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Lazzaro C, Mazzanti NA, Rossi S, Parazzini F. Inebilizumab for neuromyelitis optica spectrum disorders in Italy: a budget impact model. Expert Rev Pharmacoecon Outcomes Res 2023; 23:1185-1200. [PMID: 37795872 DOI: 10.1080/14737167.2023.2267176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 10/01/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND The Italian National Health Service (INHS) has recently reimbursed the monoclonal antibody inebilizumab as a second line monotherapy after rituximab (RTX) use for neuromyelitis optica spectrum disorders (NMOSD) patients ≥ 18 years anti-aquaporin 4 antibody-immunoglobulin G positive, who experienced a relapse in the last year or cannot receive RTX, if incident patients. Other INHS-reimbursed drugs for NMOSD treatment are satralizumab, eculizumab and, off-label, besides RTX, ocrelizumab, tocilizumab, and immunosuppressants. RESEARCH DESIGN AND METHODS A 3-year (2023-2025) prevalence-based budget impact model following the INHS viewpoint compared the costs and the NMOSD attacks without (1st scenario) and with inebilizumab (2nd scenario). The epidemiology of NMOSD, and the INHS-funded healthcare resources (drugs and their administration; specialist visits; hospitalizations due to drug-related adverse events and NMOSD attacks) were obtained from the literature. One-way, threshold value and scenario sensitivity analyses investigated the robustness of the baseline findings. RESULTS During 2023-2025 inebilizumab saves the INHS €8,373,125.13 (1st scenario: €176,770,028.63; 2nd scenario: €168,396,903.50) and 12.74 NMOSD attacks (1st scenario: 213.94; 2nd scenario: 201.19). Sensitivity analyses confirmed the robustness of the baseline results. CONCLUSION Inebilizumab reduces the INHS expenditure for NMOSD drugs. Future research should explore the cost-effectiveness of inebilizumab vs other NMOSD-targeting drugs in Italy.
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Affiliation(s)
- Carlo Lazzaro
- Studio di Economia Sanitaria, Milan, Italy
- Biology and Biotechnologies Department "Lazzaro Spallanzani", University of Pavia, Pavia, Italy
| | | | | | - Fabio Parazzini
- Department of Clinical Sciences and Community Health (DISCCO), University of Milan, Milan, Italy
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Sadeghi-Bahmani D, Barzegar M, Mirmosayyeb O, Vaheb S, Nehzat N, Shaygannejad V, Brand S. Sociodemographic and Illness-Related Indicators to Predict the Status of Neuromyelitis Optica Spectrum Disorder (NMOSD) Five Years after Disease Onset. J Clin Med 2022; 11:jcm11030734. [PMID: 35160189 PMCID: PMC8836947 DOI: 10.3390/jcm11030734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/29/2021] [Accepted: 01/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Neuromyelitis Optica Spectrum Disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. Currently, no factors have been identified to predict the long-term course of NMOSD. To counter this, we analyzed data of 58 individuals with NMOSD at disease onset and about five years later. Methods: Medical records of 58 individuals with NMOSD (mean age: 31.13 years at disease onset; 86.2% female) were retrospectively analyzed. At baseline, a thorough medical and disease-related examination was performed; the same examination was repeated about five years later at follow-up, including treatment-related information. Mean outcome measure was the difference in EDSS (Expanded Disease Severity Scale) scores between baseline and follow-up. Results: Mean disease duration was 4.67 years. Based on the differences of the EDSS scores between baseline and follow-up, participants were categorized as improving (n = 39; 67.2%), unchanged (n = 13; 22.4%) and deteriorating (n = 6; 10.3%). Deteriorating was related to a higher progression index, and a higher number of attacks, while the annualized relapse rate reflecting the number of attacks per time lapse did not differ between the three groups. Improving was related to a higher intake of rituximab, and to a higher rate of seropositive cases. Unchanged was related to a lower rate of seropositive cases. Factors such as age, gender, somatic and psychiatric comorbidities, symptoms at disease onset, relapse rates, number and location of cervical plaques, or brain plaques and thoracolumbar plaques at baseline did not differ between those improving, deteriorating or remaining unchanged. Conclusions: Among a smaller sample of individuals with NMOSD followed-up about five years later, individuals deteriorating over time reported a higher progression index, while the annualized relapse rate was unrelated to the progress of disease. Overall, it appears that the course of NMOSD over a time lapse of about five years after disease onset is highly individualized. Accordingly, treatment regimen demands a highly individually tailored approach.
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Affiliation(s)
- Dena Sadeghi-Bahmani
- Department of Psychology, University of Stanford, Stanford, CA 94305, USA;
- Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, University of Basel, 4002 Basel, Switzerland;
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6714869914, Iran
| | - Mahdi Barzegar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (M.B.); (O.M.)
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (S.V.); (N.N.)
| | - Omid Mirmosayyeb
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (M.B.); (O.M.)
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (S.V.); (N.N.)
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (S.V.); (N.N.)
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (S.V.); (N.N.)
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (M.B.); (O.M.)
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan 8174673461, Iran; (S.V.); (N.N.)
- Correspondence:
| | - Serge Brand
- Psychiatric Clinics, Center for Affective, Stress and Sleep Disorders, University of Basel, 4002 Basel, Switzerland;
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah 6714869914, Iran
- Substance Abuse Prevention Research Center, Kermanshah University of Medical Sciences, Kermanshah 6714869914, Iran
- Department of Sport, Exercise and Health, Division of Sport Sciences and Psychosocial Health, University of Basel, 4052 Basel, Switzerland
- School of Medicine, Tehran University of Medical Sciences, Tehran 1417466191, Iran
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Melka D. Aquaporin-4-IgG Positive Neuromyelitis Optica Spectrum Disorder from Ethiopia: A Case Report. Ethiop J Health Sci 2021; 30:847-852. [PMID: 33911847 PMCID: PMC8047278 DOI: 10.4314/ejhs.v30i5.25] [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] [Indexed: 01/22/2023] Open
Abstract
Background Neuromyelitis Optica spectrum disorder is an inflammatory disorder affecting the central nervous system), most commonly attacking the spinal cord or optic nerves. Limited cases of neuromyelitis optica have been reported in east Africa. Based on my review, if published, this would be the second published case of Neuromyelitis Optica spectrum disorder and the first published case of seropositive Neuromyelitis Optica spectrum disorder reported from Ethiopia. It signifies the need to have a high index of suspicion to promptly identify and properly treat these patients. Case Presentation I am reporting a 32 years old female patient from Addis Ababa, Ethiopia, who presented with recurrent lower limb weakness and impairment of right eye vision of two-year duration. She was diagnosed based on Neuromyelitis Optica spectrum disorder diagnostic criteria, by having transverse myelitis, optic neuritis, confirmed by MRI imaging and high level of aquaporin-4-antibodies. Symptoms improved after providing five days of Methylprednisolone followed by low doses of corticosteroids and Azathioprine. The patient is now fully functional except for the right eye vision impairment. Conclusion The patient described here signifies a classic manifestation of Neuromylitis Optica disorder with aquaporin-4-IgG occurring in Ethiopian woman. This case highlights the existence of Devic's disease within our setting and the need to properly diagnose this condition even in a resource-limited setting to avert disability.
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Affiliation(s)
- Dereje Melka
- Department of neurology, college of health sciences, Addis Ababa University, Addis Ababa Ethiopia
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Barzegar M, Sadeghi Bahmani D, Mirmosayyeb O, Azarbayejani R, Afshari-Safavi A, Vaheb S, Nehzat N, Dana A, Shaygannejad V, Motl RW, Brand S. Higher Disease and Pain Severity and Fatigue and Lower Balance Skills Are Associated with Higher Prevalence of Falling among Individuals with the Inflammatory Disease of Neuromyelitis Optica Spectrum Disorder (NMOSD). J Clin Med 2020; 9:jcm9113604. [PMID: 33182291 PMCID: PMC7695277 DOI: 10.3390/jcm9113604] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/05/2020] [Accepted: 11/06/2020] [Indexed: 12/13/2022] Open
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a chronic inflammatory and autoimmune disorder that is associated with impaired vision, sensory loss, pain, fatigue, and spasms in the upper and lower limbs. Typically, persons with this disorder are also at higher risks of falls. Given this, the aims of the study were to compare the prevalence rates of falling for NMOSD cases and healthy controls (HCs), and to predict falling in the former group based on sociodemographic, psychological, and illness-related factors. Method: A total of 95 adults with NMOSD (Mean age = 34.89 years; 70.5% females) and 100 matched HCs took part in the study. All participants completed a series of questionnaires covering sociodemographic information and falling rates. The NMOSD individuals also reported on disease duration, pain, fatigue, and fear of falling, while their balance performance was objectively assessed. Results: Compared to healthy controls, the NMOSD cases had a 2.5-fold higher risk of falling. In this latter group, higher scores for pain, fatigue, fear of falling, and higher EDSS scores were distinguished between fallers and non-fallers, and objective balance skills had no predictive value. Conclusions: Compared to healthy controls, NMOSD sufferers had a 2.5-fold higher risk of experiencing falls. In this group, disease impairments (EDSS, fatigue, pain) predicted falling. Specific interventions such as regular resistance training might reduce the risk of falling.
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Affiliation(s)
- Mahdi Barzegar
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Dena Sadeghi Bahmani
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA; (D.S.B.); (R.W.M.)
- Center of Affective, Stress and Sleep Disorders (ZASS), University of Basel, Psychiatric Clinics (UPK), 4002 Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 67198-51351, Iran
| | - Omid Mirmosayyeb
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
| | - Reyhaneh Azarbayejani
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan 81746-73441, Iran
| | - Alireza Afshari-Safavi
- Department of Biostatistics and Epidemiology, Faculty of Health, North Khorasan University of Medical Sciences, Bojnurd 74877-94149, Iran;
| | - Saeed Vaheb
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
| | - Nasim Nehzat
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
| | - Afshin Dana
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran; (M.B.); (O.M.); (R.A.); (S.V.); (N.N.); (A.D.)
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran
- Correspondence: (V.S.); (S.B.); Tel.: +41-61-32-55-097 (S.B.)
| | - Robert W. Motl
- Departments of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL 35209, USA; (D.S.B.); (R.W.M.)
| | - Serge Brand
- Center of Affective, Stress and Sleep Disorders (ZASS), University of Basel, Psychiatric Clinics (UPK), 4002 Basel, Switzerland
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences (KUMS), Kermanshah 67198-51351, Iran
- Substance Abuse Prevention Research Center, Health Institute, Kermanshah University of Medical Sciences (KUMS), Kermanshah 67198-51351, Iran
- School of Medicine, Tehran University of Medical Sciences (TUMS), Tehran 14117-13135, Iran
- Department of Sport, Exercise, and Health, Division of Sport Science and Psychosocial Health, University of Basel, 4051 Basel, Switzerland
- Correspondence: (V.S.); (S.B.); Tel.: +41-61-32-55-097 (S.B.)
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Czarnecka D, Oset M, Karlińska I, Stasiołek M. Cognitive impairment in NMOSD-More questions than answers. Brain Behav 2020; 10:e01842. [PMID: 33022898 PMCID: PMC7667314 DOI: 10.1002/brb3.1842] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a type of central nervous system antibody-mediated disease which affects mainly optic nerves and spinal cord, but may also present with acute brainstem syndrome, acute diencephalic syndrome, and cerebral syndrome with typical brain lesions. One of the most disabling symptoms, diagnosed in 29%-67% of cases, is cognitive dysfunction, with such processes as memory, processing speed, executive function, attention, and verbal fluency being predominantly affected. However, description of cognition in NMOSD patients is still a relatively new area of research. METHODS A systematic MEDLINE search was performed to retrieve all studies that investigated cognitive impairment and its clinical correlates in patients with NMOSD. RESULTS We summarize the current knowledge on cognitive impairment profile, neuropsychological tests used to examine NMOSD patients, clinical and demographical variables affecting cognition, and magnetic resonance imaging correlates. We provide a comparison of cognitive profile of patients with multiple sclerosis and NMOSD. CONCLUSION Patients with NMOSD are at significant risk of cognitive deficits. However, the knowledge of cognitive symptoms in NMOSD and potential modifying interventions is still scarce. Further accumulation of clinical data may facilitate effective therapeutic interventions.
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Affiliation(s)
| | - Magdalena Oset
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Iwona Karlińska
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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García-Miranda P, Morón-Civanto FJ, Martínez-Olivo MDM, Suárez-Luna N, Ramírez-Lorca R, Lebrato-Hernández L, Lamas-Pérez R, Navarro G, Abril-Jaramillo J, García-Sánchez MI, Casado-Chocán JL, Uclés-Sánchez AJ, Romera M, Echevarría M, Díaz-Sánchez M. Predictive Value of Serum Antibodies and Point Mutations of AQP4, AQP1 and MOG in A Cohort of Spanish Patients with Neuromyelitis Optica Spectrum Disorders. Int J Mol Sci 2019; 20:ijms20225810. [PMID: 31752329 PMCID: PMC6887710 DOI: 10.3390/ijms20225810] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/11/2019] [Accepted: 11/17/2019] [Indexed: 12/15/2022] Open
Abstract
The detection of IgG aquaporin-4 antibodies in the serum of patients with Neuromyelitis optica (NMO) has dramatically improved the diagnosis of this disease and its distinction from multiple sclerosis. Recently, a group of patients have been described who have an NMO spectrum disorder (NMOsd) and who are seronegative for AQP4 antibodies but positive for IgG aquaporin-1 (AQP1) or myelin oligodendrocyte glycoprotein (MOG) antibodies. The purpose of this study was to determine whether AQP1 and MOG could be considered new biomarkers of this disease; and if point mutations in the gDNA of AQP4, AQP1 and MOG genes could be associated with the etiology of NMOsd. We evaluated the diagnostic capability of ELISA and cell-based assays (CBA), and analyzed their reliability, specificity, and sensitivity in detecting antibodies against these three proteins. The results showed that both assays can recognize these antigen proteins under appropriate conditions, but only anti-AQP4 antibodies, and not AQP1 or MOG, appears to be a clear biomarker for NMOsd. CBA is the best method for detecting these antibodies; and serum levels of AQP4 antibodies do not correlate with the progression of this disease. So far, the sequencing analysis has not revealed a genetic basis for the etiology of NMOsd, but a more extensive analysis is required before definitive conclusions can be drawn.
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Affiliation(s)
- Pablo García-Miranda
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (P.G.-M.); (F.J.M.-C.); (M.d.M.M.-O.); (N.S.-L.); (R.R.-L.)
| | - Francisco J. Morón-Civanto
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (P.G.-M.); (F.J.M.-C.); (M.d.M.M.-O.); (N.S.-L.); (R.R.-L.)
| | - Maria del Mar Martínez-Olivo
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (P.G.-M.); (F.J.M.-C.); (M.d.M.M.-O.); (N.S.-L.); (R.R.-L.)
| | - Nela Suárez-Luna
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (P.G.-M.); (F.J.M.-C.); (M.d.M.M.-O.); (N.S.-L.); (R.R.-L.)
| | - Reposo Ramírez-Lorca
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (P.G.-M.); (F.J.M.-C.); (M.d.M.M.-O.); (N.S.-L.); (R.R.-L.)
| | - Lucía Lebrato-Hernández
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología del Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (L.L.-H.); (R.L.-P.); (J.L.C.-C.); (A.J.U.-S.)
| | - Raquel Lamas-Pérez
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología del Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (L.L.-H.); (R.L.-P.); (J.L.C.-C.); (A.J.U.-S.)
| | - Guillermo Navarro
- Servicio de Neurología del Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (G.N.); (J.A.-J.); (M.I.G.-S.)
| | - Javier Abril-Jaramillo
- Servicio de Neurología del Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (G.N.); (J.A.-J.); (M.I.G.-S.)
| | - Maria Isabel García-Sánchez
- Servicio de Neurología del Hospital Universitario Virgen Macarena, 41009 Sevilla, Spain; (G.N.); (J.A.-J.); (M.I.G.-S.)
| | - José Luis Casado-Chocán
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología del Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (L.L.-H.); (R.L.-P.); (J.L.C.-C.); (A.J.U.-S.)
| | - Antonio José Uclés-Sánchez
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología del Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (L.L.-H.); (R.L.-P.); (J.L.C.-C.); (A.J.U.-S.)
| | - Mercedes Romera
- Servicio de Neurología del Hospital Universitario Virgen de Valme, 41014 Sevilla, Spain;
| | - Miriam Echevarría
- Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain; (P.G.-M.); (F.J.M.-C.); (M.d.M.M.-O.); (N.S.-L.); (R.R.-L.)
- Correspondence: (M.E.); (M.D.-S.); Tel.: +34-955-923036 (M.E.); +34-955-012593 (M.D.-S.)
| | - María Díaz-Sánchez
- Unidad de Gestión Clínica de Neurociencias, Servicio de Neurología del Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (L.L.-H.); (R.L.-P.); (J.L.C.-C.); (A.J.U.-S.)
- Correspondence: (M.E.); (M.D.-S.); Tel.: +34-955-923036 (M.E.); +34-955-012593 (M.D.-S.)
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Bulut E, Karakaya J, Salama S, Levy M, Huisman TAGM, Izbudak I. Brain MRI Findings in Pediatric-Onset Neuromyelitis Optica Spectrum Disorder: Challenges in Differentiation from Acute Disseminated Encephalomyelitis. AJNR Am J Neuroradiol 2019; 40:726-731. [PMID: 30846436 DOI: 10.3174/ajnr.a6003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/02/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Differentiating pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis could be challenging, especially in cases presenting with only brain manifestations. Our purpose was to investigate brain MR imaging features that may help distinguish these 2 entities. MATERIALS AND METHODS We retrospectively examined initial brain MR imaging studies of 10 patients with pediatric-onset neuromyelitis optica spectrum disorder (female/male ratio, 7:3) and 10 patients with acute disseminated encephalomyelitis (female/male ratio, 2:8). The mean age of the patients was 10.3 ± 5.6 and 8.7 ± 5.3 years, respectively. Brain lesions were evaluated with respect to location, extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. The χ2 test (Yates or Fisher exact χ2tests) was used to compare differences between groups. RESULTS Cerebral subcortical ± juxtacortical and pons ± middle cerebellar peduncle were the most frequent locations involved in both neuromyelitis optica spectrum disorder (n = 5 and 4, respectively) and acute disseminated encephalomyelitis (n = 9 and 7, respectively). Thalamic lesions were more frequent in acute disseminated encephalomyelitis (P = .020) and were detected only in 1 patient with neuromyelitis optica spectrum disorder. None of the patients with neuromyelitis optica spectrum disorder had hypothalamic, internal capsule, or cortical lesions. The internal capsule involvement was found to be significantly different between groups (P = .033). There was no significant difference in terms of extent, expansion, T1 hypointensity, contrast enhancement/pattern, and diffusion characteristics. CONCLUSIONS Although there is a considerable overlap in brain MR imaging findings, thalamic and internal capsule involvement could be used to differentiate pediatric-onset neuromyelitis optica spectrum disorder from acute disseminated encephalomyelitis.
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Affiliation(s)
- E Bulut
- From the Departments of Radiology (E.B.)
| | - J Karakaya
- Statistics (J.K.), Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - S Salama
- Department of Neurology and Psychiatry (S.S.), University of Alexandria, Alexandria, Egypt
| | - M Levy
- Department of Neurology (M.L.), Johns Hopkins School of Medicine, Baltimore, Maryland
| | - T A G M Huisman
- Edward B. Singleton Chair of Radiology (T.A.G.M.H.), Texas Children's Hospital, Houston, Texas
| | - I Izbudak
- Section of Pediatric Neuroradiology (I.I.), Division of Neuroradiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins School of Medicine, Baltimore, Maryland
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Shaygannejad V, Fayyazi E, Badihian S, Mirmosayyeb O, Manouchehri N, Ashtari F, Asgari N. Long-term tolerability, safety and efficacy of rituximab in neuromyelitis optica spectrum disorder: a prospective study. J Neurol 2019; 266:642-650. [PMID: 30635724 DOI: 10.1007/s00415-019-09180-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 12/29/2018] [Accepted: 01/02/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a B-cell-mediated disease with autoimmunity towards the astrocyte water channel aquaporin-4 (AQP-4) in the central nervous system. OBJECTIVE To assess the long-term safety and efficacy in NMOSD patients receiving maintenance therapy with B-cell-depleting agent rituximab for more than 2 years. METHOD NMOSD patients were included prospectively from 2014 to 2018 and received continuous cycles of rituximab infusions biannually. Incidence of adverse events (AE), serious AEs (SAE), and infusion-related AEs were evaluated through monthly phone calls and neurological examination every 4 months. RESULTS A total of 44 NMOSD patients were included, of those 30 were treatment naive (68%). The mean age was 37.2 years with 79.5% females. With overall observation period of 31.6 ± 7.3 months (24-48 months), tolerability was assessed as satisfactory in most cases. We observed infusion reactions (mostly mild) in 31.8% of patients and 31.8% never experienced any AEs after a mean 5.1 cycles of rituximab therapy. Rituximab was also beneficial in terms of improvement in relapse rate (from 0.26 ± 0.54 to 0, P = 0.003) and Expanded Disability Status Scale (from 4.1 ± 1.8 to 3.1 ± 1.8, P < 0.001). Stratification according to AQP4-IgG serostatus showed no difference between groups. CONCLUSION Rituximab treatment is well tolerated, safe, and efficacious with a minor risk of mild infusion reactions for NMOSD patients.
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Affiliation(s)
- V Shaygannejad
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - E Fayyazi
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - S Badihian
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - O Mirmosayyeb
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Student Research Committee, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - N Manouchehri
- Department of Neurology and Neurotherapeutics, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - F Ashtari
- Isfahan Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - N Asgari
- Department of Neurobiology, Institute of Molecular Medicine, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.
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9
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Barzegar M, Badihian S, Mirmosayyeb O, Ashtari F, Jamadi M, Emami S, Jahani L, Safavi A, Shaygannejad V. Comparative study of quality of life, anxiety, depression, and fatigue among patients with neuromyelitis optica spectrum disorder and multiple sclerosis: The first report from Iran. Mult Scler Relat Disord 2018; 22:161-165. [PMID: 29775851 DOI: 10.1016/j.msard.2018.04.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 03/07/2018] [Accepted: 04/13/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are associated with reduced Health Related Quality of Life (HRQOL). To the best of our knowledge, change of HRQOL in patients with NMOSD has not been yet measure in Iran. The objective of this study was to assess HRQOL in NMOSD and MS patients and identify related factors METHODS: A cross sectional study of 41 patients with NMOSD and 136 age and sex-match MS patients was performed. A series of questionnaires including Persian validated questionnaires on HRQOL (SF-36), fatigue (MFIS), depression (BDI-II), anxiety (HAM-A) and sleep quality (PSQI) were record. All demographic variables, socioeconomic status and clinical data were also obtained. Student's T test and Mann-Whitney U test used to compare variables between groups and multivariate regression analysis applied to assay predictor factors. RESULTS The mean scores of mental (MCS) and physical (PCS) components of QOL were statistically lower in patients with NMOSD compare with MS patients (β = -4.49, P = 0.004; β = -3.52, P = 0.015). Multivariate analysis indicated fatigue, depression and anxiety were independent, significant predictor of MCS (β = -0.229, P = 0.002; β = -0.229, P = 0.002; β = -0.258, P = 0.020 respectively). However, PCS was significantly predicted by fatigue (β = -0.258 P < 0.001), solely. CONCLUSION These findings indicate NMOSD patients have lower HRQOL in compare to patients with MS. Also, screening and treatment of fatigue as the most important predictor for HRQOL is necessary.
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Affiliation(s)
- Mahdi Barzegar
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shervin Badihian
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fereshteh Ashtari
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Jamadi
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran; Student Research Committee, School of medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shohreh Emami
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Jahani
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Armaghan Safavi
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Neurosciences Research Center, Alzahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
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10
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary, Canada; and Centre for Prevention of Stroke and Dementia, Nuffield Department of Clinical Neurosciences, University of Oxford, UK
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11
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Meng H, Xu J, Pan C, Cheng J, Hu Y, Hong Y, Shen Y, Dai H. Cognitive dysfunction in adult patients with neuromyelitis optica: a systematic review and meta-analysis. J Neurol 2016; 264:1549-1558. [PMID: 27909800 DOI: 10.1007/s00415-016-8345-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/08/2016] [Accepted: 11/11/2016] [Indexed: 01/11/2023]
Abstract
The objective of this study was to investigate cognitive dysfunction in 24-60-year-old neuromyelitis optica (NMO) patients, demographically matched healthy subjects, and MS patients. We conducted a comprehensive literature review of the PubMed, Medline, EMBASE, CNKI, Wan Fang Date, Web of Science, and Cochrane Library databases from inception to May 2016 for case-control studies that reported cognitive test scores in NMO patients, healthy subjects, and MS patients. Outcome measures were cognitive function evaluations, including performance on attention, language, memory, information processing speed, and executive function tests. The meta-analysis included eight studies. NMO patients performed significantly worse on attention (P < 0.00001), language (P = 0.00008), memory (P = 0.00004), information processing speed (P < 0.00001), and executive function tests (P = 0.00009) than healthy subjects. There were no significant differences in performance between NMO patients and MS patients on these tests. This meta-analysis indicates that NMO patients aged 24-60 years have significantly worse cognitive performance than demographically matched healthy subjects. However, this was comparable to the performance of demographically matched MS patients. There is a need for further rigorous randomized controlled trials with focus on elucidating the underlying mechanism of cognitive dysfunction in NMO patients.
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Affiliation(s)
- Hao Meng
- Non-Coding RNA Center, Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Jun Xu
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China.
- Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, School of Medicine, Yangzhou University, Yangzhou, 225001, Jiangsu, China.
| | - Chenling Pan
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, China
| | - Jiaxing Cheng
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Yue Hu
- Department of Neurology, Northern Jiangsu People's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Yin Hong
- Health Management Center, Northern Jiangsu Poeple's Hospital, Yangzhou, 225001, Jiangsu, China
| | - Yuehai Shen
- Faculty of Life Science and Technology, Kunming University of Science and Technology, Kunming, 650500, Yunnan, China
| | - Hua Dai
- Non-Coding RNA Center, Medical College of Yangzhou University, Yangzhou, 225001, Jiangsu, China
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