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Luo W, Zhong X, Shen S, Fang L, Huang Y, Wang Y, Qiu W. A comparative study of hypothalamic involvement in patients with myelin oligodendrocyte glycoprotein antibody-associated disease, neuromyelitis optica spectrum disorder, and multiple sclerosis. Eur J Neurol 2024; 31:e16377. [PMID: 38863307 PMCID: PMC11295172 DOI: 10.1111/ene.16377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 01/21/2024] [Accepted: 05/19/2024] [Indexed: 06/13/2024]
Abstract
BACKGROUND AND PURPOSE We aimed to characterize hypothalamic involvement in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and compare it with neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). METHODS A retrospective study was performed to identify hypothalamic lesions in patients diagnosed with MOGAD, NMOSD, or MS from January 2013 to May 2020. The demographic, clinical, and radiological features were recorded. Hypothalamic dysfunction and prognosis were assessed through physical examination, biochemical testing, sleep monitoring, and magnetic resonance imaging. RESULTS Hypothalamic lesions were observed in seven of 96 patients (7.3%) with MOGAD, 34 of 536 (6.3%) with NMOSD, and 16 of 356 (4.5%) with MS (p = 0.407). The time from disease onset to development of hypothalamic lesions was shortest in MOGAD (12 months). The frequency of bilateral hypothalamic lesions was the lowest in MOGAD (p = 0.008). The rate of hypothalamic dysfunction in MOGAD was 28.6%, which was lower than that in NMOSD (70.6%) but greater than that in MS patients (18.8%; p = 0.095 and p = 0.349, respectively). Hypothalamic dysfunction in MOGAD manifests as hypothalamic-pituitary-adrenal axis dysfunction and hypersomnia. The proportion of complete regression of hypothalamic lesions in MOGAD (100%) was much greater than that in NMOSD (41.7%) and MS patients (18.2%; p = 0.007 and p = 0.001, respectively). An improvement in hypothalamic dysfunction was observed in all MOGAD patients after immunotherapy. CONCLUSIONS MOGAD patients have a relatively high incidence of asymptomatic hypothalamic lesions. The overall prognosis of patients with hypothalamic involvement is good in MOGAD, as the lesions completely resolve, and dysfunction improves after immunotherapy.
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Affiliation(s)
- Wenjing Luo
- Department of NeurologyThe First Affiliated Hospital of Guangxi Medical UniversityNanningChina
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Xiaonan Zhong
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Shishi Shen
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Ling Fang
- Department of RadiologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yiying Huang
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Yuge Wang
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
| | - Wei Qiu
- Department of NeurologyThe Third Affiliated Hospital of Sun Yat‐Sen UniversityGuangzhouChina
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2
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Noori H, Marsool MDM, Gohil KM, Idrees M, Subash T, Alazzeh Z, Prajjwal P, Jain H, Amir O. Neuromyelitis optica spectrum disorder: Exploring the diverse clinical manifestations and the need for further exploration. Brain Behav 2024; 14:e3644. [PMID: 39135307 PMCID: PMC11319236 DOI: 10.1002/brb3.3644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/22/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disorder characterized by inflammatory assaults on the central nervous system (CNS), particularly on the optic nerves and spinal cord. In recent years, a wider range of clinical manifestations of this complex disease have been observed, emphasizing the importance of gaining a more profound understanding beyond optic neuritis (ON) and transverse myelitis (TM). CURRENT KNOWLEDGE This study explores the many clinical symptoms of NMOSD, including common and uncommon presentations. Distinctive aspects of ON, TM, and diencephalic/brainstem syndromes are examined, highlighting their unique characteristics in contrast to conditions such as multiple sclerosis. We also discuss extra-CNS involvement, such as unusual signs, including muscle involvement, retinal injury, auditory impairment, and rhinological symptoms. AIMS AND OBJECTIVES Our study intends to highlight the wide range and complexity of NMOSD presentations, emphasizing the significance of identifying unusual symptoms for precise diagnosis and prompt management. The specific processes that contribute to the varied clinical presentation of NMOSD are not well understood despite existing information. This emphasizes the necessity for more study to clarify the mechanisms that cause different symptoms and discover new treatment targets for this complex autoimmune disorder. CONCLUSION It is essential to acknowledge the complex and varied clinical manifestations of NMOSD to enhance diagnosis, treatment, and patient results. By enhancing our comprehension of the fundamental processes and investigating innovative therapeutic approaches, we may aim to enhance the quality of life for persons impacted by this illness.
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Affiliation(s)
- Hamid Noori
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | | | - Krutika Mahendra Gohil
- Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. Rustom Narsi Cooper Municipal General HospitalMumbaiIndia
| | | | - Tushar Subash
- Medical CollegeThe Aga Khan UniversityKarachiPakistan
| | - Zainab Alazzeh
- College of MedicineJordanian University of Science and TechnologyIrbidJordan
| | | | - Hritvik Jain
- All India Institute of Medical SciencesJodhpurIndia
| | - Omniat Amir
- Almanhal Academy for ScienceManhal UniversityKhartoumSudan
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3
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Alqwaifly M, Althobaiti AH, AlAibani NS, Banjar RZ, Alayed RS, Alsubaie SM, Alrashed AT. Patterns of Adult Neuromyelitis Optica Spectrum Disorder Patients Compared to Multiple Sclerosis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47565. [PMID: 38021935 PMCID: PMC10666196 DOI: 10.7759/cureus.47565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are central nervous system inflammatory conditions, now recognized to involve the brain, often identified by aquaporin-4 (AQP4) antibodies. We aimed to summarize the characteristics of adult NMOSD patients compared to multiple sclerosis (MS). A computerized search was conducted on MEDLINE via PubMed, Web of Science, and ProQuest using the relevant keywords. Three independent reviewers performed two-stage screening and data extraction. The Review Manager 5.4 program (Cochrane Collaboration, Windows, London, UK) was used for the analysis. The Joanna Briggs Institute (JIB) tool was used for the quality of included studies. Twenty-three articles were included. NMOSD patients were associated with older age at presentation and higher Expanded Disability Status Scale (MD = 3.88, 95% CI: 1.80 to 5.97, P = 0.0003) and (MD = 1.15, 95% CI: 0.58 to 1.72, P < 0.0001), respectively. The risk of NMOSD in females was significantly higher than MS (OR = 2.21, 95% CI: 1.41 to 3.46, P = 0.0005). Patients with NMOSD were associated with a lower risk of extrapyramidal symptoms (OR = 0.26, 95% CI: 0.11 to 0.60, P < 0.01), brainstem involvement symptoms (OR = 0.32, 95% CI: 0.16 to 0.64, P < 0.01), and developing brain lesions compared to MS (OR = 0.08, 95% CI: 0.03 to 0.18, P < 0.00001). The current evidence suggests that both NMOSD and MS have different demographic, clinical, and lesion characteristics. There is a need for additional validation of the identified differences compared with MS due to the lack of long-term systematic imaging investigations in NMOSD.
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Affiliation(s)
- Mohammed Alqwaifly
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU
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4
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Clarke L, Arnett S, Bukhari W, Khalilidehkordi E, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy DA, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw CP, Spies JM, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AGK, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12:722237. [PMID: 34566866 PMCID: PMC8458658 DOI: 10.3389/fneur.2021.722237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Cella Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Cameron P Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith M Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Allan G K Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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5
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Lin TY, Chien C, Lu A, Paul F, Zimmermann HG. Retinal optical coherence tomography and magnetic resonance imaging in neuromyelitis optica spectrum disorders and MOG-antibody associated disorders: an updated review. Expert Rev Neurother 2021; 21:1101-1123. [PMID: 34551653 DOI: 10.1080/14737175.2021.1982697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein IgG antibody-associated disorders (MOGAD) comprise two groups of rare neuroinflammatory diseases that cause attack-related damage to the central nervous system (CNS). Clinical attacks are often characterized by optic neuritis, transverse myelitis, and to a lesser extent, brainstem encephalitis/area postrema syndrome. Retinal optical coherence tomography (OCT) is a non-invasive technique that allows for in vivo thickness quantification of the retinal layers. Apart from OCT, magnetic resonance imaging (MRI) plays an increasingly important role in NMOSD and MOGAD diagnosis based on the current international diagnostic criteria. Retinal OCT and brain/spinal cord/optic nerve MRI can help to distinguish NMOSD and MOGAD from other neuroinflammatory diseases, particularly from multiple sclerosis, and to monitor disease-associated CNS-damage. AREAS COVERED This article summarizes the current status of imaging research in NMOSD and MOGAD, and reviews the clinical relevance of OCT, MRI and other relevant imaging techniques for differential diagnosis, screening and monitoring of the disease course. EXPERT OPINION Retinal OCT and MRI can visualize and quantify CNS damage in vivo, improving our understanding of NMOSD and MOGAD pathology. Further efforts on the standardization of these imaging techniques are essential for implementation into clinical practice and as outcome parameters in clinical trials.
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Affiliation(s)
- Ting-Yi Lin
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Claudia Chien
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Angelo Lu
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, Max-Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Ma Q, Wu X, Pan J, Zhu Q, Mao X. Primary visual cortex of the brain is associated with optic nerve head changes in neuromyelitis optica spectrum disorders. Clin Neurol Neurosurg 2021; 208:106822. [PMID: 34311202 DOI: 10.1016/j.clineuro.2021.106822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To explore the association between the primary visual cortex in the brain and optic nerve head changes, ONH, (structural thickness and microvascular changes) in neuromyelitis optica spectrum disorder (NMOSD). METHODS Nineteen patients who were aquaporin-4 (AQP-4) seropositive NMOSD patients and twenty-two healthy controls (HC) were enrolled for this cross-sectional study. Optical coherence tomographic angiography (OCT-A) was used to image and measure the capillaries density (RPC, radial peripapillary capillaries) and structural thickness (pRNFL, peripapillary retinal nerve fiber layer) around the optic nerve head. A resting-state functional magnetic resonance imaging was used to image and evaluate the gray matter volume (GMV) and functional connectivity (FC) the brain of each participant. We assessed the primary visual cortex (lingual gyrus, calcarine sulcus and thalamus) of the brain. RESULTS Changes in RPC density showed a significant association (P < 0.05) with FC of the right lingual gyrus, bilateral calcarine gyrus and left thalamus respectively. pRNFL thickness showed significant association with FC of the right lingual gyrus (Rho = 0.374, P = 0.016), right calcarine gyrus (Rho = 0.355, P = 0.023) and left thalamus (Rho = 0.376, P = 0.015) respectively. CONCLUSIONS Visual impairment, structural and microvascular changes around optic nerve head is associated with the functional visual networks in NMOSD. Our report suggests that structural and microvascular changes around the ONH reflect the changes in the primary visual cortex of the brain.
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Affiliation(s)
- Qingkai Ma
- Department of Ophthalmology, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China
| | - Xiao Wu
- Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China; Jiangsu Provincial Key Laboratory of Critical Care Medicine, Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Jiangsu 210009, China
| | - Jianfei Pan
- Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China
| | - Quanwei Zhu
- Department of Emergency, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China
| | - Xiang Mao
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Anhui 230022, China.
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Clarke L, Arnett S, Lilley K, Liao J, Bhuta S, Broadley SA. Magnetic resonance imaging in neuromyelitis optica spectrum disorder. Clin Exp Immunol 2021; 206:251-265. [PMID: 34080180 DOI: 10.1111/cei.13630] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 12/30/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disease of the central nervous system (CNS) associated with antibodies to aquaporin-4 (AQP4), which has distinct clinical, radiological and pathological features, but also has some overlap with multiple sclerosis and myelin oligodendrocyte glycoprotein (MOG) antibody associated disease. Early recognition of NMOSD is important because of differing responses to both acute and preventive therapy. Magnetic resonance (MR) imaging has proved essential in this process. Key MR imaging clues to the diagnosis of NMOSD are longitudinally extensive lesions of the optic nerve (more than half the length) and spinal cord (three or more vertebral segments), bilateral optic nerve lesions and lesions of the optic chiasm, area postrema, floor of the IV ventricle, periaqueductal grey matter, hypothalamus and walls of the III ventricle. Other NMOSD-specific lesions are denoted by their unique morphology: heterogeneous lesions of the corpus callosum, 'cloud-like' gadolinium (Gd)-enhancing white matter lesions and 'bright spotty' lesions of the spinal cord. Other lesions described in NMOSD, including linear periventricular peri-ependymal lesions and patch subcortical white matter lesions, may be less specific. The use of advanced MR imaging techniques is yielding further useful information regarding focal degeneration of the thalamus and optic radiation in NMOSD and suggests that paramagnetic rim patterns and changes in normal appearing white matter are specific to MS. MR imaging is crucial in the early recognition of NMOSD and in directing testing for AQP4 antibodies and guiding immediate acute treatment decisions. Increasingly, MR imaging is playing a role in diagnosing seronegative cases of NMOSD.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Kate Lilley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Jacky Liao
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia
| | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Radiology, Gold Coast University Hospital, Southport, QLD, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Nathan, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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8
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Hypothalamic lesions in neuromyelitis optica spectrum disorders: exploring a scoring system based on magnetic resonance imaging. Jpn J Radiol 2021; 39:659-668. [PMID: 33689108 DOI: 10.1007/s11604-021-01104-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/15/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE We propose a scoring system for early diagnosis of sleep abnormalities in neuromyelitis optica spectrum disorders (NMOSD) with hypothalamic lesions based on magnetic resonance imaging (MRI). MATERIALS AND METHODS We evaluated MRI features of 45 patients with hypothalamic lesions identified from two cohorts. Univariate logistic regression analysis identified factors associated with sleepiness, which were subsequently used to develop a scoring system. Interrater reliability was determined using intraclass correlation coefficient (ICC). Correlations between scores and clinical features were analyzed. RESULTS In total, 48.9% of 45 patients with hypothalamic lesions exhibited sleepiness. The number of involved slices, maximum width/length of hypothalamic lesions, and boundaries extending beyond the hypothalamus were associated with sleepiness (all p < 0.05). The sensitivity and specificity of the scoring system were 68.2% and 87.0%, respectively. The ICC values for the maximum width and length measurement of hypothalamic lesions were 0.82 and 0.81, respectively. Daily sleep time and Epworth sleepiness scale scores were positively correlated with MRI-based scores (p < 0.05, 95% confidence interval (CI) 0.69-0.93 and p < 0.05, 95% CI 0.55-0.88, respectively). CONCLUSION A scoring system based on MRI features was developed to provide diagnosis of sleepiness in NMOSD with hypothalamic lesions earlier than other measures.
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The prevalence of cognitive impairment in patients with neuromyelitis optica spectrum disorders (NMOSD): A systematic review and meta-analysis. Mult Scler Relat Disord 2021; 49:102757. [PMID: 33486400 DOI: 10.1016/j.msard.2021.102757] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 01/06/2021] [Accepted: 01/12/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To estimate pooled prevalence of cognitive impairment in neuromyelitis opticaspectrum disorders (NMOSD) cases. METHODS We searched PubMed, Scopus, EMBASE, Web of Science, and google scholar. We also searched the gray literature including references of the included studies, and conference abstracts which were published up to 20th October 2020. The search strategy included the MeSH and text words as (((Cognitive Dysfunctions) OR Cognitive Impairment) OR Cognitive Declines) OR Mild Cognitive Impairment) OR Mental Deterioration) AND (Neuromyelitis Optica spectrum disorder OR NMOSD OR Devic syndrome OR Neuromyelitis Optica spectrum disorders). RESULTS The literature search revealed 1830 articles, after deleting duplicates 1434 remained. For the meta-analysis, 25 studies were included. Totally, 761 NMOSD patients were evaluated and 329 patients had cognitive impairment. Mean age ranged from 34-53 years. The prevalence of cognitive impairment ranged from 3% to 75%.The pooled prevalence of cognitive impairment was 44%, 95%CI(35%-54%), (I2=89.1%, P<0.001) which shows a high statistical heterogeneity . By excluding the abstract of Jung et al which was published in 2009, we found that the pooled prevalence was 34% (95% CI:31-37%) (I2=0) CONCLUSION: Cognitive impairment should be considered in NMOSD patients as its pooled prevalence is estimated as 44%.
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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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11
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Gupta S, Rehani V, Acharya R, Purohit P, Anadure R, Ahmad F, Soni R, Gupta A, Hiremath R. Multicentric clinical and epidemiological comparison of neuromyelitis optica spectrum disorder with multiple sclerosis from India. Mult Scler Relat Disord 2020; 47:102616. [PMID: 33166808 DOI: 10.1016/j.msard.2020.102616] [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] [Received: 08/13/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND In India, Neuromyelitis optica spectrum disorders (NMOSD) can often be misdiagnosed as multiple sclerosis (MS) leading to wrong or delayed treatment. Although diagnostic criteria exist it is important to flag certain highlights in the phenotype by direct comparison which will prompt investigation in the right direction. The aim was to identify distinguishing features, especially differences in disability status and frequency of the optico-spinal syndrome. METHODS This study was designed as a multicentric, hospital based, ambispective, observational study of patients with primary demyelination due to either NMOSD or MS. Various variables were collected using a data extraction proforma and were compared using statistical means. RESULTS A total of 212 patients, 166 (78.3%) with MS and 46 (21.7%) with NMOSD, were included from six different cities across India. The male to female ratio was 1:1.3 in MS group and 1:2.3 in NMOSD group. Significant differences on logistic regression included: patients with NMOSD were more disabled despite having a shorter duration of illness with a high progression index (EDSS/ duration of disease in years) of 5.99 vs 0.74 respectively (p = 0.02); in subset of relapsing patients relapsing optico-spinal syndrome (optic neuritis with myelitis) was more common in NMOSD (39.1% vs 0.8%); presence of at least one T2 lesion in the last available MRI brain (78.6% vs 39.1%) and presence of at least one gadolinium enhancing lesion in brain MRI documented during course of illness (30.2% vs 8.7%) was more in MS patients. If the patient with demyelination had a progression index of ≥ 0.39, the Likelihood Ratio (LR) of having NMOSD was 1.32 (95% CI 1.06-1.64), the sensitivity was 0.74 and specificity 0.44. Other notable variables significant on univariate but not on multivariate analysis were: other autoimmune diseases were present more in the NMOSD group (13% vs 2.4%); proportion of patients who had only school education (up to class 12) but not higher were more in NMOSD (67.4% vs 38.5%); the most common clinical presentation in MS patients was either a brainstem or cerebral syndrome (41% vs 21.8%) while it was isolated myelitis in NMOSD patients (37% vs 19.3%). Other findings included: optic neuritis as a presenting feature was common and present in similar proportions in both the groups (around 37%); 50% (23/46) of NMOSD and around 30% (50/166) of MS patients had a single clinical episode during the course of their illness and in the relapsing patients, mean no of relapses (around 2.7) and ARR (MS 0.38, NMOSD 0.54) were similar. Secondary progressive MS was diagnosed in 4.8% (8/166) and primary progressive MS was diagnosed in 3.7% (6/166). CONCLUSION Index of suspicion for NMOSD should be high in a patient if: the course is relatively short; disability is out of proportion and progression index is ≥0.39 or the patient has had recurrent optico-spinal relapses. It is important to distinguish early in the course NMOSD from MS as timely specific treatment may prevent future disability.
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Affiliation(s)
- Salil Gupta
- Institute affiliation at time of study, Army Hospital Research and Referral, Delhi Cantt, New Delhi 110010, India.
| | - Varun Rehani
- Institute affiliation at time of study, Army Hospital Research and Referral, Delhi Cantt, New Delhi 110010, India
| | - Ritesh Acharya
- Institute affiliation at time of study, Command Hospital Air Force, Agram PO, Bangalore 560007, India
| | - Pritam Purohit
- Institute affiliation at time of study, Armed Forces Medical College, Pune, Sholapur Road, Pune 411040, India
| | - Ravi Anadure
- Institute affiliation at time of study, Command Hospital Air Force, Agram PO, Bangalore 560007, India
| | - Faiz Ahmad
- Institute affiliation at time of study, Command Hospital, Chandigarh, India
| | - Rahul Soni
- Institute affiliation at time of study, Army Hospital Research and Referral, Delhi Cantt, New Delhi 110010, India
| | - Anirban Gupta
- Institute affiliation at time of study, Command Hospital, Alipore, Kolkata, India
| | - Ravi Hiremath
- Institute affiliation at time of study, Command Hospital Air Force, Agram PO, Bangalore 560007, India
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12
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Ismail II, Ahmed SF, Al-Hashel JY, Abdelnabi EA, Alroughani R. Radiological characteristics of neuromyelitis optica spectrum disorder in Kuwait. Clin Neurol Neurosurg 2020; 196:106047. [PMID: 32604036 DOI: 10.1016/j.clineuro.2020.106047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disorder of the central nervous system that predominantly targets optic nerves and spinal cord. Studies of NMOSD are scarce in the Middle East. OBJECTIVE To evaluate the MRI characteristics of NMOSD patients in Kuwait. PATIENT AND METHODS This is an observational, retrospective study on NMOSD patients who attended the MS clinic. Patients who fulfilled the 2015 diagnostic criteria of NMOSD were included. Patients` clinical, radiological and serological data were extracted from the medical records. The radiological variables were compared according to gender and AQP4 serostatus. RESULTS Forty-two patients fulfilling the NMOSD diagnostic criteria. The mean age and mean age of onset were 32.6 ± 11.4 and 28.9 ± 9.8 years respectively. Females represented 83.3 % of the cohort with female-to-male ratio of 5:1. Thirty-one patients (73.8 %) tested positive for AQP4 antibody. Nineteen patients (45.2 %) had bilateral optic nerve involvement, while chiasmal involvement was seen in 8 (19.0 %) patients. Spinal cord was involved in 36 (85.7 %) patients; of whom 27 (64.3 %) had LETM. The most common spinal segment involved was the cervical (72.2 %) followed by the dorsal (25.0 %) regions. The brain was involved in 39 (92.8 %) patients and the periventricular region around fourth and lateral ventricles was the most commonly involved site (n = 35; 83.3 %), along with periaqueductal (n = 25; 61.9 %) and corpus callosal (n = 24; 57.1 %) regions. Isolated area postrema involvement was observed in 9 (21.4 %) patients. CONCLUSION This is the first study describing the radiological characteristics of NMOSD in Kuwait. Although our data is comparable with the previous international studies, a higher percentage of bilateral optic nerve, brain, and callosal involvement was observed. Further multicenter studies with a larger cohort are needed to confirm our results.
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Affiliation(s)
| | - Samar Farouk Ahmed
- Department of Neurology, Ibn Sina Hospital, Kuwait; Department of Neurology and Psychiatry, Minia University, Egypt.
| | - Jasem Y Al-Hashel
- Department of Neurology, Ibn Sina Hospital, Kuwait; Health Sciences Centre, Kuwait University, Department of Medicine, Kuwait.
| | | | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Sharq, Kuwait.
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Yan J, Wang Y, Miao H, Kwapong WR, Lu Y, Ma Q, Chen W, Tu Y, Liu X. Alterations in the Brain Structure and Functional Connectivity in Aquaporin-4 Antibody-Positive Neuromyelitis Optica Spectrum Disorder. Front Neurosci 2020; 13:1362. [PMID: 32009872 PMCID: PMC6971221 DOI: 10.3389/fnins.2019.01362] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/02/2019] [Indexed: 11/13/2022] Open
Abstract
Purpose To investigate the mechanisms underlying the gray matter volume (GMV) and functional connectivity (FC) changes in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (NMOSD) patients. Methods This cross-sectional study consisted of 21 patients with aquaporin-4 antibody-positive NMOSD and 22 age- and sex-matched healthy controls. All participants underwent cerebral magnetic resonance imaging and testing each individual’s visual acuity was done. Results Neuromyelitis optica spectrum disorder patients showed significantly reduced GMV in the left calcarine, left thalamus and right lingual gyrus of the NMOSD patients when compared to HC (P < 0.05). NMOSD patients showed significantly decreased FC values (P < 0.05) in both the left and right calcarine, right lingual gyrus and left thalamus, respectively, when compared to HC. We also observed a positive correlation between the FC values of the left thalamus, bilateral calcarine gyrus and the visual acuity, respectively (P < 0.05). Furthermore, a negative association was seen between the duration of the disease, frequency of optic neuritis, and the FC values in the lingual gyrus, bilateral calcarine gyrus, and right lingual gyrus, respectively (P < 0.05). Conclusion Reduced visual acuity and frequency of optic neuritis are associated with alterations in the GMV and FC in NMOSD. Our current study, which provides imaging evidence on the impairment involved in NMOSD, sheds light on pathophysiological responses of optic neuritis attack on the brain especially on the visual network.
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Affiliation(s)
- Jueyue Yan
- Department of Neurology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Yu Wang
- China-USA Neuroimaging Research Institute, Department of Radiology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Hanpei Miao
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | | | - Yi Lu
- China-USA Neuroimaging Research Institute, Department of Radiology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
| | - Qingkai Ma
- Department of Opthalmology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wei Chen
- Department of Psychiatry, Sir Run Run Shaw Hospital, Collaborative Innovation Center for Brain Science, Zhejiang University School of Medicine, Hangzhou, China
| | - Yunhai Tu
- School of Ophthalmology and Optometry, Wenzhou Medical University, Wenzhou, China
| | - Xiaozheng Liu
- China-USA Neuroimaging Research Institute, Department of Radiology, The Second Affiliated Hospital & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou, China
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14
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Papadopoulou A, Oertel FC, Gaetano L, Kuchling J, Zimmermann H, Chien C, Siebert N, Asseyer S, Bellmann-Strobl J, Ruprecht K, Chakravarty MM, Scheel M, Magon S, Wuerfel J, Paul F, Brandt AU. Attack-related damage of thalamic nuclei in neuromyelitis optica spectrum disorders. J Neurol Neurosurg Psychiatry 2019; 90:1156-1164. [PMID: 31127016 DOI: 10.1136/jnnp-2018-320249] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In neuromyelitis optica spectrum disorders (NMOSD) thalamic damage is controversial, but thalamic nuclei were never studied separately. We aimed at assessing volume loss of thalamic nuclei in NMOSD. We hypothesised that only specific nuclei are damaged, by attacks affecting structures from which they receive afferences: the lateral geniculate nucleus (LGN), due to optic neuritis (ON) and the ventral posterior nucleus (VPN), due to myelitis. METHODS Thirty-nine patients with aquaporin 4-IgG seropositive NMOSD (age: 50.1±14.1 years, 36 women, 25 with prior ON, 36 with prior myelitis) and 37 healthy controls (age: 47.8 ± 12.5 years, 32 women) were included in this cross-sectional study. Thalamic nuclei were assessed in magnetic resonance images, using a multi-atlas-based approach of automated segmentation. Retinal optical coherence tomography was also performed. RESULTS Patients with ON showed smaller LGN volumes (181.6±44.2 mm3) compared with controls (198.3±49.4 mm3; B=-16.97, p=0.004) and to patients without ON (206.1±50 mm3 ; B=-23.74, p=0.001). LGN volume was associated with number of ON episodes (Rho=-0.536, p<0.001), peripapillary retinal nerve fibre layer thickness (B=0.70, p<0.001) and visual function (B=-0.01, p=0.002). Although VPN was not smaller in patients with myelitis (674.3±67.5 mm3) than controls (679.7±68.33; B=-7.36, p=0.594), we found reduced volumes in five patients with combined myelitis and brainstem attacks (B=-76.18, p=0.017). Volumes of entire thalamus and other nuclei were not smaller in patients than controls. CONCLUSION These findings suggest attack-related anterograde degeneration rather than diffuse thalamic damage in NMOSD. They also support a potential role of LGN volume as an imaging marker of structural brain damage in these patients.
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Affiliation(s)
- Athina Papadopoulou
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Frederike Cosima Oertel
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Laura Gaetano
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Medical Image Analysis Center, Basel, Switzerland.,F. Hoffmann-La Roche, Basel, Switzerland
| | - Joseph Kuchling
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hanna Zimmermann
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Chien
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Nadja Siebert
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanna Asseyer
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Judith Bellmann-Strobl
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klemens Ruprecht
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M Mallar Chakravarty
- Cerebral Imaging Centre, Douglas Mental Health University Institute, Montreal, Québec, Canada.,Department of Psychiatry and Biomedical engineering, McGill University, Montreal, Québec, Canada
| | - Michael Scheel
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Department of Neuroradiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Stefano Magon
- Neurologic Clinic and Policlinic, Departments of Medicine, Clinical Research and Biomedicine, University Hospital Basel and University of Basel, Basel, Switzerland.,Medical Image Analysis Center, Basel, Switzerland
| | - Jens Wuerfel
- Medical Image Analysis Center, Basel, Switzerland
| | - Friedemann Paul
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Ulrich Brandt
- Neurocure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of health, Berlin, Germany .,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, University of California Irvine, Irvine, California, USA
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Cacciaguerra L, Meani A, Mesaros S, Radaelli M, Palace J, Dujmovic-Basuroski I, Pagani E, Martinelli V, Matthews L, Drulovic J, Leite MI, Comi G, Filippi M, Rocca MA. Brain and cord imaging features in neuromyelitis optica spectrum disorders. Ann Neurol 2019; 85:371-384. [PMID: 30635936 DOI: 10.1002/ana.25411] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 01/08/2019] [Accepted: 01/08/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVES To validate imaging features able to discriminate neuromyelitis optica spectrum disorders from multiple sclerosis with conventional magnetic resonance imaging (MRI). METHODS In this cross-sectional study, brain and spinal cord scans were evaluated from 116 neuromyelitis optica spectrum disorder patients (98 seropositive and 18 seronegative) in chronic disease phase and 65 age-, sex-, and disease duration-matched multiple sclerosis patients. To identify independent predictors of neuromyelitis optica diagnosis, after assessing the prevalence of typical/atypical findings, the original cohort was 2:1 randomized in a training sample (where a multivariate logistic regression analysis was run) and a validation sample (where the performance of the selected variables was tested and validated). RESULTS Typical brain lesions occurred in 50.9% of neuromyelitis optica patients (18.1% brainstem periventricular/periaqueductal, 32.7% periependymal along lateral ventricles, 3.4% large hemispheric, 6.0% diencephalic, 4.3% corticospinal tract), 72.2% had spinal cord lesions (46.3% long transverse myelitis, 36.1% short transverse myelitis), 37.1% satisfied 2010 McDonald criteria, and none had cortical lesions. Fulfillment of at least 2 of 5 of absence of juxtacortical/cortical lesions, absence of periventricular lesions, absence of Dawson fingers, presence of long transverse myelitis, and presence of periependymal lesions along lateral ventricles discriminated neuromyelitis optica patients in both training (sensitivity = 0.92, 95% confidence interval [CI] = 0.84-0.97; specificity = 0.91, 95% CI = 0.78-0.97) and validation samples (sensitivity = 0.82, 95% CI = 0.66-0.92; specificity = 0.91, 95% CI = 0.71-0.99). MRI findings and criteria performance were similar irrespective of serostatus. INTERPRETATION Although up to 50% of neuromyelitis optica patients have no typical lesions and a relatively high percentage of them satisfy multiple sclerosis criteria, several easily applicable imaging features can help to distinguish neuromyelitis optica from multiple sclerosis. ANN NEUROL 2019;85:371-384.
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Affiliation(s)
- Laura Cacciaguerra
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Sarlota Mesaros
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Marta Radaelli
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | | | - Elisabetta Pagani
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Vittorio Martinelli
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Lucy Matthews
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Jelena Drulovic
- Clinic of Neurology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Giancarlo Comi
- Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy.,Department of Neurology, Institute of Experimental Neurology, Division of Neuroscience, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
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Disruption of blood-brain barrier integrity associated with brain lesions in Chinese neuromyelitis optica spectrum disorder patients. Mult Scler Relat Disord 2018; 27:254-259. [PMID: 30419511 DOI: 10.1016/j.msard.2018.10.114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 10/28/2018] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aims of this study were to report brain characteristic abnormalities and to evaluate the relationship of blood-brain barrier (BBB) disruption and brain lesions in Chinese patients with NMOSD. METHODS Brain magnetic resonance imaging characteristics and cerebrospinal fluid (CSF) laboratory tests of 121 patients with NMOSD at acute attack were reviewed retrospectively. Qalb (CSF albumin/serum albumin) was used for assessment of disruption of BBB. RESULTS Brain MRI abnormalities were observed in 36.4% (44/121) of the NMOSD patients. Thirty patients (25%) showed typical-NMOSD abnormalities, including dorsal medulla lesions (n = 16, 13.2%), brainstem/cerebellum (n = 11, 9.1%), thalamus/hypothalamus (n = 3, 2.5%), periventricular white matter lesions (n = 4, 3.3%) hemispheric white matter (n = 4, 3.3%). Twenty-five patients (20.7%) had nonspecific lesions. Compared to the NMOSD patients without brain lesion, the proportion of patients who had abnormal BBB permeability was significantly higher in the abnormal brain MRI group (47.7% vs. 27.3%, P < 0.05). BBB permeability was not correlated to distribution of brain lesions or enhancement lesions. Qalb was associated with higher Expanded Disability Status Scale scores (r = 0.689, P < 0.05). CONCLUSIONS Brain lesions are common in NMOSD patients. Marker of BBB permeability is associated with brain lesion and EDSS scores of NMOSD.
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Borisow N, Mori M, Kuwabara S, Scheel M, Paul F. Diagnosis and Treatment of NMO Spectrum Disorder and MOG-Encephalomyelitis. Front Neurol 2018; 9:888. [PMID: 30405519 PMCID: PMC6206299 DOI: 10.3389/fneur.2018.00888] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are autoantibody mediated chronic inflammatory diseases. Serum antibodies (Abs) against the aquaporin-4 water channel lead to recurrent attacks of optic neuritis, myelitis and/or brainstem syndromes. In some patients with symptoms of NMOSD, no AQP4-Abs but Abs against myelin-oligodendrocyte-glycoprotein (MOG) are detectable. These clinical syndromes are now frequently referred to as "MOG-encephalomyelitis" (MOG-EM). Here we give an overview on current recommendations concerning diagnosis of NMOSD and MOG-EM. These include antibody and further laboratory testing, MR imaging and optical coherence tomography. We discuss therapeutic options of acute attacks as well as longterm immunosuppressive treatment, including azathioprine, rituximab, and immunoglobulins.
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Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Michael Scheel
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Department of Neuroradiology, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
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Baghbanian SM, Asgari N, Sahraian MA, Moghadasi AN. A comparison of pediatric and adult neuromyelitis optica spectrum disorders: A review of clinical manifestation, diagnosis, and treatment. J Neurol Sci 2018; 388:222-231. [DOI: 10.1016/j.jns.2018.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022]
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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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20
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Rosales D, Kister I. Common and Rare Manifestations of Neuromyelitis Optica Spectrum Disorder. Curr Allergy Asthma Rep 2017; 16:42. [PMID: 27167974 DOI: 10.1007/s11882-016-0619-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The discovery of a highly specific biomarker of neuromyelitis optica (NMO)-the anti-aquaporin-4 (AQP4) antibody-has opened new paths to understanding disease pathogenesis and afforded a way to confirm the diagnosis in clinical practice. An important consequence of the discovery is the broadening of the spectrum of syndromes seen in the context of AQP4 autoimmunity. These syndromes have been subsumed under the rubric of NMO spectrum disorder (NMOSD). The current classification recognizes not only optic neuritis and myelitis as core syndromes of NMOSD but also cerebral, diencephalic, brainstem, and area postrema syndromes. These neurologic syndromes are the focus of our review. AQP4 is also expressed in many organs outside of the central nervous system, and this may explain some of the unusual, non-neurologic features that have been occasionally reported in NMOSD. Our review catalogues non-neurologic manifestations seen in NMOSD and concludes with a discussion of frequently associated autoimmune and neoplastic comorbidities of NMOSD.
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Affiliation(s)
- Dominique Rosales
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU School of Medicine, 240 E 38th St, New York, NY, 10016, USA.
| | - Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU School of Medicine, 240 E 38th St, New York, NY, 10016, USA
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21
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Garg P, Rajasekaran M, Pandey S, Gurusamy G, Balalakshmoji D, Rathinasamy R. Magnetic resonance imaging brain findings in a case of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder, presenting with intractable vomiting and hiccups. J Neurosci Rural Pract 2017; 8:135-138. [PMID: 28149102 PMCID: PMC5225700 DOI: 10.4103/0976-3147.193533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Neuromyelitisoptica (NMO) and multiple sclerosis (MS) were once considered to be differing manifestation of same auto immune disease, NMO predominantly involving the optic nerve and cord. Now with discovery of NMO antibody the concept has changed and a spectrum of disorders with lesions in brain has been identified. Occasionally, brain may be the first or the only site of involvement in these disorders hence it is essential to be aware of this spectrum. The brain lesions in NMO/NMOSD may be located in characteristic regions and present with symptoms mimicking non neurological disease. We herein present a case of an adult female who was admitted with intractable vomiting and hiccups; subsequently on MRI brain found to have very tiny demyelinating foci in Area Postrema.
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Affiliation(s)
- Prerna Garg
- Department of Radiodiagnosis, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | | | - Salil Pandey
- Department of Radiodiagnosis, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Gnanashanmugam Gurusamy
- Department of Neurology, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Devanand Balalakshmoji
- Department of Radiodiagnosis, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
| | - Rajakumar Rathinasamy
- Department of Radiodiagnosis, PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India
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22
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Kim SH, Hyun JW, Joung A, Lee SH, Kim HJ. Occurrence of Asymptomatic Acute Neuromyelitis Optica Spectrum Disorder-Typical Brain Lesions during an Attack of Optic Neuritis or Myelitis. PLoS One 2016; 11:e0167783. [PMID: 27936193 PMCID: PMC5147946 DOI: 10.1371/journal.pone.0167783] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 11/21/2016] [Indexed: 01/02/2023] Open
Abstract
We aimed to investigate the frequency of asymptomatic acute brain MRI abnormalities accompanying optic neuritis (ON) or myelitis in neuromyelitis optica spectrum disorder (NMOSD) patients with aquaporin-4 antibodies (AQP4-Ab). We reviewed 324 brain MRI scans that were obtained during acute attacks of ON or myelitis, in 165 NMOSD patients with AQP4-Ab. We observed that acute asymptomatic NMOSD-typical brain lesions accompanied 27 (8%) acute attacks of ON or myelitis in 24 (15%) patients. The most common asymptomatic brain abnormalities included edematous corpus callosum lesions (n = 17), followed by lesions on the internal capsule and/or cerebral peduncle lesions (n = 9), periependymal surfaces of the fourth ventricle (n = 5), large deep white matter lesions (n = 4), periependymal cerebral lesions surrounding the lateral ventricles (n = 3), and hypothalamic lesions (n = 1). If asymptomatic NMOSD-typical brain abnormalities were considered as evidence for DIS, while also assuming that the AQP4-IgG status was unknown, the median time to diagnosis using the 2015 diagnosis criteria for NMOSD was shortened from 28 months to 6 months (p = 0.008). Asymptomatic acute NMOSD-typical brain lesions can be accompanied by an acute attack of ON or myelitis. Identifying these asymptomatic brain lesions may help facilitate earlier diagnosis of NMOSD.
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Affiliation(s)
- Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea
| | - AeRan Joung
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea
| | - Sang Hyun Lee
- Department of Radiology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Go-Yang, Korea
- * E-mail:
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23
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Brain parenchymal damage in neuromyelitis optica spectrum disorder – A multimodal MRI study. Eur Radiol 2016; 26:4413-4422. [DOI: 10.1007/s00330-016-4282-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 01/22/2016] [Accepted: 02/11/2016] [Indexed: 01/10/2023]
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24
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Fan Y, Shan F, Lin SP, Long Y, Liang B, Gao C, Gao Q. Dynamic change in magnetic resonance imaging of patients with neuromyelitis optica. Int J Neurosci 2015; 126:448-54. [PMID: 26010209 DOI: 10.3109/00207454.2015.1055356] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To analyze changes in magnetic resonance imaging (MRI) of spinal cord lesions in neuromyelitis optica (NMO) and the correlation between segmental length of spinal cord lesions and expanded disability status scale (EDSS) scores. METHODS Twenty-five patients with confirmed NMO were examined from the Second Affiliated Hospital of Guangzhou Medical University, China. The information collected included their treatment, MRI, laboratory tests, and EDSS scores at different stages. RESULTS All cases exhibited spinal cord lesions, with 23 (92%) having longitudinally extensive transverse myelitis (extending ≥3 vertebral segments). There was a positive correlation between segmental length of spinal cord lesions and EDSS scores: during the acute phase, r = 0.430 (P = 0.032); during remission, r = 0.605 (P = 0.002). Enlarged spinal cord lesions and swelling were found in 18 cases (72%) during the acute phase, and 4 cases (16%, P = 0.000) after 6 months of treatment. Lesion enhancements were found in 17 cases (68%) during the acute phase, and 8 cases (32%, P = 0.023) after 6 months of treatment. Leptomeningeal enhancement was found in three cases during the acute phase, which disappeared after treatment. Atrophy of spinal cord lesions occurred in two cases. Change in lesions was statistically significant (P = 0.006) after 12 months of treatment. CONCLUSION Positive correlation was found between segmental length of spinal cord lesions and EDSS scores, which was more significant during remission. After 6 months of regular treatment, restorative changes compared with the acute phase were found by MRI.
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Affiliation(s)
- Yongxiang Fan
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,b 2 Department of Neurology , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Fulan Shan
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,b 2 Department of Neurology , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Shao-peng Lin
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,c 3 Department of Emergency , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Youming Long
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,b 2 Department of Neurology , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Bin Liang
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,b 2 Department of Neurology , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Cong Gao
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,b 2 Department of Neurology , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
| | - Qingchun Gao
- a 1 Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and The Ministry of Education of China , Institute of Neuroscience and the Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China.,b 2 Department of Neurology , The Second Affiliated Hospital of Guangzhou Medical University , Guangzhou , China
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25
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Kim HJ, Paul F, Lana-Peixoto MA, Tenembaum S, Asgari N, Palace J, Klawiter EC, Sato DK, de Seze J, Wuerfel J, Banwell BL, Villoslada P, Saiz A, Fujihara K, Kim SH. MRI characteristics of neuromyelitis optica spectrum disorder: an international update. Neurology 2015; 84:1165-73. [PMID: 25695963 DOI: 10.1212/wnl.0000000000001367] [Citation(s) in RCA: 444] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Since its initial reports in the 19th century, neuromyelitis optica (NMO) had been thought to involve only the optic nerves and spinal cord. However, the discovery of highly specific anti-aquaporin-4 antibody diagnostic biomarker for NMO enabled recognition of more diverse clinical spectrum of manifestations. Brain MRI abnormalities in patients seropositive for anti-aquaporin-4 antibody are common and some may be relatively unique by virtue of localization and configuration. Some seropositive patients present with brain involvement during their first attack and/or continue to relapse in the same location without optic nerve and spinal cord involvement. Thus, characteristics of brain abnormalities in such patients have become of increased interest. In this regard, MRI has an increasingly important role in the differential diagnosis of NMO and its spectrum disorder (NMOSD), particularly from multiple sclerosis. Differentiating these conditions is of prime importance because early initiation of effective immunosuppressive therapy is the key to preventing attack-related disability in NMOSD, whereas some disease-modifying drugs for multiple sclerosis may exacerbate the disease. Therefore, identifying the MRI features suggestive of NMOSD has diagnostic and prognostic implications. We herein review the brain, optic nerve, and spinal cord MRI findings of NMOSD.
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Affiliation(s)
- Ho Jin Kim
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Friedemann Paul
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Marco A Lana-Peixoto
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Silvia Tenembaum
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nasrin Asgari
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jacqueline Palace
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Eric C Klawiter
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Douglas K Sato
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jérôme de Seze
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Jens Wuerfel
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Brenda L Banwell
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Pablo Villoslada
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Albert Saiz
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Su-Hyun Kim
- From the Department of Neurology (H.J.K., S.-H.K.), Research Institute and Hospital of National Cancer Center, Goyang, Korea; NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center (F.P., J.W.), Department of Neurology, Charité University Medicine, Berlin, Germany; CIEM MS Research Center (M.A.L.-P.), Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil; Department of Neurology (S.T.), National Paediatric Hospital Dr. Juan P. Garrahan, Buenos Aires, Argentina; Neurobiology (N.A.), Institute of Molecular Medicine, University of Southern Denmark; Department of Neurology (N.A.), Vejle Hospital, Denmark; Department of Clinical Neurology (J.P.), John Radcliffe Hospital, Oxford, UK; Department of Neurology, Massachusetts General Hospital (E.C.K.), Harvard Medical School, Boston, MA; Department of Neurology (D.K.S.), Tohoku University School of Medicine, Sendai, Japan; Neurology Department (J.d.S.), Hôpitaux Universitaires de Strasbourg, France; Institute of Neuroradiology (J.W.), University Medicine Goettingen, Germany; Department of Pediatrics (B.L.B.), Division of Neurology, The Children's Hospital of Philadelphia; Department of Neurology (B.L.B.), The University of Pennsylvania; Center of Neuroimmunology (P.V., A.S.), Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain; and Department of Multiple Sclerosis Therapeutics (K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan
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Liao MF, Chang KH, Lyu RK, Huang CC, Chang HS, Wu YR, Chen CM, Chu CC, Kuo HC, Ro LS. Comparison between the cranial magnetic resonance imaging features of neuromyelitis optica spectrum disorder versus multiple sclerosis in Taiwanese patients. BMC Neurol 2014; 14:218. [PMID: 25433369 PMCID: PMC4264553 DOI: 10.1186/s12883-014-0218-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 11/04/2014] [Indexed: 11/18/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the central nervous system with different pathogenesis, brain lesion patterns, and treatment strategies. However, it is still difficult to distinguish these two disease entities by neuroimaging studies. Herein, we attempt to differentiate NMOSD from MS by comparing brain lesion patterns on magnetic resonance imaging (MRI). Methods The medical records and cranial MRI studies of patients with NMOSD diagnosed according to the 2006 Wingerchuk criteria and the presence of anti-aquaporin 4 (anti-AQP4) antibodies, and patients with MS diagnosed according to the Poser criteria, were retrospectively reviewed. Results Twenty-five NMOSD and 29 MS patients were recruited. The NMOSD patients became wheelchair dependent earlier than MS patients (log rank test; P = 0.036). Linear ependymal (28% vs. 0%, P = 0.003) and punctate lesions (64% vs. 28%, P = 0.013) were more frequently seen in NMOSD patients. Ten NMOSD patients (40%) had brain lesions that did not meet the Matthews criteria (MS were separated from NMOSD by the presence of at least 1 lesion adjacent to the body of the lateral ventricle and in the inferior temporal lobe; or the presence of a subcortical U-fiber lesion or a Dawson finger-type lesion). The different image patterns of NMOSD didn’t correlate with the clinical prognosis. However, NMOSD patients with more (≧10) brain lesions at onset became wheelchair dependence earlier than those with fewer (<10) brain lesions (log rank test; P < 0.001). Conclusions The diagnostic sensitivity of NMOSD criteria can be increased to 56% by combining the presence of linear ependymal lesions with unmet the Matthews criteria. The prognoses of NMOSD and MS are different. A specific imaging marker, the linear ependymal lesion, was present in some NMOSD patients. The diagnosis of NMOSD can be improved by following the evolution of this imaging feature when anti-AQP4 antibody test results are not available.
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Zhang B, Zhong Y, Wang Y, Dai Y, Qiu W, Zhang L, Li H, Lu Z. Neuromyelitis optica spectrum disorders without and with autoimmune diseases. BMC Neurol 2014; 14:162. [PMID: 25135481 PMCID: PMC4236652 DOI: 10.1186/s12883-014-0162-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 08/04/2014] [Indexed: 01/01/2023] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) can coexist with non-organ-specific or organ-specific autoimmune diseases. The aim of this study was to investigate and compare the features between NMOSD without and with autoimmune diseases, and NMOSD with non-organ-specific and organ-specific autoimmune diseases. Methods One hundred and fifty five NMOSD patients without autoimmune diseases (n = 115) and with autoimmune diseases (n = 40) were enrolled. NMOSD with autoimmune diseases were divided by organ-specific autoimmune diseases. The clinical, laboratory and magnetic resonance imaging features between two groups were assessed. Results Motor deficit was less frequent in NMOSD patients with non-organ-specific autoimmune diseases (p = 0.024). Cerebrospinal fluid white blood cell and protein, serum C-reactive protein and immunoglobulin G were lower in NMOSD patients without autoimmune diseases, while several autoantibodies seropositivity and thyroid indexes were significantly higher in NMOSD patients with autoimmune diseases (p < 0.05). No difference was found in other clinical and laboratory characteristics between different NMOSD subtypes (p > 0.05). NMOSD patients with autoimmune diseases had higher brain abnormalities than NMOSD without autoimmune diseases (p < 0.001). Conclusions The characteristics between NMOSD without and with autoimmune diseases were similar. NMOSD with autoimmune diseases have high frequency of brain abnormalities.
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Affiliation(s)
| | | | | | | | | | | | | | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, No 600 Tianhe Road, Guangzhou 510630, Guangdong, China.
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Barnett Y, Sutton IJ, Ghadiri M, Masters L, Zivadinov R, Barnett MH. Conventional and advanced imaging in neuromyelitis optica. AJNR Am J Neuroradiol 2014; 35:1458-66. [PMID: 23764723 PMCID: PMC7964440 DOI: 10.3174/ajnr.a3592] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Myelitis and optic neuritis are prototypic clinical presentations of both multiple sclerosis and neuromyelitis optica. Once considered a subtype of multiple sclerosis, neuromyelitis optica, is now known to have a discrete pathogenesis in which antibodies to the water channel, aquaporin 4, play a critical role. Timely differentiation of neuromyelitis optica from MS is imperative, determining both prognosis and treatment strategy. Early, aggressive immunosuppression is required to prevent the accrual of severe disability in neuromyelitis optica; conversely, MS-specific therapies may exacerbate the disease. The diagnosis of neuromyelitis optica requires the integration of clinical, MR imaging, and laboratory data, but current criteria are insensitive and exclude patients with limited clinical syndromes. Failure to recognize the expanding spectrum of cerebral MR imaging patterns associated with aquaporin 4 antibody seropositivity adds to diagnostic uncertainty in some patients. We present the state of the art in conventional and nonconventional MR imaging in neuromyelitis optica and review the place of neuroimaging in the diagnosis, management, and research of the condition.
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Affiliation(s)
- Y Barnett
- From the Sydney Neuroimaging Analysis Centre (Y.B., M.H.B.), Sydney, AustraliaBrain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, AustraliaDepartment of Medical Imaging and Neurology (Y.B., I.J.S.), St Vincent's Hospital, Sydney, Australia
| | - I J Sutton
- Department of Medical Imaging and Neurology (Y.B., I.J.S.), St Vincent's Hospital, Sydney, Australia
| | - M Ghadiri
- Brain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, Australia
| | - L Masters
- Brain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, Australia
| | - R Zivadinov
- Buffalo Neuroimaging Analysis Center (R.Z.), Department of Neurology, University of Buffalo, Buffalo, New York
| | - M H Barnett
- From the Sydney Neuroimaging Analysis Centre (Y.B., M.H.B.), Sydney, AustraliaBrain and Mind Research Institute (Y.B., M.G., L.M., M.H.B.), University of Sydney, Sydney, Australia
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Periventricular lesions help differentiate neuromyelitis optica spectrum disorders from multiple sclerosis. Mult Scler Int 2014; 2014:986923. [PMID: 24665366 PMCID: PMC3934317 DOI: 10.1155/2014/986923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/19/2013] [Indexed: 11/18/2022] Open
Abstract
Objective. To compare periventricular lesions in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOsd). Materials and Methods. Sagittal and axial fluid attenuated inversion recovery (FLAIR) sequences of 20 NMOsd and 40 group frequency-matched MS patients were evaluated by two neuroradiologists. On axial FLAIR, periventricular area was characterized as free of lesions/smooth-bordered ("type A") or jagged-bordered ("type B") pattern. On sagittal FLAIR, the images were evaluated for presence of "Dawson's fingers." Results. Type A pattern was observed in 80% of NMOsd patients by Reader 1 and 85% by Reader 2 but only in 5% MS patients by either Reader. Type B was seen in 15% NMOsd patients by Reader 1 and 20% by Reader 2 and in 95% MS patients by either Reader. Dawson's fingers were observed in no NMOsd patients by Reader 1 and 5% by Reader 2. In MS, Dawson's fingers were seen in 92.5% patients by Reader 1 and 77.5% by Reader 2. The differences in periventricular patterns and Dawson's finger detection between NMOsd and MS were highly significant (P < 0.001). Conclusions. Dawson's fingers and "jagged-bordered" periventricular hyperintensities are typical of MS and almost never seen in NMOsd, which suggests a practical method for differentiating the two diseases.
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Neuromyelitis optica in Austria in 2011: to bridge the gap between neuroepidemiological research and practice in a study population of 8.4 million people. PLoS One 2013; 8:e79649. [PMID: 24223985 PMCID: PMC3818238 DOI: 10.1371/journal.pone.0079649] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Accepted: 10/04/2013] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In 2008 the Austrian Task Force for Neuromyelitis Optica (NMO) started a nation-wide network for information exchange and multi-centre collaboration. Their aim was to detect all patients with NMO or NMO spectrum disorders (NMO-SD) in Austria and to analyse their disease courses and response to treatment. METHODS (1) As of March 2008, 1957 serum samples (of 1557 patients) have been tested with an established cell based immunofluorescence aquaporin-4 antibody (AQP4-ab) assay with a high sensitivity and specificity (both >95%). All tests were performed in a single reference laboratory (Clinical Dept. of Neurology of the Innsbruck Medical University). (2) A nation-wide survey with several calls for participation (via email newsletters, articles in the official journal of the Austrian Society of Neurology, and workshops) was initiated in 2008. All collected data will be presented in a way that allows that every individual patient can be traced back in order to ensure transparency and to avoid any data distortion in future meta-analyses. The careful and detailed presentation allows the visualization and comparison of the different disease courses in real time span. Failure and response to treatment are made visible at one glance. Database closure was 31 December 2011. All co-operators were offered co-authorship. RESULTS All 71 NMO- or NMO-SD patients with AQP4-ab positivity (age range 12.3 to 79.6 years) were analysed in detail. Sex ratio (m:f = 1:7) and the proportion of patients without oligoclonal bands in cerebrospinal fluid (86.6%) were in line with previously published results. All identified patients were Caucasians. CONCLUSIONS A nationwide collaboration amongst Austrian neurologists with good network communications made it possible to establish a database of 71 AQP4-ab positive patients with NMO/NMO-SD. This database is presented in detail and provides the basis for further studies and international cooperation in order to investigate this rare disease.
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Chan KH, Lee R, Lee JCY, Tse ACT, Pang SYY, Lau GKK, Teo KC, Ho PWL. Central nervous system inflammatory demyelinating disorders among Hong Kong Chinese. J Neuroimmunol 2013; 262:100-5. [PMID: 23838529 DOI: 10.1016/j.jneuroim.2013.06.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 05/24/2013] [Accepted: 06/13/2013] [Indexed: 10/26/2022]
Abstract
Classical multiple sclerosis (CMS) and neuromyelitis optica spectrum disorders (NMOSD) are distinct central nervous system inflammatory demyelinating disorders (CNS IDD). Early diagnosis of CNS IDD is important as appropriate immunotherapies to optimize prognosis. We studied the diagnoses of CNS IDD among Hong Kong Chinese in a hospital-based setting. Consecutive Chinese patients who presented to our hospital with clinically isolated syndrome and subsequently diagnosed to have CNS IDD from 1980 to 2010 were reviewed. Patients with known diagnosis of CNS IDD referred for further care were excluded. Serial sera were assayed for aquaporin-4 autoantibodies (AQP4 Ab), at least 3 assays within 2-5years. A total of 210 patients diagnosed to have CNS IDD with disease duration of at least 2years were studied. Among 198 patients with serial sera available, 40 (20.2%, 20 had NMO and 20 other NMOSD) were AQP4 Ab-positive. Four patients who were AQP4 Ab-negative on the initial assay converted to AQP4 Ab-positive on repeated assays. The diagnoses of 210 patients were CMS in 88 (41.9%), NMOSD 47 (22.4%, 27 NMO, 20 other NMOSD), single attack of myelitis 23 (11.0%), single attack of optic neuritis 21 (10.0%), relapsing myelitis 10 (4.8%), acute disseminated encephalomyelitis (ADEM) 9 (4.3%), relapsing optic neuritis in 6 (2.9%), opticospinal multiple sclerosis 3 (1.4%) and single attack of brainstem encephalitis 3 (1.4%). Compared to CMS, NMOSD patients had older onset age, lower frequencies of brain MRI abnormalities and CSF OCB, higher frequency of LETM, higher CNS inflammation attack frequency in the first 2years, worse clinical outcome with higher EDSS score and mortality rate. This hospital-based study suggests that CMS (41.9%) and NMOSD (22.4%) are the most common CNS IDD among Hong Kong Chinese. NMOSD has worse clinical outcome than CMS. Detection of AQP4 Ab facilitates early diagnosis and prompts immunotherapies of NMOSD.
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Affiliation(s)
- K H Chan
- University Department of Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Neuroimmunology and Neuroinflammation Research Laboratory, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong; Research Center of Heart, Brain, Hormone and Healthy Aging, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
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Yonezu T, Ito S, Mori M, Ogawa Y, Makino T, Uzawa A, Kuwabara S. “Bright spotty lesions” on spinal magnetic resonance imaging differentiate neuromyelitis optica from multiple sclerosis. Mult Scler 2013; 20:331-7. [DOI: 10.1177/1352458513495581] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Spinal magnetic resonance imaging (MRI) finding of longitudinally extensive spinal cord lesions (LESCL) extending over three vertebral segments and involvements of spinal central gray matter have been reported in patients with neuromyelitis optica (NMO). Objectives: We aimed to review spinal MRI findings in NMO and multiple sclerosis (MS), and to determine whether the “bright spotty lesions” (BSLs) are a discriminative finding of NMO. Methods: For this study, 24 consecutive patients with NMO and 34 patients with MS were enrolled. BSLs were defined as very hyperintense spotty lesions on axial T2WI. We also studied the length, distribution, signal homogeneity, size, and presence of contrast-enhanced lesions. Results: BSLs were more frequently found in patients with NMO (54%) than in those with MS (3%; p < 0.01). LESCL were found in 67% of the NMO patients. BSLs were seen in 63% of the patients without LESCL. BSLs or LESCL were found in 88% of the NMO patients. Inhomogeneous lesions, transversally extensive lesions, and central lesions were more frequently seen in NMO than in MS. Conclusions: BSLs are a newly defined spinal MRI finding specifically seen in NMO. In combination with LESCL, BSLs can help differentiate patients with NMO from those with MS with higher sensitivity than LESCL alone.
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Affiliation(s)
- Tadahiro Yonezu
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Shoichi Ito
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Masahiro Mori
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yoshitsugu Ogawa
- Department of Neurology, Chiba Cardiovascular Center, Chiba, Japan
| | - Takahiro Makino
- Department of Neurology, Kashima Rosai Hospital, Ibaraki, Japan
| | - Akiyuki Uzawa
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University, Chiba, Japan
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Sánchez-Catasús CA, Cabrera-Gomez J, Almaguer Melián W, Giroud Benítez JL, Rodríguez Rojas R, Bayard JB, Galán L, Sánchez RG, Fuentes NP, Valdes-Sosa P. Brain Tissue Volumes and Perfusion Change with the Number of Optic Neuritis Attacks in Relapsing Neuromyelitis Optica: A Voxel-Based Correlation Study. PLoS One 2013; 8:e66271. [PMID: 23824339 PMCID: PMC3688888 DOI: 10.1371/journal.pone.0066271] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 05/03/2013] [Indexed: 12/16/2022] Open
Abstract
Recent neuroimaging studies show that brain abnormalities in neuromyelitis optica (NMO) are more frequent than earlier described. Yet, more research considering multiple aspects of NMO is necessary to better understand these abnormalities. A clinical feature of relapsing NMO (RNMO) is that the incremental disability is attack-related. Therefore, association between the attack-related process and neuroimaging might be expected. On the other hand, the immunopathological analysis of NMO lesions has suggested that CNS microvasculature could be an early disease target, which could alter brain perfusion. Brain tissue volume changes accompanying perfusion alteration could also be expected throughout the attack-related process. The aim of this study was to investigate in RNMO patients, by voxel-based correlation analysis, the assumed associations between regional brain white (WMV) and grey matter volumes (GMV) and/or perfusion on one side, and the number of optic neuritis (ON) attacks, myelitis attacks and/or total attacks on the other side. For this purpose, high resolution T1-weighted MRI and perfusion SPECT imaging were obtained in 15 RNMO patients. The results showed negative regional correlations of WMV, GMV and perfusion with the number of ON attacks, involving important components of the visual system, which could be relevant for the comprehension of incremental visual disability in RNMO. We also found positive regional correlation of perfusion with the number of ON attacks, mostly overlapping the brain area where the WMV showed negative correlation. This provides evidence that brain microvasculature is an early disease target and suggests that perfusion alteration could be important in the development of brain structural abnormalities in RNMO.
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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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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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Consciousness disturbance and poikilothermia revealing brain involvement in neuromyelitis optica. Acta Neurol Belg 2012; 112:213-5. [PMID: 22426665 DOI: 10.1007/s13760-012-0029-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 08/26/2011] [Indexed: 10/28/2022]
Abstract
A 21-year-old woman was admitted due to altered mental status and hypothermia. The patient had a diagnosis of neuromyelitis optica (NMO) for 12 years and she was positive for serum anti-aquaporin 4 antibody. On admission, physical examination revealed coma with decerebration rigidity and poikilothermia. Magnetic resonance images of the brain revealed widespread, gadolinium enhancing lesions in the periventricular areas and the diencephalic structures. Laboratory investigations revealed hyponatremia and hypothyroidism. The patient was treated with high dose steroids. Both symptomatic and asymptomatic brain lesions may develop in patients with NMO. However, poikilothermia has not been reported in patients with NMO before.
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Yaguchi H, Yabe I, Takai Y, Misu T, Matsushima M, Takahashi T, Kubota KC, Akimoto S, Fujihara K, Sasaki H. Pathological study of subacute autoimmune encephalopathy with anti-AQP4 antibodies in a pregnant woman. Mult Scler 2011; 18:683-7. [DOI: 10.1177/1352458511422928] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A pregnant woman with extensive brain lesions on magnetic resonance imaging was tested positive for anti-aquaporin4 (AQP4) antibodies. An open biopsy of the left temporal lobe showed pathological changes in both the white and gray matter. Hematoxylin and eosin, Klüver–Barrera, and myelin basic protein staining results were indicative of demyelination in the white matter. Loss of AQP4 and glial fibrillary acidic protein was observed in the white matter, and this finding is consistent with the neuropathological findings of neuromyelitis optica spinal lesions. Moreover, loss of AQP4 was observed in the gray matter. The presence of anti-AQP4 antibodies, and the pathology, led to the diagnosis of anti-AQP4 antibodies-related encephalopathy.
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Affiliation(s)
- Hiroaki Yaguchi
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Ichiro Yabe
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaaki Matsushima
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kanako C. Kubota
- Department of Surgical Pathology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Sachiko Akimoto
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Kazuo Fujihara
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hidenao Sasaki
- Department of Neurology, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan
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Okamoto T, Ogawa M, Lin Y, Murata M, Miyake S, Yamamura T. Treatment of neuromyelitis optica: current debate. Ther Adv Neurol Disord 2011; 1:5-12. [PMID: 21180560 DOI: 10.1177/1756285608093978] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease that largely affects optic nerves and spinal cord. Recent studies have identified an elevation of serum anti-aquaporin 4 antibody as a hallmark of NMO. Typical cases of NMO significantly differ from multiple sclerosis (MS) in immunological markers, histopathology, and responses to therapy. In fact, plasma exchange may be more efficacious for NMO than MS, whereas interferon-ß is recommended for MS but not for NMO. An emerging idea that pathogenesis of NMO may involve an interaction of the newly identified helper T cell subset, Th17, with B cells offers potential targets of therapy.
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Affiliation(s)
- Tomoko Okamoto
- Department of Neurology, Musashi Hospital, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
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He D, Wu Q, Chen X, Zhao D, Gong Q, Zhou H. Cognitive impairment and whole brain diffusion in patients with neuromyelitis optica after acute relapse. Brain Cogn 2011; 77:80-8. [PMID: 21723024 DOI: 10.1016/j.bandc.2011.05.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2010] [Revised: 05/23/2011] [Accepted: 05/27/2011] [Indexed: 02/05/2023]
Abstract
The objective of this study investigated cognitive impairments and their correlations with fractional anisotropy (FA) and mean diffusivity (MD) in patients with neuromyelitis optica (NMO) without visible lesions on conventional brain MRI during acute relapse. Twenty one patients with NMO and 21 normal control subjects received several cognitive tests to assess cognitive function. Head diffusion tensor imaging (DTI) of all patients with NMO were collected with a 3-T MR system. Correlations of cognitive test scores and whole brain FA and MD were examined by voxel-based analysis. Region-of-interest analysis was applied to the significantly correlated regions which the most frequently appeared. We found that NMO patients without visible brain lesions had significantly impaired learning and memory, decreased information processing speed, and damaged attention compared with normal control subjects. These impaired cognitive domains were significantly correlated with FA and MD in local regions of corpus callosum, anterior cingulate and medial frontal cortex. In corpus callosum of NMO patients, mean FA was significantly lower and mean MD higher than normal control subjects. Our findings suggest that cognitive impairments in learning and memory, information processing speed and attention occur in NMO patients without visible brain lesions during acute relapse. The impairments in immediate and short-term memory in NMO patients may be due to information encoding deficits in the process of information acquisition. The corpus callosum of such patients may have local microscopic damages that play a role in cognitive impairments during acute relapse.
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Affiliation(s)
- Dian He
- Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Kitley JL, Leite MI, George JS, Palace JA. The differential diagnosis of longitudinally extensive transverse myelitis. Mult Scler 2011; 18:271-85. [PMID: 21669935 DOI: 10.1177/1352458511406165] [Citation(s) in RCA: 105] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Longitudinally extensive transverse myelitis refers to florid and widespread inflammation of the spinal cord causing T2 hyperintensity on spinal magnetic resonance imaging that is seen to extend over three or more vertebral segments. Whilst rare, longitudinally extensive transverse myelitis is clinically important as it can lead to catastrophic morbidity, and a group of these patients are at risk of further attacks. Early identification and establishment of the underlying aetiology is vital in order to initiate appropriate therapy and optimize outcomes. Whilst longitudinally extensive transverse myelitis is classically associated with neuromyelitis optica, there are many other causes. These include other inflammatory aetiologies, infection, malignancy and metabolic disturbance. Some of these are readily treatable. Laboratory and radiological investigations can help to differentiate these causes. Treatment of longitudinally extensive transverse myelitis hinges on distinguishing inflammatory and non-inflammatory aetiologies and identifying patients who are at high risk of a recurrent course.
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Matà S, Lolli F. Neuromyelitis optica: An update. J Neurol Sci 2011; 303:13-21. [DOI: 10.1016/j.jns.2011.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 12/01/2010] [Accepted: 01/05/2011] [Indexed: 11/30/2022]
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Imaging the visual pathway in neuromyelitis optica. Mult Scler Int 2011; 2011:869814. [PMID: 22135746 PMCID: PMC3226244 DOI: 10.1155/2011/869814] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/20/2011] [Indexed: 11/17/2022] Open
Abstract
The focus of this paper is to summarize the current knowledge on visual pathway damage in neuromyelitis optica (NMO) assessed by magnetic resonance imaging (MRI) and optical coherence tomography (OCT).
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Kim JE, Kim SM, Ahn SW, Lim BC, Chae JH, Hong YH, Park KS, Sung JJ, Lee KW. Brain abnormalities in neuromyelitis optica. J Neurol Sci 2011; 302:43-8. [PMID: 21236446 DOI: 10.1016/j.jns.2010.12.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/30/2010] [Accepted: 12/02/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND Differentiating neuromyelitis optica (NMO) from multiple sclerosis (MS) is a real challenge in the clinical field. In the past, NMO (not MS), was inferred when abnormality was not detected in the brain magnetic resonance imaging (MRI). Recently, some studies have reported abnormalities in the brain MRIs of NMO, but only few among the Asian population. The aim of this study was to evaluate the frequency of brain MRI among Korean NMO patients and characterize findings that might be helpful to distinguish NMO from MS. METHODS Medical records, NMO-IgG, and brain MRI of 17 patients diagnosed with NMO by the revised diagnostic criteria of Wingerchuk et al. (2006) [6] from 2008 to 2010, were reviewed. RESULTS 11 out of 17 patients (64.7%) had abnormal MRI findings. More than two lesions were detected in most patients. The majority of patients with brain MRI abnormality showed nonspecific (5 patients) or atypical (6 patients) findings. Cerebral white matter was most frequently involved (58.8%). 3 patients (17.6%) involved corpus callosum, 4 (23.5%) with internal capsule, 2 (11.8%) with cerebellum, and 3 (17.6%) with brainstem. There were 5 (29.4%) patients who met the Paty et al. criteria (1988) [15] and 3 patients (35.3%) who met the multiple sclerosis (MS) spatial distribution diagnostic criteria of Barkhof et al. (1997) [14] in their brain MRI. CONCLUSIONS Brain abnormalities have been frequently found among Korean NMO patients and the frequencies have been reported to be higher than that of Caucasians. Current MS spatial distribution criteria, such as Paty et al. (1988) [15] or Barkhof et al. (1997) [14], are not sufficient to discriminate NMO from MS in brain MRI findings. Our results will provide valuable information that would be useful in establishing future revising criteria for NMO.
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Affiliation(s)
- Jee-Eun Kim
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
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Should Most Patients With Optic Neuritis be Tested for Neuromyelitis Optica Antibodies and Should This Affect Their Treatment? J Neuroophthalmol 2010; 30:376-8; discussion 378-9. [DOI: 10.1097/wno.0b013e3181f68c19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Kim W, Park MS, Lee SH, Kim SH, Jung IJ, Takahashi T, Misu T, Fujihara K, Kim HJ. Characteristic brain magnetic resonance imaging abnormalities in central nervous system aquaporin-4 autoimmunity. Mult Scler 2010; 16:1229-36. [PMID: 20685766 DOI: 10.1177/1352458510376640] [Citation(s) in RCA: 142] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Although neuromyelitis optica has been traditionally regarded as a disease without brain involvement, brain abnormalities are not uncommon in patients with neuromyelitis optica-related disorders. METHODS We aimed to characterize the brain magnetic resonance imaging (MRI) abnormalities in neuromyelitis optica spectrum disorder patients who are seropositive for anti-aquaporin-4 autoantibody (AQP4 Ab). Of 236 consecutive patients with inflammatory demyelinating central nervous system diseases, we retrospectively analyzed MRI characteristics of 78 patients who were seropositive for AQP4 Ab. RESULTS For an average observational period of 6.3 years, 62 patients (79%) had brain lesions on MRI. Twenty-four patients (31%) had brain MRI abnormalities at the onset of disease, and 35 (45%) had symptomatic brain involvement. Characteristic brain MRI abnormalities were classified into five categories: (1) lesions involving corticospinal tracts (e.g. posterior limb of internal capsule and cerebral peduncle (44%); (2) extensive hemispheric lesions likely due to vasogenic edema (29%); (3) periependymal lesions surrounding aqueduct and the third and fourth ventricles (22%); (4) periependymal lesions surrounding lateral ventricles (40%); and (5) medullary lesions, often contiguous with cervical lesions (31%). Fifty-four patients (69%) showed at least one kind of brain abnormality among the five characteristic MRI lesions. Ten patients showed gadolinium-enhancing lesions, which were characterized by multiple patchy enhancing patterns with blurred margins. CONCLUSIONS In central nervous system AQP4 autoimmunity, brain MRI abnormalities were more common than is generally appreciated and were characterized by their unique localization and configuration.
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Affiliation(s)
- Woojun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
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Modifications to the McDonald MRI dissemination in space criteria for use in Asians with classic multiple sclerosis: the Taiwanese experience. Mult Scler 2010; 16:1213-9. [DOI: 10.1177/1352458510376179] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The McDonald MRI dissemination in space criteria have been found to be less sensitive when applied to Asians with classic multiple sclerosis. The Asian neurological community thus proposed modifications to the criteria with reduction of minimal number of T2 lesions from nine to four, and removal of restriction on spinal cord lesion length and morphology for use in Asians. Objective: The study is to examine the accuracy of modified MRI dissemination in space criteria for prediction of conversion from clinically isolated syndrome to definite multiple sclerosis according to patients’ baseline MRI. Methods: From 2001 to 2007, we recruited 67 patients with clinically isolated syndrome. They had been followed-up until development of definite multiple sclerosis or remaining as clinically isolated syndrome for more than 2 years. The non-converters were taken as negative cases. The 67 patients’ baseline MRIs were evaluated by two radiologists and determined as either fulfilling or not fulfilling McDonald and modified MRI criteria for dissemination in space. Results: Thirty-two patients converted to definite multiple sclerosis and 35 did not. The modified criteria are slightly more sensitive (53.1% vs. 50.0%) and accurate (77.6% vs. 76.1%) as compared with McDonald criteria. However, further reduction of the cutoff of abnormal MRI criteria from three of four to two of four criteria yields best sensitivity (71.9%) and accuracy (83.6%). Conclusions: Modifications to the McDonald MRI dissemination in space criteria (by using fewer T2 lesions, removal of the restriction on the spinal cord lesion and reduction of the cutoff of MRI criteria) are more appropriate for use in the Taiwanese population for the diagnosis of classic multiple sclerosis.
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Sellner J, Boggild M, Clanet M, Hintzen RQ, Illes Z, Montalban X, Du Pasquier RA, Polman CH, Sorensen PS, Hemmer B. EFNS guidelines on diagnosis and management of neuromyelitis optica. Eur J Neurol 2010; 17:1019-32. [PMID: 20528913 DOI: 10.1111/j.1468-1331.2010.03066.x] [Citation(s) in RCA: 293] [Impact Index Per Article: 20.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica (NMO) or Devic's disease is a rare inflammatory and demyelinating autoimmune disorder of the central nervous system (CNS) characterized by recurrent attacks of optic neuritis (ON) and longitudinally extensive transverse myelitis (LETM), which is distinct from multiple sclerosis (MS). The guidelines are designed to provide guidance for best clinical practice based on the current state of clinical and scientific knowledge. SEARCH STRATEGY Evidence for this guideline was collected by searches for original articles, case reports and meta-analyses in the MEDLINE and Cochrane databases. In addition, clinical practice guidelines of professional neurological and rheumatological organizations were studied. RESULTS Different diagnostic criteria for NMO diagnosis [Wingerchuk et al. Revised NMO criteria, 2006 and Miller et al. National Multiple Sclerosis Society (NMSS) task force criteria, 2008] and features potentially indicative of NMO facilitate the diagnosis. In addition, guidance for the work-up and diagnosis of spatially limited NMO spectrum disorders is provided by the task force. Due to lack of studies fulfilling requirement for the highest levels of evidence, the task force suggests concepts for treatment of acute exacerbations and attack prevention based on expert opinion. CONCLUSIONS Studies on diagnosis and management of NMO fulfilling requirements for the highest levels of evidence (class I-III rating) are limited, and diagnostic and therapeutic concepts based on expert opinion and consensus of the task force members were assembled for this guideline.
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Affiliation(s)
- J Sellner
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Germany.
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