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Joseph J, Feizi P, Pasham SR, Sharma K, Srivastava S, Elkhooly M, Nirwan L, Jaiswal S, Sriwastava S. Relevance of bright spotty lesions in neuromyelitis optica spectrum disorders (NMOSD): a case series. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2022. [DOI: 10.1186/s41983-022-00601-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Abstract
Background
Neuromyelitis optica (NMO), or neuromyelitis optica spectrum disorder (NMOSD), is an autoimmune CNS condition which often has a complex clinical course. Longitudinally extensive transverse myelitis (LETM) is an important and sensitive MRI finding but is not very specific to NMOSD and is seen in other causes of myelitis.
Case presentations
We report 11 NMO cases, all seen in women from 25 to 75 years at the time of diagnosis, with most above 65 years of age. All patients were seropositive for AQP4–IgG antibodies, and none had anti-MOG antibodies. Clinical presentations were diverse, the most common being paralytic and visual changes. In this study, 5 of the 11 seropositive NMO patients (45%) had bright spotty lesion (BSLs) on their MRI spine, as opposed to none (0%) in the control group. BSLs were defined as hyperintense foci of signal abnormality on T2-weighted images compared to the surrounding CSF. Treatment included symptomatic management and immunotherapy; timely management led to improvement in all the cases, with partial recovery seen in most (91%) and complete recovery seen only in one.
Conclusions
BSLs are a newly defined spinal MRI finding with high specificity, but low sensitivity for NMOSD. The absence of BSLs in the control group establishes its prolific role in distinguishing NMO from MS, ITM, MOGAD and other forms of myelitis. The main aim of this retrospective case–control study was to determine the diagnostic importance and specificity of bright spotty lesions (BSLs) in NMOSD and its ability to discriminate NMOSD from other causes of LETM.
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Galym A, Akhmetova N, Zhaksybek M, Safina S, Boldyreva MN, Rakhimbekova FK, Idrissova ZR. Clinical and Genetic Analysis in Pediatric Patients with Multiple Sclerosis and Related Conditions: Focus on DR Genes of the Major Histocompatibility Complex. Open Neurol J 2022. [DOI: 10.2174/1874205x-v16-e2207200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction:
There are several diseases recognized as variants of MS: post-infectious acute disseminated encephalitis, multiple sclerosis (MS), Rasmussen leukoencephalitis and Schilder's leukoencephalitis and related, but separate neuroimmune condition – Neuromyelitis Devic’s. In Kazakhstan diagnosis of such diseases was rare and immune modified treatment was only admitted after the age of 18. Clinical and immunogenetic study of MS spectrum diseases in Kazakhstan would allow to justify early targeted treatment.
Objective:
The aim of the study was to investigate genes of the main complex of human histocompatibility (MHC) associated with diseases of MS spectrum in Kazakhstani population.
Methods:
Complex clinical, neuroimaging and immunogenetic studies were performed in 34 children (24 girls, 10 boys) aged 4 to 18 years. 21 children were diagnosed with MS (11 Kazakh origin and 10 – Russian; 4 boys, 17 girls), 7 with leucoencephalitis (all Kazakh, 5 boys, 2 girls) and 6 with Devic neuromyelitis optica (all Kazakh, 1 boy, 5 girls). Genotyping of HLA DRB1, DQA1, DQB1 genes was performed for all patients.
Results:
MS group was characterized by classical relapsing-remitting MS. Predominant haplotype as a linkage complex was DRB1*15:01~DQA1*01:02~DQB1*06:02 in 20 (47.6%) of 42 DR-alleles, in 16 (76.2%) patients. MS relative risk (RR) was 13,36 for ethnic Kazakhs and RR=5,55 in Russians.
Leukoencephalitis had 7 children, with 28.6% mortality rate. The haplotype DRB1*15:01~DQA1*01:02~DQB1*06:02 as a linkage complex was detected 3 patients (4 alleles), RR=5,88.
Devic’s neuromyelitis optica (NMO) clinical course was characterized by fast and prolonged progression. There was predominance of DRB1*14 allele with RR=3,38.
Conclusion:
Summarizing, in the Kazakh population the haplotype DRB1*15:01∼DQA1*01:02∼DQB1*06:02 as a linkage complex was associated with prediction to MS and leukoencephalitis, but not to Devic’s NMO. Our study highlights the importance of awareness of MS and related disorders diagnosis which allows to implement early admission of disease-modified treatment in pediatric MS in Kazakhstan.
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Zhou L, He Z, Zhu L, Zhu JJ, Zhu JH, Pan J. Association Analysis Between HLA-DQA1 Loci and Neuromyelitis Optica Spectrum Disorder in a Han Chinese Population. Neurologist 2022; 27:164-167. [PMID: 34873111 PMCID: PMC9257051 DOI: 10.1097/nrl.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Genome-wide association studies for neuromyelitis optica spectrum disorder (NMOSD) have established an association between HLA-DQ alpha 1 (DQA1) and risk for NMOSD. Though ethnicity is generally considered a major influencing factor in genetic analyses, little is known regarding the association of HLA-DQA1 polymorphisms with NMOSD in the Han population, especially the single-nucleotide polymorphisms (SNPs) at HLA-DQA1 . METHODS We genotyped SNP at loci rs28383224 in a case-control study consisting of 137 subjects (51 patients with NMOSD and 86 unrelated controls were recruited) of Han ethnicity. Logistic regression was used to test the association of SNP with NMOSD susceptibility, the sex and age were adjusted, odds ratios and 95% confidence intervals were estimated. RESULTS The rs28383224 polymorphism and susceptibility to NMOSD were not statistically associated ( P >0.05) in the Han population in the current study. No significant difference was found in allelic frequencies or genotypic distributions among different subsets of NMOSD patients ( P >0.05). CONCLUSION In the current study, there is no evidence that polymorphism of rs28383224 in the HLA-DQA1 gene is associated with the risk of NMOSD in the Han Chinese population.
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Affiliation(s)
| | | | | | | | - Jian-Hong Zhu
- Departments of Neurology
- Department of Preventive Medicine, Wenzhou Medical University, Wenzhou, Zhejiang Province, China
| | - Jialin Pan
- Cardiology, The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University
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Soerensen SF, Wirenfeldt M, Wlodarczyk A, Moerch MT, Khorooshi R, Arengoth DS, Lillevang ST, Owens T, Asgari N. An Experimental Model of Neuromyelitis Optica Spectrum Disorder-Optic Neuritis: Insights Into Disease Mechanisms. Front Neurol 2021; 12:703249. [PMID: 34367056 PMCID: PMC8345107 DOI: 10.3389/fneur.2021.703249] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/14/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Optic neuritis (ON) is a common inflammatory optic neuropathy, which often occurs in neuromyelitis optica spectrum disease (NMOSD). An experimental model of NMOSD-ON may provide insight into disease mechanisms. Objective: To examine the pathogenicity of autoantibodies targeting the astrocyte water channel aquaporin-4 [aquaporin-4 (AQP4)-immunoglobulin G (AQP4-IgG)] in the optic nerve. Materials and Methods: Purified IgG from an AQP4-IgG-positive NMOSD-ON patient was together with human complement (C) given to wild-type (WT) and type I interferon (IFN) receptor-deficient mice (IFNAR1-KO) as two consecutive intrathecal injections into cerebrospinal fluid via cisterna magna. The optic nerves were isolated, embedded in paraffin, cut for histological examination, and scored semi-quantitatively in a blinded fashion. In addition, optic nerves were processed to determine selected gene expression by quantitative real-time PCR. Results: Intrathecal injection of AQP4-IgG+C induced astrocyte pathology in the optic nerve with loss of staining for AQP4 and glial fibrillary acidic protein (GFAP), deposition of C, and demyelination, as well as upregulation of gene expression for interferon regulatory factor-7 (IRF7) and CXCL10. Such pathology was not seen in IFNAR1-KO mice nor in control mice. Conclusion: We describe induction of ON in an animal model for NMOSD and show a requirement for type I IFN signaling in the disease process.
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Affiliation(s)
- Sofie Forsberg Soerensen
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Martin Wirenfeldt
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Agnieszka Wlodarczyk
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Marlene Thorsen Moerch
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Reza Khorooshi
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Dina S Arengoth
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Trevor Owens
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark
| | - Nasrin Asgari
- Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.,Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
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Petzold A, Braithwaite T, van Oosten BW, Balk L, Martinez-Lapiscina EH, Wheeler R, Wiegerinck N, Waters C, Plant GT. Case for a new corticosteroid treatment trial in optic neuritis: review of updated evidence. J Neurol Neurosurg Psychiatry 2020; 91:9-14. [PMID: 31740484 PMCID: PMC6952848 DOI: 10.1136/jnnp-2019-321653] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/20/2019] [Accepted: 10/16/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Axel Petzold
- Expertise Centrum Neuro-ophthalmology, Departments of Neurology & Ophthalmology, Amsterdam UMC, Amsterdam, The Netherlands .,Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, UCL Institute of Neurology, London, UK
| | - Tasanee Braithwaite
- Neuro-ophthalmology, Moorfields Eye Hospital and The National Hospital for Neurology & Neurosurgery, London, UK
| | | | - Lisanne Balk
- Neurology, VU University Medical Center, Amsterdam, The Netherlands
| | - Elena H Martinez-Lapiscina
- Center of Neuroimmunology and Service of Neurology, Clinic Barcelona Hospital University, Barcelona, Spain
| | | | - Nils Wiegerinck
- )Patient Organisation (Neuro-ophthalmology), Lisbon, Portugal
| | - Christiaan Waters
- Neuro-ophthalmologie Vereniging Nederland (KvK nummer 66260140), Amsterdam, Netherlands
| | - Gordon T Plant
- ,National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, St. Thomas Hospital, Moorfields Eye Hospital, London, UK
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Zhang J, Ji T, Chen Q, Jiang Y, Cheng H, Zheng P, Ma W, Lei T, Zhang Y, Jin Y, Wei C, Wu Y, Chang X, Bao X, Zhang Y, Xiong H, Ji X, Feng S, Ren H, Yang J, Jiang Y. Pediatric Autoimmune Encephalitis: Case Series From Two Chinese Tertiary Pediatric Neurology Centers. Front Neurol 2019; 10:906. [PMID: 31507515 PMCID: PMC6714292 DOI: 10.3389/fneur.2019.00906] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 08/05/2019] [Indexed: 12/15/2022] Open
Abstract
Background and purpose: We retrospectively analyzed the clinical characteristics of children with autoimmune encephalitis (AE) in two Chinese tertiary pediatric neurology centers. We also compared anti-NMDAR encephalitis with and without co-positive MOG antibody, as well as specific autoantibody-positive AE and autoantibody-negative but probable AE. Methods: A retrospective study of children (0-18 years old) with AE in Peking University First Hospital and Children's Hospital Affiliated to Capital Institute of Pediatrics was carried out from May 2012 to January 2017. Demographics, clinical features, laboratory, and imaging findings, outcome, and co-positivity with MOG antibody were analyzed. Results: A total of 103 children had AE, 89 (86.4%) had anti-NMDAR encephalitis, 2 (1.9%) had anti-LGI1 encephalitis, 1 (0.9%) had anti-CASPR2 encephalitis, and 11 (10.7%) were diagnosed as autoantibody-negative but probable AE. Among the 89 children with anti-NMDAR encephalitis, 35 were males and 54 were females. The follow-up time was 1-3 years. A total of 15 cases (15/89, 16.9%) with anti-NMDAR encephalitis had co-positive MOG antibody (serum or cerebrospinal fluid or both). These patients were more likely to experience relapse later in life (P = 0.014). We had two cases with anti-LGI1 encephalitis, that is, one with sleep disorder onset, and the other one with seizure onset, both of whom recovered after treatment. One case with anti-CASPR2 encephalitis was treated with an antiepileptic drug and fully recovered. There were 11 cases diagnosed as autoantibody-negative but probable AE who had relatively poorer outcome than those with autoantibody-positive AE (15.2%, 14/89). However, the difference was not significant (P = 0.08). Only one 12-year-old girl with NMDAR-antibody AE had ovarian teratoma. Conclusion: Most subjects with AE in our Chinese cohort had anti-NMDAR AE, which had relatively good prognosis. Children with anti-LGI1 or anti-CASPR2 encephalitis were rare and showed good response on immunotherapy. Co-positive MOG antibody was relatively common in anti-NMDAR encephalitis, which was related to high relapse rate. In our study, the prognosis of autoantibody-negative but probable AE seemed worse than that of specific autoantibody-positive AE.
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Affiliation(s)
- Jianzhao Zhang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Taoyun Ji
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Qian Chen
- Department of Pediatric Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, Beijing, China
| | - Yanan Jiang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Huan Cheng
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Ping Zheng
- Department of Pediatric Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, Beijing, China
| | - Wenqiang Ma
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Ting Lei
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Yao Zhang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Yiwen Jin
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Cuijie Wei
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Ye Wu
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Xingzhi Chang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Xinhua Bao
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Yuehua Zhang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Hui Xiong
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
| | - Xinna Ji
- Department of Pediatric Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, Beijing, China
| | - Shuo Feng
- Department of Pediatric Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, Beijing, China
| | - Haitao Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China
| | - Jian Yang
- Department of Pediatric Neurology, Children's Hospital Affiliated to the Capital Institute of Pediatrics, Beijing, China
| | - Yuwu Jiang
- Division of Pediatric Neurology, Pediatrics Department, Peking University First Hospital, Beijing, China
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7
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Dal-Bianco A, Wenhoda F, Rommer PS, Weber M, Altmann P, Kraus J, Leutmezer F, Salhofer-Polanyi S. Do elevated autoantibodies in patients with multiple sclerosis matter? Acta Neurol Scand 2019; 139:238-246. [PMID: 30447159 DOI: 10.1111/ane.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 11/08/2018] [Accepted: 11/11/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The incidence and clinical impact of serum autoantibodies in patients with multiple sclerosis (MS) are controversially discussed. The aim of the study was to reassess the value of elevated serum autoantibodies in our MS study cohort. MATERIAL & METHODS In total, 176 MS patients were retrospectively analyzed for coexistence and clinical impact of increased serum autoantibody levels. RESULTS The 18.8% of the MS cohort showed elevated serum autoantibody levels, but only 10.2% of all MS patients were diagnosed with a further autoimmune disease (AI). Patients with elevated serum autoantibodies (AABS) were not significantly more often diagnosed with a clinical manifest AI as compared to patients with negative autoantibodies (P = 0.338). MS patients with disease duration of more than 10 years showed no significant increase of positive autoantibodies as compared to patients with a more recent disease onset (P = 1). MS patients with elevated serum autoantibodies did not exhibit a significantly worse disease course (P = 0.428). CONCLUSIONS According to our data, elevated serum autoantibodies do not have the potential to serve as a prognostic tool for disease severity in patients with MS Since MS patients with positive serum AABS did not significantly more often suffer from clinical manifest AIs than MS patients with negative serum AABS, the role of routine testing of serum AABS in MS patients should be critically called into question.
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Affiliation(s)
| | - Fritz Wenhoda
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | | | - Michael Weber
- Department of Radiology; Medical University of Vienna; Vienna Austria
| | - Patrick Altmann
- Department of Neurology; Medical University of Vienna; Vienna Austria
| | - Jörg Kraus
- Department of Laboratory Medicine; Paracelsus Medical University and Salzburger Landeskliniken; Salzburg Austria
- Department of Neurology, Medical Faculty; Heinrich-Heine-University; Düsseldorf Germany
| | - Fritz Leutmezer
- Department of Neurology; Medical University of Vienna; Vienna Austria
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Fan S, Xu Y, Ren H, Guan H, Feng F, Gao X, Ding D, Fang F, Shan G, Guan T, Zhang Y, Dai Y, Yao M, Peng B, Zhu Y, Cui L. Comparison of myelin oligodendrocyte glycoprotein (MOG)-antibody disease and AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) when they co-exist with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis. Mult Scler Relat Disord 2018; 20:144-152. [PMID: 29414288 DOI: 10.1016/j.msard.2018.01.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 12/23/2017] [Accepted: 01/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG)-antibody (ab) disease and AQP4-IgG-positive neuromyelitis optica spectrum disorder (NMOSD) can co-exist with anti-NMDA (N-methyl-D-aspartate) receptor encephalitis (NMDARe). OBJECTIVES To characterize MOG-ab disease and AQP4-IgG-positive NMOSD during NMDARe. METHODS We analyzed all the patients with overlapping MOG-ab disease and NMDARe (MNOS) and patients with AQP4-IgG-positive NMOSD and NMDARe (ANOS) in our hospital and compared those data with data from systematically review of previously published reports. RESULTS In our cohorts, 11.9% patients with MOG-ab disease and 0.6% patients with NMOSD had overlapping NMDARe (P < 0.01). After treatment with steroids and/or intravenous immunoglobulin (IVIg), the median modified Rankin Scale (mRS) of the MNOS group decreased significantly during attacks associated with or without NMDARe (P < 0.01 for both), while that of the ANOS group did not (attack: P < 0.05; attack associated with NMDARe: P > 0.05). Analyzed together with previously reported cases, 6% patients with MNOS and 40% patients with ANOS also used rituximab or cyclophosphamide after steroids and/or IVIg (P < 0.05) during attacks associated with NMDARe. CONCLUSION Compared with NMOSD, MOG-ab disease may more commonly co-exist with NMDARe. MNOS patients respond better to steroids and IVIg than do ANOS patients during attacks associated with NMDARe.
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Affiliation(s)
- Siyuan Fan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan Xu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Haitao Ren
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongzhi Guan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Feng Feng
- Department of Radiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xuehui Gao
- Department of Laboratory, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ding Ding
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, China
| | - Guangliang Shan
- Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, Beijing, China; School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Tianjia Guan
- School of Public Health, Peking Union Medical College, Beijing, China
| | - Yao Zhang
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi Dai
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bin Peng
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Liying Cui
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; Neurosciences Center, Chinese Academy of Medical Sciences, Beijing, China
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9
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Sahraian MA, Moghadasi AN, Azimi AR, Asgari N, H Akhoundi F, Abolfazli R, Alaie S, Ashtari F, Ayromlou H, Baghbanian SM, Moghadam NB, Fatehi F, Foroughipour M, Langroodi HG, Majdinasab N, Nickseresht A, Nourian A, Shaygannejad V, Torabi HR. Diagnosis and management of Neuromyelitis Optica Spectrum Disorder (NMOSD) in Iran: A consensus guideline and recommendations. Mult Scler Relat Disord 2017; 18:144-151. [PMID: 29141797 DOI: 10.1016/j.msard.2017.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a relapsing neuro inflammatory disease of the central nervous system that typically presents with optic neuritis or myelitis and may cause severe disability. The diagnostic criteria have been updated and several immunosuppressive agents have been demonstrated to prevent acute exacerbations. As the disease rarely develops in a progressive course, management of acute attacks and proper prevention of exacerbations may change the long term out-come and prevent future disability. Consensus recommendations and guidelines will help the physicians to improve their practice and unify the treatment approaches in different communities. In order to develop a national consensus and recommendations for the diagnosis and management of NMOSD in Iran, a group of neurologists with long term experience in management of NMOSD were gathered to develop this consensus based on available national and international data. The primary draft was prepared and discussed to suggest the most appropriate treatment for these patients. We propose strategies for early diagnosis and treatment for prevention of relapses and minimizing consequences of attacks as a primary therapeutic goal. Attacks are currently treated with intravenous corticosteroids and, in refractory cases, with plasma exchange. All participants agreed on preventive treatment with currently available immunosuppressive agents such as azothioprin, rituximab and mycofenolate mofetil based on previous positive data in NMOSD in order to reduce attack frequency. The current consensus reviews the previous data and provides the clinicians with practical recommendations and advices for the diagnosis and management of NMOSD based on scientific data and clinical experience.
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Affiliation(s)
- Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran.
| | | | - Amir Reza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran
| | - Nasrin Asgari
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Denmark
| | - Fahimeh H Akhoundi
- Department of Neurology, Firozgar Hospital, Iran University of Medical Sciences, Iran
| | - Roya Abolfazli
- Department of Neurology, Amiralam Hospital, Tehran University of Medical Sciences, Iran
| | | | - Fereshteh Ashtari
- Department of Neurology, Kashani Hospital, Isfahan University of Medical Sciences, Iran; Isfahan neurosciences research center, Alzahra Hospital, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hormoz Ayromlou
- Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Iran
| | | | - Nahid Beladi Moghadam
- Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Iran
| | - Farzad Fatehi
- Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Mohsen Foroughipour
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Iran
| | | | - Nastaran Majdinasab
- Department of Neurology, Golestan Hospital, Ahwaz University of Medical Sciences, Iran
| | - Alireza Nickseresht
- Department of Neurology, Namazi Hospital, Shiraz University of Medical Sciences, Iran
| | - Abbas Nourian
- Islamic Azad University, Faculty of Medicine, Khorasan Razavi Branch, Iran
| | - Vahid Shaygannejad
- Isfahan neurosciences research center, Alzahra Hospital, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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10
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Time is vision in recurrent optic neuritis. Brain Res 2017; 1673:95-101. [PMID: 28823952 DOI: 10.1016/j.brainres.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
In optic neuritis (ON) inflammation precedes onset of demyelination and axonal loss. The anti-inflammatory properties of corticosteroids may be most effective in the early inflammatory phase, but rapid patient recruitment remains a logistic challenge. The aim of the study was to review the effect of time to initiation of treatment on visual outcome in recurrent ON. A retrospective case note review of patients known to our centre with recurrent ON. The primary clinical outcome was change of best corrected high contrast visual acuity (BCVA). The secondary outcome was the change of optical coherence tomography (OCT) thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell layer (mGCL) from baseline and after a minimum of 3months following the episode of recurrent ON. Of 269 patients with a previous episode of ON, 54 experienced recurrent ON. In total 40 OCT documented episodes of relapsing ON were captured in 19 patients. Treatment within <2days led to better recovery of the BCVA (+0.02) and mGCL (-2.4µm) if compared to delayed treatment (BCVA -0.2, p=0.036, mGCL -25.6µm, p=0.019) or no corticosteroids treatment (BCVA -0.2, p=0.045, GCL -5.0µm, p=0.836). These data suggest a beneficial effect of hyperacute corticosteroid treatment. A pragmatic approach for a prospective treatment trial should consider patients with recurrent ON for logistic reasons.
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Abstract
OBJECTIVE The aim of this study was to report the frequency of autoimmune disorders and autoantibodies in 22 patients with neuromyelitis optica (NMO), as well as whether the seropositivity for autoantibodies differs between anti-aquaporin 4 (AQP4) positive and AQP4 negative NMO patients. METHODS Demographic, medical records, and a profile of autoantibodies were evaluated in 22 NMO patients, including AQP4, anti-thyroid-stimulating hormone receptor, antinuclear antibodies (ANA), anti-thyroperoxidase (anti-TPO), anti-thyroglobulin (anti-Tg), anti-double-stranded DNA, anti-neutrophil cytoplasmic, anti-cyclic citrullinate peptide, rheumatoid factor, anti-SSA/Ro, anti-SSB/La, anti-Smith antibodies (anti-Sm), anti-ribonucleoprotein, anti-nucleosome, and anti-Scl70. Thyroid-stimulating hormone and free thyroxin were measured. RESULTS The frequency of women was higher than men (95.5% vs. 4.5%) and 68.2% were Afro-Brazilians. Six (27.3%) patients presented other autoimmune disorders, such as Hashimoto thyroiditis (n=2), Graves' disease (n=1), juvenile idiopathic arthritis (n=1), systemic lupus erythematosus and systemic sclerosis (n=1), and Raynaud's phenomenon (n=1). The most frequent autoantibodies were anti-AQP4 (54.5%), anti-nucleosome (31.8%), ANA (27.3%), anti-TPO (22.7%), and anti-Tg (22.7%). Difference was not observed in the frequency of autoimmune disorders when the patients were compared according to their anti-AQP4 status. CONCLUSION The results of the present study underscored that the NMO patients present high frequency of autoantibodies against cellular antigens and the presence of autoimmune disorders. Further studies with large number of NMO patients may contribute to advances in the understanding of NMO disease mechanisms.
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Sánchez-Catasús CA, Cabrera-Gomez J, Almaguer Melián W, Bosch Bayard J, Rodríguez Rojas R, Valdes-Sosa P. The number of optic neuritis attacks is a potential confounder when comparing patients with NMO vs. controls by voxel-based neuroimaging analysis. Acta Radiol 2016; 57:985-91. [PMID: 26503959 DOI: 10.1177/0284185115610935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/02/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Voxel-based morphometric (VBM) studies in neuromyelitis optica (NMO) have shown limited reproducibility. A previous study suggests that the number of optic neuritis (ON) attacks may be a confounding factor when comparing NMO patients with controls if it is not taken into account during VBM analysis. PURPOSE To investigate the potential confounding effect of the number of ON attacks, for both tissue volumes and perfusion by voxel-based statistical analysis. MATERIAL AND METHODS Volumetric magnetic resonance imaging (MRI) and perfusion SPECT were obtained from 15 controls and two patient subgroups: subgroup I was composed of nine patients with one or two ON attacks; and subgroup II of six patients with three or four ON attacks. We performed non-parametric voxel-based comparison of tissue volumes and perfusion between controls versus the two patient subgroups and for the whole patient group. RESULTS Subgroup I presented no volume reductions, contrary to subgroup II that showed unequivocal reduction. We also found hypoperfusion in different brain regions in different subgroups. The results were quite different for the whole patient group. CONCLUSION These findings highlight the confounding effect of the number of ON attacks, providing a new methodological insight that could explain the limited reproducibility of previous VBM studies in NMO.
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Affiliation(s)
- Carlos A Sánchez-Catasús
- Department of Nuclear Medicine, Center for Neurological Restoration (CIREN), Havana, Cuba
- Department of Neuroimaging and Neuroinformatics, Cuban Neuroscience Center, Havana, Cuba
| | - José Cabrera-Gomez
- Department of Neurology, Center for Neurological Restoration (CIREN), Havana, Cuba
| | - William Almaguer Melián
- Department of Experimental Neurophysiology, Center for Neurological Restoration (CIREN), Havana, Cuba
| | - Jorge Bosch Bayard
- Department of Neuroimaging and Neuroinformatics, Cuban Neuroscience Center, Havana, Cuba
| | - Rafael Rodríguez Rojas
- Department of Nuclear Medicine, Center for Neurological Restoration (CIREN), Havana, Cuba
| | - Pedro Valdes-Sosa
- Department of Neuroimaging and Neuroinformatics, Cuban Neuroscience Center, Havana, Cuba
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Yang T, Wang S, Zheng Q, Wang L, Li Q, Wei M, Du Z, Fan Y. Increased plasma levels of epithelial neutrophil-activating peptide 78/CXCL5 during the remission of Neuromyelitis optica. BMC Neurol 2016; 16:96. [PMID: 27401736 PMCID: PMC4940958 DOI: 10.1186/s12883-016-0622-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/23/2016] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND In neuromyelitis optica (NMO), one of the underlying pathogenic mechanisms is the formation of antigen-antibody complexes which can trigger an inflammatory response by inducing the infiltration of neutrophils in lesions. Epithelial neutrophil-activating peptide 78 (ENA 78), known as Chemokine (C-X-C motif) ligand 5 (CXCL5), belongs to the ELR-CXCL family. It recruits and activates neutrophils. The aim of this study was to evaluate ENA 78, IL-1β and TNF-α plasma levels in multiple sclerosis (MS) and neuromyelitis optica (NMO) patients. METHODS ENA 78, IL-1β and TNF-α plasma levels were detected in 20 healthy controls (HC), 25 MS and 25 NMO patients using MILLIPLEX® map Human High Sensitivity Cytokine/Chemokine Panels. RESULTS Plasma levels of ENA 78 were significantly higher in NMO patients than in HC (P < 0.001) and MS patients (P < 0.05). The NMO patients showed higher plasma levels of IL-1β compared with HC (P < 0.01). Further, increased plasma levels of TNF-α were found in the MS (P < 0.05) and NMO patients (P < 0.001). In addition, NMO patients had higher Expanded Disability Status Scale (EDSS) scores compared with MS patients (P < 0.05). EDSS scores were correlated with plasma levels of ENA 78 in NMO patients (P < 0.05). There were no significant correlations between EDSS scores and plasma levels of ENA 78 in MS patients (P > 0.05). CONCLUSIONS The overproduction of pro-inflammatory cytokines such as IL-1β and TNF-α during the remission of NMO activates ENA 78, which in turn leads to neutrophil infiltration in lesions. ENA 78 plasma levels were correlated with EDSS scores in NMO patients. Elevated secretion of ENA 78 may be a critical step in neutrophil recruitment during the remission of NMO.
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Affiliation(s)
- Tao Yang
- Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Su Wang
- Department of Oncology, Hiser Medical Center of Qingdao, Qingdao, 266034, People's Republic of China
| | - Qi Zheng
- Department of oncology, Guang An Men Hospital of China Academy of Chinese Medical Sciences, Beijing, 100053, People's Republic of China.,School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Lei Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Qian Li
- Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Mingyan Wei
- Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Zongpan Du
- Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China
| | - Yongping Fan
- Department of Traditional Chinese Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, People's Republic of China.
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Papais-Alvarenga RM, Pereira FFCC, Bernardes MS, Papais-Alvarenga M, Batista E, Paiva CA, Santos CM, Vasconcelos CCF. Familial forms of multiple sclerosis and neuromyelitis optica at an MS center in Rio de Janeiro State, Brazil. J Neurol Sci 2015; 356:196-201. [PMID: 26115914 DOI: 10.1016/j.jns.2015.06.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Revised: 06/05/2015] [Accepted: 06/16/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe familial forms of demyelinating diseases from an MS referral center in Río de Janeiro State, Brazil. METHODS A descriptive, cross-sectional study was done to identify familial IIDD cases in Hospital da Lagoa, a public hospital where 75% of patients with IIDD who live in Rio de Janeiro state, located in the Southeast region of Brazil, are referred. The diagnoses of all consecutive patients followed in 2011 were reviewed to apply new diagnostic criteria (Wingerchuk et al., 2008). The diagnosis of IIDD was confirmed based on clinical history, neurological examination, MRI of the skull and spinal cord, CSF analysis and investigation of IgG NMO antibodies. The cases that had at least one other relative with IIDD were selected for the study. RESULTS Familial forms were found only in the multiple sclerosis (MS) and neuromyelitis optica syndrome (NMOSD) categories. 23 MS families were identified, 60.86% with first degree kinship. It has a Caucasian preponderance, 90% of whom were white. The frequency of early onset was 15% and 20% of the MSf cases have progressive primary course. CONCLUSION The frequency of familial cases of IIDD was 6.12% among MS patients and 2.8% in NMO spectrum syndromes.
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Affiliation(s)
- Regina M Papais-Alvarenga
- Department of Neurology, Federal University of the State of Rio de Janeiro-UNIRIO, Brazil; Department of Neurology, Hospital da Lagoa, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Melina S Bernardes
- Department of Neurology, Federal University of the State of Rio de Janeiro-UNIRIO, Brazil; Department of Neurology, Hospital da Lagoa, Ministry of Health, Rio de Janeiro, Brazil
| | - Marcos Papais-Alvarenga
- Department of Neurology, Federal University of the State of Rio de Janeiro-UNIRIO, Brazil; Department of Neurology, Hospital da Lagoa, Ministry of Health, Rio de Janeiro, Brazil
| | - Elizabeth Batista
- Department of Neurology, Federal University of the State of Rio de Janeiro-UNIRIO, Brazil; Department of Neurology, Hospital da Lagoa, Ministry of Health, Rio de Janeiro, Brazil
| | - Carmen A Paiva
- Department of Neurology, Federal University of the State of Rio de Janeiro-UNIRIO, Brazil
| | - Claudia Miranda Santos
- Department of Neurology, Federal University of the State of Rio de Janeiro-UNIRIO, Brazil
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Microbial view of central nervous system autoimmunity. FEBS Lett 2014; 588:4207-13. [PMID: 24746689 DOI: 10.1016/j.febslet.2014.04.007] [Citation(s) in RCA: 94] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 04/05/2014] [Accepted: 04/07/2014] [Indexed: 02/07/2023]
Abstract
Not much is known about the initial events leading to the development of the central nervous system (CNS)-specific autoimmune disorder Multiple Sclerosis (MS). Environmental factors are suspected to trigger the pathogenic events in people with genetic disease susceptibility. Historically, many infectious microbes were linked to MS, but no infection has ever been demonstrated to be the cause of the disease. Recent emerging evidence from animal models of MS suggests a causal link with resident commensal bacteria. Microbial organisms may trigger the activation of CNS-specific, auto-aggressive lymphocytes either through molecular mimicry or via bystander activation. In addition, several gut microbial metabolites and bacterial products may interact with the immune system to modulate CNS autoimmunity.
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Iyer A, Elsone L, Appleton R, Jacob A. A review of the current literature and a guide to the early diagnosis of autoimmune disorders associated with neuromyelitis optica. Autoimmunity 2014; 47:154-61. [PMID: 24512514 DOI: 10.3109/08916934.2014.883501] [Citation(s) in RCA: 88] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Neuromyelitis optica (NMO) is an immune-mediated neurological disorder characterised by recurrent episodes of optic neuritis and longitudinally extensive transverse myelitis. A serum biomarker, aquaporin-4 IgG, the autoantibody against aquaporin-4 water channel, has been specifically associated with NMO and has assisted early recognition and prediction of relapses. Less commonly, a monophasic course, associated with antibodies to myelin oligodendrocyte glycoprotein has been reported. Specific diagnostic criteria have been defined; however, some cases that do not fulfil these criteria (but are nevertheless associated with aquaporin-4 IgG) are classified as NMO spectrum disorder and follow the same relapsing course. An ever-growing list of autoimmune disorders, both organ-specific and non-organ-specific, have been associated in up to 20-30% of patients with NMO. These disorders, which may become symptomatic before or after the development of NMO, are often diagnosed long after the diagnosis of NMO, as symptoms may be wrongly attributed to NMO, its residual effects or medication side effects. In addition, autoantibodies can be found in patients with NMO without coexisting disease (up to 40% in some series) and maybe suggestive of a heightened humoral immune response. We present a comprehensive review of the current literature on autoimmune disorders co-existing with NMO and identified 22 autoimmune conditions (myasthenia gravis, coeliac disease, ulcerative colitis, sclerosing cholangitis, systemic lupus erythematosus, rheumatoid arthritis, antiphospholipid antibody syndrome, Sjogren's syndrome, autoimmune hypothyroidism, immune thrombocytopenic purpura, pernicious anaemia, narcolepsy, pemphigus foliaceus, alopecia areata, psoriasis, scleroderma, dermatitis herpetiformis, polymyositis, chronic inflammatory demyelinating polyneuropathy, paraneoplastic disorders, insulin dependent diabetes mellitus and autoimmune encephalitis).
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Affiliation(s)
- Anand Iyer
- The Walton Centre for Neurology and Neurosurgery , Liverpool , UK and
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Periventricular lesions help differentiate neuromyelitis optica spectrum disorders from multiple sclerosis. Mult Scler Int 2014; 2014:986923. [PMID: 24665366 PMCID: PMC3934317 DOI: 10.1155/2014/986923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. To compare periventricular lesions in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOsd). Materials and Methods. Sagittal and axial fluid attenuated inversion recovery (FLAIR) sequences of 20 NMOsd and 40 group frequency-matched MS patients were evaluated by two neuroradiologists. On axial FLAIR, periventricular area was characterized as free of lesions/smooth-bordered ("type A") or jagged-bordered ("type B") pattern. On sagittal FLAIR, the images were evaluated for presence of "Dawson's fingers." Results. Type A pattern was observed in 80% of NMOsd patients by Reader 1 and 85% by Reader 2 but only in 5% MS patients by either Reader. Type B was seen in 15% NMOsd patients by Reader 1 and 20% by Reader 2 and in 95% MS patients by either Reader. Dawson's fingers were observed in no NMOsd patients by Reader 1 and 5% by Reader 2. In MS, Dawson's fingers were seen in 92.5% patients by Reader 1 and 77.5% by Reader 2. The differences in periventricular patterns and Dawson's finger detection between NMOsd and MS were highly significant (P < 0.001). Conclusions. Dawson's fingers and "jagged-bordered" periventricular hyperintensities are typical of MS and almost never seen in NMOsd, which suggests a practical method for differentiating the two diseases.
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Asgari N, Kyvik KO, Steenstrup T, Stenager E, Lillevang ST. Antibodies against interferon-beta in neuromyelitis optica patients. J Neurol Sci 2014; 339:52-6. [PMID: 24477087 DOI: 10.1016/j.jns.2014.01.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 01/08/2014] [Accepted: 01/13/2014] [Indexed: 11/18/2022]
Abstract
Neuromyelitis optica (NMO) is an antibody-mediated autoimmune inflammatory disease of the CNS. A poor response to treatment with recombinant interferon beta (IFN-ß) in NMO patients has been suggested, although the precise mechanisms remain uncertain. We analyzed occurrence and clinical consequences of IFN-neutralizing antibodies (NAbs) in 15 IFN-ß treated NMO-patients from a population-based retrospective case series cohort. NMO patients not treated with IFN-ß acted as a reference group. IFN-ß antibody determinations included binding antibodies (BAbs) measured by immunoassay and NAbs measured by a neutralization bioassay. Antibodies were determined 6-36 months after initiation of IFN-β therapy and NAbs additionally 5-10 years post-therapy. BAbs were detected in 14/15 NMO patients; 6/15 were NAbs-positive (3 at 5-10 years post-therapy) two of those anti-AQP4 antibody-positive; seven of the nine NAbs-negative patients were anti-AQP4 antibody-positive. Eleven patients (three NAbs-positive, eight NAbs-negative) developed cerebral lesions and 12 patients (four NAbs-positive, eight NAbs-negative) spinal cord lesions on magnetic resonance imaging as gadolinium positive lesions or T2-weighted lesions, at significantly higher frequencies than NMO reference group (p<0.009). Exacerbation occurred within 90 days in four and 6-36 months in eight patients. Progression of disease activity in NMO patients occurred during IFN-β treatment, irrespective of IFN-neutralizing antibody status.
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Affiliation(s)
- Nasrin Asgari
- Department of Neurology, Vejle Hospital, Odense University Hospital, Denmark; Institute of Molecular Medicine, Odense University Hospital, Denmark; Institute of Regional Health Research, University of Southern Denmark, Odense University Hospital, Denmark.
| | - Kirsten Ohm Kyvik
- Institute of Regional Health Research, University of Southern Denmark, Odense University Hospital, Denmark; Odense Patient Data Explorative Network, Odense University Hospital, Denmark
| | - Troels Steenstrup
- Department of Biostatistics, University of Southern Denmark, Odense, Odense University Hospital, Denmark
| | - Egon Stenager
- Institute of Regional Health Research, University of Southern Denmark, Odense University Hospital, Denmark; The Multiple Sclerosis Clinic of Southern Jutland (Vejle, Esbjerg, Soenderborg), Department of Neurology, Odense University Hospital, Soenderborg, Denmark
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Choi SI, Lee YJ, Kim DW, Yang JY. A case of neuromyelitis optica misdiagnosed as cervicogenic headache. Korean J Pain 2013; 27:77-80. [PMID: 24478906 PMCID: PMC3903806 DOI: 10.3344/kjp.2014.27.1.77] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 10/25/2013] [Accepted: 10/25/2013] [Indexed: 11/17/2022] Open
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system associated with longitudinally extensive myelitis and optic neuritis. It is characterized by relapses that lead to blindness and paralysis sequelaes. But, this is rare disease; therefore high clinical suspicion for a correct diagnosis and proper examinations are not easy. However, early diagnosis is essential to prevent sequelae. We report the case of NMO with headache. A 30-year male patient who suffered headache visited our pain clinic because of aggravated pain despite treatment. The cause of the pain was revealed as NMO by more detailed previous history and examination.
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Affiliation(s)
- Soo Il Choi
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Yeon Ju Lee
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Do Wan Kim
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
| | - Jong Yeun Yang
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, Korea
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Owens T, Khorooshi R, Wlodarczyk A, Asgari N. Interferons in the central nervous system: A few instruments play many tunes. Glia 2013; 62:339-55. [DOI: 10.1002/glia.22608] [Citation(s) in RCA: 82] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Trevor Owens
- Department of Neurobiology Research, Institute of Molecular Medicine; University of Southern Denmark; Odense Denmark
| | - Reza Khorooshi
- Department of Neurobiology Research, Institute of Molecular Medicine; University of Southern Denmark; Odense Denmark
| | - Agnieszka Wlodarczyk
- Department of Neurobiology Research, Institute of Molecular Medicine; University of Southern Denmark; Odense Denmark
| | - Nasrin Asgari
- Department of Neurobiology Research, Institute of Molecular Medicine; University of Southern Denmark; Odense Denmark
- Department of Neurology; Vejle Hospital; Denmark
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Interferon alpha association with neuromyelitis optica. Clin Dev Immunol 2013; 2013:713519. [PMID: 24348680 PMCID: PMC3855997 DOI: 10.1155/2013/713519] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Revised: 10/09/2013] [Accepted: 10/11/2013] [Indexed: 01/15/2023]
Abstract
Interferon-alpha (IFN-α) has immunoregulatory functions in autoimmune inflammatory diseases. The goal of this study was to determine occurrence and clinical consequences of IFN-α in neuromyelitis optica (NMO) patients. Thirty-six NMO and 41 multiple sclerosis (MS) patients from a population-based retrospective case series were included. Expanded Disability Status Scale (EDSS) score and MRI findings determined disease activity. Linear regression was used to assess the effects of the level of IFN-α on disability (EDSS). IFN-α was determined by sensitive ELISA assays. IFN-α was detectable in sera from 9/36 NMO patients, significantly more often than in the MS group (2/41) (P = 0.0197). A higher frequency of IFN-α was observed in NMO patients with acute relapse compared to NMO patients in remission (P < 0.001) and compared to the MS patients with relapse (P = 0.010). In NMO patients, the levels of IFN-α were significantly associated with EDSS (P = 0.0062). It may be concluded that IFN-α was detectable in a subgroup of NMO patients. Association of IFN-α levels with clinical disease activity and severity suggests a role for IFN-α in disease perpetuation and may provide a plausible explanation for a negative effect of IFN-1 treatment in NMO patients.
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Papais-Alvarenga RM, Vasconcelos CCF, Alves-Leon SV, Batista E, Santos CMM, Camargo SMGG, Godoy M, Lacativa MC, Lorenti M, Damasceno B, Damasceno A, Brum D, Barreira AA, Guimarães Rocha MS, Alvarenga H, Tilbery CP. The impact of diagnostic criteria for neuromyelitis optica in patients with MS: a 10-year follow-up of the South Atlantic Project. Mult Scler 2013; 20:374-81. [DOI: 10.1177/1352458513495580] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: It is recognized that there is a particular geographic and ethnic distribution of neuromyelitis optica (NMO) among Caucasian and non-Caucasian populations. Objective: To review the diagnoses of patients whom were enrolled in the South Atlantic Project, a Brazilian multiple sclerosis (MS) survey performed from 1995–1998, and to identify NMO and MS case frequencies. Methods: We reviewed the data from a 10-year follow-up of MS patients. To apply the current diagnostic criteria, the neurologists were asked to collect clinical and laboratory data from the medical records of study patients treated from 1999–2009. Results: The spectrum of inflammatory demyelinating disease in 322 patients (67% white; 33% African-Brazilian) was: 49 (15%) with NMO; 14 (4%) with NMO syndromes; 10 (3%) with acute disseminated encephalomyelitis (ADEM); one isolated tumefactive brain lesion; 249 (77%) with MS (151 with relapsing–remitting MS (RRMS), 70 with secondary progressive MS (SPMS) and 27 with primary progressive MS (PPMS)). Disability was more severe in NMO and PPMS. One-third of the NMO patients had died. Conclusions: The frequency of NMO was 6.8% in São Paulo and 20.5% in Rio de Janeiro, and mainly seen in persons of African descent, which strengthens the hypothesis of there being an ethnic association of this disease. We recommend that epidemiological studies on MS that were performed previously be reviewed again, to ensure more accurate diagnoses.
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Affiliation(s)
- Regina M Papais-Alvarenga
- Hospital da Lagoa, Ministério da Saúde, Rio de Janeiro, Brazil
- Department of Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brazil
| | - Claudia CF Vasconcelos
- Department of Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brazil
| | - Soniza V Alves-Leon
- Department of Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brazil
- Hospital Universitário Clementino Fraga Filho, UFRJ (Universidade Federal do Rio de Janeiro), Rio de Janeiro, Brazil
| | | | - Claudia MM Santos
- Department of Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brazil
| | | | - Mauricio Godoy
- Hospital Universitário Pedro Ernesto, UERJ (Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Maria C Lacativa
- Department of Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brazil
- Hospital dos Servidores do Estado do Rio de Janeiro, Brazil
| | | | - Benito Damasceno
- Department of Neurology, Universidade de Campinas (UNICAMP), São Paulo, Brazil
| | - Alfredo Damasceno
- Department of Neurology, Universidade de Campinas (UNICAMP), São Paulo, Brazil
| | - Doralina Brum
- Department of Neurology, Faculdade de Botucatu, São Paulo, Brazil
| | - Amilton A Barreira
- Department of Neurology, Hospital das Clínicas de Ribeirão Preto, Universidade de São Paulo (USP), Brazil
| | | | - Helcio Alvarenga
- Department of Neurology, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Brazil
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Modifications of longitudinally extensive transverse myelitis and brainstem lesions in the course of neuromyelitis optica (NMO): a population-based, descriptive study. BMC Neurol 2013; 13:33. [PMID: 23566260 PMCID: PMC3622587 DOI: 10.1186/1471-2377-13-33] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Accepted: 03/27/2013] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Neuromyelitis optica (NMO) includes transverse myelitis, optic neuritis and brain lesions. Recent studies have indicated that the brainstem is an important site of attack in NMO. Longitudinally extensive transverse myelitis (LETM) is an important component of the clinical diagnosis of NMO. The frequency of brainstem and LETM lesions, changes over time of LETM and the clinical consequences in the course of NMO have only been sparsely studied. METHODS The study was a population-based retrospective case series with clinical and magnetic resonance imaging (MRI) follow-up of 35 patients with definite NMO and a relapsing-remitting course. RESULTS Brainstem lesions were observed in 25 patients, 18 in medulla oblongata (11 in area postrema). Lesions in the pons, mesencephalon and diencephalon occurred in 10, 7 and 7 patients, respectively. Lesions were symptomatic in medulla oblongata and pons, asymptomatic in mesencephalon and diencephalon. Brainstem lesions were observed significantly more often in anti-aquaporin-4 (AQP-4) antibody positive than in seronegative patients (p < 0.002).LETM was demonstrated by MRI of the spinal cord in 30/36 patients, 23/30 of whom had follow-up MRI of the spinal cord. Recurrent LETM was observed in five patients. In nine patients the LETM changed into multiple lesions during remission or treatment. Spinal cord atrophy was observed in 12/23 (52%) patients, correlating to Expanded Disability Status Scale (r = 0.88, p < 0.001). CONCLUSIONS NMO patients had frequent occurrence of brainstem lesions and LETM. Brainstem lesions were associated with anti-AQP4 antibody positivity. LETM lesions differentiated over time and the outcome included relapses, fragmentation and atrophy. Correlation was observed between spinal cord atrophy and neurological disability.
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Khorooshi R, Wlodarczyk A, Asgari N, Owens T. Neuromyelitis optica-like pathology is dependent on type I interferon response. Exp Neurol 2013; 247:744-7. [PMID: 23434493 DOI: 10.1016/j.expneurol.2013.02.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 02/02/2013] [Accepted: 02/08/2013] [Indexed: 01/03/2023]
Abstract
Neuromyelitis optica is an antibody-mediated autoimmune inflammatory disease of the central nervous system. Reports have suggested that interferon beta which is beneficial for multiple sclerosis, exacerbates neuromyelitis optica. Our aim was to determine whether type I interferon plays a role in the formation of neuromyelitis optica lesions. Immunoglobulin G from a neuromyelitis optica patient was injected intracerebrally with human complement to type I interferon receptor deficient and wildtype mice. Loss of aquaporin-4 and glial fibrillary acidic protein was reduced in type I interferon receptor deficient mice brain. Our findings suggest that type I interferon signaling contributes to neuromyelitis optica pathogenesis.
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Affiliation(s)
- Reza Khorooshi
- Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Denmark
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Complement-dependent pathogenicity of brain-specific antibodies in cerebrospinal fluid. J Neuroimmunol 2013; 254:76-82. [DOI: 10.1016/j.jneuroim.2012.09.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 08/25/2012] [Accepted: 09/14/2012] [Indexed: 01/06/2023]
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Asgari N, Nielsen C, Stenager E, Kyvik KO, Lillevang ST. HLA, PTPN22 and PD-1 associations as markers of autoimmunity in neuromyelitis optica. Mult Scler 2011; 18:23-30. [DOI: 10.1177/1352458511417480] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background: Neuromyelitis optica (NMO) is a disease with autoimmune characteristics. A genetic autoimmune dependency for NMO has not been clarified in detail. Objective: To investigate immunogenetic aspects of NMO. Methods: Forty-one patients with NMO and 42 patients with multiple sclerosis (MS) were diagnosed in a population-based Caucasian cohort. HLA DQA1, DQB1, and DRB1 alleles were determined. Polymorphisms in programmed death 1 (PD-1) PD-1.3 G/A and protein tyrosine phosphatase non-receptor 22 (PTPN22) 1858 C/T were genotyped. Results: In the NMO group 15% had other autoimmune disorders and 39% had family occurrence of autoimmunity, comparable to MS. A higher frequency of a family history (17%) of NMO and MS was found in the NMO group ( p < 0.026). The frequency of HLA-DQB1*0402 allele was increased in NMO ( p after Bonferroni correction, cp < 0.035) and the HLA-DRB1*15 and DQB1*06 alleles were increased in MS ( cp < 0.0027, cp < 0.01), compared to controls. No associations of the PTPN22 1858 T were detected. The PD-1.3A allele was increased both in NMO ( p < 0.0023) and in MS patients ( p < 0.028) compared to controls. Conclusion: Patients with NMO had frequent co-existence of autoimmunity and family occurrence of NMO and MS. The PD-1.3A allele was associated with NMO. The data suggest genetic autoimmune dependency of NMO.
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Affiliation(s)
- N Asgari
- The Multiple Sclerosis Clinic of Southern Jutland, (Sonderborg, Vejle, Esbjerg), Denmark
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - C Nielsen
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - E Stenager
- The Multiple Sclerosis Clinic of Southern Jutland, (Sonderborg, Vejle, Esbjerg), Denmark
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - KO Kyvik
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
| | - ST Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
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Asgari N, Lillevang ST, Skejoe HPB, Falah M, Stenager E, Kyvik KO. A population-based study of neuromyelitis optica in Caucasians. Neurology 2011; 76:1589-95. [PMID: 21536639 DOI: 10.1212/wnl.0b013e3182190f74] [Citation(s) in RCA: 210] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Epidemiologic studies have suggested different prevalence of neuromyelitis optica (NMO) in different ethnic groups. However, data on the incidence and prevalence of NMO in Caucasians are scarce. OBJECTIVE To estimate the incidence and prevalence of NMO in a predominantly Caucasian population based on the Wingerchuk 2006 criteria. METHODS The study was a population-based retrospective case series with longitudinal follow-up. Patients with multiple sclerosis (MS), optic neuritis (ON), acute transverse myelitis (TM), and NMO from the 4 neurology and 3 ophthalmology departments in the Region of Southern Denmark having been diagnosed between 1998 and 2008 were investigated. Patients were included based on 1) episodes of ON or TM and 2) an initial brain MRI not diagnostic for MS. An immunofluorescence assay was used to determine aquaporin-4 (AQP-4) antibodies. RESULTS A total of 477 patients with MS, TM, or ON were evaluated: 163 fulfilled the inclusion criteria, 42 (26%) qualified for the diagnosis of NMO, 26 (62.0%) of these were AQP4 antibody positive. All except one were Caucasian, the female:male ratio was 2.8:1, and mean age at onset was 35.6 years (range 15-64 years). The clinical presentation was heterogeneous including TM, longitudinally extensive TM, ON, and brainstem syndromes. The yearly incidence rate of NMO in the population was estimated to be 0.4 per 10(5) person-years (95% confidence interval [CI] 0.30-0.54) and the prevalence was 4.4 per 10(5) (95% CI 3.1-5.7). CONCLUSIONS Despite being a rare disease, NMO is more common in a Caucasian population than earlier believed.
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Affiliation(s)
- N Asgari
- Institute of Regional Health Services Research, University of Southern Denmark, Winsloews Vej 9B, DK-5000 Odense C, Denmark
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