prefectural University of Health Sciences, Inashiki-gun, Ibaraki, Japan
| | | | - Aya Imanishi
- Psychiatry, Akita University, Akita, Akita, Japan
| | - Yuki Omori
- Psychiatry, Tokyo Metropolitan Geriatric Hospital, Itabashi-ku, Tokyo, Japan
| | - Taisuke Ono
- Geriatric Medicine, Kanazawa Medical University, Kahoku-gun, Ishikawa, Japan
| | - Ko Tsutsui
- Psychiatry, Akita University, Akita, Akita, Japan
- Psychiatry, Kato Hospital, Akita, Akita, Japan
| | - GoEun Han
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideaki Kondo
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
- General Medicine, Institute of Biomedical Sciences, Nagasaki University, Nagasaki, Nagasaki, Japan
| | - Hiroshi Tsuji
- Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | | | - Akiko Ishii
- Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Keiko Tanaka
- Department of Animal Model Development, Brain Research Institute, Niigata University, Niigata, Niigata, Japan
| | - Akira Tamaoka
- Neurology, University of Tsukuba, Tsukuba, Ibaraki, Japan
- Neurology, Tsukuba Memorial Hospital, Tsukuba, Ibaraki, Japan
| | - Tetsuo Shimizu
- Department of Mental Health and Welfare, Akita Mental Health and Welfare Center, Akita, Akita, Japan
| | - Seiji Nishino
- Psychiatry, Sleep and Circadian Neurobiology Laboratory, Stanford University, Stanford, California, USA
| | - Tomoyuki Miyamoto
- Neurology, Dokkyo Ika Daigaku Saitama Iryo Center, Koshigaya, Saitama, Japan
| | - Takashi Kanbayashi
- International Institute for Integrative Sleep Medicine (WPI-IIIS), University of Tsukuba, Tsukuba, Ibaraki, Japan
- Neurology, Dokkyo Ika Daigaku Saitama Iryo Center, Koshigaya, Saitama, Japan
- Psychiatry, Ibaraki Prefectural Medical Center of Psychiatry, Kasama, Ibaraki, Japan
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26
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Li X, Wu W, Hou C, Zeng Y, Wu W, Chen L, Liao Y, Zhu H, Tian Y, Peng B, Zheng K, Shi K, Li Y, Gao Y, Zhang Y, Lin H, Chen WX. Pediatric myelin oligodendrocyte glycoprotein antibody-associated disease in southern China: analysis of 93 cases. Front Immunol 2023; 14:1162647. [PMID: 37342342 PMCID: PMC10277863 DOI: 10.3389/fimmu.2023.1162647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 05/22/2023] [Indexed: 06/22/2023] Open
Abstract
Objective To study the clinical features of children diagnosed with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in southern China. Methods Clinical data of children diagnosed with MOGAD from April 2014 to September 2021 were analyzed. Results A total of 93 children (M/F=45/48; median onset age=6.0 y) with MOGAD were involved. Seizures or limb paralysis was the most common onset or course symptom, respectively. The most common lesion locations in brain MRI, orbital MRI, and spinal cord MRI were basal ganglia and subcortical white matter, the orbital segment of the optic nerve, and the cervical segment, respectively. ADEM (58.10%) was the most common clinical phenotype. The relapse rate was 24.7%. Compared with the patients without relapse, relapsed patients had a longer interval from onset to diagnosis (median: 19 days VS 20 days) and higher MOG antibody titer at onset (median: 1:32 VS 1:100) with longer positively persistent (median: 3 months VS 24 months). All patients received IVMP plus IVIG at the acute phase, and 96.8% of patients achieved remission after one to three courses of treatment. MMF, monthly IVIG, and maintaining a low dose of oral prednisone were used alone or in combination as maintenance immunotherapy for relapsed patients and effectively reduced relapse. It transpired 41.9% of patients had neurological sequelae, with movement disorder being the most common. Compared with patients without sequelae, patients with sequelae had higher MOG antibody titer at onset (median: 1:32 VS 1:100) with longer persistence (median: 3 months VS 6 months) and higher disease relapse rate (14.8% VS 38.5%). Conclusions Results showed the following about pediatric MOGAD in southern China: the median onset age was 6.0 years, with no obvious sex distribution difference; seizure or limb paralysis, respectively, are the most common onset or course symptom; the lesions of basal ganglia, subcortical white matter, the orbital segment of the optic nerve, and cervical segment were commonly involved in the CNS MRI; ADEM was the most common clinical phenotype; most had a good response to immunotherapy; although the relapse rate was relatively high, MMF, monthly IVIG and a low dose of oral prednisone might effectively reduce relapse; neurological sequelae were common, and possibly associated with MOG antibody status and disease relapse.
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Fragoso DC, Salles LMODP, Pereira SLA, Callegaro D, Sato DK, Rimkus CDM. AQP4-IgG NMOSD, MOGAD, and double-seronegative NMOSD: is it possible to depict the antibody subtype using magnetic resonance imaging? ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:533-543. [PMID: 37379865 DOI: 10.1055/s-0043-1768669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND There is clinical and radiological overlap among demyelinating diseases. However, their pathophysiological mechanisms are different and carry distinct prognoses and treatment demands. OBJECTIVE To investigate magnetic resonance imaging (MRI) features of patients with myelin-oligodendrocyte glycoprotein associated disease (MOGAD), antibody against aquaporin-4(AQP-4)-immunoglobulin G-positive neuromyelitis optica spectrum disorder (AQP4-IgG NMOSD), and double-seronegative patients. METHODS A cross-sectional retrospective study was performed to analyze the topography and morphology of central nervous system (CNS) lesions. Two neuroradiologists consensually analyzed the brain, orbit, and spinal cord images. RESULTS In total, 68 patients were enrolled in the study (25 with AQP4-IgG-positive NMOSD, 28 with MOGAD, and 15 double-seronegative patients). There were differences in clinical presentation among the groups. The MOGAD group had less brain involvement (39.2%) than the NMOSD group (p = 0.002), mostly in the subcortical/juxtacortical, the midbrain, the middle cerebellar peduncle, and the cerebellum. Double-seronegative patients had more brain involvement (80%) with larger and tumefactive lesion morphology. In addition, double-seronegative patients showed the longest optic neuritis (p = 0.006), which was more prevalent in the intracranial optic nerve compartment. AQP4-IgG-positive NMOSD optic neuritis had a predominant optic-chiasm location, and brain lesions mainly affected hypothalamic regions and the postrema area (MOGAD versus AQP4-IgG-positive NMOSD, p= 0 .013). Furthermore, this group had more spinal cord lesions (78.3%), and bright spotty lesions were a paramount finding to differentiate it from MOGAD (p = 0.003). CONCLUSION The pooled analysis of lesion topography, morphology, and signal intensity provides critical information to help clinicians form a timely differential diagnosis.
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Affiliation(s)
- Diego Cardoso Fragoso
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, São Paulo SP, Brazil
| | | | | | - Dagoberto Callegaro
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Neurologia, São Paulo SP, Brazil
| | - Douglas Kazutoshi Sato
- Pontifícia Universidade Católica do Rio Grande do Sul, Instituto do Cérebro do Rio Grande do Sul (InsCer), Porto Alegre RS, Brazil
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28
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Harrison KL, Gaudioso C, Levasseur VA, Dunham SR, Schanzer N, Keuchel C, Salter A, Goyal MS, Mar S. Central Vein Sign in Pediatric Multiple Sclerosis and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Pediatr Neurol 2023; 146:21-25. [PMID: 37406422 DOI: 10.1016/j.pediatrneurol.2023.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The central vein sign (CVS) on brain magnetic resonance imaging (MRI) is a promising diagnostic marker for distinguishing adult multiple sclerosis (MS) from other demyelinating conditions, but its prevalence is not well-established in pediatric-onset multiple sclerosis (POMS) versus myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). MOGAD can mimic MS radiologically. This study seeks to determine the utility of CVS, together with other radiological findings, in distinguishing POMS from MOGAD in children. METHODS Children with POMS or MOGAD were identified in a pediatric demyelinating database. Two reviewers, blinded to diagnosis, fused fluid-attenuated inversion recovery sequences and susceptibility-weighted imaging from clinical imaging to identify CVS. Agreement in CVS number was reported using intraclass correlation coefficients (ICC). We performed topographic analyses as well as characterization of the clinical information and lesions on brain, spinal cord, and orbital MRI when available. RESULTS Twenty children, 10 with POMS and 10 with MOGAD, were assessed. The median lesion percentage of CVS was higher in POMS versus MOGAD for both raters (rater 1: 80% vs 9.8%; rater 2: 22.7% vs 7.5%). Inter-rater reliability for identifying total white matter lesions was strong (ICC 0.94 [95% confidence interval [CI] 0.84, 0.97]); however, it was poor for detecting CVS lesions (ICC -0.17 [95% CI: -0.37, 0.58]). CONCLUSION The CVS can be a useful diagnostic tool for differentiating POMS from MOGAD. However, advanced clinical imaging tools that can better detect CVS are needed to increase inter-rater reliability before clinical application.
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Affiliation(s)
- Kimystian L Harrison
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
| | - Cristina Gaudioso
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Victoria A Levasseur
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - S Richard Dunham
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Natalie Schanzer
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Connor Keuchel
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Amber Salter
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Manu S Goyal
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Soe Mar
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
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29
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Zhang Y, Zhang T, Zhang X, Yan X, Lei J, Liu R, Yang Y, Zhang C, Zhang J, Zhang Y, Yue W. Clinical spectrum and prognosis of pathologically confirmed atypical tumefactive demyelinating lesions. Sci Rep 2023; 13:7773. [PMID: 37179394 PMCID: PMC10183015 DOI: 10.1038/s41598-023-34420-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 04/29/2023] [Indexed: 05/15/2023] Open
Abstract
To describe the clinical spectrum and prognosis of atypical tumefactive demyelinating lesions (TDLs), which were confirmed by pathology. A total of 11 patients were diagnosed with atypical TDLs confirmed by brain biopsy and surgery between January 2006 and December 2017. The clinical spectrum and prognosis in these patients were analyzed. The patients' ages ranged from 29 to 62 years, with a mean age of 48.9 years; 72.7% were males. The Expanded Disability Status Scale (EDSS) of the patients with first onset was 2.36. Most of the patients started with limb numbness and weakness (45.5%) or alalia (27.2%). The mean time from symptom onset to biopsy or surgery was 12.9 days (3-30 days). Most of the patients had solitary lesions (72.7%), supratentorial lesions (90.9%, particularly predominant in the frontal, temporal, and parietal lobes), moderate edema (63.6%), mild mass effect (54.5%), and patchy lesions (54.5%). Among them, three patients were positive for myelin basic protein (MBP) and one patient was positive for myelin oligodendrocyte glycoprotein (MOG). The patients were followed up for an average of 6.9 years (2-14 years), and recurrent TDLs were observed in 2 patients. Except for the 2 patients who relapsed, only 1 of the 9 patients died; the other 8 patients improved or maintained the status quo (the EDSS scores were lower or unchanged). The patients did not have any serious nervous system injury at onset, and the main presentation included extremity weakness, headache or dizziness, and alalia. The most common form was patchy on MRI enhancement. Cerebrospinal fluid and demyelination test can be an indicator of TDLs, and seizures may be a poor prognostic indicator. Most atypical TDLs have monophasic courses and good outcomes. The effect of neurosurgery alone was good in our group, and the effect of surgery on atypical TDLs can be further studied.
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Affiliation(s)
- Yajing Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Ting Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Xuebin Zhang
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin, China
| | - Xiaoling Yan
- Department of Pathology, Tianjin Huanhu Hospital, Tianjin, China
| | - Jing Lei
- Imaging Department, Tianjin Huanhu Hospital, Tianjin, China
| | - Ran Liu
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Yun Yang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Chao Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Jun Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Ying Zhang
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China
| | - Wei Yue
- Department of Neurology, Tianjin Huanhu Hospital, Jizhao Road 6, Tianjin, 300060, Jinnan, China.
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30
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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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31
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Cacciaguerra L, Morris P, Tobin WO, Chen JJ, Banks SA, Elsbernd P, Redenbaugh V, Tillema JM, Montini F, Sechi E, Lopez-Chiriboga AS, Zalewski N, Guo Y, Rocca MA, Filippi M, Pittock SJ, Lucchinetti CF, Flanagan EP. Tumefactive Demyelination in MOG Ab-Associated Disease, Multiple Sclerosis, and AQP-4-IgG-Positive Neuromyelitis Optica Spectrum Disorder. Neurology 2023; 100:e1418-e1432. [PMID: 36690455 PMCID: PMC10065219 DOI: 10.1212/wnl.0000000000206820] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies on tumefactive brain lesions in myelin oligodendrocyte glycoprotein-immunoglobulin G (IgG)-associated disease (MOGAD) are lacking. We sought to characterize the frequency clinical, laboratory, and MRI features of these lesions in MOGAD and compare them with those in multiple sclerosis (MS) and aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). METHODS We retrospectively searched 194 patients with MOGAD and 359 patients with AQP4+NMOSD with clinical/MRI details available from the Mayo Clinic databases and included those with ≥1 tumefactive brain lesion (maximum transverse diameter ≥2 cm) on MRI. Patients with tumefactive MS were identified using the Mayo Clinic medical record linkage system. Binary multivariable stepwise logistic regression identified independent predictors of MOGAD diagnosis; Cox proportional regression models were used to assess the risk of relapsing disease and gait aid in patients with tumefactive MOGAD vs those with nontumefactive MOGAD. RESULTS We included 108 patients with tumefactive demyelination (MOGAD = 43; AQP4+NMOSD = 16; and MS = 49). Tumefactive lesions were more frequent among those with MOGAD (43/194 [22%]) than among those with AQP4+NMOSD (16/359 [5%], p < 0.001). Risk of relapse and need for gait aid were similar in tumefactive and nontumefactive MOGAD. Clinical features more frequent in MOGAD than in MS included headache (18/43 [42%] vs 10/49 [20%]; p = 0.03) and somnolence (12/43 [28%] vs 2/49 [4%]; p = 0.003), the latter also more frequent than in AQP4+NMOSD (0/16 [0%]; p = 0.02). The presence of peripheral T2-hypointense rim, T1-hypointensity, diffusion restriction (particularly an arc pattern), ring enhancement, and Baló-like or cystic appearance favored MS over MOGAD (p ≤ 0.001). MRI features were broadly similar in MOGAD and AQP4+NMOSD, except for more frequent diffusion restriction in AQP4+NMOSD (10/15 [67%]) than in MOGAD (11/42 [26%], p = 0.005). CSF analysis revealed less frequent positive oligoclonal bands in MOGAD (2/37 [5%]) than in MS (30/43 [70%], p < 0.001) and higher median white cell count in MOGAD than in MS (33 vs 6 cells/μL, p < 0.001). At baseline, independent predictors of MOGAD diagnosis were the presence of somnolence/headache, absence of T2-hypointense rim, lack of T1-hypointensity, and no diffusion restriction (Nagelkerke R 2 = 0.67). Tumefactive lesion resolution was more common in MOGAD than in MS or AQP4+NMOSD and improved model performance. DISCUSSION Tumefactive lesions are frequent in MOGAD but not associated with a worse prognosis. The clinical, MRI, and CSF attributes of tumefactive MOGAD differ from those of tumefactive MS and are more similar to those of tumefactive AQP4+NMOSD with the exception of lesion resolution, which favors MOGAD.
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Affiliation(s)
- Laura Cacciaguerra
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pearse Morris
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - W Oliver Tobin
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Samantha A Banks
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Paul Elsbernd
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Vyanka Redenbaugh
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Jan-Mendelt Tillema
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Federico Montini
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elia Sechi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Nicholas Zalewski
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Yong Guo
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Maria A Rocca
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Massimo Filippi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Claudia F Lucchinetti
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN.
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Banwell B, Bennett JL, Marignier R, Kim HJ, Brilot F, Flanagan EP, Ramanathan S, Waters P, Tenembaum S, Graves JS, Chitnis T, Brandt AU, Hemingway C, Neuteboom R, Pandit L, Reindl M, Saiz A, Sato DK, Rostasy K, Paul F, Pittock SJ, Fujihara K, Palace J. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol 2023; 22:268-282. [PMID: 36706773 DOI: 10.1016/s1474-4422(22)00431-8] [Citation(s) in RCA: 305] [Impact Index Per Article: 305.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/07/2022] [Accepted: 10/13/2022] [Indexed: 01/26/2023]
Abstract
Serum antibodies directed against myelin oligodendrocyte glycoprotein (MOG) are found in patients with acquired CNS demyelinating syndromes that are distinct from multiple sclerosis and aquaporin-4-seropositive neuromyelitis optica spectrum disorder. Based on an extensive literature review and a structured consensus process, we propose diagnostic criteria for MOG antibody-associated disease (MOGAD) in which the presence of MOG-IgG is a core criterion. According to our proposed criteria, MOGAD is typically associated with acute disseminated encephalomyelitis, optic neuritis, or transverse myelitis, and is less commonly associated with cerebral cortical encephalitis, brainstem presentations, or cerebellar presentations. MOGAD can present as either a monophasic or relapsing disease course, and MOG-IgG cell-based assays are important for diagnostic accuracy. Diagnoses such as multiple sclerosis need to be excluded, but not all patients with multiple sclerosis should undergo screening for MOG-IgG. These proposed diagnostic criteria require validation but have the potential to improve identification of individuals with MOGAD, which is essential to define long-term clinical outcomes, refine inclusion criteria for clinical trials, and identify predictors of a relapsing versus a monophasic disease course.
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Affiliation(s)
- Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, USA.
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Romain Marignier
- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon, France; Université Claude Bernard Lyon, Lyon, France
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia; School of Medical Sciences, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Eoin P Flanagan
- Departments of Neurology, Laboratory Medicine and Pathology and Center MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sudarshini Ramanathan
- Department of Neurology, Concord Hospital, Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, Australia; Brain and Mind Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Silvia Tenembaum
- Paediatric Neuroimmunology Clinic, Department of Neurology, National Paediatric Hospital Dr J P Garrahan, Ciudad de Buenos Aires, Argentina
| | - Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Tanuja Chitnis
- Department of Pediatric Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK; Institute of Neurology, UCL, London, UK
| | - Rinze Neuteboom
- Department of Neurology, MS Center ErasMS, Sophia Children's Hospital, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lekha Pandit
- Center for Advanced Neurological Research, Nitte University Mangalore, Mangalore, India
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Douglas Kazutoshi Sato
- School of Medicine and Institute for Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Kevin Rostasy
- Department of Paediatric Neurology, Children'sHospital Datteln, University Witten and Herdecke, Datteln, 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, and Berlin Institute of Health, Berlin, Germany
| | - Sean J Pittock
- Departments of Neurology, Laboratory Medicine, and Pathology and Center MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Jacqueline Palace
- Department of Neurology John Radcliffe Hospital Oxford and Nuffield Department of Clinical Neurosciences Oxford University, Oxford, UK
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33
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Bachhuber A. [Diagnostic work-up, findings, and documentation of multiple sclerosis]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:115-119. [PMID: 36658297 DOI: 10.1007/s00117-022-01104-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Although multiple sclerosis is the most common chronic inflammatory demyelinating disease of the central nervous system, the rate of misdiagnosis in clinical practice is high. This is usually due to the inadequate application of the McDonald criteria and misinterpretation of images. OBJECTIVE This review focuses on typical clinical symptoms, choice of magnetic resonance imaging (MRI) sequences, correct application of the McDonald criteria, and finally interpretation of the images.
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Affiliation(s)
- Armin Bachhuber
- Klinik für Diagnostische und Interventionelle, Neuroradiologie, Universitätsklinikum des Saarlandes, Kirrberger Straße, 66424, Homburg-Saar, Deutschland.
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Gaudioso CM, Mar S, Casper TC, Codden R, Nguyen A, Aaen G, Benson L, Chitnis T, Francisco C, Gorman MP, Goyal MS, Graves J, Greenberg BM, Hart J, Krupp L, Lotze T, Narula S, Pittock SJ, Rensel M, Rodriguez M, Rose J, Schreiner T, Tillema JM, Waldman A, Weinstock-Guttman B, Wheeler Y, Waubant E, Flanagan EP. MOG and AQP4 Antibodies among Children with Multiple Sclerosis and Controls. Ann Neurol 2023; 93:271-284. [PMID: 36088544 PMCID: PMC10576841 DOI: 10.1002/ana.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency of myelin oligodendrocyte glycoprotein (MOG)-IgG and aquaporin-4 (AQP4)-IgG among patients with pediatric-onset multiple sclerosis (POMS) and healthy controls, to determine whether seropositive cases fulfilled their respective diagnostic criteria, to compare characteristics and outcomes in children with POMS versus MOG-IgG-associated disease (MOGAD), and identify clinical features associated with final diagnosis. METHODS Patients with POMS and healthy controls were enrolled at 14 US sites through a prospective case-control study on POMS risk factors. Serum AQP4-IgG and MOG-IgG were assessed using live cell-based assays. RESULTS AQP4-IgG was negative among all 1,196 participants, 493 with POMS and 703 healthy controls. MOG-IgG was positive in 30 of 493 cases (6%) and zero controls. Twenty-five of 30 patients positive with MOG-IgG (83%) had MOGAD, whereas 5 of 30 (17%) maintained a diagnosis of multiple sclerosis (MS) on re-review of records. MOGAD cases were more commonly in female patients (21/25 [84%] vs 301/468 [64%]; p = 0.044), younger age (mean = 8.2 ± 4.2 vs 14.7 ± 2.6 years; p < 0.001), more commonly had initial optic nerve symptoms (16/25 [64%] vs 129/391 [33%]; p = 0.002), or acute disseminated encephalomyelitis (ADEM; 8/25 [32%] vs 9/468 [2%]; p < 0.001), and less commonly had initial spinal cord symptoms (3/20 [15%] vs 194/381 [51%]; p = 0.002), serum Epstein-Barr virus (EBV) positivity (11/25 [44%] vs 445/468 [95%]; p < 0.001), or cerebrospinal fluid oligoclonal bands (5/25 [20%] vs 243/352 [69%]; p < 0.001). INTERPRETATION MOG-IgG and AQP4-IgG were not identified among healthy controls confirming their high specificity for pediatric central nervous system (CNS) demyelinating disease. Five percent of those with prior POMS diagnoses ultimately had MOGAD; and none had AQP4-IgG positivity. Clinical features associated with a final diagnosis of MOGAD in those with suspected MS included initial ADEM phenotype, younger age at disease onset, and lack of EBV exposure. ANN NEUROL 2023;93:271-284.
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Affiliation(s)
- Cristina M Gaudioso
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - Soe Mar
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - T Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Rachel Codden
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Adam Nguyen
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center at Loma Linda University Children’s Hospital, Loma Linda University, Loma Linda, CA, United States
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanuja Chitnis
- Partners Pediatric MS Center, Massachusetts General Hospital, Boston, MA, United States
| | - Carla Francisco
- UCSF Regional Pediatric MS Center, San Francisco, CA, United States
| | - Mark P Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Manu S Goyal
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - Jennifer Graves
- University of California San Diego Health, Rady Children’s Hospital San Diego
| | - Benjamin M Greenberg
- Department of Neurology, University of Texas Southwestern and Children’s Health, Dallas, TX, United States
| | - Janace Hart
- UCSF Regional Pediatric MS Center, San Francisco, CA, United States
| | - Lauren Krupp
- New York University, Pediatric MS Center, Neurology
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Sona Narula
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sean J. Pittock
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Moses Rodriguez
- Mayo Clinic Pediatric MS Center, Mayo Clinic, Rochester, MN, United States
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Teri Schreiner
- Rocky Mountain MS Center, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | | | - Amy Waldman
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center at the Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yolanda Wheeler
- Center for Pediatric-Onset Demyelinating Disease at the Children’s of Alabama, University of Alabama, Birmingham, AL, United States
| | | | - Eoin P Flanagan
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
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Chia NH, Redenbaugh V, Chen JJ, Pittock SJ, Flanagan EP. Corpus callosum involvement in MOG antibody-associated disease in comparison to AQP4-IgG-seropositive neuromyelitis optica spectrum disorder and multiple sclerosis. Mult Scler 2023; 29:748-752. [PMID: 36691800 PMCID: PMC10175177 DOI: 10.1177/13524585221150743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Data on corpus callosum involvement in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are limited. OBJECTIVE The objective of the study was to compare callosal lesions in MOGAD, multiple sclerosis (MS), and aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). RESULTS Callosal lesion frequency was similar in MOGAD (38/171 (22%)), MS (24/72 (33%)), and AQP4+NMOSD (18/63 (29%)). Clinical phenotypes included encephalopathy (47%) and focal supratentorial (21%) or infratentorial (45%) deficits. None had callosal-disconnection syndromes. Maximal callosal-T2-lesion diameter (median (range)) in millimeter was similar in MOGAD (21 (4-77)) and AQP4+NMOSD (22 (5-49); p = 0.93) but greater than in MS (10.5 (2-64)). Extracallosal extension (21/38 (55%)) and T2-lesion resolution (19/34 (56%)) favored MOGAD. CONCLUSIONS Despite similar frequency and imaging overlap, larger lesions, sagittal midline involvement, and lesion resolution favored MOGAD.
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Affiliation(s)
| | | | - John J Chen
- Departments of Neurology and Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Departments of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Departments of Neurology and Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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36
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Belova AN, Sheiko GE, Rakhmanova EM, Boyko AN. [Clinical features and modern diagnostic criteria of the disease associated with myelin oligodendrocyte glycoprotein antibody disease]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:47-56. [PMID: 37994888 DOI: 10.17116/jnevro202312311147] [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] [Indexed: 11/24/2023]
Abstract
Demyelinating disease of the central nervous system associated with antibodies to myelin oligodendrocyte glycoprotein (MOGAD) has been proposed to be distinguished from neuromyelitis optica spectrum disorders (NMOSD) into a separate nosological form. The basis for the recognition of nosological independence was the presence of clinical features of this disease and the detection of a specific biomarker in the blood serum of patients - IgG class antibodies to MOG. The article summarizes the current data on the clinical and radiological phenotypes of MOGAD in children and adults and the features of the course of the disease. The requirements for the laboratory diagnosis of the disease and diagnostic criteria for MOGAD proposed by an international group of experts in 2023 are given.
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Affiliation(s)
- A N Belova
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - G E Sheiko
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - E M Rakhmanova
- Volga Research Medical University, Nizhny Novgorod, Russia
| | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain and Neurotechnologies of the Federal Medical Biological Agency, Moscow, Russia
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37
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Pozzilli C, Pugliatti M, Vermersch P, Grigoriadis N, Alkhawajah M, Airas L, Oreja-Guevara C. Diagnosis and treatment of progressive multiple sclerosis: A position paper. Eur J Neurol 2023; 30:9-21. [PMID: 36209464 PMCID: PMC10092602 DOI: 10.1111/ene.15593] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/05/2022] [Accepted: 09/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND PURPOSE Multiple sclerosis (MS) is an unpredictable disease characterised by a highly variable disease onset and clinical course. Three main clinical phenotypes have been described. However, distinguishing between the two progressive forms of MS can be challenging for clinicians. This article examines how the diagnostic definitions of progressive MS impact clinical research, the design of clinical trials and, ultimately, treatment decisions. METHODS We carried out an extensive review of the literature highlighting differences in the definition of progressive forms of MS, and the importance of assessing the extent of the ongoing inflammatory component in MS when making treatment decisions. RESULTS Inconsistent results in phase III clinical studies of treatments for progressive MS, may be attributable to differences in patient characteristics (e.g., age, clinical and radiological activity at baseline) and endpoint definitions. In both primary and secondary progressive MS, patients who are younger and have more active disease will derive the greatest benefit from the available treatments. CONCLUSIONS We recommend making treatment decisions based on the individual patient's pattern of disease progression, as well as functional, clinical and imaging parameters, rather than on their clinical phenotype. Because the definition of progressive MS differs across clinical studies, careful selection of eligibility criteria and study endpoints is needed for future studies in patients with progressive MS.
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Affiliation(s)
- Carlo Pozzilli
- Multiple Sclerosis Center, Sant'Andrea Hospital, Rome, Italy.,Department of Human Neuroscience, University Sapienza, Rome, Italy
| | - Maura Pugliatti
- Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy.,Interdepartmental Center of Research for Multiple Sclerosis and Neuro-inflammatory and Degenerative Diseases, University of Ferrara, Ferrara, Italy
| | - Patrick Vermersch
- Inserm U1172 LilNCog, CHU Lille, FHU Precise, University of Lille, Lille, France
| | - Nikolaos Grigoriadis
- Laboratory of Experimental Neurology and Neuroimmunology, Second Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mona Alkhawajah
- Section of Neurology, Neurosciences Center, King Faisal Specialist Hospital and Research Center, College of Medicine, Al Faisal University, Riyadh, Kingdom of Saudi Arabia
| | - Laura Airas
- Division of Clinical Neurosciences, University of Turku, Turku, Finland.,Neurocenter of Turku University Hospital, Turku, Finland
| | - Celia Oreja-Guevara
- Department of Neurology, Hospital Clinico San Carlos, IdISSC, Madrid, Spain.,Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid (UCM), Madrid, Spain
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38
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Cortese R, Mariotto S, Mancinelli CR, Tortorella C. Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know? Front Neurol 2022; 13:1048502. [PMID: 36601293 PMCID: PMC9806181 DOI: 10.3389/fneur.2022.1048502] [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: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Antibody-mediated central nervous system (CNS) disorders including those associated with aquaporin-4 or myelin oligodendrocyte glycoprotein IgG and autoimmune encephalitis often affect women of childbearing age. Pathogenic antibodies of these diseases can potentially alter reproductive functions and influence fetal development. Hormonal changes occurring during pregnancy may modify the course of autoimmune diseases by influencing relapse risk, attack severity, and affect the delivery and postpartum period. Moreover, balancing treatment related safety issues with the risk of potentially disabling relapses during pregnancy and breastfeeding are major challenges. Intentional prenatal, gestational, and post-partum counseling is paramount to address these issues and mitigate these risks. Fortunately, new insights on risk factors for adverse pregnancy outcomes and possible preventive strategies are emerging. This review aims to summarize the interplay between antibody-mediated CNS disorders and pregnancy during the prenatal, gestational, and postpartum periods, highlight current treatment recommendations, and discuss future areas of research.
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Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,*Correspondence: Rosa Cortese
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
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39
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MOG antibody associated disease (MOGAD) presenting with extensive brain stem encephalitis: A case report. eNeurologicalSci 2022; 29:100432. [DOI: 10.1016/j.ensci.2022.100432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/06/2022] Open
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40
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Ishikura T, Okuno T, Takahashi T, Mochizuki H. Myelin Oligodendrocyte Glycoprotein Antibody-associated Disease with Frequent Cerebellitis. Intern Med 2022; 61:3629-3630. [PMID: 35569984 PMCID: PMC9790771 DOI: 10.2169/internalmedicine.9446-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Teruyuki Ishikura
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Tatsusada Okuno
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Japan
- Department of Neurology, National Hospital Organization Yonezawa National Hospital, Japan
| | - Hideki Mochizuki
- Department of Neurology, Osaka University Graduate School of Medicine, Japan
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Francis AG, Elhadd K, Camera V, Ferreira Dos Santos M, Rocchi C, Adib-Samii P, Athwal B, Attfield K, Barritt A, Craner M, Fisniku L, Iversen AKN, Leach O, Matthews L, Redmond I, O'Riordan J, Scalfari A, Tanasescu R, Wren D, Huda S, Leite MI, Fugger L, Palace J. Acute Inflammatory Diseases of the Central Nervous System After SARS-CoV-2 Vaccination. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2022; 10:10/1/e200063. [PMID: 36411077 PMCID: PMC9679888 DOI: 10.1212/nxi.0000000000200063] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 09/26/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Acute inflammatory CNS diseases include neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Both MOGAD and acute disseminated encephalomyelitis (ADEM) have been reported after vaccination. Consequently, the mass SARS-CoV-2 vaccination program could result in increased rates of these conditions. We described the features of patients presenting with new acute CNS demyelination resembling NMOSDs or MOGAD within 8 weeks of SARS-CoV-2 vaccination. METHODS The study included a prospective case series of patients referred to highly specialized NMOSD services in the UK from the introduction of SARS-CoV-2 vaccination program up to May 2022. Twenty-five patients presented with new optic neuritis (ON) and/or transverse myelitis (TM) ± other CNS inflammation within 8 weeks of vaccination with either AstraZeneca (ChAdOx1S) or Pfizer (BNT162b2) vaccines. Their clinical records and paraclinical investigations including MRI scans were reviewed. Serologic testing for antibodies to myelin oligodendrocyte glycoprotein (MOG) and aquaporin 4 (AQP4) was performed using live cell-based assays. Patients' outcomes were graded good, moderate, or poor based on the last clinical assessment. RESULTS Of 25 patients identified (median age 38 years, 14 female), 12 (48%) had MOG antibodies (MOGIgG+), 2 (8%) had aquaporin 4 antibodies (AQP4IgG+), and 11 (44%) had neither. Twelve of 14 (86%) antibody-positive patients received the ChAdOx1S vaccine. MOGIgG+ patients presented most commonly with TM (10/12, 83%), frequently in combination with ADEM-like brain/brainstem lesions (6/12, 50%). Transverse myelitis was longitudinally extensive in 7 of the 10 patients. A peak in new MOGAD cases in Spring 2021 was attributable to postvaccine cases. Both AQP4IgG+ patients presented with brain lesions and TM. Four of 6 (67%) seronegative ChAdOx1S recipients experienced longitudinally extensive TM (LETM) compared with 1 of 5 (20%) of the BNT162b2 group, and facial nerve inflammation was reported only in ChAdOx1S recipients (2/5, 40%). Guillain-Barre syndrome was confirmed in 1 seronegative ChAdOx1S recipient and suspected in another. DISCUSSION ChAdOx1S was associated with 12/14 antibody-positive cases, the majority MOGAD. MOGAD patients presented atypically, only 2 with isolated ON (1 after BNT162b2 vaccine) but with frequent ADEM-like brain lesions and LETM. Within the seronegative group, phenotypic differences were observed between ChAdOx1S and BNT162b2 recipients. These observations might support a causative role of the ChAdOx1S vaccine in inflammatory CNS disease and particularly MOGAD. Further study of this cohort could provide insights into vaccine-associated immunopathology.
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Affiliation(s)
- Anna G Francis
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.).
| | - Kariem Elhadd
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Valentina Camera
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Monica Ferreira Dos Santos
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Chiara Rocchi
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Poneh Adib-Samii
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Bal Athwal
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Kathrine Attfield
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Andrew Barritt
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Matthew Craner
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Leonora Fisniku
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Astrid K N Iversen
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Oliver Leach
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Lucy Matthews
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Ian Redmond
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Jonathan O'Riordan
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Antonio Scalfari
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Radu Tanasescu
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Damian Wren
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Saif Huda
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Maria Isabel Leite
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Lars Fugger
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
| | - Jacqueline Palace
- From the Nuffield Department of Clinical Neurology (A.G.F., V.C., M.F.S., K.A., M.C., A.K.N.I., M.I.L., Lars Fugger, J.P.), Oxford University; The Walton Centre NHS Foundation Trust (K.E., C.R.)Neurology Unit (V.C.), Azienda Ospedaliero-Universitaria of Modena, Italy; Neurology (M.F.S.), Department of Neurosciences and Mental Health, Hospital de Santa Maria, Centro Hospitalar Universitário Lisboa Norte, Lisbon, Portugal; Neurological Clinic (C.R.), Marche Polytechnic University, Ancona, Italy; Department of Neurology (P.A.-S., B.A.), Royal Free London NHS Trust; Department of Neurology (A.B., L.E.), Brighton and Sussex University Hospitals NHS Foundation Trust; Royal Cornwall Hospitals NHS Trust (O.L.); Milton Keynes University Hospital (L.M.); East Kent Hospitals University Foundation Trust (I.R.); Department of Clinical Neurology (J.O.), University of Dundee; Imperial College London (A.S.); Centre of Neuroscience (A.S.), Department of Medicine, Charing Cross Hospital; Division of Clinical Neuroscience (R.T.), University of Nottingham, United Kingdom; Nottingham Centre for Multiple Sclerosis and Neuroinflammation (R.T.), Queen's Medical Centre, Nottingham University Hospitals NHS Trust; Frimley Health NHS Foundation Trust (D.W.); and University of Liverpool (S.H.)
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Miyaue N, Hosokawa Y, Yamanishi Y, Tada S, Ando R, Nagai M. Clinical use of CSF neopterin levels in CNS demyelinating diseases. J Neurol Sci 2022; 441:120385. [PMID: 36027640 DOI: 10.1016/j.jns.2022.120385] [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: 06/05/2022] [Revised: 08/08/2022] [Accepted: 08/15/2022] [Indexed: 10/15/2022]
Abstract
BACKGROUND There is some phenotypic overlap between MS, AQP4-IgG positive NMOSD, and MOG-IgG associated disease (MOGAD), and distinguishing a true relapse and a pseudorelapse can be difficult. CSF neopterin, a marker of inflammation-immune-mediated processes in the CNS, may be a useful marker in a wide range of CNS infectious and inflammatory diseases. We compared CSF neopterin levels and other CSF parameters in patients with MS, AQP4-IgG-positive NMOSD, and MOGAD and also investigated whether CSF neopterin levels can distinguish between active and inactive phases of the diseases. METHODS We retrospectively reviewed the medical records of 22 patients with MS, 18 with AQP4-IgG-positive NMOSD, and five with MOGAD. CSF neopterin concentrations were measured by HPLC with fluorometric detection. RESULTS CSF neopterin levels at diagnosis were significantly higher in patients with AQP4-IgG-positive NMOSD (52.77 ± 34.56 pmol/mL) than patients with MS (16.92 ± 5.03 pmol/mL, p < 0.001), and tended to be higher in patients with MOGAD (28.87 ± 9.66 pmol/mL) than patients with MS (p = 0.092). ROC analysis revealed that CSF neopterin most accurately discriminated between MS and AQP4-IgG-positive NMOSD (AUC, 0.912; sensitivity, 75.0%; specificity, 100.0%). At diagnosis/relapse and during remission, CSF neopterin most accurately discriminated between the disease phases in patients with MS (AUC, 0.779; sensitivity, 58.1%; specificity, 94.7%) and patients with AQP4-IgG-positive NMOSD (AUC, 0.934; sensitivity, 83.3%; specificity, 94.1%). CONCLUSION Measurement of CSF neopterin may be useful for differential diagnosis and assessment of disease activity in CNS demyelinating diseases. Further studies with larger cohorts, including comparisons with other biomarkers, are needed to validate the utility of CSF neopterin.
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Affiliation(s)
- Noriyuki Miyaue
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Tohon, Ehime, Japan.
| | - Yuko Hosokawa
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Tohon, Ehime, Japan
| | - Yuki Yamanishi
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Tohon, Ehime, Japan
| | - Satoshi Tada
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Tohon, Ehime, Japan
| | - Rina Ando
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Tohon, Ehime, Japan
| | - Masahiro Nagai
- Department of Clinical Pharmacology and Therapeutics, Ehime University Graduate School of Medicine, Tohon, Ehime, Japan
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Coexistence of Myelin Oligodendrocyte Glycoprotein Immunoglobulin G and Neuronal or Glial Antibodies in the Central Nervous System: A Systematic Review. Brain Sci 2022; 12:brainsci12080995. [PMID: 36009058 PMCID: PMC9405704 DOI: 10.3390/brainsci12080995] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/23/2022] [Accepted: 07/24/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) has been considered a diagnostic marker for patients with demyelinating disease, termed “MOG-IgG associated disorder” (MOGAD). Recently, the coexistence of MOG-IgG and other neuronal or glial antibodies has attracted extensive attention from clinicians. In this article, we systematically review the characteristics of MOG-IgG-related antibody coexistence syndrome. Methods: Two authors independently searched PubMed for relevant studies published before October 2021. We also manually searched the references of each related article. The appropriateness of the included studies was assessed by reading the titles, abstracts, and full texts if necessary. Results: Thirty-five relevant publications that met our inclusion criteria were finally included, of which fourteen were retrospective studies and twenty-one were case reports. A total of 113 patients were reported to show the coexistence of MOG-IgG and neuronal or glial antibodies. Additionally, 68.14% of patients were double positive for MOG-IgG and N-Methyl-D-Aspartate Receptor-IgG (NMDAR-IgG), followed by 23.01% of patients who were double positive for MOG-IgG and aquaporin4-IgG (AQP4-IgG). Encephalitis was the predominant phenotype when MOG-IgG coexisted with NMDAR-IgG, probably accompanied by imaging features of demyelination. Patients with dual positivity for MOG-IgG and AQP4-IgG experienced more severe disease and more frequent relapses. The coexistence of MOG-IgG and antibodies other than NMDAR-IgG and AQP4-IgG was extremely rare, and the clinical presentations were diverse and atypical. Except for patients who were double positive for MOG-IgG and AQP4-IgG, most patients with multiple antibodies had a good prognosis. Conclusions: MOG-IgG may coexist with neuronal or glial antibodies. Expanded screening for neuronal or glial antibodies should be performed in patients with atypical clinical and radiological features.
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MR-imaging in children with transverse myelitis and acquired demyelinating syndromes. Mult Scler Relat Disord 2022; 67:104068. [DOI: 10.1016/j.msard.2022.104068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Revised: 07/13/2022] [Accepted: 07/21/2022] [Indexed: 11/17/2022]
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Sechi E, Cacciaguerra L, Chen JJ, Mariotto S, Fadda G, Dinoto A, Lopez-Chiriboga AS, Pittock SJ, Flanagan EP. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front Neurol 2022; 13:885218. [PMID: 35785363 PMCID: PMC9247462 DOI: 10.3389/fneur.2022.885218] [Citation(s) in RCA: 101] [Impact Index Per Article: 50.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is the most recently defined inflammatory demyelinating disease of the central nervous system (CNS). Over the last decade, several studies have helped delineate the characteristic clinical-MRI phenotypes of the disease, allowing distinction from aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD) and multiple sclerosis (MS). The clinical manifestations of MOGAD are heterogeneous, ranging from isolated optic neuritis or myelitis to multifocal CNS demyelination often in the form of acute disseminated encephalomyelitis (ADEM), or cortical encephalitis. A relapsing course is observed in approximately 50% of patients. Characteristic MRI features have been described that increase the diagnostic suspicion (e.g., perineural optic nerve enhancement, spinal cord H-sign, T2-lesion resolution over time) and help discriminate from MS and AQP4+NMOSD, despite some overlap. The detection of MOG-IgG in the serum (and sometimes CSF) confirms the diagnosis in patients with compatible clinical-MRI phenotypes, but false positive results are occasionally encountered, especially with indiscriminate testing of large unselected populations. The type of cell-based assay used to evaluate for MOG-IgG (fixed vs. live) and antibody end-titer (low vs. high) can influence the likelihood of MOGAD diagnosis. International consensus diagnostic criteria for MOGAD are currently being compiled and will assist in clinical diagnosis and be useful for enrolment in clinical trials. Although randomized controlled trials are lacking, MOGAD acute attacks appear to be very responsive to high dose steroids and plasma exchange may be considered in refractory cases. Attack-prevention treatments also lack class-I data and empiric maintenance treatment is generally reserved for relapsing cases or patients with severe residual disability after the presenting attack. A variety of empiric steroid-sparing immunosuppressants can be considered and may be efficacious based on retrospective or prospective observational studies but prospective randomized placebo-controlled trials are needed to better guide treatment. In summary, this article will review our rapidly evolving understanding of MOGAD diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
| | - John J. Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Fadda
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Alessandro Dinoto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eoin P. Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eoin P. Flanagan
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Vaneckova M, Piredda GF, Andelova M, Krasensky J, Uher T, Srpova B, Havrdova EK, Vodehnalova K, Horakova D, Hilbert T, Maréchal B, Fartaria MJ, Ravano V, Kober T. Periventricular gradient of T 1 tissue alterations in multiple sclerosis. Neuroimage Clin 2022; 34:103009. [PMID: 35561554 PMCID: PMC9112026 DOI: 10.1016/j.nicl.2022.103009] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/24/2022] [Accepted: 04/12/2022] [Indexed: 01/12/2023]
Abstract
T1 relaxation times alterations were assessed based on a study-specific atlas. T1 alterations depend on distance from lateral ventricles (“periventricular gradient”). Gradient parameters correlate better with disability compared to conventional MRI.
Objective Pathology in multiple sclerosis is not homogenously distributed. Recently, it has been shown that structures adjacent to CSF are more severely affected. A gradient of brain tissue involvement was shown with more severe pathology in periventricular areas and in proximity to brain surfaces such as the subarachnoid spaces and ependyma, and hence termed the “surface–in” gradient. Here, we study whether (i) the surface-in gradient of periventricular tissue alteration measured by T1 relaxometry is already present in early multiple sclerosis patients, (ii) how it differs between early and progressive multiple sclerosis patients, and (iii) whether the gradient-derived metrics in normal-appearing white matter and lesions correlate better with physical disability than conventional MRI-based metrics. Methods Forty-seven patients with early multiple sclerosis, 52 with progressive multiple sclerosis, and 92 healthy controls were included in the study. Isotropic 3D T1 relaxometry maps were obtained using the Magnetization-Prepared 2 Rapid Acquisition Gradient Echoes sequence at 3 T. After spatially normalizing the T1 maps into a study-specific common space, T1 inter-subject variability within the healthy cohort was modelled voxel-wise, yielding a normative T1 atlas. Individual comparisons of each multiple sclerosis patient against the atlas were performed by computing z-scores. Equidistant bands of voxels were defined around the ventricles in the supratentorial white matter; the z-scores in these bands were analysed and compared between the early and progressive multiple sclerosis cohorts. Correlations between both conventional and z-score-gradient-derived MRI metrics and the Expanded Disability Status Scale were assessed. Results Patients with early and progressive multiple sclerosis demonstrated a periventricular gradient of T1 relaxation time z-scores. In progressive multiple sclerosis, z-score-derived metrics reflecting the gradient of tissue abnormality in normal-appearing white matter were more strongly correlated with disability (maximal rho = 0.374) than the conventional lesion volume and count (maximal rho = 0.189 and 0.21 respectively). In early multiple sclerosis, the gradient of normal-appearing white matter volume with z-scores > 2 at baseline correlated with clinical disability assessed at two years follow-up. Conclusion Our results suggest that the surface-in white matter gradient of tissue alteration is detectable with T1 relaxometry and is already present at clinical disease onset. The periventricular gradients correlate with clinical disability. The periventricular gradient in normal-appearing white matter may thus qualify as a promising biomarker for monitoring of disease activity from an early stage in all phenotypes of multiple sclerosis.
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Affiliation(s)
- Manuela Vaneckova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
| | - Gian Franco Piredda
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Michaela Andelova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Jan Krasensky
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tomas Uher
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Barbora Srpova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Eva Kubala Havrdova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Karolina Vodehnalova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Dana Horakova
- Department of Neurology and Center of Clinical Neuroscience, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic
| | - Tom Hilbert
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Bénédicte Maréchal
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Mário João Fartaria
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Veronica Ravano
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Tobias Kober
- Advanced Clinical Imaging Technology, Siemens Healthcare AG, Lausanne, Switzerland; Department of Radiology, Lausanne University Hospital and University of Lausanne, Switzerland; Signal Processing Laboratory (LTS 5), École Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
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Fadda G, Waters P, Woodhall M, Brown RA, O'Mahony J, Castro DA, Longoni G, Yeh EA, Marrie RA, Arnold DL, Banwell B, Bar-Or A. Serum MOG-IgG in children meeting multiple sclerosis diagnostic criteria. Mult Scler 2022; 28:1697-1709. [PMID: 35581944 PMCID: PMC9442635 DOI: 10.1177/13524585221093789] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is now recognized as distinct from multiple sclerosis (MS). Objective: To evaluate the importance of considering myelin oligodendrocyte glycoprotein (MOG)-immunoglobulin-G (IgG) serology when applying MS diagnostic criteria in children. Methods: Within a prospective cohort of children meeting MS criteria (median follow-up = 6 years, interquartile range (IQR) = 4–9), we measured MOG-IgG in serial archived serum obtained from presentation, and compared imaging and clinical features between seropositive and seronegative participants. Results: Of 65 children meeting MS criteria (median age = 14.0 years, IQR = 10.9–15.1), 12 (18%) had MOG-IgG at disease onset. Seropositive participants were younger, had brain magnetic resonance imaging (MRI) features atypical for MS, rarely had cerebrospinal fluid (CSF) oligoclonal bands (2/8, 25%), and accumulated fewer T2 lesions over time. On serial samples, 5/12 (42%) were persistently seropositive, 5/12 (42%) became seronegative, and 2/12 (17%) had fluctuating results. All 12 children experienced a disease course different from typical MS. Conclusion: While children with MOG-IgG can have clinical, CSF, and MRI features conforming to MS criteria, the presence of MOG-IgG is associated with atypical features and predicts a non-MS disease course. Given MOG-IgG seropositivity can wane over time, testing at first attack is of considerable importance for the diagnosis of MOGAD.
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Affiliation(s)
- Giulia Fadda
- Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA/Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - Julia O'Mahony
- Institute of Health Policy, Management and Evaluation, University of Toronto and The Hospital for Sick Children, Toronto, ON, Canada
| | - Denise A Castro
- Department of Diagnostic Imaging, Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada/Department of Diagnostic Radiology, Queen's University, Kingston, ON, Canada
| | - Giulia Longoni
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Division of Neuroscience and Mental Health, SickKids Research Institute, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Department of Pediatrics (Neurology), The Hospital for Sick Children, Division of Neuroscience and Mental Health, SickKids Research Institute, University of Toronto, Toronto, ON, Canada
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Douglas L Arnold
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada
| | - Brenda Banwell
- Division of Child Neurology, Department of Neurology, The Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Amit Bar-Or
- Center for Neuroinflammation and Neurotherapeutics, and Multiple Sclerosis Division, Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ji Q, Dong H, Lee H, Liu Z, Tong Y, Elkin K, Haddad Y, Geng X, Ding Y. Clinical Characteristics and Outcomes of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder With Brainstem Lesions as Heralding Prodrome. Front Neurol 2022; 13:836337. [PMID: 35614913 PMCID: PMC9124782 DOI: 10.3389/fneur.2022.836337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
ObjectiveThe present study sought to differentiate multiple sclerosis and neuromyelitis optica spectrum disorder patients at their first attack by describing and distinguishing their clinical features, radiographic characteristics, and immunologic characteristics of serum and cerebrospinal fluid.MethodsWe retrospectively studied 58 patients with multiple sclerosis (MS) and 52 patients with neuromyelitis optica spectrum disorder (NMOSD) by referencing brainstem lesions as the prodromal events. Their demographics and presentation at the time of the first attack was evaluated including their gender, age, clinical features of the first attack, the expanded disability status scale (EDSS), brainstem lesion(s) by head MRI, and immunological indices of serum and cerebrospinal fluid.ResultsThe NMOSD group had more female patients (4.8 vs. 1.9, p < 0.05), and was older than the MS group (37.81 ± 16.60 vs. 27.57 ± 11.17, p <0.001). NMOSD patients also had a significantly higher association with autoimmune diseases or positive autoimmune antibodies (p < 0.01). There was no significant difference in the EDSS scores between the two groups (p = 0.420). Central hiccups, vomiting, and pyramidal tract signs were more common in the NMOSD group than the MS group (p < 0.001, p < 0.001, p < 0.01), while eye movement abnormalities were more common with MS (p < 0.01). There were no significant differences in other clinical manifestations such as vertigo, diplopia, limb weakness, numbness, and eating difficulty. MS patients were more likely to have midbrain and pons imaging lesions (p < 0.001, p < 0.001), while NMOSD patients had more lesions in the medulla oblongata (p < 0.001). The lesions in the MS group were mostly located in the periphery, while those in the NMOSD group were centrally located (p < 0.001, p < 0.001). Patchy lesions were more common in MS patients (p < 0.001), while large lesions were more common in the NMOSD group (p < 0.001). Finally, serum AQP4 Ab was found only in the NMOSD group (p < 0.001).ConclusionPatients with MS and NMOSD have differentiating clinical manifestations at the time of their first brainstem lesions which include central hiccups, vomiting, pyramidal tract signs, and abnormal eye movements. Additionally, distinct imaging manifestations such as lesion location(s) and morphology may also aid in the development of pathognomonic criteria leading to timely initial diagnosis of MS and NMOSD.
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Affiliation(s)
- Qiling Ji
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Huiqing Dong
| | - Hangil Lee
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanna Tong
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Kenneth Elkin
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yazeed Haddad
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
- Xiaokun Geng
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
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Patel J, Pires A, Derman A, Fatterpekar G, Charlson RE, Oh C, Kister I. Development and validation of a simple and practical method for differentiating MS from other neuroinflammatory disorders based on lesion distribution on brain MRI. J Clin Neurosci 2022; 101:32-36. [PMID: 35525154 DOI: 10.1016/j.jocn.2022.04.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 04/24/2022] [Accepted: 04/26/2022] [Indexed: 12/30/2022]
Abstract
There is an unmet need to develop practical methods for differentiating multiple sclerosis (MS) from other neuroinflammatory disorders using standard brain MRI. To develop a practical approach for differentiating MS from neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody-associated disorder (MOGAD) with brain MRI, we first identified lesion locations in the brain that are suggestive of MS-associated demyelination ("MS Lesion Checklist") and compared frequencies of brain lesions in the "MS Lesion Checklist" locations in a development sample of patients (n = 82) with clinically definite MS, NMOSD, and MOGAD. Patients with MS were more likely than patients with non-MS to have lesions in 3 locations only: anterior temporal horn (p < 0.0001), periventricular ("Dawson's finger") (p < 0.0001), and cerebellar hemisphere (p = 0.02). These three lesion locations were used as predictor variables in a multivariable regression model for discriminating MS from non-MS. The model had area under the curve (AUC) of 0.853 (95% confidence interval: 0.76-0.945), sensitivity of 87.1%, and specificity of 72.5%. We then used an independent validation sample with equal representation of MS and NMOSD/MOGAD cases (n = 97) to validate our prediction model. In the validation sample, the model was 76.3% accurate in discriminating MS from non-MS. Our simple method for predicting MS versus NMOSD/MOGAD only requires a neuroradiologist or clinician to ascertain the presence of lesions in three locations on conventional MRI sequences. It can therefore be readily applied in the real-world setting for training and clinical practice.
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Affiliation(s)
- J Patel
- NYU MS Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA.
| | - A Pires
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - A Derman
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - G Fatterpekar
- Department of Radiology, New York University Grossman School of Medicine, New York, NY, USA
| | - R E Charlson
- NYU MS Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
| | - C Oh
- Department of Population Health and Department of Environmental Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - I Kister
- NYU MS Comprehensive Care Center, Department of Neurology, New York University Grossman School of Medicine, New York, NY, USA
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Cooper SA, Leddy SG, Skipper NT, Barrett VJM, Plant GT. Optic neuritis with potential for poor outcome. Pract Neurol 2022; 22:190-200. [DOI: 10.1136/practneurol-2021-003228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2022] [Indexed: 11/03/2022]
Abstract
The Optic Neuritis Treatment Trial previously reported that corticosteroids accelerated visual recovery in optic neuritis (ON) without improving outcome. This finding related largely to multiple sclerosis (MS), and subsequently neurologists tended to await spontaneous recovery in ON. Since then, non-MS cases of ON have been identified with antibodies to aquaporin-4 (AQP4) or myelin oligodendrocyte glycoprotein (MOG). These disorders can closely mimic multiple sclerosis-associated or idiopathic demyelinating optic neuritis (MS/IDON) initially but risk a worse visual outcome. Scrutinising the clinical features and neuroimaging often enables differentiation between MS/IDON and other causes of ON. Early treatment with high-dose corticosteroids is an important determinant of visual outcome in non-MS/IDON. Prompt use of plasma exchange may also save sight. In this review, we contrast the presentations of myelin oligodendrocyte glycoprotein associated optic neuritis (MOG-ON) and aquaporin 4 associated optic neuritis (AQP4-ON) with MS/IDON and provide an approach to acute management while awaiting results of antibody testing.
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