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Rovira À, Vidal-Jordana A, Auger C, Sastre-Garriga J. Optic Nerve Imaging in Multiple Sclerosis and Related Disorders. Neuroimaging Clin N Am 2024; 34:399-420. [PMID: 38942524 DOI: 10.1016/j.nic.2024.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2024]
Abstract
Optic neuritis is a common feature in multiple sclerosis and in 2 other autoimmune demyelinating disorders such as aquaporin-4 IgG antibody-associated neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein antibody-associated disease. Although serologic testing is critical for differentiating these different autoimmune-mediated disorders, MR imaging, which is the preferred imaging modality for assessing the optic nerve, can provide valuable information, suggesting a specific diagnosis and guiding the appropriate serologic testing.
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Affiliation(s)
- Àlex Rovira
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain.
| | - Angela Vidal-Jordana
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Department of Radiology, Section of Neuroradiology, Vall d'Hebron University Hospital, Autonomous Univesity of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Department of Neurology, Centro de Esclerosis Múltiple de Catalunya (Cemcat), Vall d'Hebron University Hospital, Autonomous University of Barcelona, Barcelona, Spain
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Shen X. Research progress on pathogenesis and clinical treatment of neuromyelitis optica spectrum disorders (NMOSDs). Clin Neurol Neurosurg 2023; 231:107850. [PMID: 37390569 DOI: 10.1016/j.clineuro.2023.107850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are characteristically referred to as various central nervous system (CNS)-based inflammatory and astrocytopathic disorders, often manifested by the axonal damage and immune-mediated demyelination targeting optic nerves and the spinal cord. This review article presents a detailed view of the etiology, pathogenesis, and prescribed treatment options for NMOSD therapy. Initially, we present the epidemiology of NMOSDs, highlighting the geographical and ethnical differences in the incidence and prevalence rates of NMOSDs. Further, the etiology and pathogenesis of NMOSDs are emphasized, providing discussions relevant to various genetic, environmental, and immune-related factors. Finally, the applied treatment strategies for curing NMOSD are discussed, exploring the perspectives for developing emergent innovative treatment strategies.
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Affiliation(s)
- Xinyu Shen
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200000, PR China.
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Frau J, Coghe G, Lorefice L, Fenu G, Cocco E. The Role of Microorganisms in the Etiopathogenesis of Demyelinating Diseases. Life (Basel) 2023; 13:1309. [PMID: 37374092 DOI: 10.3390/life13061309] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/28/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2023] Open
Abstract
Multiple sclerosis (MS), neuromyelitis optica (NMO) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) are inflammatory diseases of the central nervous system (CNS) with a multifactorial aetiology. Environmental factors are important for their development and microorganisms could play a determining role. They can directly damage the CNS, but their interaction with the immune system is even more important. The possible mechanisms involved include molecular mimicry, epitope spreading, bystander activation and the dual cell receptor theory. The role of Epstein-Barr virus (EBV) in MS has been definitely established, since being seropositive is a necessary condition for the onset of MS. EBV interacts with genetic and environmental factors, such as low levels of vitamin D and human endogenous retrovirus (HERV), another microorganism implicated in the disease. Many cases of onset or exacerbation of neuromyelitis optica spectrum disorder (NMOSD) have been described after infection with Mycobacterium tuberculosis, EBV and human immunodeficiency virus; however, no definite association with a virus has been found. A possible role has been suggested for Helicobacter pylori, in particular in individuals with aquaporin 4 antibodies. The onset of MOGAD could occur after an infection, mainly in the monophasic course of the disease. A role for the HERV in MOGAD has been hypothesized. In this review, we examined the current understanding of the involvement of infectious factors in MS, NMO and MOGAD. Our objective was to elucidate the roles of each microorganism in initiating the diseases and influencing their clinical progression. We aimed to discuss both the infectious factors that have a well-established role and those that have yielded conflicting results across various studies.
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Affiliation(s)
- Jessica Frau
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
| | - Giancarlo Coghe
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
| | - Lorena Lorefice
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
| | | | - Eleonora Cocco
- Multiple Sclerosis Centre, ASL Cagliari, 09126 Cagliari, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
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Bichuetti DB. Neuromyelitis optica spectrum disorders and beyond: telling a story one hundred years later. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:513-514. [PMID: 37379862 DOI: 10.1055/s-0043-1770932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
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Valdivia-Tangarife ER, Gamez-Nava JI, Cortés-Enríquez F, Mireles-Ramírez MA, Gonzalez-López L, Saldaña-Cruz AM, Macías-Islas MA. Risk factors associated with permanent disability in neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2022; 68:104114. [PMID: 36037753 DOI: 10.1016/j.msard.2022.104114] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/05/2022] [Accepted: 08/13/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune inflammatory disease of the central nervous system. In NMOSD, a relapse results in increased disability. OBJECTIVE To assess risk factors associated with permanent disability (PD) in patients with neuromyelitis optica spectrum disorders (NMOSD). METHODS We evaluated 34 cases (who developed permanent disability) and 33 controls. The assessment included the following variables: sociodemographic data and characteristics of the disease. Logistic regression analysis was performed to adjust variables associated with PD. RESULTS fifty-one percent developed PD during follow-up; 15 (22%) developed permanent visual disability, 13 (19%) developed permanent motor disability and 6 (9%) were restricted to wheelchair. Factors associated with PD in the crude analysis were: age at onset ≥ 50 years (OR 3.95, 95% IC 1.12-13.94, p= 0.032), time from onset to diagnosis ≥ 12 months (OR 3.30, 95% IC 1.13-9.64, p= 0.029), time from onset to treatment ≥ 60 months (OR 4.16, 95% IC 1.03-16.85, p= 0.045), EDSS ≥ 4.0 at the first appointment (OR 3.21, 95% IC 1.18-8.76, p= 0.022) and severe relapses during disease evolution (OR 5.72, 95% IC 1.98-16.57, p= 0.001). Factors associated with PD in the adjusted analysis were: age at onset ≥ 50 years (OR 5.82, 95% IC 1.30-26.05, p= 0.021), time from onset to diagnosis ≥ 12 months (OR 5.43, 95% IC 1.47-20.08, p= 0.011) and severe relapses during disease evolution (OR 6.65, 95% IC 1.98-22.31, p= 0.002). CONCLUSION Half of patients with NMOSD may develop PD during disease evolution. Age of onset ≥ 50 years, delay to diagnosis ≥12 months and initial EDSS ≥ 4.0 constitute the strongest risk factors for PD.
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Affiliation(s)
- Edgar R Valdivia-Tangarife
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México
| | - Jorge I Gamez-Nava
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México; Programa de Doctorado en Salud Publica, CUCS, Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México
| | - Fernando Cortés-Enríquez
- Departamento de Neurología, Hospital General Regional No 45 del Instituto Mexicano del Seguro Social, Guadalajara, Jalisco, México
| | - Mario A Mireles-Ramírez
- Departamento de Neurología, Unidad de Alta Especialidad Médica, Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social. Guadalajara, Jalisco, México
| | - Laura Gonzalez-López
- Programa de Doctorado en Farmacología, Centro Universitario de Ciencias de la Salud (CUCS), Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México; Programa de Doctorado en Salud Publica, CUCS, Universidad de Guadalajara, 44340, Guadalajara, Jalisco, México
| | - Ana M Saldaña-Cruz
- Instituto de Terapéutica Experimental y Clínica, Departamento de Fisiología, CUSC, Universidad de Guadalajara, Jalisco, México
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Characteristics of Optic Neuritis in South Korean Children and Adolescents: A Retrospective Multicenter Study. J Ophthalmol 2022; 2022:4281772. [PMID: 36119139 PMCID: PMC9473900 DOI: 10.1155/2022/4281772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 07/15/2022] [Indexed: 11/28/2022] Open
Abstract
Purpose To analyze the clinical characteristics and prognosis of optic neuritis (ON) in pediatric patients aged <19 years in South Korea. Methods This multicenter retrospective cohort study included 127 pediatric patients (median age: 10.3 (IQR: 7.3–14.2) years; female, 62.2%) who experienced ON for the first time between January 2004 and January 2018, with data obtained from five tertiary university-based hospitals in Korea. When ON was bilateral, the worse eye was selected for analysis. The baseline clinical characteristics and prognoses of patients, as well as the associations between these parameters, were analyzed. Results The baseline clinical characteristics of the patients were as follows: best-corrected visual acuity (BCVA) < 20/200, 65.9%; pain on eye movement, 47.2%; optic disc swelling, 66.9%; and bilateral involvement, 41.7%. Among 101 patients who were followed up for ≥6 months, 48 (47.5%), 12 (11.9%), 19 (18.8%), 13 (12.9%), and 9 (8.9%) had been diagnosed with isolated ON, recurrent ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and acute disseminated encephalomyelitis (ADEM)-related ON, respectively. At the latest visit, 81.9% and 71.1% had achieved BCVA of ≥20/40 and ≥ 20/25, respectively. Only disc swelling at presentation was associated with poor baseline BCVA (coefficient: 0.31, P=0.004) and greater improvement in BCVA (coefficient: 0.49, P = 0.001P=0.001); there were no significant associations between the baseline factors and final BCVA. Conclusions This study demonstrated pediatric ON-related clinical characteristics and visual outcomes in South Korea. Within this cohort, in about 40.6% of patients, ON was associated with other demyelinating diseases, namely, MS, NMOSD, and ADEM.
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Alves CS, Santos FBC, Diniz DS. Correlation between Amerindian ancestry and neuromyelitis optica spectrum disorders (NMSOD) among patients in Midwestern Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2022; 80:497-504. [PMID: 35766640 DOI: 10.1590/0004-282x-anp-2020-0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 02/24/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is the second most frequently demyelinating, autoimmune, and inflammatory Central Nervous System (CNS) disease, and its prevalence varies greatly according to geography and ethnicity. OBJECTIVE To determine the prevalence and phenotype of NMOSD at a reference center for demyelinating diseases in Goiás State. METHODS This was a cross-sectional study, approved under CAAE number 8380.9317.9.0000.5078. All patients fulfilled the 2015 international consensus criteria. RESULTS Our study showed NMOSD as 9.37% of all demyelinating diseases registered in. It occurred predominantly in women (81%) and non-white individuals (83.4% had self-declared mixed skin color), and the median age at onset was 48 years. Amerindian ancestry was significantly higher (68.75%) than others. Longitudinally extensive transverse myelitis (LETM) alone ≥3 vertebral segments (35%) and optic neuritis (ON) alone (35%) were the most common onset manifestations. The median length of time from disease beginning to study enrollment was 48 months. A relapsing course and moderate disability (Expanded Disability Status Scale (EDSS) 3.0-4.0) were most commonly observed. The worst neurological impairments, characterized by EDSS>4.5, occurred more frequently in males (44.5% among men versus 20.5% among women). The majority of the patients had been receiving immunosuppressive treatment with azathioprine since the diagnosis of NMSOD: 77% (37) had a good therapeutic response. The prevalent outcome (84%) was permanent disability: 52% became physically handicapped; 54% had permanent visual impairment (25% with bilateral and 75% with unilateral amaurosis) and 30% had sphincter disability (82% with neurogenic bladder and 18% with ostomy). CONCLUSION The estimated prevalence of NMOSD in Goiás is 0.79/per 100,000 inhabitants. The predominant phenotype comprises women, non-whites, onset in the fourth decade of life, relapsing course, and permanent moderate disability. Our study was the first on the epidemiology of NMOSD in Goiás, where NMOSD predominantly correlates with Amerindian ancestry.
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Affiliation(s)
- Claudia Soares Alves
- Universidade Federal de Goiás, Faculdade de Medicina, Centro de Referência em Doenças Desmielinizantes, Departamento de Neurologia, Goiânia GO, Brazil
| | - Flavia Borges Carapina Santos
- Universidade Federal de Goiás, Faculdade de Medicina, Centro de Referência em Doenças Desmielinizantes, Departamento de Neurologia, Goiânia GO, Brazil
| | - Denise Sisterolli Diniz
- Universidade Federal de Goiás, Faculdade de Medicina, Centro de Referência em Doenças Desmielinizantes, Departamento de Neurologia, Goiânia GO, Brazil
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Carnero Contentti E, Rojas JI, Criniti J, Lopez PA, Daccach Marques V, Soto de Castillo I, Tkachuk V, Marrodan M, Correale J, Farez MF, Kim HJ, Hyun JW, Messina S, Mariano R, Rocca MA, Cacciaguerra L, Filippi M, Palace J, Juryńczyk M. Towards imaging criteria that best differentiate MS from NMOSD and MOGAD: Large multi-ethnic population and different clinical scenarios. Mult Scler Relat Disord 2022; 61:103778. [PMID: 35452969 DOI: 10.1016/j.msard.2022.103778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/11/2022] [Accepted: 03/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND The "1/3″ brain magnetic resonance imaging (MRI) criteria including 1) a lesion adjacent to the lateral ventricle and in the inferior temporal lobe, or 2) a juxtacortical lesion, or 3) a Dawson finger-type lesion were shown to distinguish multiple sclerosis (MS) from antibody-mediated conditions. In this large multicentre study, we aimed to assess how the criteria perform 1) in different onset phenotypes, 2) distinct ethnic groups, 3) when the absence of myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD)-typical fluffy infratentorial (FIT) lesions and longitudinally extensive transverse myelitis (LETM) lesions are added as features ("2/4″ and 3/5″ criteria, respectively). METHODS 577 patients with MS (n = 332), aquaporin-4 antibody (AQP4-Ab) neuromyelitis optica spectrum disorder (NMOSD) (n = 196) and MOGAD (n = 49) were recruited from 6 international centres (Buenos Aires, Sao Paolo, Maracaibo, Goyang, Oxford and Milan). Imaging scans were obtained at disease onset or relapse. RESULTS Adding the absence of FIT lesions increased the specificity of the "1/3″ criteria vs. AQP4-Ab NMOSD from 84.7% to 87.2% and vs. MOGAD from 85.7% to 93.9% without compromising their sensitivity (86%). In particular, for those presenting with brain/brainstem attacks "2/4″ had significantly higher specificity than "1/3″ (85% vs. 80% against AQP4-Ab NMOSD, 88.9% vs. 72.2% against MOGAD). Positive predictive values of the "1/3″ criteria for MS were lowest for Asian patients (84.8 vs. 99.1% for White) but were significantly increased by adding further criteria (94.1% for "3/5″). CONCLUSION The "1/3″ criteria perform well in discriminating MS from NMOSD and MOGAD regardless of ethnic background and clinical scenario. Adding the absence of FIT lesions increases the specificity in those presenting with brain/brainstem symptoms.
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Affiliation(s)
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Verónica Tkachuk
- Neuroimmunology Unit, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Mariano Marrodan
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - Jorge Correale
- Department of Neurology, Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - Mauricio F Farez
- Center for Research on Neuroimmunological Diseases (CIEN), Institute for Neurological Research Dr. Raúl Carrea (FLENI), Buenos Aires, Argentina
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Romina Mariano
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit and Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Maciej Juryńczyk
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK; Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.
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Gracia F, Ramírez D, Parajeles-Vindas A, Díaz A, Díaz de la Fé A, Sánchez NER, Escobar RC, Valle LAG, Weiser R, Santos B, Candelario A, Benzadon A, Araujo P, Valderrama C, Larreategui M, Carrillo G, Gracia K, Vázquez-Céspedes J, Monterrey-Alvarez P, Carazo-Céspedes K, Sanabria-Castro A, Miranda-Loria G, Balmaceda-Meza A, Rivera LIP, Leal IO, Salinas LCR, Thompson A, Torres EL, Pereira DE, Zepeda C, López CA, Valse EAC, Urbina KZC, Urrutia MA, Van Sijtveld I, Armien B, Rivera VM. Neuromyelitis Optica Spectrum Disorder in Central America and the Caribbean: A Multinational Clinical Characterization Study. Neurol Int 2022; 14:284-293. [PMID: 35324579 PMCID: PMC8952282 DOI: 10.3390/neurolint14010023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/09/2022] [Accepted: 03/12/2022] [Indexed: 02/01/2023] Open
Abstract
Here, a study of NMOSD in Central America and the Caribbean with a multinational collaborative, multicentric and descriptive approach involving 25 institutions from 9 countries is presented. Demographics, clinical manifestations, expanded disability scale status (EDSS), brain and spinal cord MRI, serological anti-AQP4-IgG and anti-MOG-IgG antibodies, and cerebrospinal fluid (CSF) oligoclonal bands were included. A central serological repository utilized the cell-based assay. The specimens outside of this network employed diverse methodologies. Data were collected at the Gorgas Commemorative Institute of Health Studies (ICGES), Panama, and included 186 subjects, of which 84% were females (sex ratio of 5.6:1). Mestizos constituted 72% of the study group. The median age was 42.5 years (IQR: 32.0–52.0). Associated autoimmune diseases (8.1%) were myasthenia gravis, Sjögren’s syndrome and systemic lupus erythematosus. The most common manifestation was optic neuritis-transverse myelitis (42.5%). A relapsing course was described in 72.3% of cases. EDSS scores of 0–3.5 were reported in 57.2% of cases and higher than 7.0 in 14.5%. Positive anti-AQP4-IgG antibody occurred in 59.8% and anti-MOG-IgG antibody in 11.5% of individuals. Antibody testing was lacking for 13.4% of patients. The estimated crude prevalence of NMOSD from Panama and the Dominican Republic was 1.62/100,000 (incidence of 0.08–0.41) and 0.73/100,000 (incidence 0.02–0.14), respectively. This multinational study contributes additional insights and data on the understanding of NMOSD in this Latin American region.
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Affiliation(s)
- Fernando Gracia
- Neurology Service, Hospital Santo Tomás, Panama City 0819-03752, Panama;
- School of Medicine, Universidad Interamericana de Panamá, Panama City 0830-00929, Panama;
- Correspondence: (F.G.); (B.A.)
| | - Deyanira Ramírez
- Neurology Service, Hospital Docente Padre Billini, Santo Domingo City 11102, Dominican Republic; (D.R.); (A.C.)
| | - Alexander Parajeles-Vindas
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Alejandro Díaz
- Neurology Service, Instituto Guatemalteco de Seguridad Social, Guatemala City 1010, Guatemala;
| | - Amado Díaz de la Fé
- Neurology Service, Centro Internacional de Restauración Neurológica (CIREN), La Habana 11300, Cuba;
| | | | - Romy Castro Escobar
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador 1101, El Salvador; (R.C.E.); (D.E.P.); (E.A.C.V.)
| | - Luis Alberto García Valle
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua 14285, Nicaragua; (L.A.G.V.); (K.Z.C.U.)
| | - Roberto Weiser
- Neurology Service, Hospital Horacio Oduber, Oranjestad 569, Aruba; (R.W.); (I.V.S.)
| | - Biany Santos
- Neurology Service, Hospital Cabral y Baez, Santiago City 10206, Dominican Republic;
| | - Awilda Candelario
- Neurology Service, Hospital Docente Padre Billini, Santo Domingo City 11102, Dominican Republic; (D.R.); (A.C.)
| | - Aron Benzadon
- Neurology Service, Complejo Hospitalario Dr. Arnulfo Arias Madrid CSS, Panama City 0831-01654, Panama; (A.B.); (P.A.)
| | - Pahola Araujo
- Neurology Service, Complejo Hospitalario Dr. Arnulfo Arias Madrid CSS, Panama City 0831-01654, Panama; (A.B.); (P.A.)
| | - Carlos Valderrama
- Neurology Service, Hospital Regional Rafael Hernández CSS, David City 0816-06808, Panama;
| | - Mario Larreategui
- Neurology Service, Hospital Regional Anita Moreno MINSA, La Villa de Los Santos 0819-11380, Panama;
| | - Gabriela Carrillo
- Neurology Service, Hospital Santo Tomás, Panama City 0819-03752, Panama;
| | - Karla Gracia
- School of Medicine, Universidad Interamericana de Panamá, Panama City 0830-00929, Panama;
| | - Johana Vázquez-Céspedes
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Priscilla Monterrey-Alvarez
- Neurology Service, Hospital San Rafael de Alajuela CCSS, Alajuela 1481-2100, Costa Rica; (P.M.-A.); (G.M.-L.)
| | - Kenneth Carazo-Céspedes
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Alfredo Sanabria-Castro
- Neurology Service, Hospital San Juan de Dios CCSS, San Jose 1475-1000, Costa Rica; (A.P.-V.); (J.V.-C.); (K.C.-C.); (A.S.-C.)
| | - Gustavo Miranda-Loria
- Neurology Service, Hospital San Rafael de Alajuela CCSS, Alajuela 1481-2100, Costa Rica; (P.M.-A.); (G.M.-L.)
| | - Andrea Balmaceda-Meza
- Neurology Service, Centro de Desarrollo Estratégico e Información de Salud y Seguridad Social (CENDEISSSS CCSS), San Jose 1475-1000, Costa Rica;
| | | | - Irma Olivera Leal
- Neurology Service, Hospital Hermanos Almejeira, La Habana 10200, Cuba;
| | | | - Arnold Thompson
- Neurology Service, Hospital Dr. Mario Catarino Rivas, San Pedro Sula 21104, Honduras; (N.E.R.S.); (A.T.)
| | - Ericka López Torres
- Neurology Service, Hospital Nacional Rosales, San Salvador 1101, El Salvador; (E.L.T.); (C.Z.); (C.A.L.)
| | - Daniel Enrique Pereira
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador 1101, El Salvador; (R.C.E.); (D.E.P.); (E.A.C.V.)
| | - Carolina Zepeda
- Neurology Service, Hospital Nacional Rosales, San Salvador 1101, El Salvador; (E.L.T.); (C.Z.); (C.A.L.)
| | - César Abdón López
- Neurology Service, Hospital Nacional Rosales, San Salvador 1101, El Salvador; (E.L.T.); (C.Z.); (C.A.L.)
| | - Ernesto Arturo Cornejo Valse
- Neurology Service, Instituto Salvadoreño del Seguro Social, San Salvador 1101, El Salvador; (R.C.E.); (D.E.P.); (E.A.C.V.)
| | - Karla Zinica Corea Urbina
- Neurology Service, Hospital Militar Escuela Dr. Alejandro Dávila Bolaños, Managua 14285, Nicaragua; (L.A.G.V.); (K.Z.C.U.)
- Neurology Service, Hospital Carlos Roberto Huembes—Policía Nacional, Managua 14203, Nicaragua
| | - Marco Antonio Urrutia
- Neurology Service, Hospital Infantil de Nicaragua Manuel de Jesús Rivera La Mascota, Managua 12001, Nicaragua;
| | - Ivonne Van Sijtveld
- Neurology Service, Hospital Horacio Oduber, Oranjestad 569, Aruba; (R.W.); (I.V.S.)
| | - Blas Armien
- Dirección de Investigación, Instituto Conmemorativo Gorgas de Estudios de la Salud, Panama City 0816-02593, Panama
- National Research System (SNI), National Secretary of Research Technology and Innovation (SENACYT), Panama City 0816-02852, Panama
- Correspondence: (F.G.); (B.A.)
| | - Victor M. Rivera
- Neurology Department, Baylor College of Medicine, Houston, TX 77025, USA;
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Iorio R, Papi C. Neuromyelitis optica, aquaporin-4 antibodies, and neuroendocrine disorders. HANDBOOK OF CLINICAL NEUROLOGY 2021; 181:173-186. [PMID: 34238456 DOI: 10.1016/b978-0-12-820683-6.00013-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuromyelitis optica (NMO) is an autoimmune disorder of the central nervous system that preferentially affects the optic nerve and the spinal cord. In around 80% of NMO patients, autoantibodies binding to aquaporin-4 (AQP4) are detected. AQP4-IgG unifies a spectrum of disorders (NMOSD) that include not only optic neuritis, longitudinally extensive transverse myelitis but also syndromes caused by lesion of the diencephalic region and the circumventricular organs (CVOs). The distinctive immunopathological characteristics of NMOSD lesions, occurring in regions where AQP4 is highly expressed, supports a central role for AQP4-IgG in disease pathogenesis. AQP4 expression is concentrated in CVOs and in the hypothalamus, mainly in the dorsal hypothalamic area, dorsomedial hypothalamic nucleus and suprachiasmatic nucleus. Several neuroendocrine disorders caused by inflammatory lesions involving the diencephalic region have been described in patients with NMOSD, including syndrome of inappropriate antidiuresis, sleep disorders, and other endocrinopathies caused by hypothalamic injury. Focus of this chapter is the involvement of hypothalamus and CVOs in AQP4 autoimmunity.
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Affiliation(s)
- Raffaele Iorio
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
| | - Claudia Papi
- Neurology Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, and Università Cattolica del Sacro Cuore, Rome, Italy
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Raju GB, Lavanya ML, Gopi S, Kumar TS, Kumari UA. Relapsing neuromyelitis optica spectrum disorder. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2021. [DOI: 10.4103/jdrntruhs.jdrntruhs_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Paul S, Mondal GP, Bhattacharyya R, Ghosh KC, Bhat IA. Neuromyelitis optica spectrum disorders. J Neurol Sci 2020; 420:117225. [PMID: 33272591 DOI: 10.1016/j.jns.2020.117225] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/05/2020] [Accepted: 11/09/2020] [Indexed: 12/11/2022]
Abstract
The disease concept of Neuromyelitis Optica Spectrum Disorders(NMOSD) has undergone a significant change over the last two decades including the detection of Myelin Oligodendrocyte Glycoprotein(MOG) antibody in patients who are seronegative for aquaporin-4 antibody. Aquaporin-4 antibody positive NMOSD is now regarded as an immune astrocytopathy. Conversely, MOG antibody associated disease is known to target myelin rather than astrocytes, leading to an NMOSD syndrome with distinct clinical and radiological features. Incorporation of clinical features like area postrema syndrome, brainstem syndrome, diencephalic syndrome and cortical manifestations as core clinical characteristics into the revised diagnostic criteria has widened the clinical spectrum of NMOSD. With the development of these criteria, it is possible to make the diagnosis at an earlier stage so that effective immunosuppression can be instituted promptly for a better long-term prognosis. Newer therapeutic agents have been introduced for aquaporin-4 seropositive NMOSD disease; however, challenges remain in treating seronegative disease because of limited treatment options.
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Affiliation(s)
- Shabeer Paul
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Gouranga Prasad Mondal
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Ramesh Bhattacharyya
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Kartik Chandra Ghosh
- Department of Neurology Calcutta National Medical College Hospital, Kolkata, West Bengal 700014, India.
| | - Imtiyaz Ahmad Bhat
- Department of Immunology & Molecular Medicine, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
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Gomes NA, Silva PC, Teixeira YT, Eufrazio P, Souza AD, Rojas H, Brant R, Gomes Neto A, Christo PP, Simões RT, Fernandes KS. HLA-G Ins/Del polymorphism and +3142C/G SNP are not related to neuromyelitis optica spectrum disorder (NMOSD) development, disability status or anti-aquaporin 4 presence in Brazilian patients. J Neuroimmunol 2020; 339:577112. [PMID: 31765953 DOI: 10.1016/j.jneuroim.2019.577112] [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: 08/09/2018] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022]
Abstract
We analyzed the association of polymorphisms from the 3' untranslated region of the HLA-G gene in 70 neuromyelitis optica spectrum disorder (NMOSD) patients and 162 healthy controls. No associations were found between the polymorphisms in NMOSD when compared to healthy controls, serology of the anti-AQP4 NMOSD biomarker and Expanded Disability Status Scale (EDSS). In conclusion, the 3' untranslated region 14 bp Ins/Del and +3142C/G polymorphisms seem not to be associated with NMOSD susceptibility, autoantibody production, nor a neurological deficit in patients.
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Affiliation(s)
- Nathália Augusta Gomes
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Pollyanna Cristina Silva
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Ygor Tiago Teixeira
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Patrícia Eufrazio
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Alessandra D Souza
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Hugo Rojas
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Renata Brant
- Clínica de Neurologia, Hospital Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111 - Santa Efigênia, PO BOX. 30150-221, Belo Horizonte - MG, Brazil
| | - Antônio Gomes Neto
- Clínica de Neurologia, Hospital Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111 - Santa Efigênia, PO BOX. 30150-221, Belo Horizonte - MG, Brazil
| | - Paulo Pereira Christo
- Clínica de Neurologia, Hospital Santa Casa de Belo Horizonte, Av. Francisco Sales, 1111 - Santa Efigênia, PO BOX. 30150-221, Belo Horizonte - MG, Brazil
| | - Renata Toscano Simões
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil
| | - Karla Simone Fernandes
- Instituto de Ensino e Pesquisa, Santa Casa de Belo Horizonte, Rua Domingos Vieira 590, Santa Efigênia. P.O. Box: 30250-140, Belo Horizonte, MG, Brazil.
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Grieve JK, Day S, Connell D, O'Riordan J. Neuromyelitis optica spectrum disorder and active tuberculosis. BMJ Case Rep 2020; 13:13/1/e231524. [PMID: 31900293 DOI: 10.1136/bcr-2019-231524] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tuberculosis is on the rise again. It brings with it potential for neurological involvement both as a direct infection and as a parainfectious process. Accordingly we report the development of neurological problems affecting a 48-year-old patient's vision and sensation while being treated for active tuberculosis. At its nadir her vision deteriorated to nil perception of light and she had a sensory level to T10. Neuromyelitis optica spectrum disorder was diagnosed. We discuss our management strategy with neuromodulation in the context of active tuberculosis infection.
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Affiliation(s)
| | - Scott Day
- General Medicine, Ninewells Hospital, Dundee, Tayside, UK
| | - David Connell
- Respiratory, Ninewells Hospital, Dundee, Tayside, UK
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Jonsson DI, Sveinsson O, Hakim R, Brundin L. Epidemiology of NMOSD in Sweden from 1987 to 2013: A nationwide population-based study. Neurology 2019; 93:e181-e189. [PMID: 31171648 PMCID: PMC6656652 DOI: 10.1212/wnl.0000000000007746] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 02/25/2019] [Indexed: 12/22/2022] Open
Abstract
Objective To report the yearly incidence rate and prevalence of neuromyelitis spectrum disorder (NMOSD) in Sweden and to investigate clinical characteristics, treatment, and outcome. Methods We conducted a retrospective study of hospital case records of 294 individuals diagnosed with neuromyelitis optica (NMO) (G36.0 ICD-10, 341.0 ICD-9) in the Swedish National Patient Register from 1987 to end of 2013 or detected by the presence of aquaporin-4 (AQP4) immunoglobulin G (IgG) in serum during the study period. Ninety-two patients (51 NMO and 41 NMOSD) met the 2006 Wingerchuk criteria and were included in the study. Ten patients with an onset of NMO prior to 1987 and alive at the end of 2013 were included when estimating the prevalence. Results The average yearly incidence rate per 1,000,000 individuals increased significantly from 0.30 (confidence interval [CI] 0.19–0.41) between 1987 and 2006 to 0.79 (CI 0.55–1.03) between 2007 and 2013. The prevalence was 10.4 (CI 8.5–12.6) per 1,000,000 individuals at end of 2013. The median time from onset to first relapse was 1.42 years (range 0.58–3.90). The probability of relapse was 60% and 75% after 5 and 10 years after onset. More than 80% were treated with immunosuppressive drugs. Three patients died during the study period. Conclusion The increased incidence rate during the study period was likely due to heightened awareness and increased access to MRI and AQP4-IgG analysis. Incidence and prevalence of NMO in Sweden correspond to other countries with a predominately Caucasian population. We found that most patients were treated with immunosuppressant drugs, presumably resulting in low mortality among the detected cases.
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Affiliation(s)
- Dagur Ingi Jonsson
- From the Department of Neurology (D.I.J., O.S., L.B.), Karolinska University Hospital; and Department of Clinical Neuroscience (O.S., R.H.), Karolinska Institutet, Stockholm, Sweden
| | - Olafur Sveinsson
- From the Department of Neurology (D.I.J., O.S., L.B.), Karolinska University Hospital; and Department of Clinical Neuroscience (O.S., R.H.), Karolinska Institutet, Stockholm, Sweden.
| | - Ramil Hakim
- From the Department of Neurology (D.I.J., O.S., L.B.), Karolinska University Hospital; and Department of Clinical Neuroscience (O.S., R.H.), Karolinska Institutet, Stockholm, Sweden
| | - Lou Brundin
- From the Department of Neurology (D.I.J., O.S., L.B.), Karolinska University Hospital; and Department of Clinical Neuroscience (O.S., R.H.), Karolinska Institutet, Stockholm, Sweden
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Kim H, Park KA, Oh SY, Min JH, Kim BJ. Association of Optic Neuritis with Neuromyelitis Optica Spectrum Disorder and Multiple Sclerosis in Korea. KOREAN JOURNAL OF OPHTHALMOLOGY 2019; 33:82-90. [PMID: 30746915 PMCID: PMC6372377 DOI: 10.3341/kjo.2018.0050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 09/12/2018] [Indexed: 01/06/2023] Open
Abstract
PURPOSE To describe the clinical characteristics and course of optic neuritis (ON) and its association with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) in Korea. METHODS In this retrospective case series, 125 eyes of 91 Korean patients with ON were included. The medical documents of adult patients with ON were retrospectively reviewed. Patients were assigned into idiopathic ON, NMOSD, and MS groups according to the presence of an association with NMOSD or MS for subgroup analysis. Clinical characteristics, disease course, and visual and systemic prognosis were analyzed. RESULTS During the mean follow-up of 3.7 years, 73 patients were diagnosed as idiopathic ON, 14 patients were diagnosed as NMOSD, and four patients developed definite MS. At the final visit, there were 13 (13%) eyes out of 100 eyes with idiopathic ON, nine (43%) eyes out of 21 eyes with NMOSD, and one (25%) eye out of four eyes with MS had a severe visual loss of 20 / 200 or less. The mean Expanded Disability Status Scale was 3.1 ± 1.5 in NMOSD and 1.8 ± 1.5 in the MS group at the final visit. In the NMOSD group, 50% of patients showed severe visual loss in at least one eye or were unable to ambulate without assistance at the final visit (5.3 ± 4.4 years after the initial episode of ON). CONCLUSIONS Fourteen percent of patients showed positive results for NMO-immunoglobulin G test and 50% of patients with NMOSD showed a severe visual loss in at least one eye or were unable to ambulate without assistance. The proportion of MS was relatively low in Korean ON patients.
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Affiliation(s)
- HyoJeong Kim
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ju Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Machavaram KK, Endo-Tsukude C, Terao K, Gill KL, Hatley OJ, Gardner I, Parrott N, Ducray PS. Simulating the Impact of Elevated Levels of Interleukin-6 on the Pharmacokinetics of Various CYP450 Substrates in Patients with Neuromyelitis Optica or Neuromyelitis Optica Spectrum Disorders in Different Ethnic Populations. AAPS JOURNAL 2019; 21:42. [PMID: 30887238 DOI: 10.1208/s12248-019-0309-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/18/2019] [Indexed: 01/05/2023]
Abstract
A physiologically based pharmacokinetic (PBPK) model was used to simulate the impact of elevated levels of interleukin (IL)-6 on the exposure of several orally administered cytochrome P450 (CYP) probe substrates (caffeine, S-warfarin, omeprazole, dextromethorphan, midazolam, and simvastatin). The changes in exposure of these substrates in subjects with rheumatoid arthritis (and hence elevated IL-6 levels) compared with healthy subjects were predicted with a reasonable degree of accuracy. The PBPK model was then used to simulate the change in oral exposure of the probe substrates in North European Caucasian, Chinese, and Japanese population of patients with neuromyelitis optica (NMO) or NMO spectrum disorder with elevated plasma IL-6 levels (up to 100 pg/mL). Moderate interactions [mean AUC fold change, ≤ 2.08 (midazolam) or 2.36 (simvastatin)] was predicted for CYP3A4 probe substrates and weak interactions (mean AUC fold change, ≤ 1.29-1.97) were predicted for CYP2C19, CYP2C9, and CYP2D6 substrates. No notable interaction was predicted with CYP1A2. Although ethnic differences led to differences in simulated exposure for some of the probe substrates, there were no marked differences in the predicted magnitude of the change in exposure following IL-6-mediated suppression of CYPs. Decreased levels of serum albumin (as reported in NMO patients) had little impact on the magnitude of the simulated IL-6-mediated drug interactions. This PBPK modeling approach allowed us to leverage knowledge from different disease and ethnic populations to make predictions of cytokine-related DDIs in a rare disease population where actual clinical studies would otherwise be difficult to conduct.
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Affiliation(s)
| | | | - Kimio Terao
- Clinical Pharmacology Department, Chugai Pharmaceutical Co., Ltd, Tokyo, Japan
| | | | | | - Iain Gardner
- Certara UK Limited, Simcyp Division, Sheffield, UK
| | - Neil Parrott
- Roche Pharma Research and Early Development, Roche Innovation Center, Basel, Switzerland
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18
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Park KA, Oh SY, Min JH, Kim BJ. Incidence and timing of recurrence of optic neuritis. Graefes Arch Clin Exp Ophthalmol 2019; 257:651-655. [PMID: 30612145 DOI: 10.1007/s00417-018-04217-7] [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: 09/13/2018] [Revised: 11/13/2018] [Accepted: 12/06/2018] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To describe the incidence and timing of recurrence in patients with optic neuritis (ON). METHODS Medical documents of adult patients with ON were retrospectively reviewed. The incidence and timing of recurrence of an ON episode were analyzed. RESULTS One hundred eleven patients with ON were included in this study. Their mean follow-up duration was 4.1 ± 3.1 years. Seven relapses occurred after intravenous methylprednisolone treatment. The estimated cumulative incidence of recurrence in either eye was 26% at 1 year, 33% at 3 years, 37% at 5 years, and 50% at 10 years after the first episode of ON. If there was no recurrence until 6 months after the first episode of ON, the next 5-year recurrence-free survival probability was 67%. If there was no recurrence until 1 year, the next 5-year survival probability was 72%. If there was no recurrence until 2 years, the next 5-year survival probability was 81%. Relapse within 1 month and the presence of neuromyelitis optica-immunoglobulin G were factors that increased the recurrence rate over time. CONCLUSIONS We evaluated the incidence and timing of the recurrence in patients with ON after the first episode. Lower probability of recurrence was observed in patients with longer recurrence-free follow-up period. However, monitoring for recurrence is needed even in patients with a single episode of ON due to the increasing tendency of the estimated cumulative incidence of recurrence over many years.
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Affiliation(s)
- Kyung-Ah Park
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea
| | - Sei Yeul Oh
- Department of Ophthalmology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Ilwon-dong, Kangnam-gu, Seoul, Republic of Korea.
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Zarei S, Eggert J, Franqui-Dominguez L, Carl Y, Boria F, Stukova M, Avila A, Rubi C, Chinea A. Comprehensive review of neuromyelitis optica and clinical characteristics of neuromyelitis optica patients in Puerto Rico. Surg Neurol Int 2018; 9:242. [PMID: 30603227 PMCID: PMC6293609 DOI: 10.4103/sni.sni_224_18] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/21/2018] [Indexed: 12/14/2022] Open
Abstract
Neuromyelitis optica (NMO) is an immune-mediated inflammatory disorder of the central nervous system. It is characterized by concurrent inflammation and demyelination of the optic nerve (optic neuritis [ON]) and the spinal cord (myelitis). Multiple studies show variations in prevalence, clinical, and demographic features of NMO among different populations. In addition, ethnicity and race are known as important factors on disease phenotype and clinical outcomes. There are little data on information about NMO patients in underserved groups, including Puerto Rico (PR). In this research, we will provide a comprehensive overview of all aspects of NMO, including epidemiology, environmental risk factors, genetic factors, molecular mechanism, symptoms, comorbidities and clinical differentiation, diagnosis, treatment, its management, and prognosis. We will also evaluate the demographic features and clinical phenotype of NMO patients in PR. This will provide a better understanding of NMO and establish a basis of knowledge that can be used to improve care. Furthermore, this type of population-based study can distinguish the clinical features variation among NMO patients and will provide insight into the potential mechanisms that cause these variations.
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Affiliation(s)
- Sara Zarei
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - James Eggert
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Yonatan Carl
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Fernando Boria
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | - Marina Stukova
- San Juan Bautista School of Medicine, Caguas, Puerto Rico, USA
| | | | - Cristina Rubi
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
| | - Angel Chinea
- Caribbean Neurological Center, Guaynabo, Puerto Rico, USA
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20
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Carnero Contentti E, Daccach Marques V, Soto de Castillo I, Tkachuk V, Antunes Barreira A, Armas E, Chiganer E, de Aquino Cruz C, Di Pace JL, Hryb JP, Lavigne Moreira C, Lessa C, Molina O, Perassolo M, Soto A, Caride A. Frequency of brain MRI abnormalities in neuromyelitis optica spectrum disorder at presentation: A cohort of Latin American patients. Mult Scler Relat Disord 2017; 19:73-78. [PMID: 29156226 DOI: 10.1016/j.msard.2017.11.004] [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: 09/15/2017] [Revised: 10/30/2017] [Accepted: 11/03/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Brain magnetic resonance imaging (BMRI) lesions were classically not reported in neuromyelitis optica (NMO). However, BMRI lesions are not uncommon in NMO spectrum disorder (NMOSD) patients. OBJECTIVE To report BMRI characteristic abnormalities (location and configuration) in NMOSD patients at presentation. METHODS Medical records and BMRI characteristics of 79 patients with NMOSD (during the first documented attack) in Argentina, Brazil and Venezuela were reviewed retrospectively. RESULTS BMRI abnormalities were observed in 81.02% of NMOSD patients at presentation. Forty-two patients (53.1%) showed typical-NMOSD abnormalities. We found BMRI abnormalities at presentation in the brainstem/cerebellum (n = 26; 32.9%), optic chiasm (n = 16; 20.2%), area postrema (n = 13; 16.4%), thalamus/hypothalamus (n = 11; 13.9%), corpus callosum (n = 11; 13.9%), periependymal-third ventricle (n = 9; 11.3%), corticospinal tract (n = 7; 8.8%), hemispheric white matter (n = 1; 1.2%) and nonspecific areas (n = 49; 62.03%). Asymptomatic BMRI lesions were more common. The frequency of brain MRI abnormalities did not differ between patients who were positive and negative for aquaporin 4 antibodies at presentation. CONCLUSION Typical brain MRI abnormalities are frequent in NMOSD at disease onset.
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Affiliation(s)
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | | | - Veronica Tkachuk
- Neurology Department, Hospital José de San Martin, Buenos Aires, Argentina
| | - Amilton Antunes Barreira
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Elizabeth Armas
- Neurology Department, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Edson Chiganer
- Neurology Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Camila de Aquino Cruz
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - José Luis Di Pace
- Neurology Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Javier Pablo Hryb
- Neurology Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Carolina Lavigne Moreira
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of de São Paulo, São Paulo, Brazil
| | - Carmen Lessa
- Neurology Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Omaira Molina
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Venezuela
| | - Monica Perassolo
- Neurology Department, Hospital Carlos G. Durand, Buenos Aires, Argentina
| | - Arnoldo Soto
- Neurology Department, Hospital Universitario de Caracas, Caracas, Venezuela
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
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Zhong X, Zhou Y, Lu T, Wang Z, Fang L, Peng L, Kermode AG, Qiu W. Infections in neuromyelitis optica spectrum disorder. J Clin Neurosci 2017; 47:14-19. [PMID: 29066232 DOI: 10.1016/j.jocn.2017.10.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 10/01/2017] [Indexed: 12/19/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory astrocytopathy that has both genetic and environmental causes. A growing body of evidence suggests that the presence of several infectious agents correlates with the development of NMOSD. In this review, we summarize studies that either support or present evidence against the hypothesized association between infection and NMOSD. We will also present an overview of potential mechanisms underlying the pathogenesis of NMOSD. Finally, we provide some beneficial properties that infectious elements may have based on "hygiene hypothesis". It is of great clinical significance to further investigate the complex mechanisms by which infections may affect autoimmune diseases to develop better strategies to prevent and treat them, although so far no causal link between infectious agents and NMOSD has been established.
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Affiliation(s)
- Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yifan Zhou
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tingting Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhanhang Wang
- Department of Neurology, Guangdong 999 Brain Hospital, China
| | - Ling Fang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Allan G Kermode
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China; Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Department of Neurology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Australia; Institute of Immunology and Infectious Diseases, Murdoch University, Perth, Australia
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Hacohen Y, Messina S, Gan HW, Wright S, Chandratre S, Leite MI, Fallon P, Vincent A, Ciccarelli O, Wassmer E, Lim M, Palace J, Hemingway C. Endocrinopathies in paediatric-onset neuromyelitis optica spectrum disorder with aquaporin 4 (AQP4) antibody. Mult Scler 2017; 24:679-684. [DOI: 10.1177/1352458517726593] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The involvement of the diencephalic regions in neuromyelitis optica spectrum disorder (NMOSD) may lead to endocrinopathies. In this study, we identified the following endocrinopathies in 60% (15/25) of young people with paediatric-onset aquaporin 4-Antibody (AQP4-Ab) NMOSD: morbid obesity ( n = 8), hyperinsulinaemia ( n = 5), hyperandrogenism ( n = 5), amenorrhoea ( n = 5), hyponatraemia ( n = 4), short stature ( n = 3) and central hypothyroidism ( n = 2) irrespective of hypothalamic lesions. Morbid obesity was seen in 88% (7/8) of children of Caribbean origin. As endocrinopathies were prevalent in the majority of paediatric-onset AQP4-Ab NMOSD, endocrine surveillance and in particular early aggressive weight management is required for patients with AQP4-Ab NMOSD.
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Affiliation(s)
- Yael Hacohen
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK/Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK/Department of Neurosciences, Great Ormond Street Hospital for Children, London, UK
| | - Silvia Messina
- Neurology Department, John Radcliffe Hospital, Oxford, UK
| | - Hoong-Wei Gan
- Department of Paediatric Endocrinology, Great Ormond Street Hospital, London, UK
| | - Sukhvir Wright
- Department of Paediatric Neurology, Birmingham Children’s Hospital, Birmingham, UK
| | - Saleel Chandratre
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Maria Isabel Leite
- Neurology Department, John Radcliffe Hospital, Oxford, UK/Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Penny Fallon
- Department of Paediatric Neurology, St George’s Hospital, London, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Olga Ciccarelli
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children’s Hospital, Birmingham, UK
| | - Ming Lim
- Department of Children’s Neurosciences, Evelina London Children’s Hospital, Guy’s and St Thomas’ NHS Foundation Trust, King’s Health Partners Academic Health Science Centre, London, UK
| | | | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
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Alvarenga MP, Schimidt S, Alvarenga RP. Epidemiology of neuromyelitis optica in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317730098. [PMID: 28979797 PMCID: PMC5617096 DOI: 10.1177/2055217317730098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/13/2017] [Indexed: 01/08/2023] Open
Abstract
A major development over the past two decades was the recognition of recurrent neuromyelitis optica (NMO) as a particular central nervous system disorder different from multiple sclerosis (MS). Here we reviewed the epidemiology of NMO in Latin America (LATAM). A predominance of a mixed population is found in this region. Recurrent NMO in black women was described in the Caribbean Islands and in Rio de Janeiro. The prevalence of NMO in LATAM varied from 0.37/100,000 (Volta Redonda city) to 4.2/100,000 inhabitants (Caribbean Islands). NMO differs significantly from MS with respect to gender, ethnicity, morbidity and genetic susceptibility. An association of the HLA DRB1*03 alleles with NMO was described in the French Antilles, Ribeirão Preto, Rio de Janeiro and Mexico. It is not common to find familial forms of NMO. NMO represents 11.8% of all inflammatory idiopathic diseases in South America (SA). In SA, the highest frequency of NMO occurs in African Brazilian young women. The overall relative frequency of NMO among MS cases in this region was 14%, decreasing following a north-south gradient, which parallels the percentage of nonwhite people.
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Affiliation(s)
- M P Alvarenga
- Department of Neurology, Hospital Federal da Lagoa, Brazil
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Ashtari F, Safaei A, Shaygannejad V, Najafi MA, Vesal S. Neuromyelitis optica spectrum disease characteristics in Isfahan, Iran: A cross-sectional study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2017; 22:41. [PMID: 28465700 PMCID: PMC5393101 DOI: 10.4103/1735-1995.202142] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 07/13/2016] [Accepted: 12/02/2016] [Indexed: 01/19/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disease (NMOSD) is a severe autoimmune demyelinating disorder of the central nervous system that throughout epidemiological data, it has not been completely determined. The aim of this study was to assess characteristics of NMOSD patients in Isfahan as one of the most prevalent cities for multiple sclerosis in Iran. MATERIALS AND METHODS Forty-five patients diagnosed as neuromyelitis optica (NMO) disease through 5 years enrolled in this study. Demographics and characteristics of disease such as Expanded Disability Status Scale (EDSS) score, disease duration, clinical symptoms, laboratory data, and magnetic resonance imaging findings (including T1, T2, and flair protocols) were recorded. NMO-immunoglobulin G serology assay was done in all of the patients by ELISA test. RESULTS Female to male ratio was 5.4:1. The mean age of disease onset was 29.8 ± 11.2 years. NMO antibody was positive in 24.4% of patients. The presenting symptoms were optic neuritis (55.5%), transverse myelitis (40%), and brainstem symptoms (4.5%). The interval between the first and second attack was 19.28 ± 31.27 months (range: 1 month to 17 years). The mean EDSS score of the patients was 2.8 ± 2.25. Frequency of long-extending cervical plaque was higher among men than women (85.7% vs. 57.9%). CONCLUSION Based on this study, the mean age of NMOSD onset among Isfahan population was considerably lower than other studies, and there was higher frequency of long-extending cervical lesion among male patients which needs more consideration in further studies.
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Affiliation(s)
- Fereshte Ashtari
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Safaei
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Student of Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Amin Najafi
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Student of Medicine, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahar Vesal
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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Del Negro MC, Marinho PBC, Papais-Alvarenga RM. Neuromyelitis optica: phenotypic characteristics in a Brazilian case series. ARQUIVOS DE NEURO-PSIQUIATRIA 2017; 75:81-86. [DOI: 10.1590/0004-282x20160193] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/17/2016] [Indexed: 11/22/2022]
Abstract
ABSTRACT The definition of neuromyelitis optica (NMO) is still evolving. In 2015, the International Panel for NMO Diagnosis was convened to develop revised diagnostic criteria. There have been few studies on NMO in the Brazilian population. Objective To describe the characteristics of 34 Brazilian NMO patients. To evaluate the contribution of the 2015 criteria to the diagnosis of NMO spectrum disorders (NMOSD) in 40 patients with longitudinal extensive transverse myelitis (LEMT). Methods This is a retrospective, descriptive and analytic study. Results Among NMO patients, there was a predominance of women, with onset in the fourth decade of life, and AQP4-IgG seropositivity in 73.5%. The diagnosis of NMOSD was established in 37.5% of LETM patients according to AQP4-IgG positivity and in 5% of LETM patients if the AQP4-IgG result was unknown. Conclusions The characteristics of this series are similar to those of other Western populations. The AQP4-IgG testing assists in the diagnosis of NMOSD.
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Cabrera-Gómez JA, Quevedo-Sotolongo L, González-Quevedo A, Lima S, Real-González Y, Cristófol-Corominas M, Romero-García K, Ugarte-Sánchez C, Jordán-González J, de la Nuez JEG, Lahera JG, Tellez R, Pedroso-Ibañez I, Roca RR, Cabrera-Núñez AY. Brain magnetic resonance imaging findings in relapsing neuromyelitis optica. Mult Scler 2017; 13:186-92. [PMID: 17439883 DOI: 10.1177/1352458506070725] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Some studies showed abnormalities in brain magnetic resonance imaging (MRI) of relapsing neuromyelitis optica (R-NMO) from 12 to 46%. These abnormalities are described as compatible/non-compatible with multiple sclerosis (MS). Objective To describe the abnormal brain MRI lesions in R-NMO with imaging studies conducted with more sensitive white matter change techniques. Methods Thirty patients with R-NMO were selected. All MRI brain studies were performed with a 1.5-T Siemens MRI system according to the Standardized MR Imaging Protocol for Multiple Sclerosis from the Consortium of MS Centers Consensus Guidelines. Results Brain MRI images were evaluated in 29 R-NMO cases because in one case the MRI images were not appropriate for the study. Of these 29 brain MRI studies, 19 cases (65.5%) had at least one or more lesions (1–57) and 10 were negative (34.4%). Brain MRI findings in 19 cases were characterized in T2/fluid-attenuated inversion-recovery (FLAIR) by the presence of subcortical/deep white matter lesions in 16 (84.2%) cases (1–50), most of them < 3 mm and without juxtacortical localization. Periventricular lesions were observed in 13 (68.4%) cases, but morphologically they were not oval, ovoid or perpendicularly orientated. Infratentorial lesions, all >3 mm, were observed in 4 (21.05%) cases without cerebellar involvement. T1 studies demonstrated absence of hypointense regions. Optic nerve enhancement was observed in 6/19 patients (31.5%). None of the brain MRI abnormalities observed were compatible with Barkhof et al. criteria of MS. Conclusions This study, based on a Cuban patient population, with long duration of disease, good sample size and detailed characterization by MRI, demonstrated the brain MRI pattern of R-NMO patients, which is different from MS. Multiple Sclerosis 2007; 13: 186–192. http://msj.sagepub.com
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Affiliation(s)
- José A Cabrera-Gómez
- International Center of Neurological Restoration, Reparto Cubanacán, Playa, Ciudad de La Habana, Cuba.
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Galactorrhea in a Patient With Aquaporin-4 Antibody-positive Neuromyelitis Optica Spectrum Disorder: A Case Report and Review of the Literature. Neurologist 2016; 20:101-3. [PMID: 26671741 DOI: 10.1097/nrl.0000000000000061] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is the first report of a case of galactorrhea in a patient with neuromyelitis optica spectrum disorder (NMOSD) diagnosed on the basis of antiaquaporin-4 antibody seropositivity. The hypothalamus is becoming known as an area highly expressing aquaporin-4 and frequently involved in intracranial lesions of patients with neuromyelitis optica (NMO). We reviewed cases of hypothalamic endocrinopathy among patients with NMO, NMOSD, and the Japanese opticospinal form of MS. Among these cases, galactorrhea was the second most common symptom. Signs of hypothalamic endocrinopathies may be obscured by the grave neurological deficits caused by NMO. We recommend paying special attention to hypothalamic endocrinopathies among patients with NMO or NMOSD, irrespective of brain MRI findings.
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Petravić D, Habek M, Supe S, Brinar VV. Recurrent optic neuromyelitis with endocrinopathies: a new syndrome or just a coincidence? Mult Scler 2016; 12:670-3. [PMID: 17086917 DOI: 10.1177/1352458506070756] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The spectrum of optic neuromyelitis (ONM) ranges from monophasic or recurrent idiopathic forms of the disease, to ONM associated with autoimmune disorders. A distinct form of the disease, called recurrent ONM with endocrinopathies, characterized by spinal cord involvement (cavitations with syringomyeloid sensory disturbance), rapid evolution to blindness and paraplegia, characteristic cerebrospinal fluid (CSF) findings, and association with hypothalamus - pituitary dysfunction, has recently been described. The first case of ONM with endocrinopathies in a female Caucasian from Europe is presented, supporting the existence of this syndrome as a separate entity.
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Affiliation(s)
- D Petravić
- University Department of Neurology, Zagreb School of Medicine and University Hospital Center, Kispatićeva 12, HR-10000 Zagreb, Croatia
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Barros PO, Cassano T, Hygino J, Ferreira TB, Centurião N, Kasahara TM, Andrade RM, Linhares UC, Andrade AFB, Vasconcelos CCF, Alvarenga R, Marignier R, Bento CAM. Prediction of disease severity in neuromyelitis optica by the levels of interleukin (IL)-6 produced during remission phase. Clin Exp Immunol 2015; 183:480-9. [PMID: 26472479 DOI: 10.1111/cei.12733] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Revised: 10/05/2015] [Accepted: 10/12/2015] [Indexed: 01/01/2023] Open
Abstract
T helper type 17 (Th17) cytokines have been implicated in the pathogenesis of neuromyelitis optica (NMO). As humanized anti-interleukin (IL)-6R (tocilizumab) immunoglobulin (Ig)G has been used as disease-modifying therapy for NMO, the objective of our study was to investigate the role of endogenous IL-6 on NMO-derived CD4(+) T cell behaviour. High production of IL-6, IL-17 and IL-21 by CD4(+) T-cells was detected in NMO patients. Further, IL-21 and IL-6 levels were related directly to the level of neurological disabilities. The addition of anti-IL-6R IgG not only reduced directly the production of these cytokines, but also almost abolished the ability of activated autologous monocytes in enhancing IL-6, IL-17 and IL-21 release by CD4(+) T cells. In contrast, the production of IL-10 was amplified in those cell cultures. Further, anti-IL-6R monoclonal antibodies (mAb) also potentiated the ability of glucocorticoid in reducing Th17 cytokines. Finally, the in-vivo and in-vitro IL-6 levels were significantly higher among those patients who experienced clinical relapse during 2-year follow-up. In summary, our results suggest a deleterious role of IL-6 in NMO by favouring, at least in part, the expansion of corticoid-resistant Th17 cells.
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Affiliation(s)
- P O Barros
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro
| | - T Cassano
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro
| | - J Hygino
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro
| | - T B Ferreira
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro
| | - N Centurião
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro
| | - T M Kasahara
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro
| | - R M Andrade
- Department of General Medicine, Federal University of the State of Rio De Janeiro
| | - U C Linhares
- Postgraduate Program in Neurology, Federal University of the State of Rio De Janeiro
| | - A F B Andrade
- Department of Microbiology of State University of Rio De Janeiro, Rio De Janeiro, Brazil
| | - C C F Vasconcelos
- Postgraduate Program in Neurology, Federal University of the State of Rio De Janeiro
| | - R Alvarenga
- Postgraduate Program in Neurology, Federal University of the State of Rio De Janeiro
| | - R Marignier
- Team ONCOFLAM, Lyon's Neuroscience Research Center, Lyon, France
| | - C A M Bento
- Department of Microbiology and Parasitology, Federal University of the State of Rio De Janeiro.,Postgraduate Program in Neurology, Federal University of the State of Rio De Janeiro
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Kashipazha D, Mohammadianinejad SE, Majdinasab N, Azizi M, Jafari M. A descriptive study of prevalence, clinical features and other findings of neuromyelitis optica and neuromyelitis optica spectrum disorder in Khuzestan Province, Iran. IRANIAN JOURNAL OF NEUROLOGY 2015; 14:204-10. [PMID: 26885339 PMCID: PMC4754599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neuromyelitis optica (NMO) is an uncommon neuro-inflammatory syndrome that has shown to be distinct from multiple sclerosis (MS) and associated with the autoantibody marker NMO-immunoglobulin G (IgG). There are still only a few studies regarding the epidemiology of NMO in Iran. In the present study, we tried to describe the epidemiology of NMO in Khuzestan as one of the densely populated regions in Iran. METHODS A cross-sectional study was performed during the period 2013-2014. Multiple regional sources of data were used including hospital records, details from neurologists and MS society database. The diagnosis of NMO was based on clinical presentation, abnormal findings on neuroimaging and serological tests. RESULTS A 51 Caucasian patients (36 patients with NMO and 15 with NMO-spectrum disorder) were identified with a female/male ratio of 7.5:1.0. The crude prevalence of NMO was 1.1/100,000 population. The mean age at onset was 29.2 ± 6.1 years and the mean duration of symptoms was 5.0 ± 0.4 years. The majority of patients (60.8%) were classified as having mild disability (Expanded Disability Status Scale = 0-3.5). Among of 35 patients whose titer of NMO-IgG was measured, 19 (54.2%) were seropositive. CONCLUSION Our study suggests that NMO prevalence rate in South West Iran (Khuzestan Province) is much lower than that reported for MS prevalence rate (16.2/100,000) and our patients had a lower age at onset presentation and milder course of the disease than western countries.
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Affiliation(s)
- Davood Kashipazha
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Nastaran Majdinasab
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mostafa Azizi
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Jafari
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Jagtap SA, Mandliya A, Sarada C, Nair MD. Neuromyelitis optica and neuromyelitis optica spectrum disorder: Natural history and long-term outcome, an Indian experience. J Neurosci Rural Pract 2015; 6:331-5. [PMID: 26167014 PMCID: PMC4481785 DOI: 10.4103/0976-3147.158755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Neuromyelitis optica (NMO) has evolved from devic's classical description to a broader disease spectrum, from monophasic illness to a polyphasic illness with multiple recurrences, disease confined to optic nerve and spinal cord to now brain stem, cerebrum and even endocrinopathy due to hypothalamic involvement. Objectives: To report, the epidemiological characteristics, clinical presentations, recurrence rate, treatment and response to therapy in 26 patients with NMO and NMO spectrum disorder among the Indian population. Methods: We performed observational, retrospective analysis of our prospectively maintained data base of patients with NMO, longitudinally extensive transverse myelitis during the period of January 2003–December 2012 who satisfied the national multiple sclerosis society (NMSS) task force criteria for diagnosis of NMO and NMO spectrum disorder. Results: There were 26 patients (female: male, 21:5), the mean age of onset of symptom was 27 years (range 9–58, standard deviation = 12). Twenty-one patients (80%) fulfilled NMSS criteria for NMO while rest 5 patients (20%) were considered as NMO spectrum disorder. Seven patients (27%) had a monophasic illness, 19 patients (73%) had a polyphasic illness with recurrences. The Median recurrence rate was 4/patient in the polyphasic group. 13 (50%) patient were tested for aquaporin 4 antibody, 8 (61%) were positive while 5 patients (39%) were negative. All patients received intravenous methyl prednisolone, 9 patients (35%) required further treatment for acute illness in view of unresponsiveness to steroids. Thirteen patients (50%) received disease-modifying agents for recurrences. Mean duration of follow-up was 5 years. All patients had a good outcome (modified Rankin scale, <3) except one who had poor visual recovery. Conclusion: Neuromyelitis optica/NMO spectrum disorder is demyelinating disorder with female predominance, polyphasic course, myelitis being most common event although brain stem involvement is not uncommon with NMO antibody positivity in 60% patients, confirms the literature data.
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Affiliation(s)
- Sujit Abajirao Jagtap
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - Alok Mandliya
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - C Sarada
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
| | - M D Nair
- Department of Neurology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Pereira WLDCJ, Reiche EMV, Kallaur AP, Kaimen-Maciel DR. Epidemiological, clinical, and immunological characteristics of neuromyelitis optica: A review. J Neurol Sci 2015; 355:7-17. [PMID: 26050520 DOI: 10.1016/j.jns.2015.05.034] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 01/16/2023]
Abstract
The aim of this study was to review the epidemiological and clinical characteristics of neuromyelitis optica (NMO) and the immunopathological mechanisms involved in the neuronal damage. NMO is an inflammatory demyelinating autoimmune disease of the central nervous system that most commonly affects the optic nerves and spinal cord. NMO is thought to be more prevalent among non-Caucasians and where multiple sclerosis (MS) prevalence is low. NMO follows a relapsing course in more than 80-90% of cases, which is more commonly in women. It is a complex disease with an interaction between host genetic and environmental factors and the main immunological feature is the presence of anti-aquaporin 4 (AQP4) antibodies in a subset of patients. NMO is frequently associated with multiple other autoantibodies and there is a strong association between NMO with other systemic autoimmune diseases. AQP4-IgG can cause antibody-dependent cellular cytotoxicity (ADCC) when effector cells are present and complement-dependent cytotoxicity (CDC) when complement is present. Acute therapies, including corticosteroids and plasma exchange, are designed to minimize injury and accelerate recovery. Several aspects of NMO pathogenesis remain unclear. More advances in the understanding of NMO disease mechanisms are needed in order to identify more specific biomarkers to NMO diagnosis.
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Affiliation(s)
- Wildéa Lice de Carvalho Jennings Pereira
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil; Outpatient Clinic for Demyelinating Diseases, University Hospital, State University of Londrina, Londrina, Paraná 86061-335, Brazil.
| | - Edna Maria Vissoci Reiche
- Department of Pathology, Clinical Analysis and Toxicology, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil.
| | - Ana Paula Kallaur
- Health Sciences Postgraduate Program, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil.
| | - Damacio Ramón Kaimen-Maciel
- Outpatient Clinic for Demyelinating Diseases, University Hospital, State University of Londrina, Londrina, Paraná 86061-335, Brazil; Department of Clinical Medicine, Health Sciences Center, State University of Londrina, Londrina, Paraná 86038-440, Brazil.
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Diagnostic value of aquaporin 4 antibody in assessing idiopathic inflammatory demyelinating central nervous system diseases in Egyptian patients. J Clin Neurosci 2015; 22:670-5. [DOI: 10.1016/j.jocn.2014.09.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 01/31/2014] [Accepted: 09/14/2014] [Indexed: 11/19/2022]
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Souza CS, Brooks JBB, Oliveira CLS, Fragoso YD. Neuromyelitis optica with very late onset. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:556-7. [PMID: 23982016 DOI: 10.1590/0004-282x20130077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 04/01/2013] [Indexed: 11/22/2022]
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Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system that selectively targets the optic nerve and spinal cord, although it may also target certain areas of the brain. The majority of cases are associated with relapses. A specific biomarker, an autoantibody that targets aquaporin-4, is present in the majority of patients and facilitates the diagnosis. Detection of this biomarker in serum has enabled recognition of an expanded spectrum of clinical disorders that previously would not have met diagnostic criteria for NMO. Aquaporin-4 IgG1 autoantibodies are pathogenic and produce lesions of the brain when injected intracerebrally or systemically. The clinical course of NMO is dominated by acute attacks. Progressive worsening of disability, as occurs in prototypic multiple sclerosis, is distinctly unusual. Corticosteroids and plasma exchange are useful for management of acute attacks. Several treatments used to prevent attacks of multiple sclerosis are ineffective in this condition; effective immunotherapies include azathioprine, mycophenolate mofetil and rituximab.
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Pandit L, Mustafa S, Kunder R, Shetty R, Misri Z, Pai S, Shetty R. Optimizing the management of neuromyelitis optica and spectrum disorders in resource poor settings: Experience from the Mangalore demyelinating disease registry. Ann Indian Acad Neurol 2013; 16:572-6. [PMID: 24339582 PMCID: PMC3841603 DOI: 10.4103/0972-2327.120474] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/23/2013] [Accepted: 06/29/2013] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND In resource-poor settings, the management of neuromyelitis optica (NMO) and NMO spectrum (NMOS) disorders is limited because of delayed diagnosis and financial constraints. AIM To device a cost-effective strategy for the management of NMO and related disorders in India. MATERIALS AND METHODS A cost-effective and disease-specific protocol was used for evaluating the course and treatment outcome of 70 consecutive patients. RESULTS Forty-five patients (65%) had a relapse from the onset and included NMO (n = 20), recurrent transverse myelitis (RTM; n = 10), and recurrent optic neuritis (ROPN; n = 15). In 38 (84.4%) patients presenting after multiple attacks, the diagnosis was made clinically. Only 7 patients with a relapsing course were seen at the onset and included ROPN (n = 5), NMO (n = 1), and RTM (n = 1). They had a second attack after a median interval of 1 ± 0.9 years, which was captured through our dedicated review process. Twenty-five patients had isolated longitudinally extensive transverse myelitis (LETM), of which 20 (80%) remained ambulant at follow-up of 3 ± 1.9 years. Twelve patients (17%) with median expanded disability status scale (EDSS) of 8.5 at entry had a fatal outcome. Serum NMO-IgG testing was done in selected patients, and it was positive in 7 of 18 patients (39%). Irrespective of the NMO-IgG status, the treatment compliant patients (44.4%) showed significant improvement in EDSS (P ≤ 0.001). CONCLUSIONS Early clinical diagnosis and treatment compliance were important for good outcome. Isolated LETM was most likely a post-infectious demyelinating disorder in our set-up. NMO and NMOS disorders contributed to 14.9% (45/303) of all demyelinating disorders in our registry.
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Affiliation(s)
- Lekha Pandit
- Department of Neurology, KS Hegde Medical Academy, Deralakatte, India
| | - Sharik Mustafa
- Department of Neurology, KS Hegde Medical Academy, Deralakatte, India
| | - Ramya Kunder
- Department of Neurology, KS Hegde Medical Academy, Deralakatte, India
| | - Rajesh Shetty
- Department of Neurology, AJ Institute of Medical Sciences, Mangalore, Karnataka, India
| | - Zulkifly Misri
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Shivanand Pai
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
| | - Rakshith Shetty
- Department of Neurology, Kasturba Medical College, Mangalore, Karnataka, India
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Abstract
Neuromyelitis optica (NMO) is a demyelinating and inflammatory disease essentially restricted to the spinal cord and the optic nerves. Emerging evidence indicates that serum antiaquaporin-4 (AQP4) antibodies have a critical role in its pathogenesis. NMO courses with multiple relapses, often leading to severe disability. Management of NMO focuses on the effective treatment of acute attacks and the prevention of relapses. The latter is currently attempted with immunosuppressive drugs. Although several factors have been associated with disease activity, especially serum levels of anti-AQP4 IgG, no single one of them has been proved clinically useful for guiding treatment. New drugs that target specifically AQP4 antibodies and complement activation are being developed; they may prove to be more efficient with fewer side effects.
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Affiliation(s)
- Susana Noval
- Department of Ophthalmology, Hospital Universitario La Paz, Instituto de Investigación La Paz, Madrid, Spain
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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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High in vitro immune reactivity to Escherichia coli in neuromyelitis optica patients is correlated with both neurological disabilities and elevated plasma lipopolysaccharide levels. Hum Immunol 2013; 74:1080-7. [PMID: 23777933 DOI: 10.1016/j.humimm.2013.06.016] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/03/2013] [Accepted: 06/07/2013] [Indexed: 01/08/2023]
Abstract
The pathogenesis of neuromyelitis optica (NMO) is influenced by a combination of genetic and environmental factors, including infectious agents. Several infectious diseases can both trigger or exacerbate autoimmunity. The objective of the present work was to evaluate the in vitro immune responsiveness to Escherichia coli (EC), Staphylococcus aureus (SA) and Candida albicans (CA) in remittent-recurrent NMO patients, and correlate it with the level of neurological disability. Our results revealed that the extent of lymphoproliferation and cytokine profile in response to SA- and CA-stimulated PBMC cultures was similar between NMO patients and healthy individuals. Nevertheless, a higher in vitro CD4(+) T cell proliferation associated with elevated IL-1β, IL-6 and IL-17 release was observed in NMO-derived EC-stimulated cell cultures. Additionally, in these last cultures, the IL-10 production was significantly lower as compared with control group. The in vitro EC-induced levels of IL-6 and IL-17 were positively related with neurological disabilities. This higher tendency to produce Th17-related cytokines was proportional to the production of IL-23 and IL-6 by LPS-activated monocytes. Interestingly, elevated LPS levels were quantified in the plasma of NMO patients. The results suggest that a higher Th17-responsiveness to E. coli could be involved in the NMO pathogenesis.
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Bichuetti DB, Oliveira EMLD, Souza NAD, Tintoré M, Gabbai AA. Patients with neuromyelitis optica have a more severe disease than patients with relapsingremitting multiple sclerosis, including higher risk of dying of a demyelinating disease. ARQUIVOS DE NEURO-PSIQUIATRIA 2013; 71:275-9. [DOI: 10.1590/0004-282x20130020] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Accepted: 12/07/2012] [Indexed: 11/22/2022]
Abstract
Although neuromyelitis optica (NMO) is known to be a more severe disease than relapsing-remitting multiple sclerosis (RRMS), few studies comparing both conditions in a single center have been done.Methods:Comparison of our previously published cohort of 41 NMO patients with 177 RRMS patients followed in the same center, from 1994 to 2007.Results:Mean age of onset was 32.6 for NMO and 30.2 for RRMS (p=0.2062) with mean disease duration of 7.4 years for NMO and 10.3 years for RRMS. Patients with NMO had a higher annualized relapse rate (1.0 versus 0.8, p=0.0013) and progression index (0.9 versus 0.6, p≪0.0001), with more patients reaching expanded disability status scale (EDSS) 6.0 (39 versus 17%, p=0.0036). The odds ratio for reaching EDSS 6.0 and being deceased due to NMO in comparison to RRMS were, respectively, 3.14 and 12.15.Conclusion:Patients with NMO have a more severe disease than patients with RRMS, including higher risk of dying of a demyelinating disease.
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Carroll WM, Saida T, Kim HJ, Kira J, Kermode AG, Tsai CP, Fujihara K, Kusunoki S, Tanaka M, Kim KK, Bates D. A guide to facilitate the early treatment of patients with idiopathic demyelinating disease (multiple sclerosis and neuromyelitis optica). Mult Scler 2013; 19:1371-80. [PMID: 23325588 DOI: 10.1177/1352458512471092] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Definite diagnosis of inflammatory demyelinating disease (multiple sclerosis (MS) and neuromyelitis optica (NMO)) may require time, but early treatment offers the opportunity to maximize patient outcomes. The purpose of this report is to provide guidance to facilitate early treatment decisions for patients with inflammatory demyelinating disease, before definitive diagnosis. Neurology experts reviewed the existing literature and clinical evidence. A treatment decision pathway was developed, defining patients for whom first-line MS disease-modifying therapies (a) are unlikely to be effective, (b) may be effective but require careful monitoring and (c) are likely to provide benefit. This algorithm seeks to ensure that patients, particularly those in Asia, receive appropriate treatment early in inflammatory demyelinating disease.
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Brain abnormalities in neuromyelitis optica spectrum disorder. Mult Scler Int 2012; 2012:735486. [PMID: 23259063 PMCID: PMC3518965 DOI: 10.1155/2012/735486] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Accepted: 11/02/2012] [Indexed: 12/17/2022] Open
Abstract
Neuromyelitis optica (NMO) is an idiopathic inflammatory syndrome of the central nervous system that is characterized by severe attacks of optic neuritis (ON) and myelitis. Until recently, NMO was considered a disease without brain involvement. However, since the discovery of NMO-IgG/antiaqaporin-4 antibody, the concept of NMO was broadened to NMO spectrum disorder (NMOSD), and brain lesions are commonly recognized. Furthermore, some patients present with brain symptoms as their first manifestation and develop recurrent brain symptoms without ON or myelitis. Brain lesions with characteristic locations and configurations can be helpful in the diagnosis of NMOSD. Due to the growing recognition of brain abnormalities in NMOSD, these have been included in the NMO and NMOSD diagnostic criteria or guidelines. Recent technical developments such as diffusion tensor imaging, MR spectroscopy, and voxel-based morphometry reveal new findings related to brain abnormalities in NMOSD that were not identified using conventional MRI. This paper focuses on the incidence and characteristics of the brain lesions found in NMOSD and the symptoms that they cause. Recent studies using advanced imaging techniques are also introduced.
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Bukhari W, Barnett MH, Prain K, Broadley SA. Molecular pathogenesis of neuromyelitis optica. Int J Mol Sci 2012; 13:12970-93. [PMID: 23202933 PMCID: PMC3497307 DOI: 10.3390/ijms131012970] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 09/08/2012] [Accepted: 09/13/2012] [Indexed: 11/16/2022] Open
Abstract
Neuromyelitis optica (NMO) is a rare autoimmune disorder, distinct from multiple sclerosis, causing inflammatory lesions in the optic nerves and spinal cord. An autoantibody (NMO IgG) against aquaporin-4 (AQP4), a water channel expressed on astrocytes is thought to be causative. Peripheral production of the antibody is triggered by an unknown process in genetically susceptible individuals. Anti-AQP4 antibody enters the central nervous system (CNS) when the blood brain barrier is made permeable and has high affinity for orthogonal array particles of AQP4. Like other autoimmune diseases, Th17 cells and their effector cytokines (such as interleukin 6) have been implicated in pathogenesis. AQP4 expressing peripheral organs are not affected by NMO IgG, but the antibody causes extensive astrocytic loss in specific regions of the CNS through complement mediated cytotoxicity. Demyelination occurs during the inflammatory process and is probably secondary to oligodendrocyte apoptosis subsequent to loss of trophic support from astrocytes. Ultimately, extensive axonal injury leads to severe disability. Despite rapid advances in the understanding of NMO pathogenesis, unanswered questions remain, particularly with regards to disease mechanisms in NMO IgG seronegative cases. Increasing knowledge of the molecular pathology is leading to improved treatment strategies.
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Affiliation(s)
- Wajih Bukhari
- School of Medicine, Gold Coast Campus, Griffith University, QLD 4222, Australia; E-Mail:
- Department of Neurology, Gold Coast Hospital, Southport, QLD 4215, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, Camperdown, NSW 2050, Australia; E-Mail:
| | - Kerri Prain
- Autoimmune laboratory, Division of Immunology, Pathology Queensland, Herston, QLD 4029, Australia; E-Mail:
| | - Simon A Broadley
- School of Medicine, Gold Coast Campus, Griffith University, QLD 4222, Australia; E-Mail:
- Department of Neurology, Gold Coast Hospital, Southport, QLD 4215, Australia
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Ren Z, Wang Y, Duan T, Patel J, Liggett T, Loda E, Brahma S, Goswami R, Grouse C, Byrne R, Stefoski D, Javed A, Miller SD, Balabanov R. Cross-immunoreactivity between bacterial aquaporin-Z and human aquaporin-4: potential relevance to neuromyelitis optica. THE JOURNAL OF IMMUNOLOGY 2012; 189:4602-11. [PMID: 23008451 DOI: 10.4049/jimmunol.1200486] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Neuromyelitis optica (NMO) is a chronic inflammatory disease of the CNS that is mediated, in part, by a self-reactive Ab against the astrocyte aquaporin-4 protein. In the current study, we examined the possibility and the biological significance of cross-immunoreactivity between bacterial aquaporin-Z and human aquaporin-4 proteins. Sequence-alignment analysis of these proteins revealed several regions of significant structural homology. Some of the homologous regions were also found to overlap with important immune and disease-relevant epitopes. Cross-immunoreactivity between aquaporin-Z and aquaporin-4 was investigated and ascertained in multiple immune-based assays using sera from patients with neuromyelitis optica, immune mouse serum, and Abs raised against aquaporin-Z. The biological significance of this phenomenon was established in series of experiments demonstrating that induction of an immune response against aquaporin-Z or its homologous regions can also trigger an autoimmune reaction against aquaporin-4 and inflammation of the CNS. Our study indicates that the autoimmune response against aquaporin-4 in neuromyelitis optica may be triggered by infection-induced cross-immunoreactivity and presents a new perspective on the pathogenesis of this disease.
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Affiliation(s)
- Zhihua Ren
- Department of Neurological Sciences, Multiple Sclerosis Center, Rush University Medical Center, Chicago, IL 60612, USA
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Linhares UC, Schiavoni PB, Barros PO, Kasahara TM, Teixeira B, Ferreira TB, Alvarenga R, Hygino J, Vieira MMM, Bittencourt VCB, Andrade RM, Andrade AF, Bento CAM. The ex vivo production of IL-6 and IL-21 by CD4+ T cells is directly associated with neurological disability in neuromyelitis optica patients. J Clin Immunol 2012; 33:179-89. [PMID: 22948743 DOI: 10.1007/s10875-012-9780-2] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Accepted: 02/15/2012] [Indexed: 12/31/2022]
Abstract
Neuromyelitis optica (NMO), also known as Devic's disease, is an autoimmune, inflammatory disorder of the central nervous system (CNS) in which the immune system attacks myelin of the neurons located at the optic nerves and spinal cord, thus producing a simultaneous or sequential optic neuritis and myelitis. The objective of this study was evaluated the background T-cell function of patients suffering from neuromyelitis optica (NMO), an autoimmune disorder of the central nervous system. In our study, the in vitro T cell proliferation and the production of Th1 cytokines were significantly lower in cell cultures from NMO patients, as compared with healthy individuals. In contrast, a dominant Th17-like phenotype, associate with higher IL-23 and IL-6 production by LPS-activated monocytes, was observed among NMO patients. The release of IL-21 and IL-6 by polyclonally activated CD4+ T cells was directly correlated to neurological disability. In addition, the in vitro release of IL-21, IL-6 and IL-17 was significantly more resistant to glucocorticoid inhibition in NMO patients. In conclusion, the results indicate dominant Th17-related response in NMO patients that was directly proportional to neurological disability. Furthermore, our results can help to explain why NMO patients trend to be more refractory to corticoid treatment.
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Affiliation(s)
- Ulisses C Linhares
- Postgraduate Program in Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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von Glehn F, Jarius S, Penalva de Oliveira AC, Brandão CO, Farias AS, Damasceno A, Casseb J, Moraes AS, Longhini ALF, Wandinger KP, Damasceno BP, Wildemann B, Santos LMB. Aquaporin-4 antibodies are not related to HTLV-1 associated myelopathy. PLoS One 2012; 7:e39372. [PMID: 22808032 PMCID: PMC3393709 DOI: 10.1371/journal.pone.0039372] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Accepted: 05/20/2012] [Indexed: 11/19/2022] Open
Abstract
Introduction The seroprevalence of human T-cell leukemia virus type 1 (HTLV-1) is very high among Brazilians (∼1∶200). HTLV-1 associated myelopathy or tropical spastic paraparesis (HAM/TSP) is the most common neurological complication of HTLV-1 infection. HAM/TSP can present with an acute/subacute form of longitudinally extensive myelitis, which can be confused with lesions seen in aquaporin-4 antibody (AQP4-Ab) positive neuromyelitis optica spectrum disorders (NMOSD) on MRI. Moreover, clinical attacks in patients with NMOSD have been shown to be preceded by viral infections in around 30% of cases. Objective To evaluate the frequency of AQP4-Ab in patients with HAM/TSP. To evaluate the frequency of HTLV-1 infection in patients with NMOSD. Patients and Methods 23 Brazilian patients with HAM/TSP, 20 asymptomatic HTLV-1+ serostatus patients, and 34 with NMOSD were tested for AQP4-Ab using a standardized recombinant cell based assay. In addition, all patients were tested for HTLV-1 by ELISA and Western blotting. Results 20/34 NMOSD patients were positive for AQP4-Ab but none of the HAM/TSP patients and none of the asymptomatic HTLV-1 infected individuals. Conversely, all AQP4-Ab-positive NMOSD patients were negative for HTLV-1 antibodies. One patient with HAM/TSP developed optic neuritis in addition to subacute LETM; this patient was AQP4-Ab negative as well. Patients were found to be predominantly female and of African descent both in the NMOSD and in the HAM/TSP group; Osame scale and expanded disability status scale scores did not differ significantly between the two groups. Conclusions Our results argue both against a role of antibodies to AQP4 in the pathogenesis of HAM/TSP and against an association between HTLV-1 infection and the development of AQP4-Ab. Moreover, the absence of HTLV-1 in all patients with NMOSD suggests that HTLV-1 is not a common trigger of acute attacks in patients with AQP4-Ab positive NMOSD in populations with high HTLV-1 seroprevalence.
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Affiliation(s)
- Felipe von Glehn
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Campinas, Brazil
- Department of Neurology, University of Campinas, Campinas, Brazil
- * E-mail: (FvG); (LMBS)
| | - Sven Jarius
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Augusto C. Penalva de Oliveira
- Neuroinfectious Disease Unit, Department of Internal Medicine, University of Campinas, Campinas, Brazil
- Department of Neurology, Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - Carlos Otávio Brandão
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Campinas, Brazil
- Department of Neurology, University of Campinas, Campinas, Brazil
| | - Alessandro S. Farias
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Campinas, Brazil
| | | | - Jorge Casseb
- Department of Neurology, Emilio Ribas Institute of Infectious Diseases, Sao Paulo, Brazil
| | - Adriel S. Moraes
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Campinas, Brazil
| | - Ana Leda F. Longhini
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Campinas, Brazil
| | | | | | - Brigitte Wildemann
- Division of Molecular Neuroimmunology, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Leonilda M. B. Santos
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas, Campinas, Brazil
- * E-mail: (FvG); (LMBS)
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Pires CE, Silva CMCD, Lopes FCR, Malfetano FR, Pereira VC, Kubo T, Bahia PR, Alves-Leon SV, Gasparetto EL. Brain MRI abnormalities in Brazilian patients with neuromyelitis optica. J Clin Neurosci 2012; 19:969-74. [DOI: 10.1016/j.jocn.2011.10.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/03/2011] [Accepted: 10/04/2011] [Indexed: 10/28/2022]
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Comparison of Visual Acuity and Automated Perimetry Findings in Patients With Neuromyelitis Optica or Multiple Sclerosis After Single or Multiple Attacks of Optic Neuritis. J Neuroophthalmol 2012; 32:102-6. [DOI: 10.1097/wno.0b013e31823a9ebc] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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