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Carlsson O, Jonsson DI, Brundin L, Iacobaeus E. Relapses and Serious Infections in Patients with Neuromyelitis Optica Spectrum Disorder Treated with Rituximab: A Swedish Single-Center Study. J Clin Med 2024; 13:355. [PMID: 38256489 PMCID: PMC10816065 DOI: 10.3390/jcm13020355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare immune-mediated relapsing-remitting disease of the central nervous system. The usage of rituximab, as relapse-preventive therapy, in NMOSD is common. We performed a single-center retrospective cohort study to assess the risk of relapses and severe infectious events (SIEs) in rituximab-treated NMOSD patients. This study included 24 aquaporin-4 IgG+ (AQP4+), 8 myelin-oligodendrocyte-protein IgG+ (MOG+), and 10 double-seronegative NMOSD patients. Relapses were observed in 50% of all patients during a mean treatment time of 4.0 (range: 0.5-8.25) years. The incidence risk ratio (IRR) of relapse was three times higher in MOG+ compared to AQP4+ patients (IRR: 3.0, 95% confidence interval (CI); 1.2-7.7). SIEs occurred in 40% of all patients during follow-up. AQP4+ patients conferred an increased risk of SIEs compared to MOG+ patients (IRR; 5.3, 95% CI; 1.2-24.3). Incomplete CD19+ B-lymphocyte suppression was not correlated with relapse risk (hazard ratio; 1.9, 95% CI; 0.7-5.2), and there was no correlation between IgG-levels and SIE risk (odds ratio; 2.0, 95% CI; 0.8-4.8). In conclusion, considerable risks of both relapses and SIEs were observed in NMOSD patients exposed to rituximab, which underlines the need for close clinical vigilance of disease activity and infections during treatment.
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Affiliation(s)
- Olof Carlsson
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Dagur Ingi Jonsson
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurophysiology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Lou Brundin
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institute, 171 64 Solna, Sweden; (O.C.); (D.I.J.); (L.B.)
- Department of Neurology, Karolinska University Hospital, 171 76 Stockholm, Sweden
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Masha N, Kimbrough DJ, Eckstein CP, Hudak NM, Skeen MB, Hartsell FL, Lutz MW, Shah S. Neuromyelitis optica: Clinical course and potential prognostic indicators. Mult Scler Relat Disord 2023; 69:104414. [PMID: 36463620 DOI: 10.1016/j.msard.2022.104414] [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: 07/23/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune neurological disorder associated with antibodies to aquaporin-4 (AQP4). NMOSD has been thought to follow a progressive disease course, with step-wise accumulation of disability over time, even in patients undergoing immunosuppressive/immunomodulatory therapy. The influence of factors such as AQP4 seropositivity, AQP4 serum titer levels, and administration of plasmapheresis on NMOSD prognosis is, as yet, unclear. METHODS We performed a retrospective chart review of 53 persons with NMOSD at Duke University Hospital-collecting data on longitudinal disease course, imaging, demographics, and serum AQP4 titers (measured using the ELISA or FACS method). Most patients in our cohort were treated with high-dose corticosteroids and, following diagnosis, received maintenance immunosuppressive/immunomodulatory therapies. Longitudinal data on EDSS scores were used to calculate the slope of disability over time for each participant. We additionally investigated the correlation between initial AQP4 seropositivity, initial AQP4 serum titer levels, and treatment with plasmapheresis on disability progression for each participant. RESULTS Contrary to current views on NMOSD disease course, the majority of our participants showed either no change (31.9%) or improvement (27.1%) in disability over time. Our results additionally revealed no significant association between clinical prognosis and initial AQP4 seropositivity (p = 0.830), initial AQP4 serum titer levels (p = 0.338), or administration of plasmapheresis (p = 0.1149). CONCLUSIONS Our study presents a contemporary view of the clinical course of NMOSD and shows a more favorable view of its disease course than prior studies (performed before high-efficacy disease modifying therapies became widely-used for this patient population). Most patients in this study received treatment with high-dose corticosteroids following NMOSD flares, as well as a variety of maintenance immunosuppressive therapies. The results of this study cannot shed light on the disease course of untreated NMOSD. Our findings additionally challenge the theory that AQP4 seropositivity or serum titer levels at time of diagnosis may be used to effectively predict NMOSD prognosis. While we were unable to find evidence supporting a favorable effect of plasmapheresis administration on disease outcomes, further research is needed to determine the role plasmapheresis ought to play in the treatment of NMOSD.
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Affiliation(s)
- Nidhila Masha
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710, USA.
| | - Dorlan J Kimbrough
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Christopher P Eckstein
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Nicholas M Hudak
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Mark B Skeen
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - F Lee Hartsell
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Michael W Lutz
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Suma Shah
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
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Apetse K, Kouassi K, Anayo NK, Waklatsi KP, Guinhouya MK, Agba L, Kumako VK, Kombate D, Assogba K, Belo M, Balogou AK. Neuromyelitis Optica Spectrum Disorders in Black African: Experience of Togo (2015–2020). J Neurosci Rural Pract 2022; 13:541-545. [PMID: 35946029 PMCID: PMC9357491 DOI: 10.1055/s-0042-1750081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introduction
Neuromyelitis optica spectrum disorders (NMOSD) would disproportionately affect blacks within mixed populations. However, they are rarely reported in black African. The objective of this work was to report the experience of Togo, a West African country in terms of NMOSD.
Methods
This is a series of six cases diagnosed between 2015 and 2020 in the only three neurology departments in Togo. The diagnosis of NMOSD was made according to the criteria of the International Panel for NMO Diagnosis (2015) and the patients had a minimum clinical follow-up of 6 months after the diagnosis. The search for anti-aquaporin 4 (AQP4) antibodies was performed by immunofluorescence on transfected cells.
Results
The mean age was 25.33 years and the sex ratio female/male was 5/1. The average time between the first attack and the diagnosis was 122.83 days. Clinically, there was isolated medullary involvement (2/6), simultaneous opticomedullary involvement (3/6), and area postrema syndrome (1/6). Five patients were anti-AQP4 positive. All six patients had extensive longitudinal myelitis. At 6 months of follow-up, there was one case of death and one case of blindness.
Conclusion
The rarity of NMOSD cases in Togo could be linked to an underestimation. To better characterize the NMOSDs of the black African population, multicenter and multidisciplinary studies are necessary.
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Affiliation(s)
- Kossivi Apetse
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Komlan Kouassi
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Nyinèvi Komla Anayo
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Kokouvi Panabalo Waklatsi
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Mensah Kokou Guinhouya
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Léhleng Agba
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Vinyo Kodzo Kumako
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Damelan Kombate
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Komi Assogba
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Mofou Belo
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
| | - Agnon Koffi Balogou
- Service de Neurologie du CHU Campus, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
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Das J, Sharrack B, Snowden JA. Autologous hematopoietic stem-cell transplantation in neurological disorders: current approach and future directions. Expert Rev Neurother 2020; 20:1299-1313. [PMID: 32893698 DOI: 10.1080/14737175.2020.1820325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Autologous hematopoietic stem-cell transplantation (AHSCT) has become increasingly popular in recent years as an effective treatment of immune-mediated neurological diseases. Treatment-related mortality has significantly reduced primarily through better patient selection, optimization of transplant technique, and increased center experience. AREA COVERED Multiple sclerosis is the main indication, but people with neuromyelitis optica spectrum disorder, stiff-person spectrum disorder, chronic inflammatory demyelinating polyneuropathy, myasthenia gravis, and other immune-mediated neurological disorders also have been treated. The review herein discusses the use of AHSCT in these neurological disorders, the importance of patient selection and transplant technique optimization and future directions. EXPERT OPINION Phase II and III clinical trials have confirmed the safety and efficacy of AHSCT in multiple sclerosis and recent phase II clinical trials have also suggested its safety and efficacy in chronic inflammatory demyelinating polyneuropathy and neuromyelitis optica spectrum disorder, with the evidence in other neurological disorders limited to individual case reports, small case series, and registry data. Therefore, further randomized controlled clinical trials are required to assess its safety and efficacy in other neurological conditions. However, in rare neurological conditions, pragmatic treatment trials or registry-based studies may be more realistic options for gathering efficacy and safety data.
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Affiliation(s)
- Joyutpal Das
- Clinical Neurosciences, Manchester Academic Health Science Centre, Salford Royal NHS Foundation Trust , Salford, UK.,Cardiovascular medicine, University of Manchester , Manchester, UK.,Department of Neuroscience, NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield , Sheffield, UK
| | - Basil Sharrack
- Department of Neuroscience, NIHR Translational Neuroscience BRC, Sheffield Teaching Hospitals NHS Foundation Trust, University of Sheffield , Sheffield, UK
| | - John A Snowden
- Department of Hematology, Sheffield Teaching Hospitals NHS Foundation Trust , Sheffield, UK
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Mealy MA, Boscoe A, Caro J, Levy M. Assessment of Patients with Neuromyelitis Optica Spectrum Disorder Using the EQ-5D. Int J MS Care 2019; 21:129-134. [PMID: 31191178 DOI: 10.7224/1537-2073.2017-076] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune disease characterized by unpredictable attacks of the optic nerves and spinal cord that cause neurologic deficits, including weakness, numbness, bowel/bladder dysfunction, and pain and reduced vision and can ultimately lead to blindness and paralysis. We assessed the effects of NMOSD on quality of life. Methods Adult patients with NMOSD treated at a US academic neurology clinic completed the EQ-5D and several other measures of functional status and quality of life. The EQ-5D scores and correlations across measures were evaluated, and scores were compared with those of patients with multiple sclerosis and US norms. Results Twenty-one patients (90% women; mean age, 42.8 years; mean disease duration, 8.2 years) were included. The mean EQ-5D score was 0.74. Most patients reported at least some problems with mobility, pain/discomfort, usual activities, and/or anxiety/depression. Greater proportions of patients reported moderate or severe problems with mobility and pain/discomfort than they did with self-care, usual activities, or anxiety/depression. In a multivariate model, only the Brief Pain Inventory was a significant independent predictor of overall EQ-5D score. Conclusions Neuromyelitis optica spectrum disorder has a substantial effect on multiple domains of quality of life. Pain seems to be among the primary drivers of the EQ-5D scores in NMOSD.
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Fragoso YD, Sousa NAC, Alves-Leon SV, Dias RM, Pimentel MLV, Gomes S, Goncalves MVM, Stella CV, Tauil CB, Anacleto A, Spessotto CV, Correa EC, Eboni ACB, Damasceno A, Damasceno B, Farinhas JGD, Mota RSDS, Nogueira EGA, Pereira VCSR, Scorcine C, Bacon T, Kister I. Clinical characteristics of 153 Brazilian patients with neuromyelitis optica spectrum disorder (NMOSD). Mult Scler Relat Disord 2018; 27:392-396. [PMID: 30504040 DOI: 10.1016/j.msard.2018.11.031] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/28/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND The 2015 criteria for diagnosing neuromyelitis optica spectrum disorder (NMOSD) have encouraged several groups across the world to report on their patients using these criteria. The disease typically manifests with severe relapses of optic neuritis, longitudinally extensive myelitis and/or brainstem syndromes, often leading to severe disability. Some patients are seropositive for antibodies against aquaporin-4 (AQP4), others are positive for anti-myelin oligodendrocyte glycoprotein (MOG), while a few are negative for both biomarkers. The disease is complex, and only now are specific therapeutic clinical trials being carried out. The present study adds to the literature through detailed clinical data from 153 medical records of Brazilian patients. METHODS Retrospective assessment of medical records from nine specialized units in Brazil. RESULTS NMOSD was more prevalent in females (4.1:1), who had significantly fewer relapses than males (p = 0.007) but presented similar levels of disability over time. African ancestry was associated with higher levels of disability throughout the disease course (p < 0.001), although the number of relapses was similar to that observed in white patients. Concomitant autoimmune diseases were relatively rare in this population (6.5%). Positivity for anti-AQP4 antibodies was identified in 62% of the patients tested, while 3% presented anti-MOG antibodies. Anti-AQP4 antibodies were not associated to worse disease course. The last medical record showed that six patients had died and 13 were wheelchair-bound. Seventy percent of the patients did not respond to first-line therapy (azathioprine and/or corticosteroids), and five patients continued to relapse even after four different courses of treatment. CONCLUSION The present study adds to the reports from other countries presenting original data on Brazilian patients diagnosed with NMOSD according to the 2015 criteria.
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Affiliation(s)
- Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Avenida Conselheiro Nebias, Santos, SP, Brazil.
| | | | | | - Ronaldo Maciel Dias
- Department of Neurology, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Maria Lucia V Pimentel
- Department of Neurology, Santa Casa de Misericordia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Sidney Gomes
- Department of Neurology, Hospital Beneficencia Portuguesa de Sao Paulo and Hospital Paulistano, Sao Paulo, SP, Brazil
| | | | - Carla Vieira Stella
- Department of Neurology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Andrea Anacleto
- Department of Neurology, Universidade Metropolitana de Santos, Avenida Conselheiro Nebias, Santos, SP, Brazil
| | | | - Eber Castro Correa
- Department of Neurology, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | | | - Alfredo Damasceno
- Department of Neurology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Benito Damasceno
- Department of Neurology, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | | | - Eduardo G Almeida Nogueira
- Department of Neurology, Universidade Metropolitana de Santos, Avenida Conselheiro Nebias, Santos, SP, Brazil
| | | | - Claudio Scorcine
- Department of Neurology, Universidade Metropolitana de Santos, Avenida Conselheiro Nebias, Santos, SP, Brazil
| | - Tamar Bacon
- Department of Neurology, New York University, New York, NY, USA
| | - Ilya Kister
- Department of Neurology, New York University, New York, NY, USA
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7
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Fabis-Pedrini MJ, Bundell C, Wee CK, Lucas M, McLean-Tooke A, Mastaglia FL, Carroll WM, Kermode AG. Prevalence of anti-aquaporin 4 antibody in a diagnostic cohort of patients being investigated for possible neuromyelitis optica spectrum disorder in Western Australia. J Neuroimmunol 2018; 324:76-80. [PMID: 30248527 DOI: 10.1016/j.jneuroim.2018.09.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 01/21/2023]
Abstract
OBJECTIVE To evaluate the prevalence of anti-AQP4 antibody in serum and CSF samples from patients being investigated for possible neuromyelitis optica spectrum disorder (NMOSD) referred to the PathWest State reference laboratory using a sensitive cell-based assay (CBA). BACKGROUND NMOSD is an inflammatory CNS disease distinct from MS, which is relatively rare in Western countries. A proportion of patients with NMOSD have detectable serum IgG antibodies that target the water channel aquaporin-4 (AQP4-IgG), but the frequency varies in different populations studied and according to the assay method employed. METHODS Sera or CSF from a diagnostic cohort of 196 consecutive patients with possible NMOSD which had previously been screened by indirect immunofluorescence (IIF) on primate cerebellum were re-tested for AQP4-IgG reactivity to the M1 and M23 isoforms of AQP4 using a commercial CBA. A control group of 205 patients with definite MS was also included in the study. RESULTS Of the 196 patients, only 5 sera were AQP4-IgG positive, representing 2.6% of patients in the diagnostic cohort. All 5 AQP4-IgG positive patients fulfilled the 2015 revised diagnostic criteria for NMOSD and were females of varied ethnic origins, 4 of whom had longitudinally extensive transverse myelitis. The CBA confirmed AQP4-IgG positivity in the four patients previously reported as positive by IIF, and an additional patient with NMOSD who had previously been diagnosed as MS was also identified. None of the 205 MS sera were AQP4-IgG positive. CONCLUSIONS Our study confirms the utility and greater reliability of the M1/M23 CBA for detecting AQP4-IgG in patients with possible NMOSD, and indicates a prevalence of seropositive NMOSD in the Western Australian population similar to that in other Western populations.
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Affiliation(s)
- Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Christine Bundell
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, Western Australia, Australia
| | - Chee-Keong Wee
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Michaela Lucas
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; School of Medicine and Pharmacology, School of Pathology and Laboratory Medicine, UWA, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; Department of Immunology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Andrew McLean-Tooke
- PathWest Laboratory Medicine, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Department of Immunology, Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - Frank L Mastaglia
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Department of Neurology & Clinical Neurophysiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, University of Western Australia, Perron Institute for Neurological & Translational Science, Queen Elizabeth II Medical Centre, Perth, Western Australia, Australia; Institute for Immunology and Infectious Diseases, Murdoch University, Perth, Western Australia, Australia; Department of Neurology & Clinical Neurophysiology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
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Alvarenga MP, Schimidt S, Alvarenga RP. Epidemiology of neuromyelitis optica in Latin America. Mult Scler J Exp Transl Clin 2017; 3:2055217317730098. [PMID: 28979797 PMCID: PMC5617096 DOI: 10.1177/2055217317730098] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Accepted: 08/13/2017] [Indexed: 01/08/2023] Open
Abstract
A major development over the past two decades was the recognition of recurrent neuromyelitis optica (NMO) as a particular central nervous system disorder different from multiple sclerosis (MS). Here we reviewed the epidemiology of NMO in Latin America (LATAM). A predominance of a mixed population is found in this region. Recurrent NMO in black women was described in the Caribbean Islands and in Rio de Janeiro. The prevalence of NMO in LATAM varied from 0.37/100,000 (Volta Redonda city) to 4.2/100,000 inhabitants (Caribbean Islands). NMO differs significantly from MS with respect to gender, ethnicity, morbidity and genetic susceptibility. An association of the HLA DRB1*03 alleles with NMO was described in the French Antilles, Ribeirão Preto, Rio de Janeiro and Mexico. It is not common to find familial forms of NMO. NMO represents 11.8% of all inflammatory idiopathic diseases in South America (SA). In SA, the highest frequency of NMO occurs in African Brazilian young women. The overall relative frequency of NMO among MS cases in this region was 14%, decreasing following a north-south gradient, which parallels the percentage of nonwhite people.
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Affiliation(s)
- M P Alvarenga
- Department of Neurology, Hospital Federal da Lagoa, Brazil
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Fan M, Fu Y, Su L, Shen Y, Wood K, Yang L, Liu Y, Shi FD. Comparison of brain and spinal cord magnetic resonance imaging features in neuromyelitis optica spectrum disorders patients with or without aquaporin-4 antibody. Mult Scler Relat Disord 2017; 13:58-66. [PMID: 28427704 DOI: 10.1016/j.msard.2017.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND The spinal cord and brain measurements are rarely investigated in neuromyelitis optica (NMO) patients with and without antibodies to aquaporin-4 (AQP4), directly compared to multiple sclerosis (MS) patients. OBJECTIVES To investigate magnetic resonance imaging (MRI) features of both brain and spinal cord in NMO patients with and without antibodies to AQP4, compared with MS patients and healthy controls (HC). METHODS We recruited 55 NMO including 30 AQP4 (+) and 25 AQP4 (-), 25 MS and 25 HC. Brain and spinal cord MRIs were obtained for each participant. Brain lesions (BL), whole brain and deep grey matter volumes (DGMV), white matter diffusion metrics and spinal cord lesions were measured and compared among groups. RESULTS The incidence of BL was lower in the AQP4 (+) group than in the AQP4 (-) and MS groups (p<0.05). In the AQP4 (+) group, there was a lower incidence of infratentorial lesions (ITL) and higher spinal cord lesions length than in the MS group (p<0.05). The thalamic and hippocampal volumes were smaller in the AQP4 (-) group and MS group than in the HC group (p<0.05). CONCLUSIONS The NMO patients with AQP4 (-) showed higher prevalence of BL, ITL, and similar spinal cord lesion length, compared to AQP4 (+), and demonstrated deep grey matter atrophy, suggesting an intermediate phenotype between that of typical MS and NMO.
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Affiliation(s)
- Moli Fan
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China
| | - Ying Fu
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China
| | - Lei Su
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China
| | - Yi Shen
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China
| | - Kristofer Wood
- Barrow Neurological Institute, St Joseph's Hospital and Medical Center, USA
| | - Li Yang
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China
| | - Yaou Liu
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China; Department of Radiology, Xuanwu Hospital, Capital Medical University, China; Department of Radiology and Nuclear Medicine, Neuroscience Campus Amsterdam, VU University Medical Center, Amsterdam 1007 MB, The Netherlands.
| | - Fu-Dong Shi
- Department of Neurology, Key Laboratory of Posttraumatic Neuro-repair and Regeneration in the Central Nervous System, Tianjin Neurological Institute, Tianjin Medical University General Hospital, China; Barrow Neurological Institute, St Joseph's Hospital and Medical Center, USA
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10
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Carnero Contentti E, Hryb JP, Morales S, Gomez A, Chiganer E, Di Pace JL, Lessa C, Perassolo M. Longitudinally extensive transverse myelitis immune-mediated in aquaporin-4 antibody negative patients: Disease heterogeneity. J Neurol Sci 2017; 373:134-137. [DOI: 10.1016/j.jns.2016.12.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/24/2016] [Accepted: 12/19/2016] [Indexed: 12/29/2022]
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ZhangBao J, Zhou L, Li X, Cai T, Lu J, Lu C, Zhao C, Quan C. The clinical characteristics of AQP4 antibody positive NMO/SD in a large cohort of Chinese Han patients. J Neuroimmunol 2016; 302:49-55. [PMID: 27988051 DOI: 10.1016/j.jneuroim.2016.11.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
Abstract
We aim to summarize the clinical features of AQP4-ab-positive NMO/SD in a large Chinese Han cohort. The clinical data of 145 AQP4-ab-seropositive patients was retrospectively reviewed. 55.9% (81/145) of the patients were defined as NMO while 39.3% (57/145) were defined as NMOSD according to the criteria established in 2006 and 2007. The mean onset age was 34.4years and the female to male ratio was 8.7:1. The median disease duration was 57months. The median of "time to second attack" and "time to develop NMO" was 7 and 13months respectively. Ratio of monophasic to relapsing was 1:7.1. Myelitis and optic neuritis (ON) were the most common manifestations at onset, followed by postrema syndrome. The median age of patients presenting with ON at disease onset was significantly younger than patients presenting with myelitis. Only 17.2% of the patients younger than 30years presented with longitudinally extensive transverse myelitis (LETM) at onset, while 55.6% of the patients over 30years presented with LETM at onset. The patients presenting with ON at disease onset all exhibited a relapsing course, had a higher probability of subsequent involvement of other CNS regions and developing into definite NMO over time compared with those with LETM as the first attack. AQP4-ab levels were higher in patients with circulating auto-antibodies such as ANA, SSA, anti-Ro-52, anti-dsDNA, anti-histone antibody, pANCA and SSB, and positively correlated with CSF protein concentrations.
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Affiliation(s)
- Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Xiaoyang Li
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Tongjia Cai
- Department of Neurology, Jing'an District Centre Hospital of Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China; Department of Neurology, Jing'an District Centre Hospital of Shanghai, China.
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, China.
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Cheng C, Jiang Y, Lu X, Gu F, Kang Z, Dai Y, Lu Z, Hu X. The role of anti-aquaporin 4 antibody in the conversion of acute brainstem syndrome to neuromyelitis optica. BMC Neurol 2016; 16:203. [PMID: 27769253 PMCID: PMC5073440 DOI: 10.1186/s12883-016-0721-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 10/15/2016] [Indexed: 12/20/2022] Open
Abstract
Background Acute brainstem syndrome (ABS) may herald multiple sclerosis (MS), neuromyelitis optica (NMO), or occur as an isolated syndrome. The aquaporin 4 (AQP4)-specific serum autoantibody, NMO-IgG, is a biomarker for NMO. However, the role of anti-AQP4 antibody in the conversion of ABS to NMO is unclear. Methods Thirty-one patients with first-event ABS were divided into two groups according to the presence of anti-AQP4 antibodies, their clinical features and outcomes were retrospectively analyzed. Results Fourteen of 31 patients (45.16 %) were seropositive for NMO-IgG. The 71.43 % of anti-AQP4 (+) ABS patients converted to NMO, while only 11.76 % of anti-AQP4 (-) ABS patients progressed to NMO. Anti-AQP4 (+) ABS patients demonstrated a higher IgG index (0.68 ± 0.43 vs 0.42 ± 0.13, p < 0.01) and Kurtzke Expanded Disability Status Scale (4.64 ± 0.93 vs 2.56 ± 0.81, p < 0.01) than anti-AQP4 (-) ABS patients. Area postrema clinical brainstem symptoms occurred more frequently in anti-AQP4 (+) ABS patients than those in anti-AQP4 (-) ABS patients (71.43 % vs 17.65 %, p = 0.004). In examination of magnetic resonance imaging (MRI), the 78.57 % of anti-AQP4 (+) ABS patients had medulla-predominant involvements in the sagittal view and dorsal-predominant involvements in the axial view. Conclusions ABS represents an inaugural or limited form of NMO in a high proportion of anti-AQP4 (+) patients.
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Affiliation(s)
- Chen Cheng
- Department of Neurology, The Affiliated Hospital, Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Ying Jiang
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
| | - Xiaodong Lu
- Department of Neurology, The Affiliated Hospital, Hangzhou Normal University, 126 Wenzhou Road, Hangzhou, Zhejiang, 310015, People's Republic of China
| | - Fu Gu
- Department of Chemical and Environmental Engineering, University of Nottingham, 199 Taikang East Road, Ningbo, Zhejiang, 315100, People's Republic of China
| | - Zhuang Kang
- Department of Radiology, the Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Yongqiang Dai
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital, Sun Yat-sen University, 600 Tianhe Road, Guangzhou, Guangdong, 510630, People's Republic of China.
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Central Nervous System Idiopathic Inflammatory Demyelinating Disorders in South Americans: A Descriptive, Multicenter, Cross-Sectional Study. PLoS One 2015. [PMID: 26222205 PMCID: PMC4519274 DOI: 10.1371/journal.pone.0127757] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The idiopathic inflammatory demyelinating disease (IIDD) spectrum has been investigated among different populations, and the results have indicated a low relative frequency of neuromyelitis optica (NMO) among multiple sclerosis (MS) cases in whites (1.2%-1.5%), increasing in Mestizos (8%) and Africans (15.4%-27.5%) living in areas of low MS prevalence. South America (SA) was colonized by Europeans from the Iberian Peninsula, and their miscegenation with natives and Africans slaves resulted in significant racial mixing. The current study analyzed the IIDD spectrum in SA after accounting for the ethnic heterogeneity of its population. A cross-sectional multicenter study was performed. Only individuals followed in 2011 with a confirmed diagnosis of IIDD using new diagnostic criteria were considered eligible. Patients’ demographic, clinical and laboratory data were collected. In all, 1,917 individuals from 22 MS centers were included (73.7% female, 63.0% white, 28.0% African, 7.0% Mestizo, and 0.2% Asian). The main disease categories and their associated frequencies were MS (76.9%), NMO (11.8%), other NMO syndromes (6.5%), CIS (3.5%), ADEM (1.0%), and acute encephalopathy (0.4%). Females predominated in all main categories. The white ethnicity also predominated, except in NMO. Except in ADEM, the disease onset occurred between 20 and 39 years old, early onset in 8.2% of all cases, and late onset occurred in 8.9%. The long-term morbidity after a mean disease time of 9.28±7.7 years was characterized by mild disability in all categories except in NMO, which was scored as moderate. Disease time among those with MS was positively correlated with the expanded disability status scale (EDSS) score (r=0.374; p=<0.001). This correlation was not observed in people with NMO or those with other NMO spectrum disorders (NMOSDs). Among patients with NMO, 83.2% showed a relapsing-remitting course, and 16.8% showed a monophasic course. The NMO-IgG antibody tested using indirect immunofluorescence (IIF) with a composite substrate of mouse tissues in 200 NMOSD cases was positive in people with NMO (95/162; 58.6%), longitudinally extensive transverse myelitis (10/30; 33.3%) and bilateral or recurrent optic neuritis (8/8; 100%). No association of NMO-IgG antibody positivity was found with gender, age at onset, ethnicity, early or late onset forms, disease course, or long-term severe disability. The relative frequency of NMO among relapsing-remitting MS (RRMS) + NMO cases in SA was 14.0%. Despite the high degree of miscegenation found in SA, MS affects three quarters of all patients with IIDD, mainly white young women who share similar clinical characteristics to those in Western populations in the northern hemisphere, with the exception of ethnicity; approximately one-third of all cases occur among non-white individuals. At the last assessment, the majority of RRMS patients showed mild disability, and the risk for secondary progression was significantly superior among those of African ethnicity. NMO comprises 11.8% of all IIDD cases in SA, affecting mostly young African-Brazilian women, evolving with a recurrent course and causing moderate or severe disability in both ethnic groups. The South-North gradient with increasing NMO and non-white individuals from Argentina, Paraguay, Brazil and Venezuela confirmed previous studies showing a higher frequency of NMO among non-white populations.
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Specificity and sensitivity of aquaporin 4 antibody detection tests in patients with neuromyelitis optica: A meta-analysis. Mult Scler Relat Disord 2015. [DOI: 10.1016/j.msard.2015.06.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Sandy S, Pittock SJ, Seemungal TAR, Ali A. Aquaporin-4 immuneglobulin g testing in 36 consecutive jamaican patients with inflammatory central nervous system demyelinating disease. Neurol Int 2014; 6:5395. [PMID: 25309712 PMCID: PMC4192434 DOI: 10.4081/ni.2014.5395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/28/2014] [Accepted: 06/05/2014] [Indexed: 11/23/2022] Open
Abstract
Epidemiological studies of neuromyelitis optica (NMO) in Jamaica are lacking. Here we reviewed the clinical records of 700 patients undergoing neurological evaluation at the Kingston Public Hospital, the largest tertiary institution in Jamaica over a 4 month period. We investigated the diagnostic utility of Aquaporin-4 ImmuneglobulinG (AQP4-IgG) testing in 36 consecutive patients with a diagnosis of an inflammatory demyelinating disorder (IDD) of the central nervous system (CNS). Patients were classified into 3 categories: i) NMO, n=10; ii) multiple sclerosis (MS), n=14 and iii) unclassified IDD (n=12). All sera were tested for AQP-IgG status by cell binding assay (Euroimmun). No MS cases were positive. Ninety per cent of NMO cases were positive. Four of 12 patients with unclassified IDD tested positive for AQP4-IgG. AQP4-IgG seropositivity was associated with a lower socioeconomic status, higher EDSS (P=0.04) and lower pulmonary function than the seronegative cases (P=0.007). Aquaporin-4 autoimmunity may account for a significant proportion of Jamaican CNS IDDs.
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Affiliation(s)
- Sherri Sandy
- Department of Clinical Medical Sciences, The University of the West Indies , St. Augustine, Trinidad and Tobago
| | - Sean J Pittock
- Department of Clinical Medical Sciences, The University of the West Indies , St. Augustine, Trinidad and Tobago
| | - Terence A R Seemungal
- Department of Clinical Medical Sciences, The University of the West Indies , St. Augustine, Trinidad and Tobago
| | - Amza Ali
- Kingston Public and University Hospital of the West Indies , Mona, Jamaica
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Comparative clinical characteristics of neuromyelitis optica spectrum disorders with and without medulla oblongata lesions. J Neurol 2014; 261:954-62. [DOI: 10.1007/s00415-014-7298-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/17/2014] [Accepted: 02/20/2014] [Indexed: 01/03/2023]
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17
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Woodhall M, Çoban A, Waters P, Ekizoğlu E, Kürtüncü M, Shugaiv E, Türkoğlu R, Akman-Demir G, Eraksoy M, Vincent A, Tüzün E. Glycine receptor and myelin oligodendrocyte glycoprotein antibodies in Turkish patients with neuromyelitis optica. J Neurol Sci 2013; 335:221-3. [DOI: 10.1016/j.jns.2013.08.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 08/27/2013] [Indexed: 10/26/2022]
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Liu Y, Han Y, Duan Y, Huang J, Ren Z, Butzkueven H, Li K. Anti-aquaporin-4 antibody positivity in neuromyelitis optica is associated with lesion activity. Eur Neurol 2013; 70:113-6. [PMID: 23860467 DOI: 10.1159/000352034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2013] [Accepted: 05/05/2013] [Indexed: 11/19/2022]
Abstract
AIMS To assess the demographic, clinical and spinal cord MRI characteristics of clinically definite neuromyelitis optica (NMO) patients for association with anti-aquaporin-4 (AQP4) antibody positivity in Chinese patients. METHODS We recruited 72 consecutive patients with NMO. The clinical assessments, sera and spinal MRI scans were obtained within 1 week after the onset of symptoms of acute myelitis. The statistical significance of potential differences in demographic, clinical and spinal MRI lesion characteristics between the two groups (anti-AQP4 antibody positive vs. negative) was determined using the two-sample t test or Fisher's exact test. RESULTS Forty-nine patients (49/72, 68.1%) were anti-AQP4 antibody positive and 23 patients (23/72, 31.9%) were anti-AQP4 antibody negative. The only characteristic that was significantly different between the groups was the presence of an enhancing spinal cord lesion (p < 0.001). CONCLUSION We found a strong association between serum anti-AQP4 antibody positivity and lesional gadolinium enhancement in patients with clinically definite NMO. These findings support prior evidence that anti-AQP4 antibody could be pathogenic in NMO lesion development.
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Affiliation(s)
- Yaou Liu
- Department of Radiology, Xuanwu Hospital, Capital Medical University, Beijing, PR China
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Fragoso YD, Adoni T, Bichuetti DB, Brooks JBB, Ferreira MLB, Oliveira EML, Oliveira CLS, Ribeiro SBF, Silva AE, Siquineli F. Neuromyelitis optica and pregnancy. J Neurol 2013; 260:2614-9. [DOI: 10.1007/s00415-013-7031-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 06/15/2013] [Accepted: 06/28/2013] [Indexed: 11/29/2022]
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Chang KH, Lyu RK, Chen CM, Wu YR, Chang HS, Huang CC, Kuo HC, Chu CC, Hsu WC, Ro LS. Distinct features between longitudinally extensive transverse myelitis presenting with and without anti-aquaporin 4 antibodies. Mult Scler 2012; 19:299-307. [PMID: 22829325 DOI: 10.1177/1352458512451659] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Longitudinally extensive transverse myelitis (LETM) with spinal cord lesions spanning three or more vertebral segments is a key feature of neuromyelitis optica (NMO). However, the role of anti-aquaporin 4 (anti-AQP4) antibody, a sensitive biomarker of NMO, in the conversion of LETM to NMO remains uncertain. METHODS Thirty first-ever LETM patients were retrospectively analysed and divided into two groups according to the presence of anti-AQP4 antibodies. RESULTS Eighteen (60%) patients presented with anti-AQP4 antibodies. Fifteen (83.33%) anti-AQP4 (+) LETM patients converted to NMO, while only three of 12 (25%, p = 0.002) anti-AQP4 (-) LETM patients progressed to NMO, over a mean follow-up period of 5.63 years. Seven (38.89%) anti-AQP4 (+) and one (8.33%) anti-AQP4 (-) LETM patients received interferon-β1a treatment, respectively. Anti-AQP4 (+) LETM patients demonstrated a higher immunogamma globulin (IgG) index (0.68 ± 0.43 versus 0.47 ± 0.19, p = 0.018), annual relapse rate (0.72 ± 0.31 versus 0.42 ± 0.17, p = 0.01) and Kurtzke Expanded Disability Status Scale (4.28 ± 2.22 versus 2.67 ± 2.26, p = 0.031), than anti-AQP4 (-) LETM patients. In spinal magnetic resonance imaging (MRIs), more than half (58.33%) of the anti-AQP4 (+) LETM patients were observed to have central grey matter-predominant involvement in the axial view, while peripheral white matter-predominant involvement (51.85%) was the most common pattern observed in the anti-AQP4 (-) LETM patients. CONCLUSION Anti-AQP4 (+) LETM demonstrated a high conversion rate to NMO (83.33%), suggesting that anti-AQP4 (+) LETM may represent an early, isolated syndrome of NMO spectrum disorder. The greater number of patients receiving interferon-β treatment in anti-AQP4 (+) LETM may contribute to its high annual relapse rate.
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Affiliation(s)
- K-H Chang
- Section of Neuromuscular Diseases, Department of Neurology, Chang Gung Memorial Hospital, Linkou Medical Center and University College of Medicine, Taiwan
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Komori M, Matsuyama Y, Nirasawa T, Thiele H, Becker M, Alexandrov T, Saida T, Tanaka M, Matsuo H, Tomimoto H, Takahashi R, Tashiro K, Ikegawa M, Kondo T. Proteomic pattern analysis discriminates among multiple sclerosis-related disorders. Ann Neurol 2012; 71:614-23. [PMID: 22522477 DOI: 10.1002/ana.22633] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To use a new, unbiased biomarker discovery strategy to obtain and assess proteomic data from cerebrospinal fluid (CSF) of patients with multiple sclerosis (MS)-related disorders. METHODS CSF protein profiles were analyzed from 107 patients with either MS-related disorders (including relapsing remitting MS [RRMS], primary progressive MS [PPMS], anti-aquaporin4 antibody seropositive-neuromyelitis optica spectrum disorder [SP-NMOSD], and seronegative-NMOSD with long cord lesions on spinal magnetic resonance imaging [SN-NMOSD]), amyotrophic lateral sclerosis (ALS), or other inflammatory neurological diseases (used as controls). CSF peptides/proteins were purified with magnetic beads, and directly measured by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. The obtained spectra were analyzed with multivariate statistics and pattern matching algorithms. These analyses were replicated in an independent sample set of 84 patients composed of those with MS-related disorders or with other neurological diseases (the second cohort). RESULTS MS-related disorders differed considerably in terms of CSF protein profiles. SP-NMOSD and SN-NMOSD, both of which fit within the NMO spectrum, were distinguishable from RRMS with high cross-validation accuracy on a support vector machine classifier, especially in relapse phases. Some peaks derived from samples of relapsed SP-NMOSD can discriminate RRMS with high area under curve scores (>0.95) and this was reproduced on the second cohort. The similarity of proteomic patterns between selected neurological diseases were demonstrated by pattern matching analysis. To our surprise, the spectral differences between RRMS and PPMS were much larger than those of PPMS and ALS. INTERPRETATION Our findings suggest that CSF proteomic pattern analysis can increase the accuracy of disease diagnosis of MS-related disorders and will aid physicians in appropriate therapeutic decision-making.
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Affiliation(s)
- Mika Komori
- Department of Neurology, Graduate School of Medicine, Kyoto University, Japan
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Kitley J, Leite MI, Nakashima I, Waters P, McNeillis B, Brown R, Takai Y, Takahashi T, Misu T, Elsone L, Woodhall M, George J, Boggild M, Vincent A, Jacob A, Fujihara K, Palace J. Prognostic factors and disease course in aquaporin-4 antibody-positive patients with neuromyelitis optica spectrum disorder from the United Kingdom and Japan. Brain 2012; 135:1834-49. [DOI: 10.1093/brain/aws109] [Citation(s) in RCA: 291] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Jindahra P, Plant T. Update on neuromyelitis optica: natural history and management. Eye Brain 2012; 4:27-41. [PMID: 28539779 DOI: 10.2147/eb.s8392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Neuromyelitis optica or Devic disease is an inflammatory disorder of the central nervous system. It is caused by antibodies that attack aquaporin 4 water channels in the cell membrane of astrocytic foot processes at the blood brain barrier. It can involve the optic nerve, the spinal cord and beyond. Here we review its pathophysiology, clinical features, and therapy.
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Affiliation(s)
- Panitha Jindahra
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,St Thomas' Hospital, Westminster Bridge Road, London, UK
| | - T Plant
- The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.,St Thomas' Hospital, Westminster Bridge Road, London, UK
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Plasma exchange in severe attacks of neuromyelitis optica. Mult Scler Int 2012; 2012:787630. [PMID: 22474589 PMCID: PMC3306943 DOI: 10.1155/2012/787630] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 11/13/2011] [Accepted: 11/17/2011] [Indexed: 12/29/2022] Open
Abstract
Background. Neuromyelitis optica (NMO) attacks are poorly controlled by steroids and evolve in stepwise neurological impairments. Assuming the strong humoral response underlying NMO attacks, plasma exchange (PLEX) is an appropriate technique in severe NMO attacks. Objective. Presenting an up-to-date review of the literature of PLEX in NMO. Methods. We summarize the rationale of PLEX in relation with the physiology of NMO, the main technical aspects, and the available studies. Results. PLEX in severe attacks from myelitis or optic neuritis are associated with a better outcome, depending on PLEX delay (“time is cord and eyes”). NMO-IgG status has no influence. Finally, we build up an original concept linking the inner dynamic of the lesion, the timing of PLEX onset and the expected clinical results. Conclusion. PLEX is a safe and efficient add-on therapy in NMO, in synergy with steroids. Large therapeutic trials are required to definitely assess the procedure and define the time opportunity window.
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Neuromyelitis optica: an antibody-mediated disorder of the central nervous system. Neurol Res Int 2012; 2012:460825. [PMID: 22363840 PMCID: PMC3272864 DOI: 10.1155/2012/460825] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 10/04/2011] [Accepted: 10/13/2011] [Indexed: 01/17/2023] Open
Abstract
Neuromyelitis optica (NMO) is a recurrent inflammatory disease that preferentially targets the optic nerves and spinal cord leading to blindness and paralysis. The hallmarks of NMO include bilateral optic neuritis and longitudinally extensive transverse myelitis. Woman and African Americans are overrepresented in the US patient population. NMO is associated with the NMO-IgG biomarker, which targets the aquaporin-4 water channel on astrocytes. The humoral pathology of NMO lesions include IgG and IgM deposits and infiltration by granulocytes suggesting that the NMO-IgG may be involved in the pathogenesis of disease. This review of the recent NMO literature covers the clinical features, epidemiology, radiology and pathology of disease and includes discussion of the important basic science research work in the field.
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Chhibber V, Weinstein R. Evidence-Based Review of Therapeutic Plasma Exchange in Neurological Disorders. Semin Dial 2012; 25:132-9. [DOI: 10.1111/j.1525-139x.2011.01023.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Kira JI. Autoimmunity in neuromyelitis optica and opticospinal multiple sclerosis: Astrocytopathy as a common denominator in demyelinating disorders. J Neurol Sci 2011; 311:69-77. [DOI: 10.1016/j.jns.2011.08.043] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Accepted: 08/29/2011] [Indexed: 10/17/2022]
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Landys Chovel M, Perea S, de los Ángeles Robinson M, Rodeiro I, Delgado R, Ochoa RF, Hernández AM. Immunopharmacology 2011: an updated report of clinical achievements and perspectives. Expert Rev Clin Pharmacol 2011; 4:693-5. [PMID: 22111854 DOI: 10.1586/ecp.11.61] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
On 26-30 June 2011 the Cuban Society of Pharmacology organized the Second International Congress on Immunopharmacology (Immunopharmacology 2011), held at the beautiful Convention Centre 'Plaza América' and the Meliá Varadero Hotel, in Varadero beach, Cuba. The main topics of the congress were immunopharmacology (including inflammation, cancer immunotherapy and immunomodulation), neuroimmunology, and the pharmacology of cytochrome P450 and transporters, among other relevant and updated related topics. Immunopharmacology 2011 offered an outstanding scientific program with the active contribution of 90 speakers from 23 foreign countries, as well as more than 170 Cuban researchers from the most important local institutions devoted to the development of immunology and pharmacology sciences.
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Matsuoka T, Suzuki SO, Suenaga T, Iwaki T, Kira JI. Reappraisal of aquaporin-4 astrocytopathy in Asian neuromyelitis optica and multiple sclerosis patients. Brain Pathol 2011; 21:516-32. [PMID: 21241398 DOI: 10.1111/j.1750-3639.2011.00475.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Selective aquaporin-4 (AQP4) loss and vasculocentric complement and immunoglobulin deposition are characteristic of neuromyelitis optica (NMO). We recently reported extensive AQP4 loss in demyelinated and myelinated layers of Baló's lesions without perivascular immunoglobulin and complement deposition. We aimed to reappraise AQP4 expression patterns in NMO and multiple sclerosis (MS). We evaluated AQP4 expression relative to glial fibrillary acidic protein, extent of demyelination, lesion staging (CD68 staining for macrophages), and perivascular deposition of complement and immunoglobulin in 11 cases with NMO and NMO spectrum disorders (NMOSD), five with MS and 30 with other neurological diseases. The lesions were classified as actively demyelinating (n = 66), chronic active (n = 86), chronic inactive (n = 48) and unclassified (n = 12). Six NMO/NMOSD and two MS cases showed preferential AQP4 loss beyond the demyelinated areas, irrespective of lesion staging. Five NMO and three MS cases showed AQP4 preservation even in actively demyelinating lesions, despite grave tissue destruction. Vasculocentric deposition of complement and immunoglobulin was detected only in NMO/NMOSD patients, with less than 30% of actively demyelinating lesions showing AQP4 loss. Our present and previous findings suggest that antibody-independent AQP4 loss can occur in heterogeneous demyelinating conditions, including NMO, Baló's disease and MS.
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Affiliation(s)
- Takeshi Matsuoka
- Department of Neurology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Kira JI. Neuromyelitis optica and opticospinal multiple sclerosis: Mechanisms and pathogenesis. PATHOPHYSIOLOGY 2011; 18:69-79. [DOI: 10.1016/j.pathophys.2010.04.008] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2010] [Revised: 03/24/2010] [Accepted: 04/08/2010] [Indexed: 12/28/2022] Open
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Wang KC, Tsai CP, Lee CL, Chen SY, Chen SJ. The prevalence of long spinal cord lesions and anti-aquaporin 4 antibodies in neuromyelitis optica patients in Taiwan. Eur Neurol 2011; 65:99-104. [PMID: 21273778 DOI: 10.1159/000322740] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 11/11/2010] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE It was the aim of this study to determine the prevalence of anti-aquaporin 4 antibody (anti-AQP4 Ab) and long spinal cord lesions in neuromyelitis optica (NMO) and multiple sclerosis (MS) patients in Taiwan. Asia has a relatively high rate of NMO compared with MS patients. Anti-AQP4 Ab is an important marker for NMO worldwide, but serological data and clinical profiles of NMO patients in Taiwan have not been reported. METHODS This retrospective study compared the clinical symptoms, demographics, spinal cord lesion length and AQP4 Ab status of 34 patients with NMO with 34 patients diagnosed with conventional MS. RESULTS Our NMO patients were predominantly middle-aged women (median age 45 years), exhibited many relapses (1.0/year) and displayed a higher Expanded Disability Status Scale score (4.75) than conventional MS patients. NMO patients exhibited long spinal cord lesions as detected by MRI. Forty-one percent of the NMO patients had detectable anti-AQP4 Ab. The Expanded Disability Status Scale score was significantly higher in AQP4 Ab- NMO patients. CONCLUSION The prevalence of AQP4 Ab in a Taiwanese NMO group was 41%. Long spinal cord lesions and detection of AQP4 Ab helped to differentiate NMO patients from MS patients. Long spinal cord lesions with the anti-AQP4 Ab test may allow for an earlier diagnosis of NMO and improve therapeutic decisions.
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Affiliation(s)
- Kai-Chen Wang
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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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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Nakamura Y, Ikeda K, Yoshii Y, Ito H, Hirayama T, Kawabe K, Kano O, Iwasaki Y. Influenza-associated monophasic neuromyelitis optica. Intern Med 2011; 50:1605-9. [PMID: 21804290 DOI: 10.2169/internalmedicine.50.5027] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disorder characterized by optic neuritis and acute myelitis. A parainfectious pathogenesis may play a partial role in the development of this disorder. Several viral infections are known to cause NMO. Here we report the case of a 15-year-old girl diagnosed with postinfluenza monophasic NMO. The patient developed sudden fever and chills, and the rapid diagnostic test for influenza was positive. She was diagnosed as influenza A and was treated with zanamivir hydrate (10 mg/day, inhalation). Three days later, she complained of dysuria and dysesthesia in the lower extremities. After nine days, she experienced blurred vision bilaterally. Neurological examination revealed visual disturbance, dysuria, dysesthesia and hyperreflexia in the lower extremities. Her visual acuity was counting fingers in OD and 2/100 in OS. Pupillary size was 4.0 mm and light reflexes were sluggish on both sides. Ophthalmoscopy showed marked edema of the optic discs. Serum influenza immunoglobulin M antibodies were elevated and serum anti-aquaporin 4 (AQP4) antibodies were undetectable. Spinal cord magnetic resonance imaging (MRI) displayed longitudinally extensive lesions in the thoracic cord. Brain MRI disclosed three subcortical lesions. The patient fulfilled the revised diagnostic criteria for NMO (2006). After methylprednisolone pulse therapy followed by oral administration of prednisolone, visual dysfunction, dysuria, limb dysesthesia and hyperreflexia were improved. Subsequently, she experienced no attacks for 3 years. This is the first case report of influenza A-associated NMO with such features of postinfectious NMO as a pediatric onset, monophasic course and anti-AQP4 antibody-seronegative status.
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Graves J, Balcer LJ. Eye disorders in patients with multiple sclerosis: natural history and management. Clin Ophthalmol 2010; 4:1409-22. [PMID: 21188152 PMCID: PMC3000766 DOI: 10.2147/opth.s6383] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Multiple sclerosis (MS) is a demyelinating disease of the central nervous system and leading cause of disability in young adults. Vision impairment is a common component of disability for this population of patients. Injury to the optic nerve, brainstem, and cerebellum leads to characteristic syndromes affecting both the afferent and efferent visual pathways. The objective of this review is to summarize the spectrum of eye disorders in patients with MS, their natural history, and current strategies for diagnosis and management. We emphasize the most common disorders including optic neuritis and internuclear ophthalmoparesis and include new techniques, such as optical coherence tomography, which promise to better our understanding of MS and its effects on the visual system.
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Affiliation(s)
- Jennifer Graves
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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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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Chanson JB, Zéphir H, Collongues N, Outteryck O, Blanc F, Fleury M, Vermersch P, de Seze J. Evaluation of health-related quality of life, fatigue and depression in neuromyelitis optica. Eur J Neurol 2010; 18:836-41. [PMID: 21087360 DOI: 10.1111/j.1468-1331.2010.03252.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The burden of multiple sclerosis (MS) includes fatigue, depression and worsening of health-related quality of life (HRQOL). These changes have not been yet measured in neuromyelitis optica (NMO). Our aim was to assess the HRQOL, fatigue and depression in NMO. METHODS We administered French validated self-questionnaires on HRQOL (SEP-59), fatigue (EMIF-SEP) and depression (EHD) to 40 patients followed up in two centres. We assessed the relationship of these parameters with gender, age, disability, disease duration, visual acuity and NMO-antibody status and also compared our results with equivalent data in MS and normal subjects derived from previous studies. RESULTS Health-related quality of life scores were lower (P < 0.01) in patients with NMO when compared to normal subjects. No significant difference was noted between patients with NMO and MS for most scores, the exceptions being HRQOL related to cognitive function (better in NMO than in MS), HRQOL related to sphincter dysfunction (worse in NMO than in MS) and the psychological dimension of fatigue (milder in NMO than in MS). Disability was the main predictive factor of an unfavourable evolution. DISCUSSION This study reveals the strong impact of NMO on HRQOL, fatigue and depression and the importance of screening patients, especially the more disabled, so as to initiate suitable treatment.
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Affiliation(s)
- J-B Chanson
- Département de Neurologie, Centre Hospitalier Régional Universitaire de Strasbourg, Strasbourg, France.
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Prognostic implications of aquaporin-4 antibody status in neuromyelitis optica patients. J Neurol 2010; 258:464-70. [DOI: 10.1007/s00415-010-5780-4] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2010] [Revised: 09/20/2010] [Accepted: 09/29/2010] [Indexed: 11/26/2022]
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Illes Z. Pathogenesis, diagnosis and treatment of neuromyelitis optica: Changing concept of an old disease. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1759-1961.2010.00011.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Abstract
Multiple sclerosis (MS) is rare in Asians, but selective and severe involvement of the optic nerve and spinal cord is characteristic when it does occur. Recent epidemiological studies have demonstrated an increase in the prevalence of MS in Japan. Moreover, while there are two distinct phenotypes of MS in Asians, opticospinal (OSMS) and conventional (CMS), it is important to determine if MS phenotypes in Japanese are presently undergoing change. Four nationwide surveys of MS have been conducted in Japan: 1972, 1982, 1989, and 2004. The most recent survey demonstrated: (1) a four-fold increase in the estimated number of clinically definite MS patients in 2003 (9.900; crude MS prevalence. 7.7/100.000) compared to the numbers in 1972; (2) a shift in the peak age at onset from the early 30s in 1989 to the early 20s in 2003; (3) a successive proportional decrease in optic-spinal involvement; (4) a significant north-south gradient for the CMS/OSMS ratio: (5) after dividing the mainland (30-45 degrees North) into northern and southern parts at 37 degrees N, northern-born northern-residents (northern patients) showed a significantly higher CMS/OSMS ratio and higher frequency of brain lesions fulfilling the Barkhof criteria (Barkhof brain lesions) than southern-born southern-residents; (6) among northern patients, the absolute numbers of CMS patients and those with Barkhof brain lesions rapidly increased with advancing birth year; (7) further classifications based on MRI findings demonstrated distinct demographic features with not only the CMS/OSMS phenotype but also the presence or absence of longitudinally extensive spinal cord lesions (LESCLs). In northern patients, the incidence of OSMS with LESCLs had decreased with advancing year of birth, while incidences of intermediate phenotypes, such as CMS with LESCLs and OSMS without LESCLs, had increased. Although phenotypic changes appeared to be mostly attributable to the increase in CMS patients with Barkhof brain lesions in younger northern populations, the emergence of such intermediate phenotypes may support the notion that CMS and OSMS represent opposite ends of a single spectrum of disease. These findings suggest that phenotype is drastically altered by environmental factors, such as latitude and "Westernization". The recent discovery of a specific IgG against neuromyelitis optica (NMO) suggests that NMO is a disease entity distinct from MS. NMO-IgG targeting aquaporin-4 (AQP4) is present in 30 to 60% of Japanese OSMS patients with LESCLs. MS patients with anti-AQP4 antibodies were not responsive to interferon beta-1b while those without anti-AQP4 antibody did respond. In CSF, IL-17, IFN-gamma, granulocyte-colony stimulating factor, and IL-8 were markedly upregulated in OSMS patients, irrespective of the presence or absence of the anti-AQP4 antibody. Pathological studies of autopsy specimens of OSMS patients disclose that there are two subtypes of OSMS, with or without showing a selective AQP4 loss; although both subtypes had severe necrotic spinal cord lesions. There are also OSMS cases showing both pathological patterns at different lesions. These findings indicate that both anti-AQP4 autoimmunity-related and -unrelated OSMS occur in Japanese. Th17/Th1 cells are involved in both conditions, while additional humoral factors also act in the former.
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Affiliation(s)
- Jun-ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
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