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Yazdan Panah M, Vaheb S, Mokary Y, Afshari-Safavi A, Shaygannejad A, Ebrahimi N, Shaygannejad V, Mirmosayyeb O. Comparing the consequences of COVID-19 vaccination between central nervous system (CNS) demyelinating diseases and other neurological disorders. Vaccine 2024:S0264-410X(24)00702-3. [PMID: 38886142 DOI: 10.1016/j.vaccine.2024.06.028] [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: 12/25/2023] [Revised: 05/27/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
BACKGROUND Vaccination constitutes a crucial preventive measure against COVID-19 infection. Concerns have been raised regarding the efficacy of vaccines in multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients due to various immunomodulatory medications and potential adverse events that may impact neurological function. This study aimed to explore the implications of COVID-19 vaccination within MS and NMSOD patients and compare it with other neurological disorders (OND). METHOD In this cross-sectional study conducted in Isfahan, Iran, baseline data and information on COVID-19 infections and vaccinations were collected from MS, NMOSD, and OND patients between September 2021 and September 2022. The predominant neurological disorders identified among OND patients encompassed headache, epilepsy, and Parkinson's disease. Logistic regression analysis was employed to compare COVID-19 vaccination outcomes among different patient groups, presenting odds ratios (OR) with 95% confidence intervals (CI). RESULTS The study included 1,307 participants, with 738 having MS, 96 having NMOSD, 76 having clinically isolated syndrome (CIS), and 397 having OND. Significantly higher odds of post-vaccination COVID-19 infection were detected in MS (OR = 3.86, p < 0.001) NMOSD (OR = 2.77, p = 0.015) patients than OND patients. The prior history of COVID-19 infection and the type of vaccine administered did not demonstrate significant associations with the likelihood of post-vaccination COVID-19 infection in MS and NMOSD patients (p > 0.05 for all). There were no significant differences in the rates of adverse events in MS, NMOSD, and OND patients, except the second dose, where NMOSD patients had lower odds than OND patients (OR = 0.55, p = 0.019). CONCLUSION Although the safety profile of COVID-19 vaccination in MS and NMOSD was similar to that in OND, the rates of post-vaccination COVID-19 infection in MS and NMOSD seem higher than OND. These findings highlight the importance of regular serological monitoring and the potential advantages of supplementary vaccine doses in MS and NMOSD patients.
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Affiliation(s)
- Mohammad Yazdan Panah
- Student Research Committee, Shahrekord University of Medical Sciences, Shahrekord, Iran; Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Yousef Mokary
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd, Iran
| | - Aysa Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Narges Ebrahimi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Miguez J, Patrucco L, Cristiano E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Fernández Liguori N, Nadur D, Alonso Serena M, Caride A, Rojas JI. Treatment strategies and responses for attacks of neuromyelitis optica spectrum disorder: A real-world retrospective cohort study. J Neurol Sci 2024; 462:123099. [PMID: 38897155 DOI: 10.1016/j.jns.2024.123099] [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: 05/04/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/21/2024]
Abstract
We aimed to assess the treatment strategies utilized in patients with neuromyelitis optica spectrum disorder (NMOSD) experiencing relapses, including their frequency, types, and response after 6 months based on the Expanded Disability Status Scale (EDSS) score. METHODS We conducted a retrospective study involving NMOSD patients from the Argentinean MS and NMOSD registry (RelevarEM, NCT03375177). Treatment response at 6 months was categorized as "good" if the EDSS score decreased by ≥1 point after a nadir EDSS score ≤ 3, or by ≥2 points after a nadir EDSS score > 3, "poor" if the EDSS score decrease was slighter, and as "absent" if the EDSS score remained unchanged or worsened. RESULTS We included 120 NMOSD patients (seropositive N = 75), who experienced 250 NMOSD-related relapses and received 248 treatments. At 6 months, complete recovery was achieved in 70/98 (71.4%) and 15/19 (79%) patients, respectively. Predictors of a "good" response in our regression model were a younger age at disease onset (OR:3.54, CI95% 2.45-5.01, p < 0.0001) and a short delay from onset of relapse to treatment initiation (OR:1.56, CI95% 1.22-2.13, p = 0.004). CONCLUSIONS Approximately two-thirds of patients experienced complete recovery, and younger age and a short delay to start treatment were independent predictors of a "good" response.
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Affiliation(s)
- Edgar Carnero Contentti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina.
| | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | | | - Jorge Correale
- Departamento de Neurología - FLENI, Buenos Aires, Argentina
| | | | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, Buenos Aires, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, Buenos Aires, Argentina; Hospital Naval, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de clínica médica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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3
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Xu Y, Wang H, Song T, Yin L, Yao Y, Wei Y, Cong H, Sun J, Zhang X, Tian D. Efficacy and safety of apheresis therapy in AQP4 antibody-positive NMOSD attack: A propensity score-matched cohort study. CNS Neurosci Ther 2024; 30:e14780. [PMID: 38790106 PMCID: PMC11126786 DOI: 10.1111/cns.14780] [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: 02/03/2024] [Revised: 04/06/2024] [Accepted: 05/12/2024] [Indexed: 05/26/2024] Open
Abstract
OBJECTIVE Plasma exchange (PE) and immunoadsorption (IA) are recognized as effective ways to treat attacks in AQP4 antibody-positive NMOSD, but high-quality evidence was lacking. To evaluate the efficacy and safety of PE/IA plus intravenous methylprednisolone (IVMP) in NMOSD attacks using propensity scores to match IVMP as control. METHODS Patients were from a prospective observational cohort study. Stratification and interval propensity score matching (PSM) were used to reduce selection bias by matching baseline characteristics (gender, age, time to IVMP, EDSS at attack) between PE/IA + IVMP and IVMP group (in a ratio of 1:2). The primary endpoint of efficacy was EDSS change at 6 months. Adverse events and changes in laboratory tests were recorded. RESULTS Four hundred and eleven attacks of 336 patients were screened for PSM, and 90 attacks (30 PE/IA + IVMP and 60 IVMP) were included in the analysis. There were significant differences in EDSS [6.25 vs. 6.75; IQR (4.50-8.38 vs. 5.00-8.00), p = 0.671] and visual acuity [median logMAR = 0.35 vs. 1.00; IQR (0.30-0.84 vs. 0.95-1.96), p = 0.002] change between two groups at 6 months. PE/IA + IVMP treatment demonstrated predictive capacity for good recovery as indicated by an area under the curve (AUC) of 0.726. Fibrinogen reduction was found during PE/IA + IVMP treatment [n = 15 (50.00%)], but no severe adverse events led to apheresis treatment discontinuation. DISCUSSION After PSM analysis, IVMP+PE/IA in acute attack of NMOSD achieved better and continuous improvement in neurological function within 6 months compared with IVMP alone. PE/IA treatment showed a good safety profile.
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Affiliation(s)
- Yun Xu
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Huabing Wang
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Tian Song
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Linlin Yin
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
- China National Clinical Research Center for Neurological DiseasesBeijingChina
| | - Yajun Yao
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Yuzhen Wei
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Hengri Cong
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Jiali Sun
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - Xinghu Zhang
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
| | - De‐Cai Tian
- Center for Neurology, Beijing Tiantan HospitalCapital Medical UniversityBeijingChina
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Iancu R, Pirvulescu R, Anton N, Iancu G, Istrate S, Romanitan MO, Geamanu A, Popa Cherecheanu M. Visual Function Improvement after Plasma Exchange Therapy for Acute Optic Neuritis in Neuromyelitis Optica Spectrum Disorders: Case Series and Review. Diagnostics (Basel) 2024; 14:863. [PMID: 38732279 PMCID: PMC11083380 DOI: 10.3390/diagnostics14090863] [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: 04/09/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorder (NMOSD) are autoimmune-mediated central nervous system disorders distinguished by the presence of serum aquaporine-4 IgG antibody (AQP4-Ab). The clinical panel comprises severe optic neuritis (ON) and transverse myelitis, which can result in incomplete recovery and a high risk of recurrence. METHODS This study aimed to evaluate the visual outcomes of three patients with severe acute ON in NMOSD that was non-responsive to intravenous methylprednisolone (IVMP), who received plasma exchange therapy (PLEX). We included three patients (P1, P2 and P3) with severe acute ON who had no improvement after IVMP treatment and were admitted to the ophthalmology department at the Emergency University Hospital Bucharest from January 2022 to September 2023. All three patients with ON were diagnosed in accordance with the criteria described by the Optic Neuritis Treatment Trial. All the subjects were experiencing their first attack. RESULTS The mean recruitment age was 35.3 ± 7.71. All patients were seropositive for the AQP4 antibody. All patients were tested for serum myelin oligodendrocyte glycoprotein (MOG) antibody but only one showed a positive test (P3). Lesions visible in orbital MRI indicated the involvement of retrobulbar, canalicular and/or intracranial segments. All three subjects had no response or incomplete remission after an IVMP protocol (5 days of 1000 mg intravenous methylprednisolone in sodium chloride 0.9%). The mean time from onset of optic neuritis to PLEX was 37.6 days. The PLEX treatment protocol comprised five cycles of plasma exchange treatment over 10 days, with a plasma exchange session every other day. An amount of 1 to 1.5 volumes of circulating plasma were dialyzed for 2-4 h. At 1 month after the completion of PLEX therapy, BCVA and VF parameters were improved in all three patients. CONCLUSION The treatment of ON remains subject to debate and is somewhat controversial. Plasma exchange must be considered as a rescue therapy when IVMP is insufficient for AQP4-ON patients. This study revealed that PLEX treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. This study suggests that PLEX may be associated with improved visual outcomes in NMOSD acute optic neuritis.
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Affiliation(s)
- Raluca Iancu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Ruxandra Pirvulescu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Nicoleta Anton
- Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - George Iancu
- Department of Obstetrics-Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania;
| | - Sinziana Istrate
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Mihaela Oana Romanitan
- Department of Internal Medicine, Section of Neurology, Södersjukhuset, 11883 Stockholm, Sweden;
| | - Aida Geamanu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Matei Popa Cherecheanu
- Department of Cardiovascular Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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Fisher KS, Illner A, Kannan V. Pediatric neuroinflammatory diseases in the intensive care unit. Semin Pediatr Neurol 2024; 49:101118. [PMID: 38677797 DOI: 10.1016/j.spen.2024.101118] [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: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 04/29/2024]
Abstract
Inflammatory disorders of the central nervous system (CNS) include a wide spectrum of autoimmune, autoinflammatory, and paraneoplastic diseases. While many affected patients require acute hospital admission, a subset may present with severe neurological symptoms requiring intensive care unit (ICU) escalation due to disordered consciousness, respiratory failure, status epilepticus, intracranial hypertension, and/or severe autonomic dysregulation.
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Affiliation(s)
- Kristen S Fisher
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas.
| | - Anna Illner
- Department of Radiology, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Varun Kannan
- Division of Pediatric Neurology, Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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Akosman S, Li R, Asahi M, Kwon B, Dossantos J, Tavakoli M, Chen JJ. Trends in Plasma Exchange Use in Optic Neuritis Hospitalizations in the United States. Ophthalmology 2024:S0161-6420(24)00201-X. [PMID: 38552677 DOI: 10.1016/j.ophtha.2024.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To report use trends of plasma exchange (PLEX) as well as sociodemographic and medical comorbidities associated with PLEX in the United States. DESIGN Retrospective cross-sectional study. PARTICIPANTS Adult patients (≥ 18 years) admitted for inpatient hospitalization with a primary diagnosis of optic neuritis (ON). METHODS Data from the National Inpatient Sample database was compiled to assess PLEX use rates between 2000 and 2020. The cohorts of patients receiving PLEX versus not receiving PLEX were analyzed between quarter 4 of 2015 through 2020 (International Classification of Diseases, Tenth Revision [ICD-10], only) for patient sociodemographic variables, medical diagnoses, insurance types, hospital characteristics, cause of disease, time to therapy, length of stay (LOS), and total charges incurred. MAIN OUTCOME MEASURES Incidence of ON, incidence of PLEX, demographics, diagnoses associated with PLEX therapy, total charges, and LOS. RESULTS From 2000 through 2020, 11 209 patients hospitalized with a primary diagnosis of ON were identified, with a significant majority managed at urban teaching hospitals. Use of PLEX increased steadily over 2 decades from 0.63% to 5.46%. Use was greatest in the western United States and least in the eastern United States. In the subset of ICD-10 cases, 3215 patients were identified. The median time to therapy of PLEX was 1 day after admission, and PLEX use was highest in patients with neuromyelitis optica spectrum disorder (NMOSD) (21.21%) and lowest in multiple sclerosis-associated ON (3.80%). Use of PLEX was associated with significantly longer LOS and higher total charges incurred. Medical comorbidities associated with PLEX included adverse reaction to glucocorticoids (adjusted odds ratio [aOR], 31.50), hemiplegia (aOR, 28.48), neuralgia (aOR, 4.81), optic atrophy (aOR, 3.74), paralytic strabismus (aOR, 2.36), and psoriasis (aOR, 1.76). CONCLUSIONS Over the last 2 decades in the United States, PLEX therapy for ON has increased, with the highest use in the western United States and for patients with the diagnosis NMOSD ON. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sinan Akosman
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Renxi Li
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Masumi Asahi
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, California
| | - Bryan Kwon
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Jason Dossantos
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University, Washington, DC
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota.
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de Almeida GMR, de Araujo RS, Castrillo BB, Silva GD, Fortini I, Gonçalves MRR, Castro LHM, Tatsui NH, Adoni T, Sato DK, Apóstolos-Pereira SL, Callegaro D. Therapeutic plasma exchange for neuromyelitis optica attacks: Evidence and challenges from a real-world cohort from Brazil. J Neuroimmunol 2024; 388:578295. [PMID: 38280268 DOI: 10.1016/j.jneuroim.2024.578295] [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: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Therapeutic plasma exchange (TPE) can improve disability recovery after neuromyelitis optica spectrum disease (NMOSD) attacks, but its effectiveness and safety in Latin-American patients with access barriers and diverse ethnicity is underexplored. We carried out a retrospective cohort study with NMOSD patients that underwent TPE. 84 NMOSD attacks in 68 patients were evaluated. Despite a median 25-day delay from symptom onset to TPE, 65,5% of patients showed significant improvement. Adverse events occurred in 39% of patients, usually transitory and with no fatalities.
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Affiliation(s)
- Guilherme Mello Ramos de Almeida
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Hospital Cardio Pulmonar da Bahia, Salvador, Bahia, Brazil
| | - Roger Santana de Araujo
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
| | - Bruno Batitucci Castrillo
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Espírito Santo, Brazil
| | - Guilherme Diogo Silva
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Ida Fortini
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | | | - Luiz Henrique Martins Castro
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Nelson Hidekazu Tatsui
- Hematology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Tarso Adoni
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Douglas Kazutoshi Sato
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; School of Medicine and Institute for Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dagoberto Callegaro
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
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Han JS, Ryu SM, Lim YH, Kim AR, Jung TD. Treatment and Rehabilitation of a Patient with Neuromyelitis Optica Spectrum Disorder-Induced Complete Spinal Cord Injury Following COVID-19 Vaccination: A Case Report. J Clin Med 2024; 13:1175. [PMID: 38398485 PMCID: PMC10888719 DOI: 10.3390/jcm13041175] [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: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Neuromyelitis optica spectrum disease (NMOSD) is a rare autoimmune disorder of the central nervous system characterized by optic neuritis, myelitis, or brain lesions. Its symptoms overlap with those of multiple sclerosis (MS), making a diagnosis of NMOSD challenging. Here, we report a rare case of NMOSD-induced complete spinal cord injury following COVID-19 vaccination. A 52-year-old female patient developed NMOSD-induced complete spinal cord injury after receiving their third dose of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2). Despite the initial diagnosis of complete spinal cord injury, the patient underwent intensive treatment, including rituximab therapy and rehabilitation. As a result, she made a full recovery and transitioned from the ASIA Impairment Scale(AIS)-A to AIS-E. The remarkable neurological recovery from complete spinal cord injury to functional independence highlights the efficacy of a comprehensive treatment approach. In addition, this case emphasizes the need to recognize NMOSD as a potential adverse outcome of COVID-19 vaccination and emphasizes the importance of early diagnosis, timely intervention, and thorough rehabilitation for optimizing patient results. Further case reports and studies are needed to investigate the association between COVID-19 vaccination and the occurrence of NMOSD.
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Affiliation(s)
- Jun-Sang Han
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
| | - Seong-Mun Ryu
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
| | - Young-Hwan Lim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
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9
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Jiang B, Hong N, Zhao F, Dong F. Visualization and analysis of mapping knowledge domains for optic neuritis: a bibliometric research from 2013 to 2022. Int Ophthalmol 2024; 44:57. [PMID: 38342798 PMCID: PMC10859331 DOI: 10.1007/s10792-024-02948-7] [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: 08/23/2023] [Accepted: 12/04/2023] [Indexed: 02/13/2024]
Abstract
PURPOSE To explore the global research trends, hotspots and frontiers of optic neuritis (ON) over the past decade through qualitative and quantitative analysis of bibliometrics. METHODS Publications on ON from 2013 to 2022 were retrieved from Web of Science Core Collection (WoSCC). VOSviewer and CiteSpace were mainly used to facilitate bibliometric analysis and visualization. RESULTS A total of 3027 papers were retrieved from peer-reviewed publications and the annual research output increased over time. Neurosciences neurology was the most published area. The USA was the most productive and influential country, and in the focus of international cooperation. University College London was the most productive organization and Charite Medical University of Berlin had the largest number of cooperating partners. Paul F contributed the largest number of publications and Wingerchuk DM ranked first among the co-cited authors. Multiple Sclerosis and Related Disorders was the most prolific journal publishing ON research. The most co-cited references mainly focused on the diagnostic criteria for neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS). The keywords formed the following four clusters: the pathophysiology of MS-ON; the autoantibody markers and diagnostic criteria of NMOSD-ON and myelin oligodendrocyte glycoprotein associated disorder-ON (MOGAD-ON); the epidemiology and clinical characteristics of ON; and the treatment of ON. CONCLUSION This bibliometrics analysis showed a systematic view of the evolutionary process, research hotspots, and future directions of ON research. It can provide insights for ON research and valuable information for neuro-ophthalmologic specialists to evaluate research policies and promote international cooperation.
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Affiliation(s)
- Bo Jiang
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Nan Hong
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Fangkun Zhao
- Department of Ophthalmology, The Fourth Affiliated Hospital of China Medical University, Shenyang, 110032, China
| | - Feng Dong
- Department of Ophthalmology, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, 310003, China.
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10
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Ponleitner M, Rommer PS. Treatment of neuromyelitis optica spectrum disorder: revisiting the complement system and other aspects of pathogenesis. Wien Med Wochenschr 2024; 174:4-15. [PMID: 36472724 PMCID: PMC10810999 DOI: 10.1007/s10354-022-00987-2] [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: 07/22/2022] [Accepted: 10/22/2022] [Indexed: 12/12/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) represents a rare neuroimmunological disease causing recurrent attacks and accumulation of permanent disability in affected patients. The discovery of the pathogenic IgG‑1 antibody targeting a water channel expressed in astrocytes, aquaporin 4, constitutes a milestone achievement. Subsequently, multiple pathophysiological aspects of this distinct disease entity have been investigated. Demyelinating lesions and axonal damage ensue from autoantibodies targeting an astroglial epitope. This conundrum has been addressed in the current disease model, where activation of the complement system as well as B cells and interleukin 6 (IL-6) emerged as key contributors. It is the aim of this review to address these factors in light of novel treatment compounds which reflect these pathophysiological concepts in aiming for attack prevention, thus reducing disease burden in patients with NMOSD.
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Affiliation(s)
- Markus Ponleitner
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Paulus Stefan Rommer
- Department of Neurology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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11
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Levy M. Immune-Mediated Myelopathies. Continuum (Minneap Minn) 2024; 30:180-198. [PMID: 38330478 PMCID: PMC10868882 DOI: 10.1212/con.0000000000001382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Immune-mediated myelopathies are conditions in which the immune system attacks the spinal cord. This article describes the distinguishing characteristics of immune-mediated myelopathies and treatment strategies for patients affected by these disorders. LATEST DEVELOPMENTS New biomarkers, such as aquaporin 4 and myelin oligodendrocyte glycoprotein antibodies, in the blood and spinal fluid have led to the identification of antigen-specific immune-mediated myelopathies and approved therapies to prevent disease progression. ESSENTIAL POINTS The first step in the diagnosis of an immune-mediated myelopathy is confirming that the immune system is the cause of the attack by excluding non-immune-mediated causes. The second step is to narrow the differential diagnosis based on objective biomarkers such as serology and MRI patterns. The third step is to treat the specific immune-mediated myelopathy by using evidence-based medicine.
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12
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Moheb N, Chen JJ. The neuro-ophthalmological manifestations of NMOSD and MOGAD-a comprehensive review. Eye (Lond) 2023; 37:2391-2398. [PMID: 36928226 PMCID: PMC10397275 DOI: 10.1038/s41433-023-02477-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/07/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Optic neuritis (ON) is one of the most frequently seen neuro-ophthalmic causes of vision loss worldwide. Typical ON is often idiopathic or seen in patients with multiple sclerosis, which is well described in the landmark clinical trial, the Optic Neuritis Treatment Trial (ONTT). However, since the completion of the ONTT, there has been the discovery of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies, which are biomarkers for neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody-associated disease (MOGAD), respectively. These disorders are associated with atypical ON that was not well characterised in the ONTT. The severity, rate of recurrence and overall outcome differs in these two entities requiring prompt and accurate diagnosis and management. This review will summarise the characteristic neuro-ophthalmological signs in NMOSD and MOGAD, serological markers and radiographic findings, as well as acute and long-term therapies used for these disorders.
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Affiliation(s)
- Negar Moheb
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA.
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13
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Shen X. Research progress on pathogenesis and clinical treatment of neuromyelitis optica spectrum disorders (NMOSDs). Clin Neurol Neurosurg 2023; 231:107850. [PMID: 37390569 DOI: 10.1016/j.clineuro.2023.107850] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 04/11/2023] [Accepted: 06/23/2023] [Indexed: 07/02/2023]
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are characteristically referred to as various central nervous system (CNS)-based inflammatory and astrocytopathic disorders, often manifested by the axonal damage and immune-mediated demyelination targeting optic nerves and the spinal cord. This review article presents a detailed view of the etiology, pathogenesis, and prescribed treatment options for NMOSD therapy. Initially, we present the epidemiology of NMOSDs, highlighting the geographical and ethnical differences in the incidence and prevalence rates of NMOSDs. Further, the etiology and pathogenesis of NMOSDs are emphasized, providing discussions relevant to various genetic, environmental, and immune-related factors. Finally, the applied treatment strategies for curing NMOSD are discussed, exploring the perspectives for developing emergent innovative treatment strategies.
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Affiliation(s)
- Xinyu Shen
- Department of Neurology, Putuo Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200000, PR China.
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14
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Sarin S, Modak N, Sun R, Subei O, Serra A, Morgan M, Abboud H. Predicting the final clinical phenotype after the first attack of optic neuritis. J Neuroimmunol 2023; 381:578130. [PMID: 37343437 DOI: 10.1016/j.jneuroim.2023.578130] [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: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the factors determining the final clinical phenotype after an initial isolated attack of optic neuritis (ON). ON could be an isolated event or the initial presentation of a chronic neuroimmunological condition. METHODS This was a retrospective analysis of patients presenting to University Hospitals Cleveland Medical Center for an initial, isolated attack of ON. Final clinical phenotypes were idiopathic ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), or secondary ON (e.g. neurosarcoidosis). Several potential predictors at the time of initial presentation were compared among the different phenotypes to determine early predictors. Categorical variables were compared using Pearson χ2 or Fisher's exact test, and continuous variables were compared using independent t-test. RESULTS Sixty-four patients met criteria (average age 41.3 ± 13.3, 78.1% females). Average time to final diagnosis was 8.3 months, and average follow-up was 47 months. The final phenotypes were MS (22, 34%), idiopathic ON (14, 22%), MOGAD (11, 17%), NMOSD (10, 16%), and secondary ON (7, 11%). White race, unilateral ON, short segment hyperintensity on orbital MRI, classical demyelination on brain MRI, and not requiring PLEX were associated with MS. Older age, poor steroid responsiveness, and requiring PLEX were associated with NMOSD. African American race, bilateral ON, papillitis on fundoscopy, long segment hyperintensity on orbital MRI, and normal brain MRI were associated with MOGAD. Normal or thinned retinal nerve fiber layer on OCT, short segment hyperintensity on orbital MRI, and normal brain MRI were associated with idiopathic ON. CONCLUSION The final clinical phenotype may be predictable at the time of initial ON presentation. This requires a careful evaluation of patient demographics, treatment response, funduscopic findings, OCT, and orbital and brain MRIs. Utilizing early predictors in clinical practice could better inform prognosis and management decisions.
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Affiliation(s)
- Shlok Sarin
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Nikhil Modak
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rongyi Sun
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Omar Subei
- Duke University Medical Center, Durham, NC, United States of America
| | - Alessandro Serra
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; MS Center of Excellence, Cleveland Veterans Affairs Medical Center, United States of America
| | - Michael Morgan
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Department of Ophthalmology, University Hospitals Cleveland Medical Center, United States of America
| | - Hesham Abboud
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America.
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15
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Queiroz ALGD, Soares Neto HR, Kobayashi TT, Silva SMCDA. Plasma exchange in inflammatory demyelinating disorders of the central nervous system: reasonable use in the clinical practice. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:296-307. [PMID: 37059439 PMCID: PMC10104758 DOI: 10.1055/s-0042-1758447] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Plasma exchange (PLEX) is a therapeutic apheresis modality in which the plasma is separated from inflammatory factors such as circulating autoreactive immunoglobulins, the complement system, and cytokines, and its therapeutic effect is based on the removal of these mediators of pathological processes. Plasma exchange is well established for various neurological disorders, and it is applied successfully in central nervous system inflammatory demyelinating diseases (CNS-IDD). It mainly modulates the humoral immune system; thus, it has a greater theoretical effect in diseases with prominent humoral mechanisms, such as neuromyelitis optica (NMO). However, it also has a proven therapeutic effect in multiple sclerosis (MS) attacks. Several studies have suggested that patients with severe attacks of CNS-IDD have poor response to steroid therapy but show clinical improvement after the PLEX treatment. Currently, PLEX is generally established only as a rescue therapy for steroid unresponsive relapses. However, there are still research gaps in the literature regarding plasma volume, number of sessions, and how early the apheresis treatment needs to started. Thus, in the present article, we summarize the clinical studies and meta-analyses, especially about MS and NMO, outlining clinical data regarding the experience with therapeutic PLEX in severe attacks of CNS-IDD, the clinical improvement rates, the prognostic factors of a favorable response, and highlighting the likely role of the early apheresis treatment. Further, we have gathered this evidence and suggested a protocol for the treatment of CNS-IDD with PLEX in the routine clinical practice.
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Affiliation(s)
| | | | - Thiago Taya Kobayashi
- Hospital do Servidor Público Estadual de São Paulo, Serviço de Neurologia, São Paulo SP, Brazil
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16
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Heigl F, Hettich R, Fassbender C, Klingel R, Mauch E, Durner J, Kern R, Kleiter I. Immunoadsorption as maintenance therapy for refractory neuromyelitis optica spectrum disorder. Ther Adv Neurol Disord 2023; 16:17562864221150314. [PMID: 36762319 PMCID: PMC9905021 DOI: 10.1177/17562864221150314] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/12/2022] [Indexed: 02/10/2023] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing autoimmune disease of the central nervous system, affecting mainly optic nerves and spinal cord. NMOSD pathophysiology is associated with anti-aquaporin-4 (AQP4) immunoglobulin G (IgG) autoantibodies. Rapid extracorporeal elimination of autoantibodies with apheresis techniques, such as immunoadsorption (IA), was proven to be an effective treatment of NMOSD attacks. Data on the long-term use of IA to prevent attacks or progression of NMOSD are lacking. Objectives The aim of this study was to evaluate efficacy and safety of maintenance IA for preventing recurrence of NMOSD attacks in patients refractory to other immunotherapies. Design Case study. Methods Retrospective analysis of two female patients with severe NMOSD refractory to conventional immunotherapies was performed. Both patients had responded to tryptophan IA (Tr-IA) as attack therapy and subsequently were treated with biweekly maintenance Tr-IA. Results Patient 1 (AQP4-IgG seropositive, age 42 years) had 1.38 attacks of optic neuritis per year within 10.1 years before commencing regular Tr-IA. With maintenance Tr-IA for 3.1 years, one mild attack occurred, which was responsive to steroid pulse therapy. Expanded Disability Status Scale (EDSS) was stable at 5.0. Visual function score of the last eye improved from 3 to 1. Patient 2 (AQP4-IgG seronegative, age 43 years) experienced 1.7 attacks per year, mainly acute myelitis and optic neuritis, during the period of 10.0 years before the start of Tr-IA. During regular Tr-IA treatment, no further NMOSD attack occurred. The patient was clinically stable without any additional immunosuppressive treatment for 5.3 years. EDSS improved from 6.0 to 5.0, and the ambulation score from 7 to 1. Tolerability of Tr-IA was good in both patients. No serious adverse events occurred during long-term clinical trajectories. Conclusion Tr-IA was well tolerated as maintenance treatment and resulted in clinical stabilization of two patients with highly active NMOSD, who were refractory to standard drug therapy.
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Affiliation(s)
- Franz Heigl
- Medical Care Center Kempten-Allgäu, Kempten, Germany
| | | | | | - Reinhard Klingel
- Apheresis Research Institute, Cologne, Germany; 1st Department of Internal Medicine, University of Mainz, Mainz, Germany
| | - Erich Mauch
- Clinic for Neurology Dietenbronn, Academic Hospital of University of Ulm, Schwendi, Germany
| | - Joachim Durner
- Neurology Department, M&I Fachklinik Ichenhausen, Ichenhausen, Germany
| | - Rolf Kern
- Department of Neurology, Klinikum Worms, Worms, Germany
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17
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Lin Y, Oji S, Miyamoto K, Narita T, Kameyama M, Matsuo H. Real-world application of plasmapheresis for neurological disease: Results from the Japan-Plasmapheresis Outcome and Practice Patterns Study. Ther Apher Dial 2023; 27:123-135. [PMID: 35765859 PMCID: PMC10084057 DOI: 10.1111/1744-9987.13906] [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: 03/25/2022] [Accepted: 06/22/2022] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Plasmapheresis is a well-recognized treatment for autoimmune neurological diseases in Japan. However, the practice varies depending on the facility, and the actual treatment conditions are unclear. METHODS To clarify real-world conditions, a prospective observational study was conducted on patients with neurological diseases who were scheduled to receive plasmapheresis. A dataset was analyzed that included 887 treatments from 210 patients with myasthenia gravis (MG), multiple sclerosis (MS), neuromyelitis optica spectrum disorders (NMOSD), and other diseases for 82, 30, 24, and 74 patients, respectively. RESULTS The types of plasmapheresis performed included immunoadsorption plasmapheresis, plasma exchange, and double filtration plasmapheresis with 620, 213, and 54 treatments, respectively. Approximately, 60% of the treatments were performed using peripheral blood access alone. Non-serious adverse events were observed in 10 patients. CONCLUSIONS A statistically significant improvement was observed after plasmapheresis in patients with MG, MS, and NMOSD. These were evaluated using the modified Rankin Scale.
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Affiliation(s)
- Youwei Lin
- Department of Neurology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.,Department of Immunology, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Kodaira, Japan
| | - Satoru Oji
- Department of Neurology, Saitama Medical Center, Kawagoe, Japan
| | | | - Tomoko Narita
- Department of Neurology, Nagasaki Kawatana Medical Center, Kawatana, Japan
| | - Mana Kameyama
- Clinical Development Department, Asahi-Kasei Medical Co., Tokyo, Japan
| | - Hidenori Matsuo
- Department of Neurology, Nagasaki Kawatana Medical Center, Kawatana, Japan.,Department of Neurology, Nagasaki National Hospital, Nagasaki, Japan
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18
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Li Z, Wan L, Liu X, Wang J, Shi X, Zhou H, Xu Q, Wei S, Yang G. Safety and efficacy of plasma exchange treatment in children with AQP4-IgG positive neuromyelitis optica spectrum disorder. Front Immunol 2023; 13:1113406. [PMID: 36685590 PMCID: PMC9849793 DOI: 10.3389/fimmu.2022.1113406] [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: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD), a severe demyelinating disease, is rare among children. Plasma exchange (PE) is widely used as a salvage therapy for severe and corticosteroid-unresponsive patients with NMOSD. Presently, there are limited studies on the safety and efficacy of PE in children with NMOSD. Herein, we report the case of six children with NMOSD who received PE along with the outcomes and adverse events. All six children (female, age at onset 4 years 9 months-13 years 2 months) were AQP4-IgG positive and received standard PE using the COM.TEC Cell Separator. The interval between NMOSD onset and PE was 29 days (range 10-98). Only one patient (P3) who received PE 10 days after acute exacerbations exhibited clinical improvement. Her left visual acuity increased from 0.06 to 0.6 (spectacle-corrected visual acuity was 1.0) and her EDSS score decreased from 4 to 3 points. The other five patients had no clinical improvement and no EDSS scores changes after PE. Adverse events included rashes (P1, P3), acute non-occlusive thrombosis of the internal jugular vein (P1), and thrombocytopenia (P2). In conclusion, the timing of PE initiation as a rescue therapy for severe and corticosteroid-unresponsive pediatric AQP4-IgG positive NMOSD may be crucial to treatment efficacy, and early initiation of PE may be associated with a better outcome. Furthermore, PE has the potential risk for clinically significant adverse effects that should be considered before initiating the therapy and should be weighed against potential benefits.
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Affiliation(s)
- Zhichao Li
- Medical School of Chinese People’s Liberation Army, Beijing, China,Department of Pediatrics, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Lin Wan
- Medical School of Chinese People’s Liberation Army, Beijing, China,Department of Pediatrics, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Xinting Liu
- Medical School of Chinese People’s Liberation Army, Beijing, China,Department of Pediatrics, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Jing Wang
- Department of Pediatrics, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China,Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Xiuyu Shi
- Department of Pediatrics, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China,Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China
| | - Guang Yang
- Medical School of Chinese People’s Liberation Army, Beijing, China,Department of Pediatrics, The First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing, China,Senior Department of Pediatrics, The Seventh Medical Center of PLA General Hospital, Beijing, China,The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China,*Correspondence: Guang Yang,
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19
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Masha N, Kimbrough DJ, Eckstein CP, Hudak NM, Skeen MB, Hartsell FL, Lutz MW, Shah S. Neuromyelitis optica: Clinical course and potential prognostic indicators. Mult Scler Relat Disord 2023; 69:104414. [PMID: 36463620 DOI: 10.1016/j.msard.2022.104414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/08/2022] [Accepted: 11/13/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune neurological disorder associated with antibodies to aquaporin-4 (AQP4). NMOSD has been thought to follow a progressive disease course, with step-wise accumulation of disability over time, even in patients undergoing immunosuppressive/immunomodulatory therapy. The influence of factors such as AQP4 seropositivity, AQP4 serum titer levels, and administration of plasmapheresis on NMOSD prognosis is, as yet, unclear. METHODS We performed a retrospective chart review of 53 persons with NMOSD at Duke University Hospital-collecting data on longitudinal disease course, imaging, demographics, and serum AQP4 titers (measured using the ELISA or FACS method). Most patients in our cohort were treated with high-dose corticosteroids and, following diagnosis, received maintenance immunosuppressive/immunomodulatory therapies. Longitudinal data on EDSS scores were used to calculate the slope of disability over time for each participant. We additionally investigated the correlation between initial AQP4 seropositivity, initial AQP4 serum titer levels, and treatment with plasmapheresis on disability progression for each participant. RESULTS Contrary to current views on NMOSD disease course, the majority of our participants showed either no change (31.9%) or improvement (27.1%) in disability over time. Our results additionally revealed no significant association between clinical prognosis and initial AQP4 seropositivity (p = 0.830), initial AQP4 serum titer levels (p = 0.338), or administration of plasmapheresis (p = 0.1149). CONCLUSIONS Our study presents a contemporary view of the clinical course of NMOSD and shows a more favorable view of its disease course than prior studies (performed before high-efficacy disease modifying therapies became widely-used for this patient population). Most patients in this study received treatment with high-dose corticosteroids following NMOSD flares, as well as a variety of maintenance immunosuppressive therapies. The results of this study cannot shed light on the disease course of untreated NMOSD. Our findings additionally challenge the theory that AQP4 seropositivity or serum titer levels at time of diagnosis may be used to effectively predict NMOSD prognosis. While we were unable to find evidence supporting a favorable effect of plasmapheresis administration on disease outcomes, further research is needed to determine the role plasmapheresis ought to play in the treatment of NMOSD.
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Affiliation(s)
- Nidhila Masha
- Duke University School of Medicine, 8 Searle Center Dr, Durham, NC 27710, USA.
| | - Dorlan J Kimbrough
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Christopher P Eckstein
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Nicholas M Hudak
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Mark B Skeen
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - F Lee Hartsell
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Michael W Lutz
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
| | - Suma Shah
- Department of Neurology, Duke University Medical Center, 40 Duke Medicine Cir Clinic 1L, Durham, NC 27710, USA
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20
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Wang Y, Zhong X, Wang H, Peng Y, Shi F, Jia D, Yang H, Zeng Q, Quan C, ZhangBao J, Lee M, Qi J, Chen X, Qiu W. Batoclimab as an add-on therapy in neuromyelitis optica spectrum disorder patients with acute attacks. Eur J Neurol 2023; 30:195-203. [PMID: 36087008 DOI: 10.1111/ene.15561] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/13/2022] [Accepted: 09/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Neuromyelitis optica spectrum disorder (NMOSD) is a severe neurological inflammatory disease mainly caused by pathogenic aquaporin-4 antibodies (AQP4-IgG). The safety and efficacy of the neonatal Fc receptor antagonist batoclimab addition to conventional intravenous methylprednisolone pulse (IVMP) therapy in patients with NMOSD acute attacks was assessed. METHODS In an open-label, dose-escalation phase 1b study, NMOSD patients with acute myelitis and/or optic neuritis received four doses of weekly subcutaneous injections of either 340 mg or 680 mg batoclimab with concurrent IVMP and were followed up for 27 weeks. The primary end-points were safety and tolerability. Secondary end-points included pharmacodynamics and efficacy, with key efficacy assessment at week 4. RESULTS In total nine NMOSD patients were enrolled, including two and seven in the 340 and 680 mg groups. Five patients had acute myelitis, while the remaining four had unilateral optic neuritis. Batoclimab add-on therapy had an overall good safety profile without serious adverse events. In the 680 mg group, mean immunoglobulin G (IgG) reached its maximum reduction at the last dose (day 22). In the meantime, AQP4-IgG was undetectable in six of seven subjects whose baseline AQP4-IgG titers ranged from 1:32 to 1:320. Expanded Disability Status Scale score was reduced by 1.3 ± 0.4 at week 4 (2.7 ± 1.3) compared with baseline (4.0 ± 1.0). CONCLUSIONS Batoclimab add-on therapy to IVMP is safe and tolerated in patients with NMOSD. Preliminary evidence suggests a beneficial neurological effect. A randomized controlled trial would be needed to prove the efficacy.
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Affiliation(s)
- Yuge Wang
- Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xiaonan Zhong
- Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Honghao Wang
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Peng
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fudong Shi
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Dongmei Jia
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China
| | | | - Jun Qi
- Harbour BioMed, Shanghai, China
| | | | - Wei Qiu
- Department of Neurology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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21
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Wingerchuk DM, Weinshenker BG, McCormick D, Barron S, Simone L, Jarzylo L. Aligning payer and provider strategies with the latest evidence to optimize clinical outcomes for patients with neuromyelitis optica spectrum disorder. J Manag Care Spec Pharm 2022; 28:S3-S27. [DOI: 10.18553/jmcp.2022.28.12-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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22
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Mustafa R, Zalewski NL, Flanagan EP, Kumar N. Challenging Myelopathy Cases. Semin Neurol 2022; 42:723-734. [PMID: 36417994 DOI: 10.1055/a-1985-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Misdiagnosis of myelopathies is common and can lead to irreversible disability when diagnosis- and disease-specific treatments are delayed. Therefore, quickly determining the etiology of myelopathy is crucial. Clinical evaluation and MRI spine are paramount in establishing the correct diagnosis and subsequently an appropriate treatment plan. Herein, we review an approach to myelopathy diagnosis focused on the time course of neurologic symptom progression and neuroimaging pearls, and apply them to a variety of inflammatory, structural, and vascular myelopathy cases.
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Affiliation(s)
- Rafid Mustafa
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | | | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
| | - Neeraj Kumar
- Department of Neurology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota
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23
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Krasnov VS, Prakhova LN, Totolyan NA. Current view on the diagnosis and treatment of neuromyelitis optica spectrum disorders exacerbations. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2022. [DOI: 10.14412/2074-2711-2022-5-69-76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Irreversible neurological deficit and disability in neuromyelitis optica spectrum disorders (NOSD) are formed as a result of exacerbations, which are often life-threatening. Timely diagnosis and treatment of exacerbations is a key task in the management of this category of patients. A unified structured approach to the diagnosis and treatment of NOSD exacerbations has not been developed. The purpose of this article is to analyze the scientific literature data on this issue in order to optimize the diagnostics and treatment of NOSD exacerbations in everyday clinical practice.
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Affiliation(s)
- V. S. Krasnov
- Acad. I.P. Pavlov First Saint Petersburg State Medical University of Ministry of Health of Russia
| | - L. N. Prakhova
- N.P. Bekhtereva Human Brain Institute, Russian Academy of Sciences
| | - N. A. Totolyan
- Acad. I.P. Pavlov First Saint Petersburg State Medical University of Ministry of Health of Russia
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24
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Lin TY, Schindler P, Grittner U, Oertel FC, Lu A, Motamedi S, Yadav SK, Duchow AS, Jarius S, Kuhle J, Benkert P, Brandt AU, Bellmann-Strobl J, Schmitz-Hübsch T, Paul F, Ruprecht K, Zimmermann HG. Serum glial fibrillary acidic protein correlates with retinal structural damage in aquaporin-4 antibody positive neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2022; 67:104100. [PMID: 36049341 DOI: 10.1016/j.msard.2022.104100] [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: 06/03/2022] [Revised: 07/26/2022] [Accepted: 08/08/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Aquaporin-4 immunoglobulin-G positive (AQP4-IgG+) neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy associated with optic neuritis (ON). Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an oligodendrocytopathy with a similar phenotype. Serum glial fibrillary acidic protein (sGFAP), an astrocyte-derived protein, is associated with disease severity in AQP4-IgG+ NMOSD. Serum neurofilament light (sNfL) indicates neuroaxonal damage. The objective was to investigate the association of sGFAP and sNfL with subclinical afferent visual system damage in clinically stable AQP4-IgG+ NMOSD and MOGAD patients. METHODS In this cross-sectional study, clinically stable patients with AQP4-IgG+ NMOSD (N = 33) and MOGAD (N = 16), as diseased controls, underwent sGFAP and sNfL measurements by single molecule array, retinal optical coherence tomography and visually evoked potentials. RESULTS Higher sGFAP concentrations were associated with thinner ganglion cell-inner plexiform layer (β (95% confidence interval (CI)) = -0.75 (-1.23 to -0.27), p = 0.007) and shallower fovea (average pit depth: β (95%CI) = -0.59 (-0.63 to -0.55), p = 0.020) in NMOSD non-ON eyes. Participants with pathological P100 latency had higher sGFAP (median [interquartile range]: 131.32 [81.10-179.34] vs. 89.50 [53.46-121.91] pg/ml, p = 0.024). In MOGAD, sGFAP was not associated with retinal structural or visual functional measures. CONCLUSIONS The association of sGFAP with structural and functional markers of afferent visual system damage in absence of ON suggests that sGFAP may be a sensitive biomarker for chronic disease severity in clinically stable AQP4-IgG+ NMOSD.
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Affiliation(s)
- Ting-Yi Lin
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulrike Grittner
- Institute for Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Frederike C Oertel
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Department of Neurology, University of California San Francisco, CA, USA
| | - Angelo Lu
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Seyedamirhosein Motamedi
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sunil Kumar Yadav
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ankelien S Duchow
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Jens Kuhle
- Neurology Clinic and Policlinic, MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, Switzerland
| | - Pascal Benkert
- Clinical Trial Unit, Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexander U Brandt
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; Department of Neurology, University of California Irvine, CA, USA
| | - Judith Bellmann-Strobl
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Tanja Schmitz-Hübsch
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Hanna G Zimmermann
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany; NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Einstein Center Digital Future, Berlin, Germany.
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25
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Update on glial antibody-mediated optic neuritis. Jpn J Ophthalmol 2022; 66:405-412. [PMID: 35895155 DOI: 10.1007/s10384-022-00932-1] [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: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 10/16/2022]
Abstract
Optic neuritis (ON) refers to inflammatory demyelinating lesions of the optic nerve, which can cause acute or subacute vision loss and is a major cause of vision loss in young adults. Much of our understanding of typical ON is from the Optic Neuritis Treatment Trial. Glial autoantibodies to aquaporin-4 immunoglobulin (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin (MOG-IgG) are recently established biomarkers of ON that have revolutionized our understanding of atypical ON. The detection of glial antibodies is helpful in the diagnosis, treatment, and follow-up of patients with different types of ON. AQP4-IgG and MOG-IgG screening is strongly recommended for patients with atypical ON. Research on the pathogenesis of NMOSD and MOGAD will promote the development and marketing of targeted immunotherapies. The application of new and efficient drugs, such as the selective complement C5 inhibitor, IL-6 receptor inhibitor, B cell-depleting agents, and drugs against other monoclonal antibodies, provides additional medical evidence. This review provides information on the diagnosis and management of glial antibody-mediated ON.
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26
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Treatment Outcomes of First-Ever Episode of Severe Optic Neuritis. Mult Scler Relat Disord 2022; 66:104020. [DOI: 10.1016/j.msard.2022.104020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/24/2022] [Accepted: 07/01/2022] [Indexed: 11/17/2022]
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27
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Paybast S, Emami A, Baghalha F, Naser Moghadasi A. Watch out for neuromyelitis optica spectrum disorder onset or clinical relapse after COVID-19 vaccination: What neurologists need to know? Mult Scler Relat Disord 2022; 65:103960. [PMID: 35763914 PMCID: PMC9186785 DOI: 10.1016/j.msard.2022.103960] [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: 04/18/2022] [Revised: 05/22/2022] [Accepted: 06/09/2022] [Indexed: 11/25/2022]
Abstract
Introduction The ongoing global COVID-19 pandemic has dramatically impacted our lives. We conducted this systematic review to investigate the safety of the COVID-19 vaccines in NMOSD patients. Methods We systematically searched PubMed, Scopus, Web of Science, and Embase from the beginning of the COVID-19 vaccination to March 1, 2022. Except for the letters, posters, and reviews, we included all related articles to answer two main questions. Our first question examined the occurrence of NMOSD onset as an adverse effect of the COVID-19 vaccine. Our second question investigated the safety of the COVID-19 vaccines in NMOSD patients. Results Out of 262 records, nine studies, including five studies for the first question and four studies for the second question, met the inclusion criteria. Out of the six patients with NMOSD onset after COVID-19 vaccination, five (83.3%) were female. The median time to NMOSD onset was 6.5 days, and the frequency of the COVID-19 vaccine type was identical in all patients. The most common presentation was longitudinally extensive transverse myelitis, significantly improved by pulse methylprednisolone with or without plasma exchange. The maintenance therapy was described only in three patients: rituximab (n=2) and azathioprine (n=1). Regarding the second question, out of 67 patients, 77.61% were female, with a mean age of 54.75 years old, a mean EDSS of 2.83, and a mean disease duration of 9.5 years. 77% reported at least one preexisting comorbidity. 88.05% were under treatment, most of which were rituximab and azathioprine. 98.50% received two doses of the COVID-19 vaccine. mRNA vaccines were the most commonly used vaccine(86.56%), which were well tolerated. No significant adverse event was reported, and local pain was the most frequently reported. 4.67% of the patients experienced a clinical relapse after a mean interval of 49.75 days, which was mainly mild to moderate in severity. Unfortunately, the data on the COVID-19 vaccines were missing. Conclusion The analysis suggests the safety profile of the COVID-19 vaccines. All NMOSD patients are strongly recommended to vaccinate for COVID-19. To maximize the effectiveness of the COVID-19 vaccines, further studies are needed to draw the best practice for vaccination.
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Affiliation(s)
- Sepideh Paybast
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Emami
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Baghalha
- Medical Librarian, Clinical Research Developmental Center, Emam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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28
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Habek M, Andabaka M, Fanciulli A, Jakob GB, Drulović J, Leys F, Di Pauli F, Hegen H, Auer M, Pekmezović T, Mesaroš Š, Jovičević V, Junaković A, Wenning GK, Deisenhammer F, Gabelić T, Barun B, Adamec I, Krbot Skorić M. Sudomotor dysfunction in people with neuromyelitis optica spectrum disorders. Eur J Neurol 2022; 29:2772-2780. [DOI: 10.1111/ene.15413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/22/2022] [Accepted: 05/18/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Mario Habek
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Marko Andabaka
- Faculty of Medicine University of Belgrade Belgrade Serbia
| | | | - Gregor Brecl Jakob
- University Medical Centre Ljubljana Department of Neurology Ljubljana Slovenia
| | - Jelena Drulović
- Faculty of Medicine University of Belgrade Belgrade Serbia
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Fabian Leys
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Franziska Di Pauli
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Harald Hegen
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | - Michael Auer
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | | | - Šarlota Mesaroš
- Faculty of Medicine University of Belgrade Belgrade Serbia
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Vanja Jovičević
- University Clinical Center of Serbia, Clinic of Neurology Belgrade Serbia
| | - Anamari Junaković
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
| | - Gregor K. Wenning
- Medical University of Innsbruck Department of Neurology Innsbruck Austria
| | | | - Tereza Gabelić
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Barbara Barun
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Ivan Adamec
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- School of Medicine University of Zagreb Zagreb Croatia
| | - Magdalena Krbot Skorić
- University Hospital Center Zagreb Department of Neurology, Referral Center for Autonomic Nervous System Disorders Zagreb Croatia
- Faculty of Electrical Engineering and Computing University of Zagreb Zagreb Croatia
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29
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Fu J, Wang Y, Li H, Zhou H, Song H, Sun M, Xu Q, Tan S, Wei S. Efficacy of Plasma Exchange Treatment for Demyelinating Optic Neuritis Associated with Various Serum Antibodies: A Prospective Cohort Study. Neurol Ther 2022; 11:797-813. [PMID: 35397098 PMCID: PMC9095770 DOI: 10.1007/s40120-022-00344-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION To evaluate the value of plasma exchange (PE) for patients with three subtypes of demyelinating optic neuritis (ON): aquaporin-4 (AQP4) antibody-positive ON (AQP4-ON), myelin oligodendrocyte glycoprotein (MOG) antibody-positive ON (MOG-ON), and AQP4 and MOG double-antibody-seronegative ON (D-ON). METHODS A single-center prospective study compared the logarithm of the minimum angle of resolution (logMAR) best-corrected visual acuity (BCVA) at most severe onset, 1 day before intravenous high-dose methylprednisolone (IVMP) treatment, 1 day before PE treatment, after five-cycles of PE therapy, and at 1-, 3-, and 6-month follow-up visits. The proportions of eyes in each visual outcome category were also compared. Logistic regression and a receiver operating characteristic curve were used to analyze predicted factors for VA improvement. RESULTS A total of 124 ON attacks of 122 patients were included. No significant differences were found in BCVA (P = 0.659) before and after PE therapy for 22 D-ON attacks, but VA improved in two of six MOG-ON patients. In 95 AQP4-ON patients suffering 96 attacks, the mean logMAR BCVA markedly improved and was steadily maintained after five-cycles of PE treatments (adjusted P < 0.001), with VA exhibiting a significantly increasing trend (adjusted P = 0.001) after PE treatment. The combination of the number of previous ON episodes and the time window to PE treatment showed accuracy of 74.7% for predicting an improvement in BCVA score ≥ 2 levels. In addition, a combination of logMAR VA before PE and the time window to PE treatment resulted in 83.4% accuracy in predicting whether VA would regain 1.0 logMAR. CONCLUSION PE therapy effectively improves visual outcomes for AQP4-ON patients, but offers limited value for D-ON patients. Early initiation greatly increases likelihood of achieving VA improvement.
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Affiliation(s)
- Junxia Fu
- The Chinese People's Liberation Army Medical School, Beijing, China.,Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yongping Wang
- The Chinese People's Liberation Army Medical School, Beijing, China.,Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Hongen Li
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Honglu Song
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China.,Department of Ophthalmology, The 980th Hospital of the Chinese PLA Joint Logistics Support Force, Shijiazhuang, Hebei, China
| | - Mingming Sun
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Quangang Xu
- Senior Department of Ophthalmology, The Third Medical Center of PLA General Hospital, Beijing, China
| | - Shaoying Tan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China. .,Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China. .,Center for Eye and Vision Research (CEVR), 17W Hong Kong Science Park, Hong Kong, China.
| | - Shihui Wei
- The Chinese People's Liberation Army Medical School, Beijing, China. .,Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China.
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30
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Gonzalez G CA, Vargas A DC, Contreras V KM, Garcia P PK, Rodriguez S MP, Zarco L, Navas C. Therapeutic plasma exchange for optic neuritis attacks in patients with neuromyelitis optica spectrum disorders. Ther Apher Dial 2022; 26:1274-1280. [PMID: 35353437 DOI: 10.1111/1744-9987.13844] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/13/2022] [Accepted: 03/28/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Optic neuritis (ON) cause several sequela. Aggressive treatment with plasma exchange (TPE) is an option. This study describe improvement and safety outcomes with TPE. METHODS We recruited adults with ON in neuromyelitis optica spectrum disorders (NMOSD) patients treated with TPE. The primary outcome was an improvement in the visual acuity scale (VOS). We described the data and used multivariate logistic regression to identify factors associated with response. RESULTS 83 patients received 558 TPE sessions. Mean age 40.9 years (±13.7 years); 73.5% women, 50.1% first attack, and 10.7% bilateral. Median VOS: 5 (range [R], 2-7). Median time between onset and TPE was 8 days (R, 1-32. By Keegan's criteria 82.4% experience improvement, 78.3% improve in at least 1 point in VOS. Age and pre-TPE VOS were related with improvement. Low fibrinogen occurs in 26% sessions. CONCLUSION TPE is effective and safety for ON. There is a need for a clinical trial using a therapeutic equivalent.
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Affiliation(s)
- Camilo A Gonzalez G
- Nephrologist. Hospital Universitario San Ignacio, Dialysis center. Carrera 7 # 40-62 6th floor. Bogota, Colombia.,Clínica Universitaria Colombia, Clínica Colsanitas S. A. Carrera 66 # 23-46. Bogota, Colombia
| | - Diana C Vargas A
- Nephrologist. Hospital Universitario San Ignacio, Dialysis center. Carrera 7 # 40-62 6th floor. Bogota, Colombia.,Clínica Universitaria Colombia, Clínica Colsanitas S. A. Carrera 66 # 23-46. Bogota, Colombia
| | - Kateir M Contreras V
- Nephrologist. Hospital Universitario San Ignacio, Dialysis center. Carrera 7 # 40-62 6th floor. Bogota, Colombia
| | - Paola K Garcia P
- Nephrologist. Hospital Universitario San Ignacio, Dialysis center. Carrera 7 # 40-62 6th floor. Bogota, Colombia.,Pontificia Universidad Javeriana, Carrera 7 # 40-62. Bogota, Colombia
| | - Martha Patricia Rodriguez S
- Nephrologist. Hospital Universitario San Ignacio, Dialysis center. Carrera 7 # 40-62 6th floor. Bogota, Colombia.,Pontificia Universidad Javeriana, Carrera 7 # 40-62. Bogota, Colombia
| | - Luis Zarco
- Neurologist. Hospital Universitario San Ignacio, Carrera 7 # 40-62 6th floor. Bogota, Colombia.,Pontificia Universidad Javeriana, Carrera 7 # 40-62. Bogota, Colombia
| | - Carlos Navas
- Clínica Universitaria Colombia, Clínica Colsanitas S. A. Carrera 66 # 23-46. Bogota, Colombia
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31
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Carnero Contentti E, López PA, Rojas JI. Emerging drugs for the acute treatment of relapses in adult neuromyelitis optica spectrum disorder patients. Expert Opin Emerg Drugs 2022; 27:91-98. [PMID: 35341428 DOI: 10.1080/14728214.2022.2059463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorders (NMOSD) are rare but often devastating neuroinflammatory autoimmune diseases of the central nervous system. Acute treatment is critically important and it should be initiated early and aggressively, as relapses result in severe residual disability. Acute treatments are still based on clinical experience and observational studies. The most commonly used treatments are steroids and plasmapheresis. Several new treatments to improve management and recovery after relapses in NMOSD are currently under investigation. AREAS COVERED : This review discusses current and the most recent advances in active development of phase II/III clinical trials for acute treatment options and therapeutic strategies that can help management improvement of NMOSD during a relapse. These treatments include bevacizumab, ublituximab and HBM9161. EXPERT OPINION NMOSD relapses require prompt evaluation and timely treatment to restore function and mitigate disability. Timing is critical. Plasmapheresis showed better outcomes in terms of recovery when compared to high-dose intravenous methylprednisolone alone. Some groups suggest that plasmapheresis could be considered as an initial treatment approach in different clinical scenarios due to its higher effectiveness. Future research and/or real-world data will establish the advantages and disadvantages of these new treatments and define the appropriate patient profile.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Aleman, Buenos Aires, Argentina
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Servicio de Neurología, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Demuth S, Guillaume M, Bourre B, Ciron J, Zephir H, Sirejacob Y, Kerbrat A, Lebrun-Frenay C, Papeix C, Michel L, Laplaud D, Vukusic S, Maillart E, Cohen M, Audoin B, Marignier R, Collongues N. Treatment regimens for neuromyelitis optica spectrum disorder attacks: a retrospective cohort study. J Neuroinflammation 2022; 19:62. [PMID: 35236386 PMCID: PMC8892703 DOI: 10.1186/s12974-022-02420-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) attacks require an urgent probabilistic anti-inflammatory therapeutic strategy. As inadequately treated attacks result in disability, there is a need to identify the optimal attack-treatment regimen. Our study aimed to identify predictors of outcome after a first attack in patients with an NMOSD presentation and propose the best treatment strategy. Methods We performed a retrospective cohort study on the French national NMOSD registry (NOMADMUS), a nested cohort of the French multiple sclerosis observatory (OFSEP) recruiting patients with NMOSD presentations in France. We studied the first attack for any independent locations of clinical core characteristic of NMOSD, in treatment-naïve patients. The primary outcome was the evolution of the Expanded Disability Status Scale (EDSS) score at 6 months, stratified in two ways to account for recovery (return to baseline EDSS score) and treatment response (classified as “good” if the EDSS score decreased by ≥ 1 point after a nadir EDSS score ≤ 3, or by ≥ 2 points after a nadir EDSS score > 3). We used ordinal logistic regression to infer statistical associations with the outcome. Results We included 211 attacks among 183 patients (104 with anti-AQP4 antibodies, 60 with anti-MOG antibodies, and 19 double seronegative). Attack treatment regimens comprised corticosteroids (n = 196), plasma exchanges (PE; n = 72) and intravenous immunoglobulins (n = 6). Complete recovery was reached in 40 attacks (19%) at 6 months. The treatment response was “good” in 134 attacks (63.5%). There was no improvement in EDSS score in 50 attacks (23.7%). MOG-antibody seropositivity and short delays to PE were significantly and independently associated with better recovery and treatment response. Conclusions We identified two prognostic factors: serostatus (with better outcomes among MOG-Ab-positive patients) and the delay to PE. We, therefore, argue for a more aggressive anti-inflammatory management of the first attacks suggesting an NMOSD presentation, with the early combination of PE with corticosteroids.
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Affiliation(s)
- Stanislas Demuth
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France
| | | | - Bertrand Bourre
- CHU de Rouen / Rouen University Hospital, 76000, Rouen, France
| | - Jonathan Ciron
- Department of Neurology, CRC-SEP, CHU Toulouse, 31059, Toulouse Cedex 9, France.,Institut Toulousain des Maladies infectieuses et Inflammatoires (Infinity), INSERM UMR1291 - CNRS UMR5051, Université Toulouse III, Toulouse, France.,Department of Neurology, CHU Poitiers, 86021, Poitiers, France
| | - Hélène Zephir
- Department of Neurology, Inserm U 1172, University Hospital of Lille, University of Lille, Lille, France
| | - Yoann Sirejacob
- Department of Clinical Research, Rouen University Hospital, 76000, Rouen, France
| | - Anne Kerbrat
- Department of Neurology, Rennes University Hospital, 35033, Rennes, France
| | - Christine Lebrun-Frenay
- Department of Neurology, CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University, Nice, France
| | - Caroline Papeix
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Laure Michel
- Department of Neurology, Rennes University Hospital, 35033, Rennes, France.,CRTI-InsermU1064, Nantes, France.,CHU de Nantes, Université de Nantes, Nantes, France
| | | | - Sandra Vukusic
- Department of Neurology, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Elisabeth Maillart
- Department of Neurology, AP-HP, Pitié-Salpêtrière Hospital, 75013, Paris, France
| | - Mikael Cohen
- Department of Neurology, CHU de Nice, UR2CA-URRIS, Nice Côte d'Azur University, Nice, France
| | - Bertrand Audoin
- Department of Neurology, University Hospital of Marseille, Marseille, France.,Aix-Marseille University, CRMBM UMR 7339, CNRS, Marseille, France
| | - Romain Marignier
- Department of Neurology, Hôpital Wertheimer, HCL, Bron, France.,Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, 69677, Lyon/Bron, France.,INSERM 1028 et CNRS UMR5292, Centre Des Neurosciences de Lyon, 69003, Lyon, France.,Université Claude Bernard Lyon 1, 69000, Lyon, France
| | - Nicolas Collongues
- Department of Neurology, Strasbourg University Hospital, Strasbourg, France.
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Cai H, Zhou R, Jiang F, Zeng Q, Yang H. Vaccination in neuromyelitis optica spectrum disorders: Friend or enemy? Mult Scler Relat Disord 2022; 58:103394. [PMID: 35216775 DOI: 10.1016/j.msard.2021.103394] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 09/26/2021] [Accepted: 11/08/2021] [Indexed: 12/11/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are uncommon antibody-mediated autoimmune diseases of the central nervous system (CNS), mainly occurring in optic nerves and spinal cord, which can cause visual impairment, paralysis, and occasionally bulbar dysfunction. Such neurological deficits can adversely affect pulmonary functions and increase complicated infection risk. Besides, most NMOSD patients undergo immunosuppressive therapy. All these factors make NMOSD patients the potential high-risk group under the current pandemic of coronavirus disease 2019 (COVID-19). Meanwhile, COVID-19 infection has already been demonstrated as a risk factor for NMOSD relapses. This review discusses the basic immunology of vaccination and common problems, including immunogenicity, safety, and efficacy of vaccination on NMOSD patients. Additionally, we offered vaccination recommendations, health care and treatment advice for NMOSD patients under the background of COVID-19.
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Affiliation(s)
- Haobing Cai
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Ran Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Fei Jiang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Qiuming Zeng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China
| | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha410008, China.
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Xu Y, Liu Y, Huang W, Yang C, Wang Y. LOC100130075 Promotes Cervical Cancer Progression by Activating MDM2 Transcription through E2F1. Reprod Sci 2022; 29:1439-1448. [PMID: 35201567 DOI: 10.1007/s43032-021-00806-w] [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: 01/26/2021] [Accepted: 11/13/2021] [Indexed: 11/26/2022]
Abstract
Cervical cancer (CC) represents one of the most frequent gynecological tumors worldwide and it takes a big part in cancer-related deaths in women. The mouse double minute 2 (MDM2) gene has been elucidated to be deregulated in cancers and exert its oncogenic activity. Through ENCODE ( https://www.encodeproject.org/ ), LOC100130075 was discovered to be a nearby gene of MDM2. Emerged as a novel long non-coding RNA (lncRNA), LOC100130075 has not been studied in cancers. Therefore, we aim to figure out the function of LOC100130075 and its interaction with MDM2 in CC progression. The high expression pattern of LOC100130075 and MDM2 and a positive correlation between them were firstly verified in CC cells. Then, it was verified that LOC100130075 interference suppressed the proliferation and enhanced the apoptosis of CC cells. Furthermore, we verified through mechanism assays including ChIP, RNA pull-down, as well as luciferase reporter assays that LOC100130075 bound to E2F transcription factor 1 (E2F1) to activate MDM2 transcription. Furthermore, the result of rescue assays manifested that MDM2 overexpression reversed the inhibitory function of LOC100130075 deficiency on CC development. In a word, LOC100130075 promoted CC malignancy by activating MDM2 transcription through E2F1, which may provide a new direction in the advancement of CC treatments.
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Affiliation(s)
- Ye Xu
- Department of Gynecology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150080, Heilongjiang, China
| | - Yunduo Liu
- Department of Gynecology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150080, Heilongjiang, China
| | - Wei Huang
- Department of Gynecology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150080, Heilongjiang, China
| | - Chang Yang
- Department of Gynecology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150080, Heilongjiang, China
| | - Yaoxian Wang
- Department of Gynecology, Harbin Medical University Cancer Hospital, No.150 Haping Road, Nangang District, Harbin, 150080, Heilongjiang, China.
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Hiew FL, Thit WM, Alexander M, Thirugnanam U, Siritho S, Tan K, Mya Aye SM, Ohnmar O, Estiasari R, Yassin N, Pasco PM, Keosodsay SS, Trong Nghia HT, Islam MDB, Wong SK, Lee S, Chhabra A, Viswanathan S. Consensus recommendation on the use of therapeutic plasma exchange for adult neurological diseases in Southeast Asia from the Southeast Asia therapeutic plasma exchange consortium. J Cent Nerv Syst Dis 2022; 13:11795735211057314. [PMID: 35173510 PMCID: PMC8842418 DOI: 10.1177/11795735211057314] [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: 05/06/2021] [Accepted: 10/12/2021] [Indexed: 11/30/2022] Open
Abstract
Therapeutic plasma exchange (TPE) is an effective and affordable treatment option in most parts of Southeast Asia (SEA). In 2018, the SEA TPE Consortium (SEATPEC) was established, consisting of regional neurologists working to improve outcome of various autoimmune neurological diseases. We proposed an immunotherapeutic guideline prioritizing TPE for this region. We reviewed disease burden, evidence-based treatment options, and major guidelines for common autoimmune neurological disorders seen in SEA. A modified treatment algorithm based on consensus agreement by key-opinion leaders was proposed. Autoimmune antibody diagnostic testing through collaboration with accredited laboratories was established. Choice of first-line immunotherapies (IVIg/corticosteroid/TPE) is based on available evidence, clinicians’ experience, contraindications, local availability, and affordability. TPE could be chosen as first-line therapy for GBS, CIDP, MG (acute/short term), IgG, A paraproteinemic neuropathy, and NMDAR encephalitis. Treatment is stopped for acute monophasic conditions such as GBS and ADEM following satisfactory outcome. For chronic immune disorders, a therapy taper or long-term maintenance therapy is recommended depending on the defined clinical state. TPE as second-line treatment is indicated for IVIg or corticosteroids refractory cases of ADEM, NMOSD (acute), MG, and NMDAR/LGI1/CASPR2/Hashimoto’s encephalitis. With better diagnosis, treatment initiation with TPE is a sustainable and effective immunotherapy for autoimmune neurological diseases in SEA.
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Affiliation(s)
- Fu Liong Hiew
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
- Dr Fu Liong Hiew, Physician and Neurologist, Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia Jalan Pahang, Wilayah Persekutuan Kuala Lumpur 50586, Malaysia.
| | - Win Min Thit
- University of Medicine 1, Yangon, Myanmar
- Yangon General Hospital/University of Medicine 1, Yangon, Myanmar
| | - Mathew Alexander
- Brunei Neuroscience Stroke and Rehabilitation Centre, Pantai Jerudong Specialist Centre, Brunei Darussalam
| | | | - Sasitorn Siritho
- Division of Neurology, Faculty of Medicine, Siriraj Hospital, Bumrungrad International Hospital, Bangkok, Thailand
| | - Kevin Tan
- Department of Neurology, National Neuroscience Institute, Singapore, Singapore
| | | | - Ohnmar Ohnmar
- University of Medicine 1, Yangon, Myanmar
- Yangon General Hospital/University of Medicine 1, Yangon, Myanmar
| | - Riwanti Estiasari
- Department of Neurology, Cipto Mangunkusumo Hospital/Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | | | | | | | | | - MD Badrul Islam
- Laboratory Sciences and Services Division (LSSD), The International Centre for Diarrhoeal Disease, Dhaka, Bangladesh
| | - Sing Keat Wong
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
| | - Shirley Lee
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Malaysia
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Fang Y, Sheng C, Ding F, Zhao W, Guan G, Liu X. Adding Consolidation Capecitabine to Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer: A Propensity-Matched Comparative Study. Front Surg 2022; 8:770767. [PMID: 35155545 PMCID: PMC8830484 DOI: 10.3389/fsurg.2021.770767] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Accepted: 12/27/2021] [Indexed: 12/12/2022] Open
Abstract
Aim To determine whether adding consolidation capecitabine chemotherapy without lengthening the waiting period influences pathological complete response (pCR) and short-term outcome of locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (NCRT). Method Totally, 545 LARC who received NCRT and radical resection between 2010 and 2018 were enrolled. Short-term outcome and pCR rate were compared between patients with and without additional consolidation capecitabine. Logistic analysis was performed to identify predictors of pCR. Results After propensity score matching, 229 patients were matched in both NCRT and NCRT-Cape groups. Postoperative morbidity was comparable between groups except for operation time, which is lower in the NCRT group (213.2 ± 67.4 vs. 227.9 ± 70.5, p = 0.025). Two groups achieved similar pCR rates (21.8 vs. 22.7%, p = 1.000). Tumor size (OR = 0.439, p < 0.001), time interval between NCRT and surgery (OR = 1.241, p = 0.003), and post-NCRT carcinoembryonic antigen (OR = 0.880, p = 0.008) were significantly correlated with pCR in patients with LARC. A predictive nomogram was constructed with a C-index of 0.787 and 0.741 on internal and external validation. Conclusion Adding consolidation capecitabine chemotherapy without lengthening CRT-to-surgery interval in LARC patients after NCRT does not seem to impact pCR or short-term outcome. A predictive nomogram for pCR was successful, and it could support treatment decision-making.
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Affiliation(s)
- Yifang Fang
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Chengmin Sheng
- Fuzhou Medical College of Nanchang University, Fuzhou, China
| | - Feng Ding
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Weijie Zhao
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Guoxian Guan
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- Guoxian Guan
| | - Xing Liu
- Department of Colorectal Surgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
- *Correspondence: Xing Liu
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37
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Huang TL, Chu YC. What's new in neuromyelitis optica spectrum disorder treatment? Taiwan J Ophthalmol 2022. [DOI: 10.4103/2211-5056.355329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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38
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Huang TL, Chu YC. What's new in neuromyelitis optica spectrum disorder treatment? Taiwan J Ophthalmol 2022; 12:249-263. [PMID: 36248092 PMCID: PMC9558477 DOI: 10.4103/2211-5056.355617] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 06/15/2022] [Indexed: 11/04/2022] Open
Abstract
Optic neuritis, an optic nerve inflammatory disease presenting with acute unilateral or bilateral visual loss, is one of the core symptoms of neuromyelitis optica spectrum disorder (NMOSD). The diagnosis of NMOSD-related optic neuritis is challenging, and it is mainly based on clinical presentation, optical coherence tomography, magnetic resonance imaging scans, and the status of serum aquaporin-4 antibodies. In the pathogenesis, aquaporin-4 antibodies target astrocytes in the optic nerves, spinal cord and some specific regions of the brain eliciting a devastating autoimmune response. Current pharmacological interventions are directed against various steps within the immunological response, notably the terminal complement system, B-cells, and the pro-inflammatory cytokine Interleukin 6 (IL6). Conventional maintenance therapies were off-label uses of the unspecific immunosuppressants azathioprine and mycophenolate mofetil as well as the CD20 specific antibody rituximab and the IL6 receptor specific antibody tocilizumab. Recently, four phase III clinical trials demonstrated the safety and efficacy of the three novel biologics eculizumab, inebilizumab, and satralizumab. These monoclonal antibodies are directed against the complement system, CD19 B-cells and the IL6 receptor, respectively. All three have been approved for NMOSD in the US and several other countries worldwide and thus provide convincing treatment options.
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39
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Sokhor N, Yasniy O. A case report of neuromyelitis optica spectrum disorder with lesions of the medulla oblongata. Zh Nevrol Psikhiatr Im S S Korsakova 2022; 122:121-125. [DOI: 10.17116/jnevro2022122031121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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40
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Parashar R, Sharma A, Sharma A. Role of therapeutic plasma exchange in neuromyelitis optica: A case series. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2022. [DOI: 10.4103/gjtm.gjtm_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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41
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Ambika S, Durgapriyadarshini S, Padmalakshmi K, Noronha V, Arjundas D. Clinical profile, imaging features and short term visual outcomes of Indian optic neuritis patients with and without seromarkers for myelin oligodendrocyte glycoprotein and neuromyelitis optica. Indian J Ophthalmol 2021; 70:194-200. [PMID: 34937238 PMCID: PMC8917550 DOI: 10.4103/ijo.ijo_887_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Purpose: To analyze clinical profile, imaging features, and short-term visual outcomes of optic neuritis patients in Indian population with and without seromarkers for myelin oligodendrocyte glycoprotein (MOG)/neuromyelitis optica (NMO). Methods: Electronic medical records of 203 optic neuritis patients who presented between June 2018 and December 2019 to the Neuro-ophthalmology services of a tertiary care center in India were retrospectively analyzed. Results: Of 203 patients, 57 patients (28.08%) were positive for MOG-antibody and 20 patients (9.85%) were positive for NMO antibody. 114 patients (56.16%) were double-negative (negative for both antibodies) and 12 patients (5.91%) were diagnosed as multiple sclerosis (MS). None of the patients had both antibodies. Mean age of presentation was 31.29 ± 1.035 years. There was female preponderance in NMO-optic neuritis (NMO-ON) and MS-optic neuritis (MS-ON) groups (1:5). Mean vision on presentation was worse (logMAR 1.570 ± 0.863) in NMO-ON group. The mean visual acuity showed statistically significant recovery (logMAR 0.338 ± 0.639) in the final follow-up in MOG-optic neuritis (MOG-ON) group. Multivariate logistic regression analysis revealed poor visual outcome in patients presenting with retrobulbar neuritis, optic disc pallor, bilateral sequential optic nerve involvement, and with positive NMO antibody. Optic neuritis patients presenting with disc edema associated with pain and positive for MOG antibody were found to have a better visual outcome. Conclusion: In this Indian optic neuritis cohort, the prevalence of MOG-ON was higher than NMO-ON. MOG-ON had a better visual outcome than NMO-ON. The incidence of MS-ON was less compared to the western literature. A significant number of patients (114 patients, 56.16%) were double negative for both seromarkers and yet had presented with optic neuritis with no clinical or imaging features suggestive of MS/MOG associated disease (MOG AD)/NMO spectrum disorder (NMO SD).
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Affiliation(s)
- Selvakumar Ambika
- Department of Neuro Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | | | - Krishnakumar Padmalakshmi
- Department of Neuro Ophthalmology, Medical Research Foundation, Sankara Nethralaya, Chennai, Tamil Nadu, India
| | - Veena Noronha
- Department of Radiology, VRR Scans, Chennai, Tamil Nadu, India
| | - Deepak Arjundas
- Department of Neurology, Vijaya Health Centre, Chennai, Tamil Nadu, India
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Pediatric Neuromyelitis Optica Spectrum Disorder: Case Series and Literature Review. Life (Basel) 2021; 12:life12010019. [PMID: 35054412 PMCID: PMC8779266 DOI: 10.3390/life12010019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 12/18/2021] [Accepted: 12/21/2021] [Indexed: 12/20/2022] Open
Abstract
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a central nervous system (CNS) inflammatory demyelinating disease characterized by recurrent inflammatory events that primarily involve optic nerves and the spinal cord, but also affect other regions of the CNS, including hypothalamus, area postrema and periaqueductal gray matter. The aquaporin-4 antibody (AQP4-IgG) is specific for NMOSD. Recently, myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) have been found in a group of AQP4-IgG negative patients. NMOSD is rare among children and adolescents, but early diagnosis is important to start adequate therapy. In this report, we present cases of seven pediatric patients with NMOSD and we review the clinical and neuroimaging characteristics, diagnosis, and treatment of NMOSD in children.
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Pittock SJ, Zekeridou A, Weinshenker BG. Hope for patients with neuromyelitis optica spectrum disorders - from mechanisms to trials. Nat Rev Neurol 2021; 17:759-773. [PMID: 34711906 DOI: 10.1038/s41582-021-00568-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 02/07/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare inflammatory CNS disease that primarily manifests as relapsing episodes of severe optic neuritis and myelitis. Diagnosis of NMOSD is supported by the detection of IgG autoantibodies that target the aquaporin 4 (AQP4) water channel, which, in the CNS, is an astrocyte-specific protein. AQP4 antibody binding leads to AQP4 internalization, complement-dependent and antibody-dependent cellular cytotoxicity, and water channel dysfunction. Cumulative attack-related injury causes disability in NMOSD, so the prevention of attacks is expected to prevent disability accrual. Until recently, no regulator-approved therapies were available for NMOSD. Traditional immunosuppressant therapies, including mycophenolate mofetil, azathioprine and rituximab, were widely used but their benefits have not been assessed in controlled studies. In 2019 and 2020, five phase II and III randomized placebo-controlled trials of four mechanism-based therapies for NMOSD were published and demonstrated that all four effectively prolonged the time to first relapse. All four drugs were monoclonal antibodies: the complement C5 antibody eculizumab, the IL-6 receptor antibody satralizumab, the B cell-depleting antibody inebilizumab, which targets CD19, and rituximab, which targets CD20. We review the pathophysiology of NMOSD, the rationale for the development of these mechanism-based drugs, the methodology and outcomes of the five trials, and the implications of these findings for the treatment of NMOSD.
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Affiliation(s)
- Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA. .,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA. .,Center of Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.,Center of Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Brian G Weinshenker
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.,Center of Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
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Touma L, Muccilli A. Diagnosis and Management of Central Nervous System Demyelinating Disorders. Neurol Clin 2021; 40:113-131. [PMID: 34798965 DOI: 10.1016/j.ncl.2021.08.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The spectrum of demyelinating diseases affecting the central nervous system is broad. Although many have a chronic course, neuroinflammatory conditions often present with acute to subacute onset symptoms requiring hospitalization when severe. This article reviews the acute phase assessment and management of these disorders, with a particular focus on multiple sclerosis, neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody disorder, and several atypical demyelinating diseases.
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Affiliation(s)
- Lahoud Touma
- Department of Neurosciences, Unviersity of Montreal, Centre Hospitalier de l'Université de Montréal
| | - Alexandra Muccilli
- Department of Medicine, Division of Neurology, St. Michael's Hospital, University of Toronto, Toronto, Canada.
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45
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Factors influencing intravenous methylprednisolone pulse therapy in Chinese patients with isolated optic neuritis associated with AQP4 antibody-seropositive neuromyelitis optica. Sci Rep 2021; 11:22229. [PMID: 34782653 PMCID: PMC8593159 DOI: 10.1038/s41598-021-01109-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 09/06/2021] [Indexed: 12/02/2022] Open
Abstract
This study investigated the factors influencing intravenous methylprednisolone pulse (IVMP) therapy for recovering visual acuity in Chinese patients with aquaporin-4 (AQP4) antibody-seropositive neuromyelitis optica-related optic neuritis (NMO-ON). This retrospective case series included 243 affected eyes of 182 patients (36 male, 146 female) diagnosed with NMO-ON in the Neuro-Ophthalmology Clinic of Beijing Tongren Hospital from September 2012 to September 2020. All patients with AQP4-antibody seropositivity had clinical manifestations of acute ON, excluding other diagnoses and received IVMP treatment at 500 mg/day or 1000 mg/day for 3 days. Primary outcome was the extent of improvement in logMAR visual acuity after IVMP treatment. The therapeutic influences of sex, age, baseline visual acuity, therapeutic intervals, and IVMP dose on acute NMO-ON were analysed. Chi-square tests, Mann–Whitney U-tests, Kruskal–Wallis tests, Spearman’s correlation coefficients, and multiple linear regression were used for statistical analysis. Age ranged between 7 and 80 years (median age, 44; interquartile range [IQR], 29–52) years. Among the 243 eyes, the median improvement in logMAR visual acuity was 0.3 (IQR, 0–0.9). Therapeutic efficacy of IVMP was significantly higher in female than in male patients (Z = 2.117, P = 0.034). The treatment effect gradually decreased with increase in age at onset (Rs = 0.157, P = 0.015), and visual improvement was significantly lower in patients aged > 50 years than in those ≤ 50 years (Z = 2.571, P = 0.010). When patients had low visual acuity at onset, improvements were more obvious (rho = − 0.317, P < 0.001); however, final visual acuity was still low (rho = 0.688, P < 0.001). Therapeutic effect was negatively correlated with therapeutic intervals (rho = 0.228, P = 0.001). Dosage of methylprednisolone (1000 mg/day or 500 mg/day) did not significantly influence treatment efficacy (Z = 0.951 P = 0.342). Therefore, IVMP therapy can improve visual acuity in the affected eyes of patients with AQP4 antibody-seropositive NMO-ON with similar effect at 500 mg/day and 1000 mg/day doses. Sex, age at onset, and therapeutic intervals may influence the efficacy of IVMP in patients with NMO-ON.
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Forouzannia SM, Yarahmadi P, Alirezaei M, Rezaeimanesh N, Naser Moghadasi A. Increased Intracranial Pressure on a Patient with Neuromyelitis Optica Spectrum Disorder. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S435-S438. [PMID: 34760100 PMCID: PMC8559654 DOI: 10.22088/cjim.12.0.435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/19/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022]
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathic disease affecting central nervous system (CNS). CSF pressure in these patients is usually normal. Case Presentation: A 30-year-old woman was admitted with complaints of headache and lower limbs paresis. Lumbar puncture (LP) and magnetic resonance imaging were performed for the patient. Opening pressure was 42 cm H2O in the first LP. According to the clinical evidences, imaging, and the patient's positive aquaporin-4 antibody, the diagnosis of NMOSD was established. Conclusion: High intracranial pressure headache; however rare, may be the first sign of the onset of the acute exacerbation phase of NMOSD.
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Affiliation(s)
- Seyed Mohammad Forouzannia
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Pourya Yarahmadi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Mohammad Alirezaei
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Nasim Rezaeimanesh
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center; Neuroscience institute; Tehran University of Medical Sciences; Tehran; Iran
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Abstract
Acute myelopathies are spinal cord disorders characterized by a rapidly progressive course reaching nadir within hours to a few weeks that may result in severe disability. The multitude of underlying etiologies, complexities in confirming the diagnosis, and often unforgiving nature of spinal cord damage have always represented a challenge. Moreover, certain slowly progressive myelopathies may present acutely or show abrupt worsening in specific settings and thus further complicate the diagnostic workup. Awareness of the clinical and magnetic resonance imaging characteristics of different myelopathies and the specific settings where they occur is fundamental for a correct diagnosis. Neuroimaging helps distinguish compressive etiologies that may require urgent surgery from intrinsic etiologies that generally require medical treatment. Differentiation between various myelopathies is essential to establish timely and appropriate treatment and avoid harm from unnecessary procedures. This article reviews the contemporary spectrum of acute myelopathy etiologies and provides guidance for diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota.,Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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Jacob S, Mazibrada G, Irani SR, Jacob A, Yudina A. The Role of Plasma Exchange in the Treatment of Refractory Autoimmune Neurological Diseases: a Narrative Review. J Neuroimmune Pharmacol 2021; 16:806-817. [PMID: 34599742 PMCID: PMC8714620 DOI: 10.1007/s11481-021-10004-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Autoimmune neurological disorders are commonly treated with immunosuppressive therapy. In patients with refractory conditions, standard immunosuppression is often insufficient for complete recovery or to prevent relapses. These patients rely on other treatments to manage their disease. While treatment of refractory cases differs between diseases, intravenous immunoglobulin, plasma exchange (PLEX), and immune-modulating treatments are commonly used. In this review, we focus on five autoimmune neurological disorders that were the themes of the 2018 Midlands Neurological Society meeting on PLEX in refractory neurology: Autoimmune Encephalitis (AE), Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum disorders (NMOSD), Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Myasthenia Gravis (MG). The diagnosis of inflammatory neuropathies is often challenging, and while PLEX can be very effective in refractory autoimmune diseases, its ineffectiveness can be confounded by misdiagnosis. One example is POEMS syndrome (characterized by Polyneuropathy Organomegaly, Endocrinopathy, Myeloma protein, Skin changes), which is often wrongly diagnosed as CIDP; and while CIDP responds well to PLEX, POEMS does not. Accurate diagnosis is therefore essential. Success rates can also differ within 'one' disease: e.g. response rates to PLEX are considerably higher in refractory relapsing remitting MS compared to primary or secondary progressive MS. When sufficient efforts are made to correctly pinpoint the diagnosis along with the type and subtype of refractory autoimmune disease, PLEX and other immunotherapies can play a valuable role in the patient management.
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Affiliation(s)
- Saiju Jacob
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom. .,Department of Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
| | - Gordon Mazibrada
- Department of Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, NMO Service, Liverpool, United Kingdom.,Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Jia Z, Dong X, Song S, Guo R, Zhang L, Liu J, Li B. Physical, Emotional, Medical, and Socioeconomic Status of Patients With NMOSD: A Cross-Sectional Survey of 123 Cases From a Single Center in North China. Front Neurol 2021; 12:737564. [PMID: 34566879 PMCID: PMC8455822 DOI: 10.3389/fneur.2021.737564] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 08/16/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: This study aimed to assess the physical, emotional, medical, and socioeconomic conditions of patients with neuromyelitis optica spectrum disorder (NMOSD) in North China. Methods: A cross-sectional survey of patients with NMOSD was performed, based on an established questionnaire from the Multiple Sclerosis Patient Survival Report 2018. Logistic regression analysis was conducted to define the significant determinants of certain physical or emotional characteristics of patients. A total of 123 patients were included. Results: A total of 63.4% of participants were initially diagnosed with conditions other than NMOSD, with a median delay of 6 months for accurate diagnosis. An aggregate of 72.2% of patients had one or more relapses, corresponding to an annual relapse rate of 0.8. Paresthesia was the most frequent physical symptom among patients both at disease onset (53.7%) and throughout the duration of the disease (86.2%). Onset in elderly (>50 years) patients was associated with an annual Expanded Disability Status Scale increase ≥1, compared with onset in younger (<30 years) patients (P = 0.001, OR = 7.83). A total of 76.4% of patients had received attack-prevention treatments in the remission phase, and 31.7 and 10.6% of patients had ever been administered rituximab and traditional Chinese medicine, respectively. Additionally, 63.4 and 43.1% of patients reported participating in few or no social activities and being out of work because of the disease. To be noted, 76.4% of patients reported suffering from negative emotions, with the most frequent being worry (60.2%), with 20.3% of patients experiencing suicidal thoughts. The inability to work and participating in few or no social activities due to NMOSD were two determinants of experiencing negative emotions (Pwork = 0.03, ORwork = 3.34; Psocialactivities = 0.02, ORsocialactivities = 3.19). Conclusion: This study reported patient perspectives on NMOSD in North China, whereby demonstrating that the inability to work and participating in few or no social activities due to NMOSD rather than the physical impairment caused by the disease, was directly associated with patients experiencing negative emotions. This insight offers potential ways to manage patients' negative emotions by enhancing family and social support and facilitating active employment.
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Affiliation(s)
- Zhen Jia
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - XiuYu Dong
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Shuang Song
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Ruoyi Guo
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Lu Zhang
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
| | - Jia Liu
- Department of Neurology, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China.,Institute for Brain Disorders, Beijing University of Chinese Medicine, Beijing, China
| | - Bin Li
- Department of Neurology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.,Neurological Laboratory of Hebei, Shijiazhuang, China
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Fiani B, Covarrubias C, Jarrah R. Neuroimmunology and Novel Methods of Treatment for Acute Transverse Myelitis. Cureus 2021; 13:e17043. [PMID: 34522521 PMCID: PMC8428159 DOI: 10.7759/cureus.17043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 08/09/2021] [Indexed: 11/05/2022] Open
Abstract
Acute transverse myelitis (ATM) is a rare, immune-mediated pathology that is defined as an adverse inflammatory response in the spinal cord leading to neurologic injury. The pathophysiology of ATM is poorly understood, with no apparent differences in age, ethnicities, or race, along with variable radiographic and clinical presentation. Therefore, in this review, we will characterize what is known about ATM's etiology and diagnostic criteria, and relate it to properties of neuroimmunology. Moreover, we will further discuss current treatment options, along with potential novel methods, to provide a comprehensive overview of the status of ATM's research development. Among these novel treatments, potassium blockers reveal exciting early outcomes in restoring neurologic motor function. In addition, human glial progenitor cell transportations have been described as a potential treatment through integrating and remyelinating lesion sites. Nevertheless, despite these novel methods, there is a paucity of clinical trials establishing ATM's immunopathology and the therapeutic role of potential treatment methods. Therefore, we will highlight the importance of larger well-designed clinical trials in revealing significant biomarkers of injury and recovery.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Claudia Covarrubias
- School of Medicine, Universidad Anáhuac Querétaro, Santiago de Querétaro, MEX
| | - Ryan Jarrah
- College of Arts and Sciences, University of Michigan - Flint, Flint, USA
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