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Nasr Z, Casper TC, Waltz M, Virupakshaiah A, Lotze T, Shukla N, Chitnis T, Gorman M, Benson LA, Rodriguez M, Tillema JM, Krupp L, Schreiner T, Mar S, Rensel M, Rose J, Liu C, Guye S, Manlius C, Waubant E. Clinical and magnetic resonance imaging outcomes in pediatric-onset MS patients on fingolimod and ocrelizumab. Mult Scler Relat Disord 2024; 87:105647. [PMID: 38838422 DOI: 10.1016/j.msard.2024.105647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 03/25/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Observational studies looking at clinical a++nd MRI outcomes of treatments in pediatric MS, could assess current treatment algorithms, and provide insights for designing future clinical trials. OBJECTIVE To describe baseline characteristics and clinical and MRI outcomes in MS patients initiating ocrelizumab and fingolimod under 18 years of age. METHODS MS patients seen at 12 centers of US Network of Pediatric MS were included in this study if they had clinical and MRI follow-up and started treatment with either ocrelizumab or fingolimod prior to the age of 18. RESULTS Eighty-seven patients initiating fingolimod and 52 initiating ocrelizumab met the inclusion criteria. Before starting fingolimod, mean annualized relapse rate was 0.43 (95 % CI: 0.29 - 0.65) and 78 % developed new T2 lesions while during treatment it was 0.12 (95 % CI: 0.08 - 1.9) and 47 % developed new T2 lesions. In the ocrelizumab group, the mean annualized relapse rate prior to initiation of treatment was 0.64 (95 % CI: 0.38-1.09) and a total of 83 % of patients developed new T2 lesions while during treatment it was 0.09 (95 % CI: 0.04-0.21) and none developed new T2 lesions. CONCLUSION This study highlights the importance of evaluating current treatment methods and provides insights about the agents in the ongoing phase III trial comparing fingolimod and ocrelizumab.
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Affiliation(s)
- Zahra Nasr
- UCSF, Weill Institute for Neurosciences, San Francisco, United States.
| | - T Charles Casper
- University of Utah, Department of Pediatrics, Salt Lake City, United States
| | - Michael Waltz
- University of Utah, Department of Pediatrics, Salt Lake City, United States
| | | | - Tim Lotze
- Baylor College of Medicine/Texas Children's Hospital, Neurology and Developmental Neuroscience, Houston, United States
| | - Nikita Shukla
- Baylor College of Medicine/Texas Children's Hospital, Neurology and Developmental Neuroscience, Houston, United States
| | - Tanuja Chitnis
- Massachusetts General Hospital for Children, Mass General Brigham Pediatric MS Center, Boston, United States
| | - Mark Gorman
- Boston Children's Hospital, Pediatric Multiple Sclerosis and Related Disorders Program, Boston, United States
| | - Leslie A Benson
- Boston Children's Hospital, Pediatric Multiple Sclerosis and Related Disorders Program, Boston, United States
| | | | - Jan M Tillema
- Mayo Clinic, Pediatric MS Center, Rochester, United States
| | - Lauren Krupp
- New York University Langone Medical Center, Pediatric Multiple Sclerosis Center, New York, United States
| | - Teri Schreiner
- University of Colorado, Rocky Mountain MS Center, Aurora, United States
| | - Soe Mar
- Washington University, Pediatric MS and other Demyelinating Disease Center, St. Louis, United States
| | - Mary Rensel
- Cleveland Clinic, Mellen Center for Multiple Sclerosis, Cleveland, United States
| | - John Rose
- University of Utah, Department of Neurology, Salt Lake City, United States
| | - Chuang Liu
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
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Cui Y, Wu B, Wu J, Zhang S, Guo P, Shu J, Li D, Cai C. Novel Genetic Variants Distinguishing Myelin Oligodendrocyte Glycoprotein-IgG-Positive From Myelin Oligodendrocyte Glycoprotein-IgG-Negative Pediatric Acute Disseminated Encephalomyelitis in Northern China. Pediatr Neurol 2024; 156:155-161. [PMID: 38781724 DOI: 10.1016/j.pediatrneurol.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/01/2024] [Accepted: 04/12/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Acute disseminated encephalomyelitis (ADEM) is a common phenotype in children with myelin oligodendrocyte glycoprotein IgG (MOG-IgG)-associated disease. We aimed to identify novel genetic variants that distinguish children with MOG-IgG-positive ADEM (MOG-IgG+ ADEM) from children with MOG-IgG-negative ADEM (MOG-IgG- ADEM) using whole exome sequencing (WES) analysis. METHODS We conducted a two-stage study design. First, we performed WES on five patients with MOG-IgG+ ADEM and five patients with MOG-IgG- ADEM. Following bioinformatics analysis, the candidate variant list was constructed. Second, 29 children with MOG-IgG+ ADEM and 27 children with MOG-IgG- ADEM, together with discovery cohort, were genotyped to identify the novel variants. RESULTS WES resulted in 33,999 variants, and 5388 nonsynonymous variants were selected for downstream analysis. In total, 118 protein-affecting variants that were significantly different between the two groups were identified. Together with the five variants extracted from the literature, 49 variants were selected as the candidate variant list for genotyping in the replication cohort. Finally, we identified three variants: rs11171951 in NACα, rs231775 in CTLA4, and rs11171951 in GOLGA5, which were significantly different between MOG-IgG+ ADEM and MOG-IgG- ADEM. Only rs12440118 in NACα remained significant after Bonferroni correction for multiple testing (Padj < 0.001). CONCLUSIONS We identified strong associations between NACα, CTLA4, and GOLGA5 variants and MOG-IgG+ ADEM in a Han Chinese population of Northern China, which may present novel genetic risk factor distinguishing patients with MOG-IgG+ ADEM from those with MOG-IgG- ADEM.
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Affiliation(s)
- Yaqiong Cui
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Bo Wu
- Department of Neurology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Jinying Wu
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Shuyue Zhang
- Basic Medical College, Tianjin Medical University, Tianjin, China
| | - Pan Guo
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China
| | - Jianbo Shu
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
| | - Dong Li
- Department of Neurology, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
| | - Chunquan Cai
- Tianjin Key Laboratory of Birth Defects for Prevention and Treatment, Tianjin Pediatric Research Institute, Tianjin Children's Hospital (Children's Hospital of Tianjin University), Tianjin, China.
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Jafarpour S, Pinto S, Vu MH, Khoshnood MM, Ahsan N, Saucier LE, Santoro JD. Delayed initiation of disease modifying therapy increases relapse frequency and motor disability in pediatric onset multiple sclerosis. Mult Scler Relat Disord 2024; 87:105669. [PMID: 38749351 DOI: 10.1016/j.msard.2024.105669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/15/2024] [Accepted: 05/05/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To evaluate association between time to initiation of disease modifying treatment (DMT) and outcomes in pediatric-onset Multiple Sclerosis (POMS). METHODS A retrospective analysis of children with POMS from two tertiary referral pediatric Neuroimmunology clinics. Outcome measures comprised annualized relapse rate (ARR), MRI lesion burden (T1, T2-FLAIR, and post-GAD contrast sequences), EDSS, and 25-ft walk duration at the latest follow-up visit. Univariate and multivariate analysis using linear and logistic regression models were used to assess associations between patient characteristics and outcomes. RESULTS In total, 68 patients were reviewed. More than half of patients were female (62 %) and 32 (47 %) were Hispanic/LatinX. Median age at diagnosis was 14.2 years (IQR: 11.0-16.5), and median duration from diagnosis to the latest follow-up was 2.5 years (IQR: 1.6-4.6). Sensory (29.4 %), brainstem (23.5 %), and pyramidal (19.1 %) symptoms were most common. Interferon beta (32.4 %), dimethyl fumarate (27.9 %) and rituximab (26.5 %) were the most frequently used first-line DMT. Patients had a median ARR of 0.5 (IQR: 0.08-0.84), and EDSS score of 1.0 (IQR: 0.0-2.0) at the most recent follow-up. Delayed DMT initiation correlated with higher ARR (R = 0.38, p = 0.0016) and longer 25-ft walk duration (R = 0.34, p = 0.0077). In multivariate analysis, delayed DMT remained a significant predictor of higher ARR (p = 0.002) and longer 25-ft walk duration (p = 0.047). Delayed DMT initiation and use of low/moderate efficacy DMT predicted GAD enhancing lesions at the latest follow-up (p = 0.004 and 0.019 respectively). CONCLUSION Delayed DMT initiation in POMS is linked to unfavorable outcomes, including higher ARR and longer 25-ft walk duration.
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Affiliation(s)
- Saba Jafarpour
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, USA; Department of Neurology, Keck School of Medicine of the University of Southern California, USA
| | - Soniya Pinto
- Department of Diagnostic Imaging, St. Jude's Children's Research Hospital, USA
| | - My H Vu
- Biostatistics and Data Management Core, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | | | - Nusrat Ahsan
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, USA; Department of Neurology, Keck School of Medicine of the University of Southern California, USA
| | - Laura E Saucier
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, USA; Department of Neurology, Keck School of Medicine of the University of Southern California, USA; Department of Neurology, Stanford University School of Medicine, USA
| | - Jonathan D Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, USA; Department of Neurology, Keck School of Medicine of the University of Southern California, USA.
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Kim M, Choi Y, Kim SY, Cho A, Kim H, Chae JH, Kim KJ, Park D, Kwon YS, Kim MJ, Yum MS, Kong JH, Lee YJ, Lim BC. Severe Neurological Manifestation Associated With Coronavirus Disease 2019 in Children During the Omicron Variant-Predominant Period. Pediatr Neurol 2024; 156:17-25. [PMID: 38692086 DOI: 10.1016/j.pediatrneurol.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 11/13/2023] [Accepted: 04/02/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND The Omicron variant of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is known to be more infectious and less severe than the other variants. Despite the increasing number of symptomatic patients, severe neurological complications in children with the Omicron variant have been reported rarely, unlike with wild-type or Delta variants. This study aimed to investigate severe neurological complications in children with Omicron variant infection. METHODS We conducted a retrospective study of 17 pediatric patients with severe neurological manifestations associated with coronavirus disease 2019 in Korea during the Omicron variant prevalence, from January 1 to April 30, 2022. RESULTS Among the 17 patients, 11 had pre-existing neurological disabilities and nine met the criteria for multisystem inflammatory syndrome in children (MIS-C). Four of the five vaccine-eligible patients (12 years and older) were unvaccinated. Severe neurological manifestations included acute necrotizing encephalopathy, acute fulminant cerebral edema, acute disseminated encephalomyelitis, basal ganglia encephalitis, unclassified severe encephalopathy/encephalitis, and refractory status dystonicus. Patients with MIS-C and underlying neurological disabilities had longer median hospital and intensive care unit stays compared with those without these conditions. Five patients survived with new neurological deficits at the one-year follow-up, and three died, all of whom had underlying neurological disabilities. CONCLUSIONS This study shows that severe neurological complications in pediatric patients with the Omicron variant of SARS-CoV-2 occur infrequently but may lead to significant morbidity and mortality, especially among those with pre-existing neurological disabilities and unvaccinated individuals. Continued efforts are necessary to prevent and manage such complications in these vulnerable populations.
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Affiliation(s)
- Minhye Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea
| | - Younghun Choi
- Department of Radiology, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea
| | - Soo Yeon Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea
| | - Anna Cho
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seoul, Korea
| | - Hunmin Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Hee Chae
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea
| | - Ki Joong Kim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea
| | - Dasom Park
- Department of Pediatrics, Inha University Hospital, Inha University, College of Medicine, Incheon, Korea
| | - Young Se Kwon
- Department of Pediatrics, Inha University Hospital, Inha University, College of Medicine, Incheon, Korea
| | - Min-Jee Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Korea
| | - Ju Hyun Kong
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Yoon Jin Lee
- Department of Pediatrics, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Korea
| | - Byung Chan Lim
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul National University, College of Medicine, Seoul, Korea.
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Arnett SV, Prain K, Ramanathan S, Bhuta S, Brilot F, Broadley SA. Long-term outcomes of ADEM-like and tumefactive presentations of CNS demyelination: a case-comparison analysis. J Neurol 2024:10.1007/s00415-024-12349-6. [PMID: 38861035 DOI: 10.1007/s00415-024-12349-6] [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: 12/09/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 06/12/2024]
Abstract
A minority of initial multiple sclerosis (MS) presentations clinically or radiologically resemble other central nervous system (CNS) pathologies, acute disseminated encephalomyelitis (ADEM) or tumefactive demyelination (atypical demyelination presentations). With the aim of better defining the long-term outcomes of this group we have performed a retrospective cohort comparison of atypical demyelination versus 'typical' MS presentations. Twenty-seven cases with atypical presentations (both first and subsequent demyelinating events) were identified and compared with typical MS cases. Disease features analysed included relapse rates, disability severity, whole brain and lesion volumes, lesion number and distribution. Atypical cases represented 3.9% of all MS cases. There was considerable overlap in the magnetic resonance imaging (MRI) features of ADEM-like and tumefactive demyelination cases. ADEM-like cases tended to be younger but not significantly so. Atypical cases showed a trend towards higher peak expanded disability severity score (EDSS) score at the time of their atypical presentation. Motor, cranial nerve, cerebellar, cerebral and multifocal presentations were all more common in atypical cases, and less likely to present with optic neuritis. Cerebrospinal fluid (CSF) white cell counts were higher in atypical cases (p = 0.002). One atypical case was associated with peripheral blood myelin oligodendrocyte glycoprotein (MOG) antibodies, but subsequent clinical and radiological course was in keeping with MS. There was no difference in long-term clinical outcomes including annualised relapse rates (ARR), brain volume, lesion numbers or lesion distributions. Atypical demyelination cases were more likely to receive high potency disease modifying therapy early in the course of their illness. Despite the severity of initial illness, our cohort analysis suggests that atypical demyelination presentations do not confer a higher risk of long-term adverse outcomes.
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Affiliation(s)
- Simon V Arnett
- School of Medicine, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia.
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia.
- Griffith university, Gold Coast Campus, Gold Coast, Queensland, Australia.
| | - Kerri Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, 4006, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Faculty of Medicine and Health, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, 2145, Australia
- Department of Neurology, Concord Hospital, Sydney, NSW, 2139, Australia
| | - Sandeep Bhuta
- Department of Neurology, Concord Hospital, Sydney, NSW, 2139, Australia
| | - Fabienne Brilot
- Neuroimmunology Group, Kids Neurosciences Centre, Faculty of Medicine and Health, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, 2145, Australia
| | - Simon A Broadley
- School of Medicine, Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Gold Coast, QLD, 4222, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, QLD, 4215, Australia
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Jacob A, Shatila AO, Inshasi J, Massouh J, Mir R, Noori S, Yamout B. Disease modifying treatment guidelines for multiple sclerosis in the United Arab Emirates. Mult Scler Relat Disord 2024; 88:105703. [PMID: 38924933 DOI: 10.1016/j.msard.2024.105703] [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: 01/21/2024] [Revised: 05/13/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024]
Abstract
The newly constituted National Multiple Sclerosis (MS) Society (NMSS)of the United Arab Emirates (UAE), set up a scientific committee to create a MS disease modifying treatment (DMT) guideline for UAE. The committee considered several unique features of the MS community in UAE including large number of expatriate population, wide variations in health insurance coverage, physician and patient preferences for DMT. The overall goal of the treatment guideline is to facilitate the most appropriate DMT to the widest number of patients. To this end it has adapted recommendations from various health systems and regulatory authorities into a pragmatic amalgamation of best practices from across the world. Importantly where data is unavailable or controversial, a common sense approach is taken rather than leave physicians and patients in limbo. The committee classifies MS into subcategories and suggests appropriate treatment choices. It recommends treatment of RIS and CIS with poor prognostic factors. It largely equates the efficacy and safety of DMT with similar mechanisms of action or drug classes e.g. ocrelizumab is similar to rituximab. It allows early switching of treatment for unambiguous disease activity and those with progression independent of relapses. Autologous hematopoietic stem cell transplantation can be offered to patients who fail one high efficacy DMT. Pragmatic guidance on switching and stopping DMT, DMT choices in pregnancy, lactation and pediatric MS have been included. It is expected that these guidelines will be updated periodically as new data becomes available.
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Affiliation(s)
- Anu Jacob
- Neurological Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates; The Walton Centre, Liverpool, United Kingdom.
| | - Ahmed Osman Shatila
- Department of Neurology, Sheikh Shakhbout Medical City Abu Dhabi, United Arab Emirates
| | - Jihad Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - Joelle Massouh
- Neurology Institute and Multiple Sclerosis Centre, Harley Street Medical centre, Abu Dhabi, United Arab Emirates
| | - Ruquia Mir
- Abu Dhabi stem Cell Clinic, United Arab Emirates
| | - Suzan Noori
- University Hospital Sharjah, United Arab Emirates
| | - Bassem Yamout
- Neurology Institute and Multiple Sclerosis Centre, Harley Street Medical centre, Abu Dhabi, United Arab Emirates; American University of Beirut, Lebanon
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Maillart E, Deiva K, Marignier R. Clinical characteristics of patients with myelin oligodendrocyte glycoprotein antibodies. Curr Opin Neurol 2024; 37:338-344. [PMID: 38497310 DOI: 10.1097/wco.0000000000001265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
PURPOSE OF REVIEW The clinical landscape associated to myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) has undergone a remarkable transformation over the past two decades, primarily driven by advancements in antibody detection techniques that have enhanced both the specificity and sensitivity of assays, enabling the identification of novel clinical phenotypes. RECENT FINDINGS Recent pivotal research publications, comprehensive reviews from established research groups, and most notably the first proposed international criteria for MOG-Ab associated disease (MOGAD) have substantially enriched our understanding of the clinical features associated with MOG-Ab. This review presents a comprehensive overview of the clinical characteristics of patients with MOG-Ab, systematically examining each core clinical syndrome defined by the proposed international MOGAD criteria. We incorporated recent insights and discussed potential challenges in applying these criteria across diverse clinical scenarios. SUMMARY The proposed international MOGAD criteria provide a comprehensive, homogeneous, and specific framework for characterizing the clinical features of patients with MOG-Ab, encompassing both paediatric and adult populations. In the future, the widespread adoption of specific and reliable assays for MOG-Ab detection, complemented by the development of surrogate fluid and imaging markers, holds promise for better characterizing atypical presentations, only-cerebrospinal fluid positivity and the MOGAD "seronegative" situations.
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Affiliation(s)
- Elisabeth Maillart
- Centre de Référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)
- Department of Neurology, Hôpital Pitié-Salpêtrière, APHP, Paris
| | - Kumaran Deiva
- Centre de Référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)
- Department of Pediatric Neurology, Bicêtre Hospital, University Hospitals Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre
| | - Romain Marignier
- Centre de Référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)
- Service de Neurologie, sclérose en plaques, pathologies de la myéline et neuroinflammation, Hôpital Neurologique P. Wertheimer, Hospices Civils de Lyon, France
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Czeisler BM. Emergent Management of Central Nervous System Demyelinating Disorders. Continuum (Minneap Minn) 2024; 30:781-817. [PMID: 38830071 DOI: 10.1212/con.0000000000001436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
OBJECTIVE This article reviews the various conditions that can present with acute and severe central nervous system demyelination, the broad differential diagnosis of these conditions, the most appropriate diagnostic workup, and the acute treatment regimens to be administered to help achieve the best possible patient outcomes. LATEST DEVELOPMENTS The discovery of anti-aquaporin 4 (AQP4) antibodies and anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in the past two decades has revolutionized our understanding of acute demyelinating disorders, their evaluation, and their management. ESSENTIAL POINTS Demyelinating disorders comprise a large category of neurologic disorders seen by practicing neurologists. In the majority of cases, patients with these conditions do not require care in an intensive care unit. However, certain disorders may cause severe demyelination that necessitates intensive care unit admission because of numerous simultaneous multifocal lesions, tumefactive lesions, or lesions in certain brain locations that lead to acute severe neurologic dysfunction. Intensive care may be necessary for the management and prevention of complications for patients who have severely altered mental status, rapidly progressive neurologic worsening, elevated intracranial pressure, severe cerebral edema, status epilepticus, or respiratory failure.
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Margoni M, Pagani E, Meani A, Preziosa P, Mistri D, Gueye M, Moiola L, Filippi M, Rocca MA. Cognitive Impairment Is Related to Glymphatic System Dysfunction in Pediatric Multiple Sclerosis. Ann Neurol 2024; 95:1080-1092. [PMID: 38481063 DOI: 10.1002/ana.26911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 03/04/2024] [Accepted: 03/04/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVE The aim of this study was to investigate whether, compared to pediatric healthy controls (HCs), the glymphatic system is impaired in pediatric multiple sclerosis (MS) patients according to their cognitive status, and to assess its association with clinical disability and MRI measures of brain structural damage. METHODS Sixty-five pediatric MS patients (females = 62%; median age = 15.5 [interquartile range, IQR = 14.5;17.0] years) and 23 age- and sex-matched HCs (females = 44%; median age = 14.1 [IQR = 11.8;16.2] years) underwent neurological, neuropsychological and 3.0 Tesla MRI assessment, including conventional and diffusion tensor imaging (DTI). We calculated the diffusion along the perivascular space (DTI-ALPS) index, a proxy of glymphatic function. Cognitive impairment (Co-I) was defined as impairment in at least 2 cognitive domains. RESULTS No significant differences in DTI-ALPS index were found between HCs and cognitively preserved (Co-P) pediatric MS patients (estimated mean difference [EMD] = -0.002 [95% confidence interval = -0.069; 0.065], FDR-p = 0.956). Compared to HCs and Co-P patients, Co-I pediatric MS patients (n = 20) showed significantly lower DTI-ALPS index (EMD = -0.136 [95% confidence interval = -0.214; -0.058], FDR-p ≤ 0.004). In HCs, no associations were observed between DTI-ALPS index and normalized brain, cortical and thalamic volumes, and normal-appearing white matter (NAWM) fractional anisotropy (FA) and mean diffusivity (MD) (FDR-p ≥ 0.348). In pediatric MS patients, higher brain WM lesion volume (LV), higher NAWM MD, lower normalized thalamic volume, and lower NAWM FA were associated with lower DTI-ALPS index (FDR-p ≤ 0.016). Random Forest selected lower DTI-ALPS index (relative importance [RI] = 100%), higher brain WM LV (RI = 59.5%) NAWM MD (RI = 57.1%) and intelligence quotient (RI = 51.3%) as informative predictors of cognitive impairment (out-of-bag area under the curve = 0.762). INTERPRETATION Glymphatic system dysfunction occurs in pediatric MS, is associated with brain focal lesions, irreversible tissue loss accumulation and cognitive impairment. ANN NEUROL 2024;95:1080-1092.
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Affiliation(s)
- Monica Margoni
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Elisabetta Pagani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Meani
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| | - Damiano Mistri
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mor Gueye
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Lucia Moiola
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
- Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria Assunta Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
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10
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Zhan H, Cheng L, Liu Y, Xu H, Feng X, Liu Y, Li H, Li Z, Wang S, Jin H, Zheng W, Hao H, Li Y. Significance of immunoglobulins synthesis with central nervous system involvement in Neuro-Behçet's disease. Clin Chim Acta 2024; 559:119681. [PMID: 38643816 DOI: 10.1016/j.cca.2024.119681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 04/16/2024] [Accepted: 04/18/2024] [Indexed: 04/23/2024]
Abstract
OBJECTIVES Demyelination and immunocyte-infiltrated lesions have been found in neuro-Behçet's disease (NBD) pathology. Lacking satisfying laboratory biomarkers in NBD impedes standard clinical diagnostics. We aim to explore the ancillary indicators for NBD diagnosis unveiling its potential etiology. METHODS 28 NBD with defined diagnosis, 29 patients with neuropsychiatric lupus erythematosus, 30 central nervous system idiopathic inflammatory demyelination diseases (CNS-IIDD), 30 CNS infections, 30 cerebrovascular diseases, and 30 noninflammatory neurological diseases (NIND) were retrospectively enrolled. Immunoglobulins (Ig) in serum and cerebral spinal fluid (CSF) were detected by immunonephelometry and myelin basic protein (MBP) by quantitative enzyme-linked immunosorbent assay. RESULTS IgA index is almost twice enhanced in NBD than NIND with an accuracy of 0.8488 in differential diagnosis, the sensitivity and specificity of which were 75.00 % and 90.00 % when the cutoff was > 0.6814. The accuracy of CSF Ig and quotient of Ig all exceed 0.90 in discerning NBD with damaged and intact blood-brain barrier (BBB). Clustering analyses divided NBD into two different phenotypes: one with BBB damage has lower Ig synthesis, the other with extra-synthesis in parenchymal sites but with intact BBB. MBP index is significantly correlated with kappa (KAP) index and lambda (LAM) index (r = 0.358, 0.575, P < 0.001), hinting the NBD pathogenesis of CNS demyelination in triggering excessive intrathecal Ig productions and humoral responses. CONCLUSIONS IgA index acts as a potential diagnostic indicator in differentiating NBD from NIND and CNS-IIDD. Excessive immunoglobulin production induced by CNS inflammation and demyelination might be latent immunopathogenesis of NBD.
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Affiliation(s)
- Haoting Zhan
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Linlin Cheng
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yeling Liu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Honglin Xu
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinxin Feng
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yongmei Liu
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haolong Li
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhan Li
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Siyu Wang
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing, China
| | - Wenjie Zheng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital; Chinese Academy of Medical Sciences & Peking Union Medical College; National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology; State Key Laboratory of Complex Severe and Rare Diseases; Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China.
| | - Hongjun Hao
- Department of Neurology, Neuroimmunology Laboratory, Peking University First Hospital, Beijing, China.
| | - Yongzhe Li
- Department of Clinical Laboratory, State Key Laboratory of Complex, Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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11
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Nakata T, Natsume J, Yamamoto H, Ito Y, Suzuki T, Kawaguchi M, Shiraki A, Kumai S, Sawamura F, Suzui R, Mitsumatsu T, Narita H, Tsuji T, Kubota T, Saitoh S, Okumura A, Kidokoro H. Underlying Disorders in Children With Infection-Related Acute Encephalopathy. Pediatr Neurol 2024; 155:126-132. [PMID: 38636169 DOI: 10.1016/j.pediatrneurol.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/08/2024] [Accepted: 03/18/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Various factors contribute to the development of infection-related acute encephalopathy (AE) in children, such as infectious agents and chronic underlying disorders. We studied underlying disorders in children with AE to identify predisposing factors of AE. METHODS We investigated underlying disorders or past histories in patients with two types of AE from the database in the Tokai area of Japan between 2009 and 2022: 204 patients with AE with reduced subcortical diffusion (AED) and 137 with clinically mild encephalopathy with a reversible splenial lesion (MERS). We compared them with 89 patients with acute disseminated encephalomyelitis (ADEM) to clarify the specific disorders in the two AE types. RESULTS The prevalence of underlying disorders in AED (34%, 70 patients) was significantly higher than that in ADEM (12%, 11 patients) (P < 0.01). The prevalence of underlying disorders in MERS was 23% (32 patients). The underlying disorders included seizure disorders, premature birth, genetic/congenital disorders, and endocrine/renal diseases. In patients with seizure disorders in AED, five patients (18%) had Dravet syndrome and four (15%) had West syndrome, whereas none with MERS had these syndromes. Twenty-five (12%) of 204 patients with AED, three (2%) with MERS, and one (1%) with ADEM were preterm or low birth weight. CONCLUSIONS The high prevalence of seizure disorders suggests that seizure susceptibility is an important predisposing factor in AED. Premature birth also has an impact on the development of AED. Caution is required regarding the development of AE in patients with chronic seizure disorders or premature birth.
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Affiliation(s)
- Tomohiko Nakata
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Developmental Disability Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuji Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Suzuki
- Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan
| | - Masahiro Kawaguchi
- Division of Neurology, Aichi Children's Health and Medical Center, Obu, Japan
| | - Anna Shiraki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan; Department of Pediatrics, Nagoya Memorial Hospital, Nagoya, Japan
| | - Sumire Kumai
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumi Sawamura
- Department of Pediatrics, Aichi Aoitori Medical Welfare Center, Nagoya, Japan
| | - Ryosuke Suzui
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takamasa Mitsumatsu
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hajime Narita
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshi Tsuji
- Department of Pediatrics, Aichi Prefecture Mikawa Aoitori Medical and Rehabilitation Center for Developmental Disabilities, Okazaki, Japan
| | - Tetsuo Kubota
- Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan
| | - Shinji Saitoh
- Department of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Aichi, Japan
| | - Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
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12
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Skarlis C, Markoglou N, Gontika M, Artemiadis A, Pons MR, Stefanis L, Dalakas M, Chrousos G, Anagnostouli M. The impact of HLA-DRB1 alleles in a Hellenic, Pediatric-Onset Multiple Sclerosis cohort: Implications on clinical and neuroimaging profile. Neurol Sci 2024:10.1007/s10072-024-07619-0. [PMID: 38819529 DOI: 10.1007/s10072-024-07619-0] [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: 02/27/2024] [Accepted: 05/21/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Pediatric-Onset Multiple Sclerosis (POMS) is considered a complex disease entity and several genetic, hormonal, and environmental factors have been associated with disease pathogenesis. Linkage studies in Caucasians have consistently suggested the human leukocyte antigen (HLA) polymorphisms, as the genetic locus most strongly linked to MS, with the HLA-DRB1*15:01 allele, being associated with both adult and pediatric MS patients. Here we aim to investigate the prevalence of the HLA-DRB1 alleles among a Hellenic POMS cohort and any possible associations with clinical and imaging disease features. MATERIALS AND METHODS 100 POMS patients fulfilling the IPMSSG criteria, 168 Adult-Onset MS (AOMS) patients, and 246 Healthy Controls (HCs) have been enrolled. HLA genotyping was performed with a standard low-resolution sequence-specific oligonucleotide (SSO) technique. RESULTS POMS patients display a significantly increased HLA-DRB1*03 frequency compared to both HCs [24% vs. 12.6%, OR [95%CI]: 2.19 (1.21-3.97), p=0.016) and AOMS (24% vs. 13.1%, OR [95%CI]: 2.1 (1.1-3.98), p=0.034] respectively. HLA-DRB1*03-carriers display reduced risk for brainstem lesion development (OR [CI 95%]:0.19 (0.06-0.65), p=0.011). A significantly lower frequency of HLA-DRB1*07 (4% vs 13.4%, OR (95% CI): 0.27 (0.09-0.78), p= 0.017) and HLA-DRB1*11 (37% vs 52%, OR [95% CI]: 0.54 (0.34-0.87), p= 0.016) was observed in POMS compared to HCs. CONCLUSION The HLA-DRB1*03 allele was associated with a higher risk for POMS, replicating our previous findings, and with a lower risk for brainstem lesion development, a common clinical and neuroimaging feature in POMS, while HLA-DRB1*07 and HLA-DRB1*11 display a protective role. These findings expand the existing knowledge of HLA associations and POMS.
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Affiliation(s)
- Charalampos Skarlis
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Nikolaos Markoglou
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Maria Gontika
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
- Penteli Children's Hospital, Attiki, Greece
| | | | - Maria-Roser Pons
- First Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Leonidas Stefanis
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece
| | - Marinos Dalakas
- Neuroimmunology Laboratory, Department of Pathophysiology School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Clinical Neuroimmunology and Neuromuscular Diseases Department, Thomas Jefferson University of Philadelphia, Philadelphia, Pennsylvania, USA
| | - George Chrousos
- University Research Institute of Maternal, Child and Child Health Precision Medicine, Clinical and Translational Research Unit in Endocrinology, UNESCO Chair in Adolescent Health and Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Anagnostouli
- Research Immunogenetics Laboratory, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece.
- First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Aeginition University Hospital, Vas. Sofias 72-74, 11528, Athens, Greece.
- Multiple Sclerosis and Demyelinating Diseases Unit, Center of Expertise for Rare Demyelinating and Autoimmune Diseases of CNS, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, NKUA, Aeginition University Hospital, Athens, Greece.
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13
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Mahdizad Z, Zarei M, Fakhredin H, Samiee R, Heidari H, Ebrahimiadib N. A case report of pediatric-onset MS associated uveitis. J Ophthalmic Inflamm Infect 2024; 14:21. [PMID: 38811495 PMCID: PMC11136925 DOI: 10.1186/s12348-024-00405-1] [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: 09/26/2023] [Accepted: 05/16/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND To report a case of Pediatric-onset MS associated uveitis managed with local and systemic medications. CASE PRESENTATION An 11-year-old boy who was diagnosed with Pediatric-onset MS (POMS) with the first presentation of left optic neuritis in another center, was referred to our clinic with the complaint of non-improved vision in the left eye despite receiving IV 5gr methylprednisolone. After the ophthalmologic examinations, the patient was diagnosed as bilateral POMS-associated intermediate uveitis, and local treatment with corticosteroid was administered to both eyes. He was continued on systemic therapy such as Rituximab and five sessions of plasmapheresis. After four months, the patient's vision improved from FC at 50cm to 9/10 in the left eye. The intensity of intraocular inflammation decreased in both eyes. In fluorescein angiography findings, the optic disc, as well as vascular leakage, subsided bilaterally. CONCLUSION Despite its rarity, POMS-associated uveitis presents a considerable challenge that necessitates the collaborative efforts of neurologists and ophthalmologists to achieve the most effective treatment outcomes.
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Affiliation(s)
- Zahra Mahdizad
- Ophthalmology Department, Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Zarei
- Ophthalmology Department, Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Hanieh Fakhredin
- Ophthalmology Department, Retina Service, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Retina & Vitreous Service, Farabi Comprehensive Center of Excellence in Ophthalmology, Qazvin Square, Tehran, 1336616351, Iran.
| | - Reza Samiee
- Student`S Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hora Heidari
- Multiple Sclerosis Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin Ebrahimiadib
- Ophthalmology Department, Ocular Immunology and Uveitis Foundation, Waltham, MA, USA
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14
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Stefan KA, Ciotti JR. MOG Antibody Disease: Nuances in Presentation, Diagnosis, and Management. Curr Neurol Neurosci Rep 2024:10.1007/s11910-024-01344-z. [PMID: 38805147 DOI: 10.1007/s11910-024-01344-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2024] [Indexed: 05/29/2024]
Abstract
PURPOSE OF REVIEW Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a distinct neuroinflammatory condition characterized by attacks of optic neuritis, transverse myelitis, and other demyelinating events. Though it can mimic multiple sclerosis and neuromyelitis optica spectrum disorder, distinct clinical and radiologic features which can discriminate these conditions are now recognized. This review highlights recent advances in our understanding of clinical manifestations, diagnosis, and treatment of MOGAD. RECENT FINDINGS Studies have identified subtleties of common clinical attacks and identified more rare phenotypes, including cerebral cortical encephalitis, which have broadened our understanding of the clinicoradiologic spectrum of MOGAD and culminated in the recent publication of proposed diagnostic criteria with a familiar construction to those diagnosing other neuroinflammatory conditions. These criteria, in combination with advances in antibody testing, should simultaneously lead to wider recognition and reduced incidence of misdiagnosis. In addition, recent observational studies have raised new questions about when to treat MOGAD chronically, and with which agent. MOGAD pathophysiology informs some of the relatively unique clinical and radiologic features which have come to define this condition, and similarly has implications for diagnosis and management. Further prospective studies and the first clinical trials of therapeutic options will answer several remaining questions about the peculiarities of this condition.
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Affiliation(s)
- Kelsey A Stefan
- Department of Neurology, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA
| | - John R Ciotti
- Department of Neurology, University of South Florida, 13330 USF Laurel Drive, Tampa, FL, 33612, USA.
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15
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Burk K, Pagarkar D, Khoshnood MM, Jafarpour S, Ahsan N, Mitchell WG, Santoro JD. Sexual Health Education and Quality of Counseling in Pediatric-Onset Multiple Sclerosis. Pediatr Neurol 2024; 157:108-113. [PMID: 38905743 DOI: 10.1016/j.pediatrneurol.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/15/2024] [Accepted: 05/22/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND Disease-modifying therapies (DMTs) have revolutionized the management of multiple sclerosis (MS). Many DMTs have a risk of teratogenic outcomes, which is notable as MS disproportionally affects women of reproductive age and the rates of unplanned pregnancies among persons with MS (PwMS) are as high as 34%. Prior research suggests that patients' culture may influence their perspectives surrounding family planning. Given our institution's patient population, we compared the spectrum of knowledge in Hispanic and non-Hispanic patients with pediatric-onset MS (POMS) regarding DMTs and their associated risks during pregnancy and possible disparities in their treatment and counseling. METHODS A small cohort of patients with POMS (n = 22) were surveyed on their knowledge and beliefs surrounding family planning and sexual health counseling. Odds ratios and 95% confidence intervals were used to evaluate the association between survey question responses and ethnicity. RESULTS No significant differences in beliefs or knowledge regarding sexual health between Hispanic and non-Hispanic participants were identified, but many valuable themes emerged. Internet access and social relationships heavily influence participants' knowledge surrounding birth control and sexual health. Patients also desired continuous engagement in sexual health counseling. CONCLUSIONS In this small pilot cohort, cultural views did not significantly influence whether adolescent and young adult patients with POMS seek sexual health resources. Future studies should aim to identify effective interventions for providers to educate PwMS about sexual health and family planning to address the elevated unplanned pregnancy rate in this population and provide the education these patients have vocalized a desire to receive.
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Affiliation(s)
- Kelly Burk
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Dania Pagarkar
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California
| | - Mellad M Khoshnood
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Saba Jafarpour
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Nusrat Ahsan
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Wendy G Mitchell
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California
| | - Jonathan D Santoro
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, California; Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California.
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16
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Gklinos P, Dobson R. Myelin Oligodendrocyte Glycoprotein-Antibody Associated Disease: An Updated Review of the Clinical Spectrum, Pathogenetic Mechanisms and Therapeutic Management. Antibodies (Basel) 2024; 13:43. [PMID: 38804311 PMCID: PMC11130828 DOI: 10.3390/antib13020043] [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: 03/16/2024] [Revised: 04/17/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024] Open
Abstract
Clinical syndromes associated with antibodies against myelin oligodendrocyte glycoprotein (MOG) are now recognized as a distinct neurological disease entity, and are gaining increasing attention. The pathogenic mechanisms underlying MOG-antibody disease (MOGAD) remain incompletely understood. Case series, facilitated by registries, and observational studies over the past few years have shed increasing light on the clinical aspects and therapeutic approaches of MOGAD. MOGAD may manifest with a variety of clinical syndromes, including acute disseminated encephalomyelitis (ADEM), autoimmune encephalitis, optic neuritis (ON) and transverse myelitis (TM). MOGAD can be either monophasic or relapsing. This review aims to provide a comprehensive updated description of the clinical spectrum, paraclinical features, and prognosis of MOG-antibody disease, as well as summarize its therapeutic considerations. Randomized clinical trials, standardized diagnostic criteria and treatment guidelines are the steps forward.
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Affiliation(s)
- Panagiotis Gklinos
- First Neurology Department, Eginition University Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece
| | - Ruth Dobson
- Centre for Preventive Neurology, Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK;
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17
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Sollini ML, Pellegrino C, Barone G, Capitanucci ML, Zaccara AM, Crescentini L, Castelli E, Della Bella G, Scorletti F, Papetti L, Monte G, Ferilli MAN, Valeriani M, Mosiello G. Lower Urinary Tract Dysfunction in Pediatric Patients with Multiple Sclerosis: Diagnostic and Management Concerns. CHILDREN (BASEL, SWITZERLAND) 2024; 11:601. [PMID: 38790596 PMCID: PMC11119741 DOI: 10.3390/children11050601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 05/10/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is increasing in the pediatric population and, as in adults, symptoms vary among patients. In children the first manifestations can sometimes overlap with acute neurological symptoms. Urological symptoms have not been much studied in childhood. We shared our experience with MS urological manifestation in children. METHODS This article is a retrospective evaluation of all children with MS, according to the Krupp criteria, who also present with urological symptoms. We collected demographic and clinical history, the MR localization of demyelinating lesions, urological symptoms, and exams. RESULTS We report on six MS pediatric cases with urological manifestation. Urinary symptoms, characterized by urinary incontinence in five patients and urinary retention in one patient, appeared in a different time frame from MS diagnosis. Urodynamic exams showed both overactive and underactive bladder patterns. Treatment was defined according to lower urinary tract dysfunction, using clean intermittent catheterization, oxybutynin, and intradetrusor Onabotulinum Toxin-A injection. A low acceptance rate of invasive evaluation and urological management was observed. CONCLUSIONS The MS diagnosis was traumatic for all our patients. We believe it is important to address urological care in young people from the time of diagnosis for prompt management; it could be useful to include a pediatric urologist in multidisciplinary teams.
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Affiliation(s)
- Maria Laura Sollini
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
- Clinical Science and Translational Medicine, Tissue Engineering and Remodeling Biotechnologies for Body Function PhD School, University of Rome Tor Vergata, Via Cracovia 50, 00133 Rome, Italy
| | - Chiara Pellegrino
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Giulia Barone
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
- Pediatric Surgery, University of Genoa, DINOGMI, Largo Paolo Daneo 3, 16132 Genoa, Italy
| | - Maria Luisa Capitanucci
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Antonio Maria Zaccara
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Leonardo Crescentini
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
| | - Enrico Castelli
- Neurorehabilitation Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Gessica Della Bella
- Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Federico Scorletti
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy;
| | - Laura Papetti
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Gabriele Monte
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Michela Ada Noris Ferilli
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Massimiliano Valeriani
- Developmental Neurology Unit, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (L.P.); (G.M.); (M.A.N.F.); (M.V.)
| | - Giovanni Mosiello
- Division of Neuro-Urology, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy; (M.L.S.); (G.B.); (M.L.C.); (A.M.Z.); (L.C.); (G.M.)
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Breu M, Sandesjö F, Milos RI, Svoboda J, Salzer J, Schneider L, Reichelt JB, Bertolini A, Blaschek A, Fink K, Höftberger R, Lycke J, Rostásy K, Seidl R, Siegert S, Wickström R, Kornek B. Rituximab treatment in pediatric-onset multiple sclerosis. Eur J Neurol 2024; 31:e16228. [PMID: 38375947 DOI: 10.1111/ene.16228] [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: 09/08/2023] [Revised: 12/05/2023] [Accepted: 01/15/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE Rituximab (RTX) is frequently used off-label in multiple sclerosis. However, studies on the risk-benefit profile of RTX in pediatric-onset multiple sclerosis are scarce. METHODS In this multicenter retrospective cohort study, patients with pediatric-onset multiple sclerosis from Sweden, Austria and Germany, who received RTX treatment were identified by chart review. Annualized relapse rates, Expanded Disability Status Scale scores and magnetic resonance imaging parameters (new T2 lesions and contrast-enhancing lesions) were assessed before and during RTX treatment. The proportion of patients who remained free from clinical and disease activity (NEDA-3) during RTX treatment was calculated. Side effects such as infusion-related reactions, infections and laboratory abnormalities were assessed. RESULTS Sixty-one patients received RTX during a median (interquartile range) follow-up period of 20.9 (35.6) months. The annualized relapse rate decreased from 0.6 (95% confidence interval [CI] 0.38-0.92) to 0.03 (95% CI 0.02-0.14). The annual rate of new T2 lesions decreased from 1.25 (95% CI 0.70-2.48) to 0.08 (95% CI 0.03-0.25) and annual rates of new contrast-enhancing lesions decreased from 0.86 (95% CI 0.30-3.96) to 0. Overall, 70% of patients displayed no evidence of disease activity (NEDA-3). Adverse events were observed in 67% of patients. Six patients discontinued treatment due to ongoing disease activity or adverse events. CONCLUSION Our study provides class IV evidence that RTX reduces clinical and radiological activity in pediatric-onset multiple sclerosis.
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Affiliation(s)
- Markus Breu
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Fredrik Sandesjö
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ruxandra-Iulia Milos
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Jan Svoboda
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Jonatan Salzer
- Department of Clinical Science, Neurosciences, Umeå University, Umeå, Sweden
| | - Lisa Schneider
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Julian Benedikt Reichelt
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - Annikki Bertolini
- Department of Pediatric Neurology, University Witten/Herdecke, Children's Hospital Datteln, Datteln, Germany
| | - Astrid Blaschek
- Paediatric Neurology and Developmental Medicine, Ludwig Maximilian University of Munich, Dr. von Hauner Children's Hospital, Munich, Germany
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Romana Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kevin Rostásy
- Department of Pediatric Neurology, University Witten/Herdecke, Children's Hospital Datteln, Datteln, Germany
| | - Rainer Seidl
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Sandy Siegert
- Division of Pediatric Pulmonology, Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ronny Wickström
- Neuropediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Barbara Kornek
- Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
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Amiola TO, Oh U, Richard H, Newsome SD, Graves J, Zamvil SS, Goldman MD. A 42-Year-Old Woman With Rapidly Expanding White Matter Lesions: From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200201. [PMID: 38285968 DOI: 10.1212/nxi.0000000000200201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 01/31/2024]
Abstract
A 42-year-old woman and active cocaine user complained of subacutely worsening blurred vision and imbalance. Examination of the brain MRI showed rapidly expanding white matter lesions. Brain biopsy was consistent with inflammatory demyelination. Given an unusual presentation and a history of cocaine use, a broad differential diagnosis was considered including neurologic toxidromes.
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Affiliation(s)
- Tolulope O Amiola
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Unsong Oh
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Hope Richard
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Scott D Newsome
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Jennifer Graves
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Scott S Zamvil
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
| | - Myla D Goldman
- From the Departments of Neurology (T.O.A., U.O., M.D.G.) and Neuropathology (H.R.), VCU School of Medicine, Richmond, VA; Department of Neurology (S.D.N.), Johns Hopkins Hospital, Baltimore, MD; Department of Neurosciences (J.G.), University of California at San Diego, La Jolla and Department of Neurology (S.S.Z.), Program in Immunology, University of California at San Francisco
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20
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Aloni R, Kalron A, Goodman A, Ben-Ari A, Yoeli-Shalom T, Menascu S. Attention Deficit/Hyperactivity Disorder in Children with Multiple Sclerosis. J Atten Disord 2024; 28:1105-1113. [PMID: 38385203 DOI: 10.1177/10870547241232710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic neurological autoimmune disease; pediatric-onset multiple sclerosis (POMS) represents 5% to 10% of total MS population. Children with POMS may experience attention difficulties due to the disease's impact on the central nervous system. However, little is known regarding Attention Deficit Hyperactivity Disorder (ADHD) in POMS, and its relation to cognitive performance. METHODS A retrospective case review was conducted using medical records of 66 children and adolescent patients diagnosed with POMS between 2012 and 2021 in a MS center of a tertiary medical center. All patients had undergone routine clinical neurological examinations and had been assessed for a diagnosis of ADHD by a department pediatric neurologist. In addition, sociodemographic data, disease-related variables, and cognitive performance were collected. RESULTS Of the 66 patients, 31 (47%) had a diagnosis of ADHD; 29 (44%) had cognitive impairment. Moreover, we identified four different profiles of POMS: those with only ADHD (17, 26%); only cognitive impairment (15, 23%), ADHD and cognitive impairment (14, 21%), and only POMS (20, 30%). A significant difference in disease duration was found among the four profiles [F(3,65) = 8.17, p < .001, η² = 0.29], indicating that patients with ADHD and cognitive impairment were characterized by longer disease duration. CONCLUSIONS ADHD may be prominently involved in POMS, even during the early stages of the disease and early diagnosis is crucial in order to provide appropriate interventions and support.
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Affiliation(s)
- Roy Aloni
- Department of Psychology, Ariel University, Israel
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Alon Kalron
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Department of Physical Therapy, School of Health Professions, Tel-Aviv Faculty of Medicine, Tel-Aviv University, Israel
| | - Assaf Goodman
- Department of Behavioral Sciences, Ruppin Academic Center, Emek Hefer, Israel
| | | | - Talya Yoeli-Shalom
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - Shay Menascu
- Multiple Sclerosis Center, Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
- Tel-Aviv School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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21
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Parrilla GE, Gupta V, Wall RV, Salkar A, Basavarajappa D, Mirzaei M, Chitranshi N, Graham SL, You Y. The role of myelin in neurodegeneration: implications for drug targets and neuroprotection strategies. Rev Neurosci 2024; 35:271-292. [PMID: 37983528 DOI: 10.1515/revneuro-2023-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023]
Abstract
Myelination of axons in the central nervous system offers numerous advantages, including decreased energy expenditure for signal transmission and enhanced signal speed. The myelin sheaths surrounding an axon consist of a multi-layered membrane that is formed by oligodendrocytes, while specific glycoproteins and lipids play various roles in this formation process. As beneficial as myelin can be, its dysregulation and degeneration can prove detrimental. Inflammation, oxidative stress, and changes in cellular metabolism and the extracellular matrix can lead to demyelination of these axons. These factors are hallmark characteristics of certain demyelinating diseases including multiple sclerosis. The effects of demyelination are also implicated in primary degeneration in diseases such as glaucoma and Alzheimer's disease, as well as in processes of secondary degeneration. This reveals a relationship between myelin and secondary processes of neurodegeneration, including resultant degeneration following traumatic injury and transsynaptic degeneration. The role of myelin in primary and secondary degeneration is also of interest in the exploration of strategies and targets for remyelination, including the use of anti-inflammatory molecules or nanoparticles to deliver drugs. Although the use of these methods in animal models of diseases have shown to be effective in promoting remyelination, very few clinical trials in patients have met primary end points. This may be due to shortcomings or considerations that are not met while designing a clinical trial that targets remyelination. Potential solutions include diversifying disease targets and requiring concomitant interventions to promote rehabilitation.
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Affiliation(s)
- Gabriella E Parrilla
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Vivek Gupta
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Roshana Vander Wall
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Akanksha Salkar
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Devaraj Basavarajappa
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Mehdi Mirzaei
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Nitin Chitranshi
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
| | - Stuart L Graham
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
- Save Sight Institute, University of Sydney, 8 Macquarie St, Sydney, NSW 2000, Australia
| | - Yuyi You
- Faculty of Human, Health, and Medical Science, Department of Clinical Medicine, Macquarie University, Wallumattagal Campus, Macquarie Park, NSW 2109, Australia
- Save Sight Institute, University of Sydney, 8 Macquarie St, Sydney, NSW 2000, Australia
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22
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Nakamura Y, Namba T, Kawazu Y, Yasui M. Pediatric acute disseminated encephalomyelitis following asymptomatic coronavirus disease 2019. IDCases 2024; 36:e01950. [PMID: 38699523 PMCID: PMC11063528 DOI: 10.1016/j.idcr.2024.e01950] [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] [Received: 10/22/2023] [Revised: 01/09/2024] [Accepted: 04/14/2024] [Indexed: 05/05/2024] Open
Abstract
After the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic emerged, the virus spread rapidly worldwide, and outbreaks continued to occur intermittently. Here, we present the case of a 5-year-old boy with acute disseminated encephalomyelitis (ADEM) and initial symptoms of dysphoria and pain in the right lower extremity. Around the time of this episode, the patient exhibited no fever or respiratory symptoms. Brain magnetic resonance imaging (MRI) revealed multiple T2-weighted image/fluid-attenuated inversion recovery high-signal areas bilaterally subcortical to the deep white matter, corpus callosum, and bilateral basal ganglia. MRI of the cervical and thoracic regions indicated a long lesion with continuous T2WI high signal intensity in the central gray matter. Serum aquaporin-4 antibody and serum myelin oligodendrocyte glycoprotein antibody tests were negative and positive, respectively. A polymerase chain reaction test using nasopharyngeal swab fluid upon admission was positive for SARS-CoV-2. Patients with severe coronavirus disease 2019 (COVID-19) in the acute phase may show central nervous system symptoms. There have been no previous reports of ADEM in the subacute phase of COVID-19, lacking symptoms in the acute phase, as in the present case. Notably, ADEM can develop in the subacute phase of asymptomatic COVID-19 infection.
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Affiliation(s)
- Yuta Nakamura
- Department of Pediatrics, Fukuyama City Hospital, Fukuyama, Japan
| | - Takahiro Namba
- Correspondence to: Department of Pediatrics, Fukuyama City Hospital, 5–23-1, Zaocho, Fukuyama, Hiroshima 721–8511, Japan.
| | - Yukiko Kawazu
- Department of Pediatrics, Fukuyama City Hospital, Fukuyama, Japan
| | - Masato Yasui
- Department of Pediatrics, Fukuyama City Hospital, Fukuyama, Japan
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23
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Olivé-Cirera G, Bruijstens AL, Fonseca EG, Chen LW, Caballero E, Martinez-Hernandez E, Guasp M, Sepúlveda M, Naranjo L, Ruiz-García R, Blanco Y, Saiz A, Dalmau JO, Armangue T. MOG Antibodies Restricted to CSF in Children With Inflammatory CNS Disorders. Neurology 2024; 102:e209199. [PMID: 38447115 DOI: 10.1212/wnl.0000000000209199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/13/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES To assess the clinical significance of myelin oligodendrocyte glycoprotein antibodies (MOG-abs) restricted to CSF in children with inflammatory CNS disorders. METHODS Patients included 760 children (younger than 18 years) from 3 multicenter prospective cohort studies: (A) acquired demyelinating syndromes, including acute disseminated encephalomyelitis (ADEM); (B) non-ADEM encephalitis; and (C) noninflammatory neurologic disorders. For all cases, paired serum/CSF samples were systematically examined using brain immunohistochemistry and live cell-based assays. RESULTS A total of 109 patients (14%) had MOG-abs in serum or CSF: 79 from cohort A, 30 from B, and none from C. Of these, 63 (58%) had antibodies in both samples, 37 (34%) only in serum, and 9 (8%) only in CSF. Children with MOG-abs only in CSF were older than those with MOG-abs only in serum or in both samples (median 12 vs 6 vs 5 years, p = 0.0002) and were more likely to have CSF oligoclonal bands (86% vs 12% vs 7%, p = 0.0001) and be diagnosed with multiple sclerosis (6/9 [67%] vs 0/37 [0%] vs 1/63 [2%], p < 0.0001). DISCUSSION Detection of MOG-abs in serum or CSF is associated with CNS inflammatory disorders. Children with MOG-abs restricted to CSF are more likely to have CSF oligoclonal bands and multiple sclerosis than those with MOG-abs detectable in serum.
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Affiliation(s)
- Gemma Olivé-Cirera
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Arlette L Bruijstens
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Elianet G Fonseca
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Li-Wen Chen
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Eva Caballero
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Mar Guasp
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Maria Sepúlveda
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Laura Naranjo
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Raquel Ruiz-García
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Yolanda Blanco
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Albert Saiz
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Josep O Dalmau
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Thaís Armangue
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
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Hongo S, Shimizu H, Saji E, Nakajima A, Okamoto K, Kawachi I, Onodera O, Kakita A. Acute respiratory failure caused by brainstem demyelinating lesions in an older patient with an atypical relapsing autoimmune disorder. Neuropathology 2024. [PMID: 38583489 DOI: 10.1111/neup.12976] [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: 02/05/2024] [Revised: 03/14/2024] [Accepted: 03/24/2024] [Indexed: 04/09/2024]
Abstract
An 84-year-old man presented with somnolence, dysphagia, and right hemiplegia, all occurring within a month, approximately one year after initial admission due to subacute, transient cognitive decline suggestive of acute disseminated encephalomyelitis involving the cerebral white matter. Serial magnetic resonance imaging (MRI) studies over that period revealed three high-intensity signal lesions on fluid-attenuated inversion recovery images, appearing in chronological order in the left upper and left lower medulla oblongata and left pontine base. Despite some clinical improvement following methylprednisolone pulse therapy, the patient died of respiratory failure. Autopsy revealed four fresh, well-defined lesions in the brainstem, three of which corresponded to the lesions detected radiologically. The remaining lesion was located in the dorsal medulla oblongata and involved the right solitary nucleus. This might have appeared at a later disease stage, eventually causing respiratory failure. Histologically, all four lesions showed loss of myelin, preservation of axons, and infiltration of lymphocytes, predominantly CD8-positive T cells, consistent with the histological features of autoimmune demyelinating diseases, particularly the confluent demyelination observed in the early and acute phases of multiple sclerosis (MS). In the cerebral white matter, autoimmune demyelination appeared superimposed on ischemic changes, consistent with the cerebrospinal fluid (CSF) and MRI findings on initial admission. No anti-AQP4 or MOG antibodies or those potentially causing autoimmune encephalitis/demyelination were detected in either the serum or CSF. Despite several similarities to MS, such as the relapsing-remitting disease course and lesion histology, the entire clinicopathological picture in the present patient, especially the advanced age at onset and development of brainstem lesions in close proximity within a short time frame, did not fit those of MS or other autoimmune diseases that are currently established. The present results suggest that exceptionally older individuals can be affected by an as yet unknown inflammatory demyelinating disease of the CNS.
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Affiliation(s)
- Shoko Hongo
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Hiroshi Shimizu
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Etsuji Saji
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akihiro Nakajima
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Kouichirou Okamoto
- Department of Translational Research, Brain Research Institute, Niigata University, Niigata, Japan
| | - Izumi Kawachi
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
- Medical Education Center, Niigata University School of Medicine, Niigata, Japan
| | - Osamu Onodera
- Department of Neurology, Brain Research Institute, Niigata University, Niigata, Japan
| | - Akiyoshi Kakita
- Department of Pathology, Brain Research Institute, Niigata University, Niigata, Japan
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25
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Singh J, Sharma P, Randev S, Kaur N, Kumar P, Guglani V. Acute demyelinating encephalomyelitis in a child with pulmonary tuberculosis. Paediatr Int Child Health 2024:1-3. [PMID: 38571368 DOI: 10.1080/20469047.2024.2335422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 03/20/2024] [Indexed: 04/05/2024]
Abstract
Tuberculosis is a leading cause of mortality in children worldwide. One of the greatest challenges in its management is the difficulty of diagnosis as the manifestations are non-specific and often mimic other illnesses. Neurological infection occurs in approximately 1% of patients diagnosed with tuberculosis, and usually takes the form of tuberculous meningitis or tuberculoma. An 11-year-old girl who was diagnosed with acute disseminated encephalomyelitis, a rare immunological manifestation of tuberculosis, is presented. She recovered completely after a course of high-dose systemic corticosteroids in addition to anti-tuberculosis treatment. Considering the immense burden of this infectious disease, recognition and understanding of the uncommon manifestations are important to enable appropriate and timely treatment.Abbreviations: ADEM: acute disseminated encephalomyelitis; ATT: anti-tuberculosis therapy; CBNAAT: cartridge-based nucleic acid amplification test; CNS: central nervous system; CSF: cerebrospinal fluid; CT: computed tomography; FLAIR: fluid attenuated inversion recovery; IFN: interferon; MRI: magnetic resonance imaging; MTB: Mycobacterium tuberculosis; TB: tuberculosis; TNF: tumour necrosis factor.
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Affiliation(s)
- Jasmine Singh
- Departments of Pediatrics and Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Pallavi Sharma
- Departments of Pediatrics and Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Shivani Randev
- Departments of Pediatrics and Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Narinder Kaur
- Departments of Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Pankaj Kumar
- Departments of Pediatrics and Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
| | - Vishal Guglani
- Departments of Pediatrics and Radiodiagnosis, Government Medical College and Hospital, Chandigarh, India
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26
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Makhani N, Lebrun-Frenay C, Siva A, Shabanova V, Wassmer E, Santoro JD, Narula S, Brenton JN, Mar S, Durand-Dubief F, Zephir H, Mathey G, Rojas JI, de Seze J, Tenembaum S, Stone RT, Casez O, Carra-Dallière C, Neuteboom RF, Ahsan N, Arroyo HA, Cabre P, Gombolay G, Inglese M, Louapre C, Margoni M, Palavra F, Pohl D, Reich DS, Ruet A, Thouvenot E, Timby N, Tintore M, Uygunoglu U, Vargas W, Venkateswaran S, Verhelst H, Wickstrom R, Azevedo CJ, Kantarci O, Shapiro ED, Okuda DT, Pelletier D. The diagnostic workup of children with the radiologically isolated syndrome differs by age and by sex. J Neurol 2024:10.1007/s00415-024-12289-1. [PMID: 38564056 DOI: 10.1007/s00415-024-12289-1] [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: 09/26/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Cerebrospinal fluid (CSF) and spinal MRIs are often obtained in children with the radiologically isolated syndrome (RIS) for diagnosis and prognosis. Factors affecting the frequency and timing of these tests are unknown. OBJECTIVE To determine whether age or sex were associated with (1) having CSF or spinal MRI obtained or (2) the timing of these tests. METHODS We analyzed children (≤ 18 y) with RIS enrolled in an international longitudinal study. Index scans met 2010/2017 multiple sclerosis (MS) MRI criteria for dissemination in space (DIS). We used Fisher's exact test and multivariable logistic regression (covariates = age, sex, MRI date, MRI indication, 2005 MRI DIS criteria met, and race). RESULTS We included 103 children with RIS (67% girls, median age = 14.9 y). Children ≥ 12 y were more likely than children < 12 y to have CSF obtained (58% vs. 21%, adjusted odds ratio [AOR] = 4.9, p = 0.03). Pre-2017, girls were more likely than boys to have CSF obtained (n = 70, 79% vs. 52%, AOR = 4.6, p = 0.01), but not more recently (n = 30, 75% vs. 80%, AOR = 0.2, p = 0.1; p = 0.004 for interaction). Spinal MRIs were obtained sooner in children ≥ 12 y (median 11d vs. 159d, p = 0.03). CONCLUSIONS Younger children with RIS may be at continued risk for misdiagnosis and misclassification of MS risk. Consensus guidelines are needed.
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Affiliation(s)
- Naila Makhani
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA.
- Department of Neurology, Yale University, New Haven, CT, USA.
| | - Christine Lebrun-Frenay
- CRCSEP Neurologie Pasteur 2, CHU de Nice, Université Cote d'Azur, UMR2CA (URRIS), Nice, France
| | - Aksel Siva
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Veronika Shabanova
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Evangeline Wassmer
- Neurology Department, Birmingham Children's Hospital, Aston University, Birmingham, UK
| | - Jonathan D Santoro
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Sona Narula
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, USA
| | | | - Soe Mar
- Department of Neurology, Washington University School of Medicine, St. Louis, USA
| | - Francoise Durand-Dubief
- Service de sclérose en plaques, Pathologies de la myéline et Neuro-Inflammation, Hôpital Neurologique, Groupement Hospitalier Est, 59 Bd Pinel, 69677, BRON Cedex, France
| | - Helene Zephir
- Inserm UMR-S 1172 LilNcog, Lille University Hospital FHU Precise, Lille University, Lille, France
| | - Guillaume Mathey
- Department of Neurology, Nancy University Hospital, 54035, Nancy, France
| | - Juan I Rojas
- Hospital Universitario de CEMIC, Buenos Aires, Argentina
| | - Jerome de Seze
- Department of Neurology, Hospital Hautepierre, CHU de Strasbourg and Clinical Investigation Center (CIC) INSERM 1434, Strasbourg, France
| | - Silvia Tenembaum
- Department of Neurology, National Pediatric Hospital Dr. Juan P Garrahan, Buenos Aires, Argentina
| | | | - Olivier Casez
- Neurology MS Clinic Grenoble, Grenoble Alpes University Hospital, Grenoble, France
- T-RAIG, TIMC-IMAG, Grenoble Alpes University, Grenoble, France
| | - Clarisse Carra-Dallière
- Neurology MS Clinic, Montpellier University Hospital, 34295, Montpellier, France
- University of Montpellier (MUSE), 34295, Montpellier, France
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus MC Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands
| | - Nusrat Ahsan
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
- Division of Neurology, Department of Pediatrics, Children's Hospital of Los Angeles, Los Angeles, USA
| | - Hugo A Arroyo
- Department of Neurology, Hospital de Pediatría SAMIC. Prof. Dr. J.P. Garrahan, Buenos Aires, Argentina
| | - Philippe Cabre
- Centre Hospitalo Universitaire, Fort-de-France, Martinique
| | - Grace Gombolay
- Division of Neurology, Department of Pediatrics, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Matilde Inglese
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health Department of Neuroscience (DINOGMI), University of Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Celine Louapre
- Assistance Publique Hôpitaux de Paris, Inserm, CNRS, Hôpital de la Pitié Salpêtrière, CIC Neurosciences, Sorbonne Université, Paris Brain Institute - ICM, Paris, France
| | - Monica Margoni
- Department of Neurosciences, Multiple Sclerosis Center of the Veneto Region, University Hospital-School of Medicine, Padua, Italy
| | - Filipe Palavra
- Center for Child Development - Neuropaediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Daniela Pohl
- Division of Neurology, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Daniel S Reich
- Translational Neuroradiology Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, USA
| | - Aurélie Ruet
- Department of Neurology, CHU Bordeaux, Bordeaux, France
- INSERM, Neurocentre Magendie, University of Bordeaux, U1215, Bordeaux, France
| | - Eric Thouvenot
- Department of Neurology, Nîmes University Hospital, Nîmes, France
- IGF, University of Montpellier, CNRS, INSERM, Montpellier, France
| | - Niklas Timby
- Department of Clinical Sciences/Pediatrics, Umeå University, Umeå, Sweden
| | - Mar Tintore
- Neurology Department, MS Center of Catalunya Cemcat, Vall d'Hebron University Hospital, Universitat Autònoma de Barcelona (UAB), UVIC-Universitat Central de Catalunya, Barcelona, Spain
| | - Ugur Uygunoglu
- Neuroimmunology Unit, Neurology Department, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Wendy Vargas
- Department of Neurology, Columbia University Medical Center, New York, USA
| | | | - Helene Verhelst
- Division of Pediatric Neurology, Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Ronny Wickstrom
- Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Christina J Azevedo
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
| | - Orhun Kantarci
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eugene D Shapiro
- Department of Pediatrics, Yale University, LMP 3088, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, Dallas, USA
| | - Daniel Pelletier
- Department of Neurology, Keck School of Medicine of the University of Southern California, Los Angeles, USA
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27
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Rajiv D, Tullu MS, Jain S, Karande S. Acute disseminated encephalomyelitis with coexisting neurocysticercosis in an 11-year-old boy: An unusual occurrence. J Postgrad Med 2024; 70:121-122. [PMID: 38668848 PMCID: PMC11160987 DOI: 10.4103/jpgm.jpgm_926_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/27/2023] [Accepted: 04/13/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- D Rajiv
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - MS Tullu
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - S Jain
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
| | - S Karande
- Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India
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Arkar U, Vipotnik Vesnaver T, Osredkar D, Perković Benedik M, Bizjak N. Multiple sclerosis in a 4-year-old boy: a case report and literature review. Front Neurol 2024; 15:1359938. [PMID: 38585366 PMCID: PMC10996918 DOI: 10.3389/fneur.2024.1359938] [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] [Received: 12/22/2023] [Accepted: 03/12/2024] [Indexed: 04/09/2024] Open
Abstract
Pediatric onset multiple sclerosis (POMS) in the very young is a very rare entity and presents a difficult diagnostic challenge due to overlapping signs and symptoms with other diseases. We present a 4-year-old boy who initially presented with right-sided hemiparesis and demyelinating lesions on MRI. Follow-up MRI examinations 3 and 6 months later revealed new demyelinating lesions. Ten months after initial presentation, he presented with right-sided hemiparesis, central facial nerve palsy on the right side and new demyelinating lesions on MRI. Two clinical events and new MRI lesions on follow-up MRIs confirmed the diagnosis of POMS. He was treated with rituximab and experienced no further relapses or radiological progression during the follow-up period.
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Affiliation(s)
- Ula Arkar
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - Damjan Osredkar
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, Center for Developmental Neuroscience, University of Ljubljana, Ljubljana, Slovenia
| | - Mirjana Perković Benedik
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Neli Bizjak
- Department of Child, Adolescent and Developmental Neurology, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia
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McClelland AC, Benitez SJ, Burns J. COVID-19 neuroimaging update: pathophysiology, acute findings, and post-acute developments. Semin Ultrasound CT MR 2024:S0887-2171(24)00026-X. [PMID: 38518814 DOI: 10.1053/j.sult.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
COVID-19 has prominent effects on the nervous system with important manifestations on neuroimaging. In this review, we discuss the neuroimaging appearance of acute COVID-19 that became evident during the early stages of the pandemic. We highlight the underlying pathophysiology mediating nervous system effects and neuroimaging appearances including systemic inflammatory response such as cytokine storm, coagulopathy, and para/post-infections immune mediated phenomena. We also discuss the nervous system manifestations of COVID-19 and the role of imaging as the pandemic has evolved over time, including related to the development of vaccines and the emergence of post-acute sequalae such as long COVID.
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Affiliation(s)
| | | | - Judah Burns
- Albert Einstein College of Medicine; Bronx, NY, Department of Radiology, Montefiore Medical Center; Bronx, NY.
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Ying Y, Liu X, Li X, Mei N, Ruan Z, Lu Y, Yin B. Distinct MRI characteristics of spinal cord diffuse midline glioma, H3 K27-altered in comparison to spinal cord glioma without H3 K27-alteration and demyelination disorder. Acta Radiol 2024; 65:284-293. [PMID: 38115811 DOI: 10.1177/02841851231215803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND An applicable magnetic resonance imaging (MRI) biomarker for diffuse midline glioma (DMG), H3 K27-altered of the spinal cord is important for non-invasive diagnosis. PURPOSE To evaluate the efficacy of conventional MRI (cMRI) in distinguishing between DMGs, H3 K27-altered, gliomas without H3 K27-alteration, and demyelinating lesions in the spinal cord. MATERIAL AND METHODS Between January 2017 and February 2023, patients with pathology-confirmed spinal cord gliomas (including ependymomas) with definite H3 K27 status and demyelinating diseases diagnosed by recognized criteria were recruited as the training set for this retrospective study. Morphologic parameter assessment was performed by two neuroradiologists on T1-weighted, T2-weighted, and contrast-enhanced T1-weighted imaging. Variables with high inter- and intra-observer agreement were included in univariable correlation analysis and multivariable logistic regression. The performance of the final model was verified by internal and external testing sets. RESULTS The training cohort included 21 patients with DMGs (13 men; mean age = 34.57 ± 13.489 years), 21 with wild-type gliomas (10 men; mean age = 46.76 ± 17.017 years), and 20 with demyelinating diseases (5 men; mean age = 49.50 ± 18.872 years). A significant difference was observed in MRI features, including cyst(s), hemorrhage, pial thickening with enhancement, and the maximum anteroposterior diameter of the spinal cord. The prediction model, integrating age, age2, and morphological characteristics, demonstrated good performance in the internal and external testing cohort (accuracy: 0.810 and 0.800, specificity: 0.810 and 0.720, sensitivity: 0.872 and 0.849, respectively). CONCLUSION Based on cMRI, we developed a model with good performance for differentiating among DMGs, H3 K27-altered, wild-type glioma, and demyelinating lesions in the spinal cord.
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Affiliation(s)
- Yinwei Ying
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xiujuan Liu
- Department of Pathology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Xuanxuan Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Nan Mei
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Zhuoying Ruan
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Yiping Lu
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
| | - Bo Yin
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, PR China
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Yamout B, Al-Jumah M, Sahraian MA, Almalik Y, Khaburi JA, Shalaby N, Aljarallah S, Bohlega S, Dahdaleh M, Almahdawi A, Khoury SJ, Koussa S, Slassi E, Daoudi S, Aref H, Mrabet S, Zeineddine M, Zakaria M, Inshasi J, Gouider R, Alroughani R. Consensus recommendations for diagnosis and treatment of Multiple Sclerosis: 2023 revision of the MENACTRIMS guidelines. Mult Scler Relat Disord 2024; 83:105435. [PMID: 38245998 DOI: 10.1016/j.msard.2024.105435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/21/2023] [Accepted: 01/06/2024] [Indexed: 01/23/2024]
Abstract
With evolving diagnostic criteria and the advent of new oral and parenteral therapies for Multiple Sclerosis (MS), most current diagnostic and treatment algorithms need revision and updating. The diagnosis of MS relies on incorporating clinical and paraclinical findings to prove dissemination in space and time and exclude alternative diseases that can explain the findings at hand. The differential diagnostic workup should be guided by clinical and laboratory red flags to avoid unnecessary tests. Appropriate selection of MS therapies is critical to maximize patient benefit. The current guidelines review the current diagnostic criteria for MS and the scientific evidence supporting treatment of acute relapses, radiologically isolated syndrome, clinically isolated syndrome, relapsing remitting MS, progressive MS, pediatric cases and pregnant women. The purpose of these guidelines is to provide practical recommendations and algorithms for the diagnosis and treatment of MS based on current scientific evidence and clinical experience.
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Affiliation(s)
- B Yamout
- Neurology Institute and Multiple Sclerosis Center, Harley Street Medical Center, Abu Dhabi, United Arab Emirates.
| | - M Al-Jumah
- InterHealth hospital, Multiple Sclerosis Center, Riyadh, Saudi Arabia
| | - M A Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Y Almalik
- Division of Neurology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, National Guard Health Affairs, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - J Al Khaburi
- Department of Neurology, The Royal Hospital, Sultanate of Oman
| | - N Shalaby
- Neurology Department, Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | | | - S Bohlega
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - A Almahdawi
- Consultant Neurologist, Neurology Unit, Baghdad Teaching Hospital, Medical City Complex, Iraq
| | - S J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - S Koussa
- Multiple Sclerosis Center, Geitaoui Lebanese University Hospital, Beirut, Lebanon
| | - E Slassi
- Hôpital Cheikh Khalifa Ibn Zaid, Casablanca, Morocco
| | - S Daoudi
- Hospital Center Nedir Mohamed, Faculty of Medicine, University Mouloud Mammeri Tizi-Ouzou, Algeria
| | - H Aref
- Neurology Department, Ain Shams University, Cairo, Egypt
| | - S Mrabet
- Department of Neurology, CIC, Razi Universitary Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - M Zeineddine
- Middle East and North Africa Committee for Treatment and Research in Multiple Sclerosis (MENACTRIMS), Beirut, Lebanon
| | | | - J Inshasi
- Department of Neurology, Rashid Hospital and Dubai Medical College, Dubai Health Authority, Dubai, United Arab Emirates
| | - R Gouider
- Department of Neurology, CIC, Razi Universitary Hospital, University of Tunis El Manar, Tunis, Tunisia
| | - R Alroughani
- Amiri Hospital, Arabian Gulf Street, Sharq, Kuwait
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Rao S, Gross RS, Mohandas S, Stein CR, Case A, Dreyer B, Pajor NM, Bunnell HT, Warburton D, Berg E, Overdevest JB, Gorelik M, Milner J, Saxena S, Jhaveri R, Wood JC, Rhee KE, Letts R, Maughan C, Guthe N, Castro-Baucom L, Stockwell MS. Postacute Sequelae of SARS-CoV-2 in Children. Pediatrics 2024; 153:e2023062570. [PMID: 38321938 PMCID: PMC10904902 DOI: 10.1542/peds.2023-062570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 02/08/2024] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has caused significant medical, social, and economic impacts globally, both in the short and long term. Although most individuals recover within a few days or weeks from an acute infection, some experience longer lasting effects. Data regarding the postacute sequelae of severe acute respiratory syndrome coronavirus 2 infection (PASC) in children, or long COVID, are only just emerging in the literature. These symptoms and conditions may reflect persistent symptoms from acute infection (eg, cough, headaches, fatigue, and loss of taste and smell), new symptoms like dizziness, or exacerbation of underlying conditions. Children may develop conditions de novo, including postural orthostatic tachycardia syndrome, myalgic encephalomyelitis/chronic fatigue syndrome, autoimmune conditions and multisystem inflammatory syndrome in children. This state-of-the-art narrative review provides a summary of our current knowledge about PASC in children, including prevalence, epidemiology, risk factors, clinical characteristics, underlying mechanisms, and functional outcomes, as well as a conceptual framework for PASC based on the current National Institutes of Health definition. We highlight the pediatric components of the National Institutes of Health-funded Researching COVID to Enhance Recovery Initiative, which seeks to characterize the natural history, mechanisms, and long-term health effects of PASC in children and young adults to inform future treatment and prevention efforts. These initiatives include electronic health record cohorts, which offer rapid assessments at scale with geographical and demographic diversity, as well as longitudinal prospective observational cohorts, to estimate disease burden, illness trajectory, pathobiology, and clinical manifestations and outcomes.
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Affiliation(s)
- Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora, Colorado
| | - Rachel S. Gross
- Departments of Pediatrics
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Sindhu Mohandas
- Division of Infectious Diseases
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Cheryl R. Stein
- Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York
| | - Abigail Case
- Department of Pediatrics and Rehabilitation Medicine, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Benard Dreyer
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Nathan M. Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - H. Timothy Bunnell
- Biomedical Research Informatics Center, Nemours Children’s Health, Nemours Children’s Hospital, Delaware, Wilmington, Delaware
| | - David Warburton
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Elizabeth Berg
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Jonathan B. Overdevest
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Mark Gorelik
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Joshua Milner
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Sejal Saxena
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - John C. Wood
- Department of Pediatrics and Radiology, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Kyung E. Rhee
- Department of Pediatrics, University of California, San Diego, School of Medicine, San Diego, California
| | - Rebecca Letts
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Christine Maughan
- Population Health, NYU Grossman School of Medicine, New York, New York
| | - Nick Guthe
- Population Health, NYU Grossman School of Medicine, New York, New York
| | | | - Melissa S. Stockwell
- Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, New York
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York
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33
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Pedrosa DA, de Paula Oliveira LKL, Bertanha R, Júnior EA, Fernandes GBP, Thomaz RB. Acute disseminated encephalomyelitis following Saint Louis encephalitis virus infection. Neurol Sci 2024; 45:1263-1266. [PMID: 38177968 DOI: 10.1007/s10072-023-07246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024]
Abstract
Saint Louis encephalitis virus (SLEV) infection is an arbovirosis associated with a broad spectrum of neurological complications. We present a case of a 55-year-old man hailing from Manaus, a city situated in the heart of the Amazon Rainforest, who exhibited symptoms of vertigo, tremors, urinary and fecal retention, compromised gait, and encephalopathy 3 weeks following SLEV infection. Neuroaxis MRI revealed diffuse, asymmetric, and poorly defined margins hyperintense lesions with peripheral and ring enhancement in subcortical white matter, as well as severe spinal cord involvement. Serology for SLEV was positive both on serum and cerebrospinal fluid. To the best of our knowledge, the present report is the first to show brain lesions along with myelitis as a post-infectious complication of SLEV infection.
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Affiliation(s)
- Denison Alves Pedrosa
- Albert Einstein Israelita Hospital, Av. Albert Einstein 627, São Paulo, 05620-900, Brazil.
| | | | - Renata Bertanha
- Albert Einstein Israelita Hospital, Av. Albert Einstein 627, São Paulo, 05620-900, Brazil
| | - Edson Amaro Júnior
- Albert Einstein Israelita Hospital, Av. Albert Einstein 627, São Paulo, 05620-900, Brazil
| | | | - Rodrigo B Thomaz
- Albert Einstein Israelita Hospital, Av. Albert Einstein 627, São Paulo, 05620-900, Brazil
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Teru SS, Dogiparthi J, Bonitz TJ, Buzas C. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease: A Case Report. Cureus 2024; 16:e55652. [PMID: 38586776 PMCID: PMC10996974 DOI: 10.7759/cureus.55652] [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: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a newly discovered autoimmune demyelinating disorder. The clinical manifestations of MOGAD are divergent but often characterized by inflammatory central nervous system (CNS) deficits such as optic neuritis, encephalitis, or transverse myelitis that predominantly affect the pediatric population. Despite the distinct features often associated with MOGAD, the disease exhibits a diverse range of clinical manifestations, making timely diagnosis and treatment challenging. In particular, distinguishing MOGAD from multiple sclerosis (MS) is important for adequate treatment and the prevention of relapsing disease. In this report, we present a rare case of MOGAD in a 57-year-old male who initially exhibited symptoms of bilateral optic nerve edema and flame hemorrhage. This led to an initial misdiagnosis of pseudotumor cerebri. Serological analysis at a tertiary care center ultimately led to the diagnosis of MOGAD after multiple visits to the ophthalmologist with worsening vision deficits.
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Affiliation(s)
- Smaran S Teru
- Medical School, Lake Erie College of Osteopathic Medicine, Erie, USA
| | | | - Thomas J Bonitz
- Medical School, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Chris Buzas
- Ophthalmology, Lake Erie College of Osteopathic Medicine, Erie, USA
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Ren C, Zhou A, Zhou J, Zhuo X, Dai L, Tian X, Yang X, Gong S, Ding C, Fang F, Ren X, Zhang W. Encephalitis is an Important Phenotype of Myelin Oligodendrocyte Glycoprotein Antibody-Associated Diseases: A Single-Center Cohort Study. Pediatr Neurol 2024; 152:98-106. [PMID: 38242024 DOI: 10.1016/j.pediatrneurol.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/21/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is considered a demyelinating disease of the central nervous system, but an increasing number of encephalitis cases associated with MOG antibodies have been reported recently. METHODS This was a single-center, retrospective study. All data for pediatric patients with MOGAD diagnosed at Beijing Children's Hospital from January 2017 to January 2022 were collected. Clinical characteristics and outcomes were analyzed, and treatment responses were compared between the rituximab (RTX) and mycophenolate mofetil (MMF) groups. RESULTS A total of 190 patients (age range: 5 months to 16 years; median age: 7.2 years; females: 97) were included in this study. The phenotypes of the first attack included acquired demyelinating syndromes (105 [55%]), encephalitis other than acute disseminated encephalomyelitis (82 [43%]), and isolated meningitis (3 [2%]). After a median follow-up of 30.4 months (interquartile range: 14.8-43.7), 64 (34%) patients had relapses. Fifty-one of the 64 (80%) patients who had relapse received maintenance therapy, including MMF (41), RTX (11), maintenance intravenous immunoglobulin (two), and tocilizumab (two). The annualized relapse rates decreased significantly after treatment in both the RTX and MMF cohorts (P < 0.05); however, there were no significant differences between the two groups (P = 0.56). A total of 178 (94%) patients had complete (175 patients) or almost complete (three patients) recovery (modified Rankin scale [mRS] < 2), and 12 had moderate to severe deficits (mRS ≥ 2). CONCLUSIONS The spectrum of pediatric MOGAD is broader than previously reported and includes demyelinating syndromes and encephalitis. Encephalitis is an important initial phenotype observed in pediatric patients with MOGAD.
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Affiliation(s)
- Changhong Ren
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Anna Zhou
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Ji Zhou
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiuwei Zhuo
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Lifang Dai
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaojuan Tian
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xinying Yang
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Shuai Gong
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Changhong Ding
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Fang Fang
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Xiaotun Ren
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China
| | - Weihua Zhang
- Department of Neurology, Beijing Children's Hospital, National Center for Children's Health, Capital Medical University, Beijing, China.
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Liu J, Jin M, Zhang M, Wang Y, Sun S. Multimodal evoked potentials are useful for the diagnosis of pediatric acute disseminated encephalomyelitis. BMC Pediatr 2024; 24:92. [PMID: 38308211 PMCID: PMC10835841 DOI: 10.1186/s12887-024-04576-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 01/18/2024] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND The application of evoked potentials (EPs) to the diagnosis of acute disseminated encephalomyelitis (ADEM ) has not been investigated in detail. The aim of this study, therefore, was to analyze the value of multimodal EPs in the early diagnosis of pediatric ADEM. METHODS This was a retrospective study in which we enrolled pediatric ADEM patients and controls (Cs) from neurology units between 2017 and 2021. We measured indices in patients using brainstem auditory evoked potentials (BAEPs), visual evoked potentials (VEPs) and somatosensory evoked potentials (SEPs), and then we analyzed their early diagnostic value in ADEM patients. RESULTS The mean age of the ADEM group was 6.15 ± 3.28 years (range,1-12 years) and the male/female ratio was 2.1:1 The mean age of the Cs was 5.97 ± 3.40 years (range,1-12 years) and the male/female ratio was 1.3:1. As we used magnetic resonance imaging (MRI) as the diagnostic criterion, the sensitivity, specificity, and accuracy (κ was 0.88) of multimodal EPs were highly consistent with those of MRI; and the validity could be ranked in the following order with respect to the diagnosis of ADEM: multimodal Eps > single SEP > single VEP > single BAEP. Of 34 patients with ADEM, abnormalities in multimodal EPs were 94.12%, while abnormalities in single VEPs, BAEPs and SEPs were 70.59%,64.71%and 85.3%, respectively. We noted significant differences between single VEP/BAEPs and multimodal EPs (χ2 = 6.476/8.995,P = 0.011/0.003). CONCLUSIONS The combined application of multimodal EPs was superior to BAEPs, VEPs, or SEPs alone in detecting the existence of central nerve demyelination, and we hypothesize that these modalities will be applicable in the early diagnosis of ADEM.
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Affiliation(s)
- Jing Liu
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Mei Jin
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China.
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China.
| | - Meijie Zhang
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Yonggang Wang
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China
| | - Suzhen Sun
- The Children Hospital of Hebei Province, Shijiazhuang, Hebei, 050000, China.
- The Key Laboratory of Pediatric Epilepsy and Neurological Disorders of Hebei Province, Shijiazhuang, Hebei, 050000, China.
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Zheng S, Wang Y, Geng J, Liu X, Huo L. Global trends in research on MOG antibody-associated disease: bibliometrics and visualization analysis. Front Immunol 2024; 15:1278867. [PMID: 38370410 PMCID: PMC10869486 DOI: 10.3389/fimmu.2024.1278867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
Objective The purpose of this study was to investigate the current research status, focus areas, and developmental trends in the field of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) through an analysis of scientific literature. Methods The relevant research articles on MOGAD published from 1947 to 2022 were retrieved from the Web of Science database. The quantitative output of MOGAD related research articles, their distribution by country/region, data on collaborative publishing, influential authors, high-yield institutions, keywords, hotspots, and development trends were analyzed. Additionally, visual knowledge maps were generated using VOSviewer and Citespace. Results There has been a steady increase in the number of MOGAD related publications indicating that the subject has garnered increasing interest among researchers globally. The United States has been the leading contributor with 496 papers (19.25%), followed by China (244, 9.63%), Japan (183, 7.10%), the United Kingdom (154, 5.98%), and Germany (149, 5.78%). Among these countries, the United Kingdom boasts the highest citation frequency at the rate of 46.49 times per paper. Furthermore, active collaboration in MOGAD related research is observed primarily between the United States and countries such as Canada, Germany, Australia, Italy, the United Kingdom and Japan. Mayo Clinic ranks first in total articles published (109) and frequency of citations per article (77.79). Takahashi Toshiyuki from Tohoku University is the most prolific author, while Multiple Sclerosis and Related Disorders is the most widely read journal in this field. "Disease Phenotype", "Treatment", "Novel Coronavirus Infection and Vaccination", "Immunopathological Mechanisms", "Clinical characteristics of children" and "Prognosis" are the primary keywords clusters in this field. "Novel Coronavirus Infection and Vaccination" and "Immunopathological Mechanisms" are research hotspots and have great development potential. Conclusion The past three decades have witnessed a significant expansion of research on MOGAD. The pathogenetic mechanism of MOGAD is poised to be the prominent research focus in this field in the foreseeable future.
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Affiliation(s)
- Shuhan Zheng
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yang Wang
- National Science Library, Chinese Academy of Sciences, Beijing, China
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing, China
| | - Jiaming Geng
- Department of Information Resources Management, School of Economics and Management, University of Chinese Academy of Sciences, Beijing, China
- Department of Pharmaceutical Biotechnology, China Medical University-The Queen’s University if Belfast Joint College, Shenyang, China
| | - Xueyan Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
| | - Liang Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang, China
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Salunkhe M, Tayade K, Priyadarshi M, Goel V, Gulati I, Garg A, Bhatia R, Srivastava MVP. Spectrum of various CNS inflammatory demyelination diseases following COVID-19 vaccinations. Acta Neurol Belg 2024; 124:193-203. [PMID: 37668946 DOI: 10.1007/s13760-023-02373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND AND PURPOSE Although rare, neurological adverse events have been reported post-COVID-19 vaccination. This study reports 16 patients diagnosed with CNS inflammatory demyelinating diseases (CNS-IDD) within 6 weeks of COVID-19 vaccine administration. METHODOLOGY A prospective observational study was conducted from June 2021 to May 2022. All patients were diagnosed according to the latest international guidelines with CNS-IDD within 6 weeks of COVID-19 vaccine exposure. Data regarding the demographic profile, clinical features, type of COVID-19 vaccination, radiological findings and occurrence of symptoms were noted and further analysed using descriptive statistics. RESULTS We reported 16 cases (median age 40 years) of CNS demyelination: fourteen occurred in temporal association with ChAdOx1-S vaccine and two in association with BBV152 vaccine. Median time duration of presenting symptoms after vaccination was 19 days (3-40 days). The most common presentation was myelitis (7/16 patients), followed by optic neuritis (6/16 patients). Demyelination events were reported after first and second dose in thirteen and five patients respectively, although two patients reported such events after both vaccine dosages. Myelin oligodendrocyte glycoprotein (MOG) IgG antibodies were positive in eight patients. Tumefactive demyelination was seen in four patients. Management included high-dose methylprednisolone, PLEX, IVIG or a combination of those, with a favourable outcome in the majority of cases. CONCLUSION Although a rare event, awareness regarding potential demyelinating episodes post-COVID-19 vaccination can help in early diagnosis. The presence of increased MOG-IgG antibodies with temporal association in post-COVID vaccine patients raises a possibility of an immunogenic phenomenon leading to demyelinating disorders.
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Affiliation(s)
- Manish Salunkhe
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Kamlesh Tayade
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Megha Priyadarshi
- Department of Infectious Diseases, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goel
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Isha Gulati
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India.
| | - M V Padma Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
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Huang Y, Luo W, Cheng X, Sun X, Wang Y, Shu Y, Lu Z, Hu X, Qiu W, Kermode A, Zhong X. Clinical and imaging features of patients with late-onset myelin oligodendrocyte glycoprotein antibody-associated disease. Mult Scler Relat Disord 2024; 82:105405. [PMID: 38194895 DOI: 10.1016/j.msard.2023.105405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/12/2023] [Accepted: 12/21/2023] [Indexed: 01/11/2024]
Abstract
BACKGROUND There is an age-dependent change in the clinical phenotype of Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). However, the clinical features of late-onset MOGAD have not been well described. METHODS Clinical data of 110 MOGAD patients, including 21 late-onset patients with onset age greater than or equal to 50 years old were retrospectively analyzed. RESULTS Compared to pediatric- and younger adult-onset ones, late-onset MOGAD patients experienced milder disease onset (p < 0.001), more monophasic course (p < 0.001), fewer relapses (p = 0.007), less cerebrospinal fluid leukocytosis (p = 0.021), less longitudinally extensive transverse myelitis (onset p = 0.026, whole course p = 0.028), fewer lesions in basal ganglia (whole course p = 0.012), thalamus (whole course p = 0.040) and cerebellum (whole course p = 0.028). However, they had more cerebral symptoms (p = 0.021 onset and whole course), more lesions in white matter (onset p = 0.005, whole course p < 0.001) and periventricular area (onset p = 0.026), along with longer and delayed therapeutic intervention (p < 0.001). The main differences in clinical characteristics between late-onset patients with and without these brain involvements might be comorbidities. CONCLUSIONS Late-onset MOGAD are more likely to experience delayed diagnosis. Brain involvement may be modulated by comorbidities of the elderly, which alter the clinical manifestations of late-onset MOGAD.
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Affiliation(s)
- Yiying Huang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wenjing Luo
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xi Cheng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yaqing Shu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xueqiang Hu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
| | - Allan Kermode
- Perron Institute for Neurological and Translational Science, University of Western Australia, Perth, Australia; Centre for Molecular Medicine and Innovative Therapeutics, Murdoch University, Perth, Australia; Institute for Immunology and Infectious Disease, Murdoch University, Perth, Australia.
| | - Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Fjellbirkeland OW, Szpirt WM, Børresen ML. The role of plasmapheresis in severe acute disseminated encephalomyelitis with clinical findings of transverse myelitis. Ther Apher Dial 2024; 28:119-124. [PMID: 37646345 DOI: 10.1111/1744-9987.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/08/2023] [Accepted: 08/16/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Acute disseminated encephalomyelitis is a rare acute demyelinating disease of the central nervous system (CNS). The pathogenesis remains unclear but is suspected to be autoimmune. High doses of methylprednisolone (HDMP) are currently considered standard of treatment. Plasmapheresis (PE) is typically given in steroid refractory cases. There is currently limited evidence supporting its use in ADEM. MATERIALS AND METHODS We report a 16-year-old girl with ADEM who improved rapidly after initiating PE. RESULTS The patient presented with acute onset of multifocal CNS symptoms, including encephalopathy, requiring intensive care unit management. Despite HDMP administration, her clinical condition continued to deteriorate. PE was therefore initiated on the same day as HDMP. Her clinical condition improved significantly following the first session. She was extubated and discharged from the intensive care unit the following day. CONCLUSION HDMP combined with PE may be an effective first-line treatment in patients with fulminant ADEM.
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Affiliation(s)
| | - Wladimir M Szpirt
- Department of Nephrology, Plasmapheresis Services, Copenhagen, Denmark
| | - Malene L Børresen
- Department of Pediatrics and Adolescent Medicine, Copenhagen, Denmark
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41
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Leung R, Yiu EM. Practical approach to the child presenting with acute generalised weakness. J Paediatr Child Health 2024; 60:41-46. [PMID: 38545899 DOI: 10.1111/jpc.16536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/03/2023] [Accepted: 03/18/2024] [Indexed: 04/17/2024]
Abstract
Acute generalised muscle weakness in children is a paediatric emergency with a broad differential diagnosis. A careful history and neurologic examination guides timely investigation and management. We review some of the more common causes of acute generalised muscle weakness in children, highlighting key history and examination findings, along with an approach to lesion localisation to guide differential diagnosis and further investigation.
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Affiliation(s)
- Rebecca Leung
- Department of Neurology and Metabolics, Queensland Children's Hospital, South Brisbane, Queensland, Australia
| | - Eppie M Yiu
- Department of Neurology, Royal Children's Hospital, Melbourne, Victoria, Australia
- Neuroscience Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
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Mashkoor Y, Nadeem A, Fatima T, Aamir M, Vohra LI, Habib A, Khan A, Raufi N, Habte A. Neurological complications of influenza vaccination: navigating the spectrum with a focus on acute disseminated encephalomyelitis (ADEM). Ann Med Surg (Lond) 2024; 86:1029-1041. [PMID: 38333316 PMCID: PMC10849354 DOI: 10.1097/ms9.0000000000001656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 12/13/2023] [Indexed: 02/10/2024] Open
Abstract
Introduction Acute disseminated encephalomyelitis (ADEM) is a rare neurological disorder characterized by inflammation in the brain and spinal cord. This systematic review aims to investigate the potential association between ADEM and influenza vaccination by analyzing relevant case reports. ADEM is traditionally thought to be a monophasic condition, predominantly affecting children, often following viral illnesses or immunizations. Recent attention has focused on a possible link between ADEM and influenza vaccination, prompting the need for a thorough investigation. Methods The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the AMSTAR2 (A MeaSurement Tool to Assess systematic Reviews 2) guidelines. Electronic searches were conducted on PubMed, Cochrane Library, and clinicaltrials.gov databases, spanning up to August 2023. Inclusion criteria encompassed full-text articles in English, observational studies, case reports, and case series providing comprehensive details for confirming clinical diagnoses of ADEM following influenza vaccination. Data were extracted, including demographic information, vaccination details, clinical symptoms, diagnostic evaluations, treatment modalities, and outcomes. Quality assessment was performed using the Joanna Briggs Institute (JBI) Critical Appraisal tool. Results A total of 23 cases of ADEM following influenza vaccination were identified from 19 included articles. The mean age of affected individuals was 40.2 years (±25.7) with 60.8% being male. Common presenting symptoms included muscle weakness (52.1%), urinary abnormalities (30.4%), altered consciousness (26%), and sensory disturbances (26%). Neurological examination revealed findings such as extensor plantar reflex (positive Babinski sign) in 26%, hyperreflexia in 30.4%, and generalized hyporeflexia in 13% of the cases. Diagnostic evaluations involved MRI, showing multiple hyperintense lesions in cerebral hemispheres (43.4%), subcortex (60.8%), and spinal cord (39.1%). Cerebrospinal fluid analysis indicated elevated white blood cell count in 69.5% of cases, with lymphocytic pleocytosis in 52.1%. Oligoclonal bands were reported positively in 8.6% of cases. Treatment approaches varied, with intravenous methylprednisolone being the most common (39.1%). Out of the 23 cases, two (8.6%) patients had a fatal outcome, while the rest showed clinical improvement with complete or partial resolution of symptoms. Persisting symptoms included numbness in the lower extremities (8.6%) and impaired ability to walk after 10 months (4.3%). Conclusion While the association between ADEM and influenza vaccination is rare, healthcare professionals should remain vigilant and consider patients' vaccination history, particularly following an influenza immunization. This systematic review highlights the clinical manifestations, diagnostic tools, treatment approaches, and outcomes of ADEM cases post-influenza vaccination. Further research is essential to understand this association and improve clinical decision-making, ensuring the safety and efficacy of immunization programs.
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Affiliation(s)
| | | | - Tehreem Fatima
- Department of Medicine, Dow University of Health Sciences
| | - Minahil Aamir
- Department of Medicine, Dow University of Health Sciences
| | - Laiba I. Vohra
- Department of Medicine, Ziauddin University, Karachi, Sindh, Pakistan
| | | | - Afsheen Khan
- Department of Medicine, Dow University of Health Sciences
| | - Nahid Raufi
- Department of Medicine, Kabul Medical University, Kabul, Afghanistan
| | - Alexander Habte
- Department of Surgery, Assab Military Hospital, Assab, Eritrea
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Zhang M, Pan G, Zhou S, Shen J, Li W, Zhou Y, Yu L, Zhang L. Etiologies and clinical characteristics of acute ataxia in a single national children's medical center. Brain Dev 2024; 46:103-107. [PMID: 38000948 DOI: 10.1016/j.braindev.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/12/2023] [Accepted: 10/21/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE To analyze etiologic factors of pediatric acute ataxia and to identify the severity of its underlying causes for urgent medical intervention. METHODS Clinical data of children diagnosed with acute ataxia between December 2015 and December 2021 from one national medical center were analyzed retrospectively. RESULTS A total of 99 children (59 boys, 40 girls), median age at disease onset 55 (range: 12-168) months, were enrolled. The median follow period was 46 (range 6-78) months. Eighty-six (86.9 %) children were diagnosed with immune-associated acute ataxia, among which acute post-infectious cerebellar ataxia (APCA) was the most common diagnosis (50.5 %), followed by demyelinating diseases of the central nervous system (18.2 %) and Guillain-Barré syndrome (9.1 %). On cerebrospinal fluid (CSF) examination, 35/73 (47.9 %) patients had pleocytosis (>5 cells/mm3), and 18/73 (24.7 %) had elevated protein levels. Thirty-one patients (31.3 %) had an abnormal cerebral MRI. Children with other immune-associated acute cerebellar ataxia had more extracerebellar symptoms, intracranial MRI lesions, abnormal CSF results, longer hospital stay, higher recurrence rates and incidence of neurological sequelae than children with APCA. CONCLUSION Immune-associated acute ataxia is the main cause of pediatric acute ataxia, among which APCA is the most common phenotype. However, some immune-associated diseases, especially autoantibody-mediated disease, which has a higher recurrence rate and neurological sequelae account for an increasing proportion of pediatric acute ataxia. When children present with extracerebellar symptoms, abnormal cranial MRI or CSF results, and without prodromal infection, prudent differential diagnosis is recommended.
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Affiliation(s)
- Min Zhang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Gang Pan
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Jin Shen
- Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Wenhui Li
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Lifei Yu
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China
| | - Linmei Zhang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, 399# Wan Yuan Road, 201102 Shanghai, China.
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Abualhasan A, Naseer MA, Shalaby N, El-Jaafary SI, Farghaly M, Shehata HS, Doma ES, Al-Azayem SA. Reliability and validity of the Arabic version of brief international cognitive assessment for multiple sclerosis in Egyptian pediatric multiple sclerosis patients. Mult Scler Relat Disord 2024; 82:105374. [PMID: 38134604 DOI: 10.1016/j.msard.2023.105374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/02/2023] [Accepted: 12/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND & OBJECTIVES About one-third of pediatric-onset MS (POMS) patients report cognitive impairment. This case-control study aimed to assess the reliability and validity of the Arabic version of the Brief International Cognitive Assessment for MS (BICAMS) in Egyptian POMS patients. METHODS A case-control study was conducted on 30 POMS patients aged 9 to 17 years old and 30 healthy controls. Both groups underwent the following tests: neuropsychological testing using the BICAMS-validated Arabic version battery involving the Symbol Digit Modality Test (SDMT), California Verbal Learning Test 2nd edition (CVLT-II) and revised Brief Visuospatial Retention Test (BVRT-R). Test-retest data were obtained from MS patients and controls 2 weeks following the primary evaluation. Mean variances between both groups were evaluated, controlling for age, gender, and educational level. RESULTS MS patients scored significantly lower on the SDMT, CVLT-II, and BVMT-R tests than healthy controls (P-value <0.001). Test-retest reliability was satisfactory for SDMT, CVLT-II total, and BVRT-R in MS patients and controls with r values of 0.73, 0.83, and 0.80, respectively. CONCLUSION BICAMS is a feasible approach to cognitive screening in POMS and adults. The Arabic version of BICAMS is a reliable and valid tool for the cognitive assessment of pediatric MS patients in different clinical and research settings.
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Affiliation(s)
| | | | - Nevin Shalaby
- Department of Neurology, Cairo University, Cairo, Egypt
| | | | - Marwa Farghaly
- Department of Neurology, Cairo University, Cairo, Egypt.
| | | | - Ebtehal S Doma
- Department of Neurology, Cairo University, Cairo, Egypt.
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Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [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] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Zhou D, Xu L, Wang T, Wei S, Gao F, Lai X, Cao J. M-DDC: MRI based demyelinative diseases classification with U-Net segmentation and convolutional network. Neural Netw 2024; 169:108-119. [PMID: 37890361 DOI: 10.1016/j.neunet.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 09/03/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023]
Abstract
Childhood demyelinative diseases classification (DDC) with brain magnetic resonance imaging (MRI) is crucial to clinical diagnosis. But few attentions have been paid to DDC in the past. How to accurately differentiate pediatric-onset neuromyelitis optica spectrum disorder (NMOSD) from acute disseminated encephalomyelitis (ADEM) based on MRI is challenging in DDC. In this paper, a novel architecture M-DDC based on joint U-Net segmentation network and deep convolutional network is developed. The U-Net segmentation can provide pixel-level structure information, that helps the lesion areas location and size estimation. The classification branch in DDC can detect the regions of interest inside MRIs, including the white matter regions where lesions appear. The performance of the proposed method is evaluated on MRIs of 201 subjects recorded from the Children's Hospital of Zhejiang University School of Medicine. The comparisons show that the proposed DDC achieves the highest accuracy of 99.19% and dice of 71.1% for ADEM and NMOSD classification and segmentation, respectively.
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Affiliation(s)
- Deyang Zhou
- Machine Learning and I-health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, 310018, China; Artificial Intelligence Institute, Hangzhou Dianzi University, Zhejiang, 310018, China; HDU-ITMO Joint Institute, Hangzhou Dianzi University, Zhejiang, 310018, China.
| | - Lu Xu
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, 310018, China.
| | - Tianlei Wang
- Machine Learning and I-health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, 310018, China; Artificial Intelligence Institute, Hangzhou Dianzi University, Zhejiang, 310018, China.
| | - Shaonong Wei
- Machine Learning and I-health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, 310018, China; Artificial Intelligence Institute, Hangzhou Dianzi University, Zhejiang, 310018, China; HDU-ITMO Joint Institute, Hangzhou Dianzi University, Zhejiang, 310018, China.
| | - Feng Gao
- Department of Neurology, Children's Hospital, Zhejiang University School of Medicine, 310018, China.
| | - Xiaoping Lai
- Machine Learning and I-health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, 310018, China; Artificial Intelligence Institute, Hangzhou Dianzi University, Zhejiang, 310018, China.
| | - Jiuwen Cao
- Machine Learning and I-health International Cooperation Base of Zhejiang Province, Hangzhou Dianzi University, 310018, China; Artificial Intelligence Institute, Hangzhou Dianzi University, Zhejiang, 310018, China.
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Co DO. Acquired Demyelinating Syndromes. Med Clin North Am 2024; 108:93-105. [PMID: 37951658 DOI: 10.1016/j.mcna.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Acquired demyelinating syndromes (ADS) are a heterogenous group of inflammatory demyelinating conditions that include presentations of optic neuritis, transverse myelitis, and acute demyelinating encephalomyelitis. They can be monophasic or can develop into relapsing episodes of the initial demyelinating event or evolve to include other types of demyelination. Significant progress has been made in differentiating subtypes of ADS that differ in their tendency to relapse and in which anti-inflammatory therapies are effective. Differentiating between these subtypes is important for the optimal management of these patients. Clinical features, labs (especially autoantibodies), and MRI findings can help to differentiate between the different ADS.
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Affiliation(s)
- Dominic O Co
- Division of Allergy, Immunology, Rheumatology, Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Clinical Science Center (CSC), H6/572, 600 Highland Avenue, Madison, WI 53792, USA.
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Carvalho IV, dos Santos CS, Amaral J, Ribeiro JA, Pereira C, Pais RP, Palavra F. Multiple sclerosis under the age of ten: the challenge of a rare diagnosis in a special population - a case series. Front Neurosci 2023; 17:1297171. [PMID: 38174051 PMCID: PMC10761493 DOI: 10.3389/fnins.2023.1297171] [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] [Received: 09/19/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
Introduction Multiple sclerosis (MS) is a chronic inflammatory demyelinating and degenerative disease of the central nervous system which, when it begins before the age of 18, is defined as paediatric MS. Most common clinical presentations include long tract involvement, brainstem/cerebellum syndromes, optic neuritis and acute disseminated encephalomyelitis. Paediatric-onset MS typically has a more inflammatory-active course and a higher lesion burden in imaging studies, but an extensive post-relapse recovery, with a slower long-term disability progression. The first demyelinating clinical attack occurs before 10 years old in less than 1% of patients, and, in this special population, the condition has particularities in clinical presentation, differential diagnosis, diagnostic assessment, current treatment options and outcome. Clinical cases We present the cases of four Caucasian children (2 girls) diagnosed with relapsing-remitting MS before the age of ten, with a mean age at the time of the first relapse of 7.4 ± 2.4 years. Clinical presentation included optic neuritis, myelitis, brainstem syndrome, and acute disseminated encephalomyelitis. Baseline MRI identified several lesions, frequently large and ill-defined. Two patients were included in clinical trials and two patients remain in clinical and imaging surveillance. Conclusion Diagnosis of MS before the age of 10 years is rare, but it has significant long-term physical and cognitive consequences, as well as a substantial impact on the current and future quality of life of the child and family. Early and correct diagnosis is essential. Prospective, randomized, large cohort studies are needed to assess the efficacy and safety of disease-modifying treatments in children under the age of ten.
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Affiliation(s)
- Inês V. Carvalho
- Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Neurology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Constança Soares dos Santos
- Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Amaral
- Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Joana Afonso Ribeiro
- Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Cristina Pereira
- Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Rui Pedro Pais
- Medical Image Department – Neuroradiology Unit, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Filipe Palavra
- Center for Child Development – Neuropediatrics Unit, Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Laboratory of Pharmacology and Experimental Therapeutics, Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Clinical Academic Center of Coimbra, Coimbra, Portugal
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Abe J, Jafarpour S, Vu MH, O'Brien D, Boyd NK, Vogel BN, Nguyen L, Paulsen KC, Saucier LE, Ahsan N, Mitchell WG, Santoro JD. Impact of endocrine dysregulation on disability and non-motor symptoms in pediatric onset multiple sclerosis. Front Neurol 2023; 14:1304610. [PMID: 38130835 PMCID: PMC10733457 DOI: 10.3389/fneur.2023.1304610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Pediatric onset multiple sclerosis (POMS) commonly occurs at the time of various endocrine changes. Evaluation of the impact of endocrine status on disease severity in POMS has not been previously explored. Objective This study sought to evaluate if sex and stress hormones in children with POMS impact motor and non-motor diseases severity. Methods A single-center case control study was performed. Individuals with POMS were compared to individuals without neurologic disease. Each individual had three blood draws assessing stress and sex hormones between 07:00 and 09:00. Measures of fatigue (Epworth sleepiness scale), depression (PHQ-9), and quality of life (PedsQL) assessed at each visit. Results Forty individuals with POMS and 40 controls were enrolled. Individuals with POMS had lower free testosterone (p = 0.003), cortisol (p < 0.001), and ACTH (p < 0.001) and had higher progesterone (p = 0.025) levels than controls. Relapses and EDSS were not impacted by endocrine variables. The POMS cohort had a significantly higher Epworth score (p < 0.001), PHQ-9 score (p < 0.001), and lower PQL score (p < 0.001) than controls. Non-motor measures were not associated with endocrine status. Conclusion Free testosterone, cortisol, ACTH, and progesterone were abnormal in children with POMS although there was no association between endocrine status and markers of disease severity or non-motor symptoms of MS.
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Affiliation(s)
- Justin Abe
- John A. Burns School of Medicine, University of Hawaii, Honolulu, HI, United States
| | - Saba Jafarpour
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - My H. Vu
- Biostatistics and Data Management Core, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Devon O'Brien
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Natalie K. Boyd
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Benjamin N. Vogel
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Lina Nguyen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Kelli C. Paulsen
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
| | - Laura E. Saucier
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Nusrat Ahsan
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Wendy G. Mitchell
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
| | - Jonathan D. Santoro
- Division of Neurology, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Neurology, Keck School of Medicine of USC, Los Angeles, CA, United States
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Safranek-Neylon H, Powers A, Rathore G. Acute Lower Extremity Weakness in a Pediatric Gymnast. Clin Pediatr (Phila) 2023; 62:1587-1590. [PMID: 36964681 DOI: 10.1177/00099228231162225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Affiliation(s)
| | - Andria Powers
- Children's Hospital & Medical Center, Omaha, NE, USA
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