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Nair A, Sankhyan N, Sukhija J, Saini AG, Vyas S, Suthar R, Sahu JK, Rawat A. Clinical outcomes and Anti-MOG antibodies in pediatric optic neuritis: A prospective observational study. Eur J Paediatr Neurol 2024; 49:1-5. [PMID: 38271780 DOI: 10.1016/j.ejpn.2024.01.003] [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: 07/15/2023] [Revised: 11/04/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES The objective of this study was to look at the clinical outcomes, and to determine the proportion of children with visual recovery after the first demyelinating event of optic neuritis (ON). METHODOLOGY In this observational study, children with the first clinical event of optic neuritis at an age less than 18 years were evaluated. High-contrast visual acuity, colour vision, Expanded Disability Status Scale (EDSS), Anti-MOG and AQP-4 antibodies were assessed. RESULTS Of the 55 screened, 45 children (77 eyes), median age-98 months, 30 (67%) bilateral were enrolled. Fifty of 77 eyes (67%) had Snellen visual acuity less than 6/60. Twelve children (27%) were MOG seropositive and 3 had AQP-4 positivity. At median follow up of 35 months, 10 (22%) children had one or more relapses. At follow up, the median (IQR) visual acuity improved from nadir of 2.1 (1-2.7) logMAR to 0 (0-0.18) logMAR and 64/77 eyes (83%) had visual recovery. The diagnosis at last follow up was isolated ON in 39/45 (86.6%), relapsing ON (5, 11%), AQP-4 positive NMOSD (3, 7%), MOG antibody associated demyelination (12, 27%), dual seronegative ON (30,67%) and Multiple sclerosis (1, 2%). CONCLUSIONS Most children with first demyelinating event as ON have a monophasic illness. Despite severe acute-phase visual loss, most eyes with ON will recover good visual functions. The risk of AQP-4 disease and multiple sclerosis is low in this group.
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Affiliation(s)
- Abhirami Nair
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jaspreet Sukhija
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sameer Vyas
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Amit Rawat
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Direk MÇ, Besen Ş, Öncel İ, Günbey C, Özdoğan O, Orgun LT, Sahin S, Cansu A, Yıldız N, Kanmaz S, Yılmaz S, Tekgül H, Türkdoğan D, Ünver O, Thomas GÖ, Başıbüyük S, Yılmaz D, Kurt AN, Gültutan P, Özsoy Ö, Yiş U, Kurul SH, Güngör S, Özgör B, Karadağ M, Dündar NO, Gençpınar P, Bildik O, Orak SA, Kabur ÇÇ, Kara B, Karaca Ö, Canpolat M, Gümüş H, Per H, Yılmaz Ü, Karaoğlu P, Ersoy Ö, Tosun A, Öztürk SB, Yüksel D, Atasoy E, Gücüyener K, Yıldırım M, Bektaş Ö, Çavuşoğlu D, Yarar Ç, Güngör O, Mert GG, Sarıgeçili E, Edizer S, Çetin İD, Aydın S, Diler B, Özdemir AA, Erol İ, Okuyaz Ç, Anlar B. Optic neuritis in Turkish children and adolescents: A multicenter retrospective study. Mult Scler Relat Disord 2024; 81:105149. [PMID: 38096730 DOI: 10.1016/j.msard.2023.105149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Various etiologies may underlie optic neuritis, including autoantibody-mediated disorders described in the last decade. We re-examined demographic, clinical, laboratory features and prognostic factors in pediatric patients with autoimmune optic neuritis according to current knowledge. METHODS Cases of pediatric ON from 27 centers in Türkiye diagnosed between 2009 and 2022 were included for retrospective evaluation. RESULTS The study included 279 patients, 174 females and 105 males, with a female-to-male ratio of 1.65. The average age at onset was 12.8 ± 3.4 years, and mean follow-up, 2.1 years (range: 1-12.1 years). Patients <10 years old were grouped as "prepubertal" and those ≥10 years old as "others". The diagnoses made at the end of follow-up were multiple sclerosis associated optic neuritis (n = 90, 32.3 %), single isolated optic neuritis (n = 86, 31 %), clinically isolated syndrome (n = 41, 14.7 %), myelin oligodendrocyte glycoprotein antibody associated optic neuritis (n = 22, 7.9 %), and relapsing isolated optic neuritis (n = 18, 6.5 %). Predominant diagnoses were myelin oligodendrocyte glycoprotein antibody associated optic neuritis and acute disseminated encephalomyelitis associated optic neuritis in the prepubertal group and multiple sclerosis associated optic neuritis in the older group. Recurrences were observed in 67 (24 %) patients, including 28 with multiple sclerosis associated optic neuritis, 18 with relapsing isolated optic neuritis, 11 with myelin oligodendrocyte glycoprotein antibody associated optic neuritis, 8 with aquaporin-4 antibody related optic neuritis, and 2 with chronic relapsing inflammatory optic neuropathy. Recurrences were more common among female patients. Findings supporting the diagnosis of multiple sclerosis included age of onset ≥ 10 years (OR=1.24, p = 0.027), the presence of cranial MRI lesions (OR=26.92, p<0.001), and oligoclonal bands (OR=9.7, p = 0.001). Treatment in the acute phase consisted of intravenous pulse methylprednisolone (n = 46, 16.5 %), pulse methylprednisolone with an oral taper (n = 212, 76 %), and combinations of pulse methylprednisolone, plasmapheresis, or intravenous immunoglobulin (n = 21, 7.5 %). Outcome at 12 months was satisfactory, with 247 out of 279 patients (88.5 %) demonstrating complete recovery. Thirty-two patients exhibited incomplete recovery and further combination treatments were applied. Specifically, patients with relapsing isolated optic neuritis and aquaporin-4 antibody related optic neuritis displayed a less favorable prognosis. CONCLUSION Our results suggest optic neuritis is frequently bilateral in prepubertal and unilateral in peri‑ or postpubertal patients. Age of onset 10 or older, presence of oligoclonal bands, and brain MRI findings reliably predict the development of multiple sclerosis. The risk of developing multiple sclerosis increases mostly during the second and third years of follow-up. Relapsing isolated optic neuritis remains a separate group where the pathogenesis and outcome remain unclear. Investigation of predisposing and diagnostic biomarkers and long follow-up could help to define this group.
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Affiliation(s)
- Meltem Çobanoğulları Direk
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye.
| | - Şeyda Besen
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - İbrahim Öncel
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ceren Günbey
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Orhan Özdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Leman Tekin Orgun
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - Sevim Sahin
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Ali Cansu
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Nihal Yıldız
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Seda Kanmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Sanem Yılmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Hasan Tekgül
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Dilşad Türkdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Olcay Ünver
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Gülten Öztürk Thomas
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Salih Başıbüyük
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Deniz Yılmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Ayşegül Neşe Kurt
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Pembe Gültutan
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Özlem Özsoy
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Uluç Yiş
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Semra Hız Kurul
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Serdal Güngör
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Bilge Özgör
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Meral Karadağ
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Nihal Olgaç Dündar
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Pınar Gençpınar
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Olgay Bildik
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Sibğatullah Ali Orak
- Department of Pediatrics, Division of Pediatric Neurology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Çişil Çerçi Kabur
- Department of Pediatrics, Division of Pediatric Neurology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Bülent Kara
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Ömer Karaca
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Mehmet Canpolat
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Hakan Gümüş
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Hüseyin Per
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Ünsal Yılmaz
- İzmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences Türkiye, İzmir, Türkiye
| | - Pakize Karaoğlu
- İzmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences Türkiye, İzmir, Türkiye
| | - Özlem Ersoy
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye
| | - Ayşe Tosun
- Department of Pediatrics, Division of Pediatric Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Semra Büyükkorkmaz Öztürk
- Department of Pediatrics, Division of Pediatric Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Deniz Yüksel
- Dr Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Ergin Atasoy
- Dr Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Kıvılcım Gücüyener
- Department of Pediatrics, Division of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Miraç Yıldırım
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Ömer Bektaş
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Dilek Çavuşoğlu
- Department of Pediatrics, Division of Pediatric Neurology, Afyonkarahisar Health Sciences University, Afyon, Türkiye
| | - Çoşkun Yarar
- Department of Pediatrics, Division of Pediatric Neurology, Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Olcay Güngör
- Department of Pediatrics, Division of Pediatric Neurology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Gülen Gül Mert
- Department of Pediatrics, Division of Pediatric Neurology, Cukurova University Faculty of Medicine, Adana, Türkiye
| | - Esra Sarıgeçili
- Department of Pediatrics, Division of Pediatric Neurology, Adana City Training and Research Hospital, Adana, Türkiye
| | - Selvinaz Edizer
- Department of Pediatrics, Division of Pediatric Neurology, Istanbul Bezm-i Alem Vakıf University Hospital, İstanbul, Türkiye
| | - İpek Dokurel Çetin
- Department of Pediatrics, Division of Pediatric Neurology, Balıkesir Ataturk City Hospital, Balıkesir, Türkiye
| | - Seren Aydın
- Department of Pediatrics, Division of Pediatric Neurology, Samsun Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Betül Diler
- Giresun Maternity and Children's Education and Research Hospital, Pediatric Neurology, Giresun, Türkiye
| | - Asena Ayça Özdemir
- Department of Medical Education, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - İlknur Erol
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - Çetin Okuyaz
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye
| | - Banu Anlar
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Kadam R, Fathalla W, Hosain SA, Al BinAli R. A Case of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis Responsive to Intravenous Immunoglobulin (IVIG) Therapy in a Pediatric Patient. Cureus 2023; 15:e43218. [PMID: 37565176 PMCID: PMC10411650 DOI: 10.7759/cureus.43218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 08/12/2023] Open
Abstract
We present a case of an eight-year-old boy who presented with complaints of headache, blurry vision, and eye pain. Ophthalmological exams and magnetic resonance imaging confirmed the presence of optic neuritis. Initial cerebrospinal fluid analysis was negative for all antibodies (Abs) associated with optic neuritis and other acute demyelinating syndromes, including anti-myelin oligodendrocyte glycoprotein Ab (anti-MOG-Ab). The child was treated with a course of pulse methylprednisolone therapy for five days, with significant improvement in his symptoms. However, the child went on to have a recurrent episode of optic neuritis one month after his initial presentation. Hence, investigations targeting immunological biomarkers were repeated and turned out to be positive for anti-MOG-Abs with elevated titers. The child was diagnosed with MOG-Ab-associated optic neuritis presenting as chronic relapsing inflammatory optic neuropathy (CRION). He was then started on maintenance intravenous immunoglobulin (IVIG) therapy as a disease-modifying therapy, following which he has not had any further relapses over two years.
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Affiliation(s)
- Rochita Kadam
- Pediatrics, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | - Waseem Fathalla
- Pediatric Neurology, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | - Syed A Hosain
- Pediatric Neurology, Sheikh Shakhbout Medical City, Abu Dhabi, ARE
| | - Reem Al BinAli
- Pediatric Neurology, Alberta Children's Hospital, Alberta, CAN
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Hardy D. Monophasic Acquired Demyelinating Syndromes of the Central Nervous System in Children. Semin Pediatr Neurol 2023; 46:101050. [PMID: 37451746 DOI: 10.1016/j.spen.2023.101050] [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: 02/01/2023] [Revised: 04/10/2023] [Accepted: 04/23/2023] [Indexed: 07/18/2023]
Abstract
Acquired demyelinating syndromes of the central nervous system are immune-mediated demyelinating disorders that can affect the brain, optic nerves, and spinal cord. These disorders have become increasingly recognized in children due to advances in imaging techniques, improvements in diagnostic testing, extensive research into understanding the pathophysiology underlying these disorders, and collaborative multi-institutional efforts to raise awareness of these disorders in children. Moreover, developments in the field of neuroimmunology have allowed us to identify autoantibodies that have presumed causal roles in acquired demyelinating syndromes. Identification of these autoantibodies helps determine clinical course (ie, monophasic vs relapsing course), prognosis, and treatment approach. Acquired demyelinating disorders can affect both children and adults. However, the clinical features, disease course, and treatments are often unique in the pediatric population. Thus, it is important to understand the spectrum of these disorders in children to help provide a timely diagnosis and prompt treatment to achieve optimal outcomes. In this article, the epidemiology, clinical features, diagnosis, treatment, and outcomes of the most common monophasic acquired demyelinating syndromes in children will be reviewed.
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Affiliation(s)
- Duriel Hardy
- Department of Neurology, Dell Medical School, University of Texas at Austin, Austin, TX.
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Suparmaniam S, Wan Hitam WH, Thilagaraj S. Bilateral Parainfectious Optic Neuritis in Young Patient. Cureus 2022; 14:e29220. [PMID: 36259010 PMCID: PMC9569424 DOI: 10.7759/cureus.29220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2022] [Indexed: 11/24/2022] Open
Abstract
Parainfectious optic neuritis arises from infectious aetiology either from pathogen direct invasion or after an infectious disease which can be immunologically mediated demyelination of optic nerve or, from inflammation of optic disc vasculature. We report a case of bilateral optic neuritis in a young patient. A 13-year-old boy presented with painless profound vision loss in both eyes preceded by an episode of fever two weeks prior. Visual acuity in both eyes was a perception of light. Fundoscopy showed a bilateral hyperemic swollen disc. Blood investigations were normal except for C-reactive protein and ESR was elevated. CSF analysis was also normal with no growth of micro-organisms. Both CT scans and MRIs of the brain and orbit showed normal findings. The patient was diagnosed to have parainfectious optic neuritis. He was started on intravenous methylprednisolone for five days followed by a tapering dose of oral prednisolone for a total of one month. His final visual acuity improved to 6/6 in both eyes with a normal optic disc appearance.
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6
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Abstract
The coronavirus disease 2019 (COVID-19) is now known to be associated with several ocular manifestations. The literature thoroughly discussed those that affect adults, with a lesser focus in the pediatric age group. We aim to outline the various pediatric ocular manifestations described in the literature. The manifestations may be divided into isolated events attributed to COVID-19 or occurring in the new multisystem inflammatory syndrome in children (MIS-C), a novel entity associated by COVID-19 infection. Ocular manifestations have virtually affected all ages. They manifested in neonates, infants, children, and adolescents. Episcleritis, conjunctivitis, optic neuritis, cranial nerve palsies, retinal vein occlusion, retinal vasculitis, retinal changes, orbital myositis, orbital cellulitis were reported in the literature with this emerging viral illness. Conjunctivitis was the most common ocular manifestation in MIS-C in nearly half of the patients. Other ocular manifestations in MIS-C were anterior uveitis, corneal epitheliopathy, optic neuritis, idiopathic intracranial hypertension, and retinitis. The clinical outcome was favorable, and children regain their visual ability with minimal or no deficits in most of the cases. Further follow-up may be warranted to better understand the long-term effects and visual prognosis.
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Affiliation(s)
- Muhannad A Alnahdi
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada,College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia,Department of Ophthalmology, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia,Muhannad A Alnahdi, Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada.
| | - Maan Alkharashi
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts,Department of Ophthalmology, Harvard Medical School, Boston, Massachusetts
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Lasrado A, Chattannavar G, Sachdeva V, Kekunnaya R. Optic chiasm, optic tract and deep white demyelination: an unusual distribution of myelin oligodendrocyte glycoprotein-associated demyelination (MOGAD), case report and review of literature. BMJ Case Rep 2022; 15:e249398. [PMID: 35798498 PMCID: PMC9263899 DOI: 10.1136/bcr-2022-249398] [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] [Accepted: 05/26/2022] [Indexed: 11/04/2022] Open
Abstract
A preschool girl presented with sudden-onset bilateral painless loss of vision from 2 days prior. Child's examination showed light perception vision, sluggishly reacting pupils, otherwise normal anterior segment, healthy optic disc and retina in both eyes. MRI of brain and orbit with contrast revealed thickened left part of the optic chiasm with contrast enhancement extending proximally to bilateral optic tract and hyperintensities in the left thalamus and periventricular white mater. Considering the topographical distribution of lesions in the brain, neuromyelitis optica spectrum disorder was suspected. The child was started on intravenous methylprednisolone followed by tapering oral steroids. Serological testing was positive for myelin oligodendrocyte glycoprotein (MOG) and negative for aquaporin-4 antibodies. This case represents an unusual case of MOG associated demyelination disorder where the distribution of lesions showed chiasmal involvement along with optic tract, thalamus and deep white mater lesions.
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Affiliation(s)
- Adeline Lasrado
- Fellow LVPEI, Standard Chartered LVPEI Academy of Eye Care Education, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Goura Chattannavar
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
| | - Virender Sachdeva
- Paediatric Ophthalmology, Strabismus and Neuro-ophthalmology, LV Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Ramesh Kekunnaya
- Child Sight Institute, Jasti V Ramanamma Children's Eye Care Centre, LV Prasad Eye Institute, Hyderabad, Telangana, India
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Mudri J, Warne R, Lock J, Shah S. Myelin oligodendrocyte glycoprotein antibody-associated bilateral optic neuritis with unilateral prepapillary vitreous hemorrhage. J AAPOS 2022; 26:161-164. [PMID: 35525384 DOI: 10.1016/j.jaapos.2022.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/27/2022]
Abstract
We present a case of bilateral myelin oligodendrocyte glycoprotein antibody optic neuritis (MOG-ON) with unilateral vitreous hemorrhage in a 6-year-old boy. Multidisciplinary team care, including extensive investigations and prolonged follow-up, excluded alternative causes of vitreous hemorrhage. Early suspicion and diagnosis of MOG-ON led to timely intravenous methylprednisolone treatment, with protracted oral steroid taper, resulting in complete resolution of optic nerve swelling, vitreous hemorrhage, and visual function.
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Affiliation(s)
- Joel Mudri
- Department of Ophthalmology, Fremantle Hospital, Perth WA Australia.
| | - Richard Warne
- Department of Medical Imaging, Perth Children's Hospital WA Australia
| | - Jane Lock
- Department of Ophthalmology, Perth Children's Hospital WA Australia; Department of Ophthalmology, Royal Perth Hospital, Perth WA Australia; Department of Ophthalmology, Sir Charles Gairdner Hospital, Perth WA Australia
| | - Snehal Shah
- Department of Neurology, Perth Children's Hospital, Perth WA Australia; The University of Western Australia
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9
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Yang M, Wu Y, Lai M, Song H, Li H, Sun M, Xie L, Zhou H, Xu Q, Wei S, Wu W. Clinical predictive factors for diagnosis of MOG-IgG and AQP4-IgG related paediatric optic neuritis: a Chinese cohort study. Br J Ophthalmol 2022; 106:262-266. [PMID: 33199301 DOI: 10.1136/bjophthalmol-2020-317524] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/26/2020] [Accepted: 10/19/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Different glial-autoantibodies-related paediatric optic neuritis (ON) are associated with different clinical characteristics and prognosis that require different treatments. Because glial autoantibody detection is not available in some parts of the world and there is often a delay in obtaining results, clinical factors that can be used to predict the subtype of paediatric ON are needed. METHODS This was a single-centre retrospective cohort study. Children who presented with their first ON attack and with complete clinical data were included in the analysis. Single and multiple parameters for predicting paediatric myelin oligodendrocyte glycoprotein immunoglobin-associated ON (MOG-ON) and aquaporin-4 immunoglobin-related ON (AQP4-ON) were calculated. RESULTS 78 paediatric patients had their first ON attack from January 2016 to December 2019, of whom 69 were included in the final analysis, including 33 MOG-ON cases, 17 AQP4-ON cases and 19 Seronegative-ON cases. For predicting paediatric MOG-ON, the most sensitive predictors were 'male or optic disc swelling (ODS) or bilateral' (sensitivity 0.97 (95% CI 0.82 to 1.00)) and 'follow-up visual acuity (VA) ≤0.1 logMAR or ODS' (sensitivity 0.97 (95% CI 0.82 to 1.00)), and the most specific factor was 'Age ≤11 y and simultaneous CNS involvement' (specificity 0.97 (95% CI 0.84 to 1.00)). For predicting paediatric AQP4-ON, the most sensitive predictor was 'Female or without ODS' (sensitivity 1.00 (95% CI 0.77 to 1.00)), and the most specific factors were Neurological history (sensitivity 0.94 (95% CI 0.83 to 0.98)) and follow-up VA >1.0 logMAR (sensitivity 0.96 (95% CI 0.86 to 0.99)). CONCLUSION According to our data from a Chinese paediatric cohort, using multiple parameters increases the sensitivity and specificity of diagnosing paediatric MOG-ON and AQP4-ON. These can assist clinicians in diagnosing and treating paediatric ON when glial autoantibody status is not available.
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Affiliation(s)
- Mo Yang
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Neurology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yiqun Wu
- Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | - Mengying Lai
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,Shantou University Medical College, Shantou, China
| | - Honglu Song
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Ophthalmology, Bethune International Peace Hospital, Shijiazhuang, China
| | - Hongen Li
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Mingming Sun
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Lindan Xie
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Weiping Wu
- Department of Neurology, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing, China
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10
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Pediatric Optic Neuritis: Description of Four Cases and Review of the Literature. CHILDREN-BASEL 2021; 8:children8100855. [PMID: 34682120 PMCID: PMC8534428 DOI: 10.3390/children8100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
Pediatric optic neuritis (PON) may be a clinically isolated and self-limiting event or may present in the context of underlying neurologic, infective, or systemic disease. PON has a high impact on the quality of life as it may or may not evolve into other acquired demyelinating syndromes (ADSs), such as multiple sclerosis (MS), neuromyelitis optica (NMO), or other syndromes related to the myelin oligodendrocyte glycoprotein IgG antibodies (MOG-IgG). These different PON phenotypes present variable clinical and radiological features, plasma and liquor biomarkers, and prognosis. We describe four pediatric cases presenting clinically with ON, with different etiopathogenetic pictures: one case had a probable infective etiology, while the others were associated with different demyelinating disorders (MS, NMO, syndrome related to MOG-IgG). We discuss the possible evolution of presenting ON in other ADSs, based on recent literature. A careful evaluation of the clinical and investigation findings and the natural course of PON is necessary to define its pathogenic pathway and evolution. Further prolonged follow-up studies are needed to highlight the predictors of PON evolution, its potential sequelae, and the best treatment options.
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11
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Feng C, Chen Q, Zhao G, Li Z, Chen W, Sha Y, Sun X, Wang M, Tian G. Clinical characteristics of optic neuritis phenotypes in a 3-year follow-up Chinese cohort. Sci Rep 2021; 11:14603. [PMID: 34272440 PMCID: PMC8285465 DOI: 10.1038/s41598-021-93976-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 07/05/2021] [Indexed: 11/09/2022] Open
Abstract
To evaluate the clinical characteristics of optic neuritis (ON) with different phenotypes. This prospective study recruited patients with new-onset ON between January 2015 and March 2017 who were followed-up for 3 years. They were divided into the myelin oligodendrocyte glycoprotein-seropositive (MOG-ON), aquaporin-4-seropositive (AQP4-ON), and double-seronegative (seronegative-ON) groups, and their clinical characteristics and imaging findings were evaluated and compared. Two-hundred-eighty patients (405 eyes) were included (MOG-ON: n = 57, 20.4%; AQP4-ON: n = 98, 35.0%; seronegative-ON: n = 125, 44.6%). The proportion of eyes with best-corrected visual acuity > 20/25 at the 3-year follow-up was similar between the MOG-ON and seronegative-ON groups; the proportion in both groups was higher than that in the AQP4-ON group (p < 0.001). Relapse rates were higher in the MOG-ON and AQP4-ON groups than in the seronegative-ON group (p < 0.001). Average retinal nerve fiber layer (RNFL) thickness at 3 years was similar between the MOG-ON and AQP4-ON groups (63.41 ± 13.39 and 59.40 ± 11.46 μm, p = 0.476) but both were thinner than the seronegative-ON group (74.06 ± 11.14 μm, p < 0.001). Macular ganglion cell-inner plexiform layer (GCIPL) revealed the same pattern. Despite RNFL and GCIPL thinning, the MOG-ON group’s outcome was as favorable as that of the seronegative-ON group, whereas the AQP4-ON group showed unsatisfactory results.
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Affiliation(s)
- Chaoyi Feng
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Qian Chen
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China
| | - Guixian Zhao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhenxin Li
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Weimin Chen
- Department of Neurology, Shanghai Deji Hospital, Shanghai, China
| | - Yan Sha
- Department of Radiology, Eye Ear Nose and Throat Hospital of Fudan University, Shanghai, China
| | - Xinghuai Sun
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China.,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China
| | - Min Wang
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China.
| | - Guohong Tian
- Department of Ophthalmology, Eye Ear Nose and Throat Hospital of Fudan University, 83 Fenyang Road, Shanghai, 200031, China. .,State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China.
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12
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Sachdeva V, Kekunnaya R. Working up a child with demyelinating optic neuritis: Striking a balance! Oman J Ophthalmol 2021; 14:74-77. [PMID: 34345139 PMCID: PMC8300277 DOI: 10.4103/ojo.ojo_105_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/09/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
Pediatric optic neuritis (PON) is one of the commonest causes of acute vision loss in children. Although it might often be postinfectious or postvaccination, recent understanding and available evidence suggest that it can be the first manifestation of a neuro-inflammatory syndrome such as multiple sclerosis, neuromyelitis optica spectrum disorder, acute disseminated encephalomyelitis or myelin oligodendrocyte glycoprotein associated optic neuritis. Therefore, neuroimaging, serological testing, cerebrospinal fluid analysis, testing for various systemic autoimmune conditions become a part of the workup. However, this can be exhaustive and expensive, especially in countries with limited access to health insurance. Many recent studies suggest that neuroimaging and few clinical features can provide clues to the underlying etiology. However, serological tests can provide a confirmatory evidence. Therefore, in this mini-review, we propose a balanced approach to the evaluation of PON, based on the available literature emanating in the last decade.
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Affiliation(s)
- Virender Sachdeva
- Nimmagadda Prasad Childrenfs Eye Care Centre, Child Sight Institute, Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, L V Prasad Eye Institute, Visakhapatnam, Andhra Pradesh, India
| | - Ramesh Kekunnaya
- Jasti V Ramanamma Childrenfs Eye Care Centre, Child Sight Institute, Department of Pediatric Ophthalmology, Strabismus and Neuro-Ophthalmology, L V Prasad Eye Institute, Hyderabad, Telangana, India
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13
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Schmidt MF, Pihl-Jensen G, Bille MB, Frederiksen JL. Anti-myelin oligodendrocyte glycoprotein antibodies in a girl with good recovery after five episodes of prior idiopathic optic neuritis. Am J Ophthalmol Case Rep 2021; 22:101060. [PMID: 33997466 PMCID: PMC8100534 DOI: 10.1016/j.ajoc.2021.101060] [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: 05/26/2020] [Revised: 01/19/2021] [Accepted: 02/20/2021] [Indexed: 11/26/2022] Open
Abstract
Purpose To describe the clinical, radiological, immunological and electrophysiological features of a myelin oligodendrocyte glycoprotein (MOG)-IgG positive girl with five prior episodes of idiopathic bilateral optic neuritis (ON). Observations We report a Danish girl who has been followed by pediatricians and pediatric neurologists since the age of 10 with recurrent episodes of idiopathic bilateral ON. Since the age of 15 there has been no recurrence of ON, and the patient has been thoroughly investigated for Multiple Sclerosis (MS) several times, but with negative findings. At the age of 19 the patient was referred to the Clinic of Optic Neuritis where she was tested seropositive for antibodies against MOG (MOG- IgG) on a conventionally cell-based assay. Despite 5 previous episodes of ON, the latency and amplitude signals of pattern-reversal visual evoked potentials (pVEP) including multifocal VEP were detected within the normal range. Conclusion The clinical implications of MOG- IgG are not yet clear, but in cases where the diagnosis of MS is less likely and where ON is the main symptom, testing for both IgG antibodies against AQP4 and MOG while having atypical optic neuropathies in mind is important. MOG-IgG positive patients may have a good prognosis with regards to visual function.
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Affiliation(s)
- Mathias Falck Schmidt
- Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | - Gorm Pihl-Jensen
- Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Department of Neurology, Rigshospitalet - Glostrup, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
| | | | - Jette Lautrup Frederiksen
- Clinic of Optic Neuritis, The Danish Multiple Sclerosis Center (DMSC), Department of Neurology, Rigshospitalet - Glostrup, University of Copenhagen, Valdemar Hansens Vej 13, 2600, Glostrup, Denmark
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14
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15
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Milea D. Pediatric Optic Neuritis-Building Foundations for a Randomized Clinical Trial. JAMA Ophthalmol 2020; 138:1262-1263. [PMID: 33057675 DOI: 10.1001/jamaophthalmol.2020.4250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Dan Milea
- Singapore National Eye Centre, Singapore.,Singapore Eye Research Institute, Singapore.,Duke-NUS Medical School, Singapore
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16
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Bruijstens AL, Lechner C, Flet-Berliac L, Deiva K, Neuteboom RF, Hemingway C, Wassmer E, Baumann M, Bartels F, Finke C, Adamsbaum C, Hacohen Y, Rostasy K. E.U. paediatric MOG consortium consensus: Part 1 - Classification of clinical phenotypes of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders. Eur J Paediatr Neurol 2020; 29:2-13. [PMID: 33162302 DOI: 10.1016/j.ejpn.2020.10.006] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022]
Abstract
Over the past few years, increasing interest in the role of autoantibodies against myelin oligodendrocyte glycoprotein (MOG-abs) as a new candidate biomarker in demyelinating central nervous system diseases has arisen. MOG-abs have now consistently been identified in a variety of demyelinating syndromes, with a predominance in paediatric patients. The clinical spectrum of these MOG-ab-associated disorders (MOGAD) is still expanding and differs between paediatric and adult patients. This first part of the Paediatric European Collaborative Consensus emphasises the diversity in clinical phenotypes associated with MOG-abs in paediatric patients and discusses these associated clinical phenotypes in detail. Typical MOGAD presentations consist of demyelinating syndromes, including acute disseminated encephalomyelitis (ADEM) in younger, and optic neuritis (ON) and/or transverse myelitis (TM) in older children. A proportion of patients experience a relapsing disease course, presenting as ADEM followed by one or multiple episode(s) of ON (ADEM-ON), multiphasic disseminated encephalomyelitis (MDEM), relapsing ON (RON) or relapsing neuromyelitis optica spectrum disorders (NMOSD)-like syndromes. More recently, the disease spectrum has been expanded with clinical and radiological phenotypes including encephalitis-like, leukodystrophy-like, and other non-classifiable presentations. This review concludes with recommendations following expert consensus on serologic testing for MOG-abs in paediatric patients, the presence of which has consequences for long-term monitoring, relapse risk, treatments, and for counselling of patient and families. Furthermore, we propose a clinical classification of paediatric MOGAD with clinical definitions and key features. These are operational and need to be tested, however essential for future paediatric MOGAD studies.
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Affiliation(s)
| | - Christian Lechner
- Department of Paediatrics, Division of Paediatric Neurology, Medical University of Innsbruck, Austria
| | - Lorraine Flet-Berliac
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Kumaran Deiva
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France; French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, European Reference Network-RITA, France
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
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17
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Parrotta E, Kister I. The Expanding Clinical Spectrum of Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Associated Disease in Children and Adults. Front Neurol 2020; 11:960. [PMID: 33013639 PMCID: PMC7509044 DOI: 10.3389/fneur.2020.00960] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 07/24/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Erica Parrotta
- Saint Peter's Health Partners, Saint Peter's MS & Headache Center, Albany, NY, United States
| | - Ilya Kister
- New York University Langone Medical Center, Multiple Sclerosis Comprehensive Care Center, New York, NY, United States
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18
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Server Alonso A, Sakinis T, Pfeiffer HCV, Sandvig I, Barlinn J, Marthinsen PB. Understanding Pediatric Neuroimmune Disorder Conflicts: A Neuroradiologic Approach in the Molecular Era. Radiographics 2020; 40:1395-1411. [PMID: 32735475 DOI: 10.1148/rg.2020200032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuroimmune disorders in children are a complex group of inflammatory conditions of the central nervous system with diverse pathophysiologic mechanisms and clinical manifestations. Improvements in antibody analysis, genetics, neuroradiology, and different clinical phenotyping have expanded knowledge of the different neuroimmune disorders. The authors focus on pediatric-onset myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease, which is a new entity in the spectrum of inflammatory demyelinating diseases, distinct from both multiple sclerosis (MS) and anti-aquaporin-4 (AQP4) antibody neuromyelitis optica spectrum disorders (NMOSDs). The authors review the importance of an optimized antibody-detection assay, the frequency of MOG antibodies in children with acquired demyelinating syndrome (ADS), the disease course, the clinical spectrum, proposed diagnostic criteria, and neuroimaging of MOG antibody-associated disease. Also, they outline differential diagnosis from other neuroimmune disorders in children according to the putative primary immune mechanism. Finally, they recommend a diagnostic algorithm for the first manifestation of ADS or relapsing ADS that leads to four demyelinating syndromes: MOG antibody-associated disease, AQP4 antibody NMOSDs, MS, and seronegative relapsing ADS. This diagnostic approach provides a framework for the strategic role of neuroradiology in diagnosis of ADS and decision making, to optimize patient care and treatment outcome in concert with clinicians. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Andres Server Alonso
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Tomas Sakinis
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Helle Cecilie V Pfeiffer
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Inger Sandvig
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Jon Barlinn
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
| | - Pål B Marthinsen
- From the Section of Neuroradiology, Department of Radiology and Nuclear Medicine (A.S.A., T.S., P.B.M.), and Department of Child Neurology (H.C.V.P., I.S., J.B.), Oslo University Hospital-Rikshospitalet, Postboks 4950 Nydalen, 0424 Oslo, Norway
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