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Noori H, Marsool MDM, Gohil KM, Idrees M, Subash T, Alazzeh Z, Prajjwal P, Jain H, Amir O. Neuromyelitis optica spectrum disorder: Exploring the diverse clinical manifestations and the need for further exploration. Brain Behav 2024; 14:e3644. [PMID: 39135307 PMCID: PMC11319236 DOI: 10.1002/brb3.3644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 06/22/2024] [Accepted: 07/12/2024] [Indexed: 08/16/2024] Open
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disorder characterized by inflammatory assaults on the central nervous system (CNS), particularly on the optic nerves and spinal cord. In recent years, a wider range of clinical manifestations of this complex disease have been observed, emphasizing the importance of gaining a more profound understanding beyond optic neuritis (ON) and transverse myelitis (TM). CURRENT KNOWLEDGE This study explores the many clinical symptoms of NMOSD, including common and uncommon presentations. Distinctive aspects of ON, TM, and diencephalic/brainstem syndromes are examined, highlighting their unique characteristics in contrast to conditions such as multiple sclerosis. We also discuss extra-CNS involvement, such as unusual signs, including muscle involvement, retinal injury, auditory impairment, and rhinological symptoms. AIMS AND OBJECTIVES Our study intends to highlight the wide range and complexity of NMOSD presentations, emphasizing the significance of identifying unusual symptoms for precise diagnosis and prompt management. The specific processes that contribute to the varied clinical presentation of NMOSD are not well understood despite existing information. This emphasizes the necessity for more study to clarify the mechanisms that cause different symptoms and discover new treatment targets for this complex autoimmune disorder. CONCLUSION It is essential to acknowledge the complex and varied clinical manifestations of NMOSD to enhance diagnosis, treatment, and patient results. By enhancing our comprehension of the fundamental processes and investigating innovative therapeutic approaches, we may aim to enhance the quality of life for persons impacted by this illness.
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Affiliation(s)
- Hamid Noori
- Nuffield Department of Clinical NeurosciencesUniversity of OxfordOxfordUK
| | | | - Krutika Mahendra Gohil
- Hinduhridaysamrat Balasaheb Thackeray Medical College and Dr. Rustom Narsi Cooper Municipal General HospitalMumbaiIndia
| | | | - Tushar Subash
- Medical CollegeThe Aga Khan UniversityKarachiPakistan
| | - Zainab Alazzeh
- College of MedicineJordanian University of Science and TechnologyIrbidJordan
| | | | - Hritvik Jain
- All India Institute of Medical SciencesJodhpurIndia
| | - Omniat Amir
- Almanhal Academy for ScienceManhal UniversityKhartoumSudan
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2
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Rohatgi S, Rao P, Nirhale S, Naphade P, Kotharu S, Gupta S. Neuromyelitis Optica Presenting as Non-Communicating Hydrocephalus: A Case Report. Neurol India 2023; 71:1239-1240. [PMID: 38174465 DOI: 10.4103/0028-3886.391387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Neuromyelitis Optica (NMO) is a demyelinating disease predominantly involving optic nerves, spinal cord and peri-ventricular regions which are rich in Aquaporin-4 receptors. Aquaporin-4 (AQP4) antibodies are implicated in the pathogenesis of NMO. Association of hydrocephalus ( communicating and non communicating) with NMO is very rare. We report a case of 32 years old female patient who presented with 2 months history of progressive headache, visual obscurations and gait imbalance . Clinical examination revealed bilateral papilloedema with preserved visual acuity. She had truncal and gait ataxia. Rest of the examination of nervous system was normal. MRI brain showed non- communicating hydrocephalus and T2 and FLAIR hyperintensities in periventricular and periaqueductal regions. AQP4 antibodies were positive in serum and negative in cerebrospinal fluid(CSF). Ventriculo - peritoneal shunt was placed and she was treated with steroids and azathioprine. Her headache and visual symptoms improved. However, after 8 months she presented with acute optic neuritis of right eye which was treated with intravenous methylprednisolone and plasmapharaesis.
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Affiliation(s)
- Shalesh Rohatgi
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Prajwal Rao
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Satish Nirhale
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Pravin Naphade
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Sravya Kotharu
- Department of Medicine, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Sahil Gupta
- Department of Medicine, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
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3
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Pique J, Nicolas P, Marignier R. Neuromielite ottica acuta (malattia di Devic). Neurologia 2022. [DOI: 10.1016/s1634-7072(22)47095-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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4
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Marra CM, Rohatgi S, Bloom AK, Kahle KT, Haj AK. Case 25-2022: A 25-Year-Old Woman with Headache and Blurred Vision. N Engl J Med 2022; 387:641-650. [PMID: 36070713 DOI: 10.1056/nejmcpc2201241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Christina M Marra
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Saurabh Rohatgi
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Allyson K Bloom
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Kristopher T Kahle
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
| | - Amelia K Haj
- From the Department of Neurology (C.M.M.), University of Washington, Seattle; and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Massachusetts General Hospital, and the Departments of Radiology (S.R.), Medicine (A.K.B.), Neurosurgery (K.T.K.), and Pathology (A.K.H.), Harvard Medical School - both in Boston
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5
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Gastaldi M, Todisco M, Carlin G, Scaranzin S, Zardini E, Minafra B, Zangaglia R, Pichiecchio A, Reindl M, Jarius S, Pacchetti C, Franciotta D. AQP4 autoantibodies in patients with idiopathic normal pressure hydrocephalus. J Neuroimmunol 2020; 349:577407. [PMID: 33032017 DOI: 10.1016/j.jneuroim.2020.577407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/14/2020] [Accepted: 09/24/2020] [Indexed: 11/25/2022]
Abstract
Idiopathic normal pressure hydrocephalus (iNPH) is a common neurological disorder with unknown etiology. A selective depletion of aquaporin 4 (AQP4) has been shown in iNPH patients. We collected serum and cerebrospinal fluid (CSF) from 43 iNPH patients and 35 with other neurodegenerative conditions, and serum from 43 healthy subjects. All samples were tested for AQP4-IgG/IgA/IgM antibodies using a live cell-based assay. No patients or controls had serum/CSF AQP4-IgG/IgA. One/43 iNPH patient and 0/43 controls tested positive for serum AQP4-IgM. The AQP4-IgM-positive iNPH patient had no clinico-radiological distinctive features. AQP4 antibodies are unlikely to play a role in iNPH pathogenesis.
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Affiliation(s)
- Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy; Neuro-oncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy.
| | - Massimiliano Todisco
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Giorgia Carlin
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - Silvia Scaranzin
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy.
| | | | - Brigida Minafra
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Roberta Zangaglia
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Anna Pichiecchio
- Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy.
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Otto Meyerhof Center, Heidelberg, Germany
| | - Claudio Pacchetti
- Parkinson's Disease and Movement Disorders Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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6
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Tian DC, Xiu Y, Wang X, Shi K, Fan M, Li T, Li H, Su L, Ma Y, Xu W, Song T, Liu Y, Shi FD, Zhang X. Cortical Thinning and Ventricle Enlargement in Neuromyelitis Optica Spectrum Disorders. Front Neurol 2020; 11:872. [PMID: 32973658 PMCID: PMC7481470 DOI: 10.3389/fneur.2020.00872] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023] Open
Abstract
Background: In neuromyelitis optica spectrum disorders (NMOSDs), inflammation is not the sole driver of accumulation of disability; neurodegeneration is another important pathological process. We aim to explore different patterns of cortical atrophy and ventricular enlargement in NMOSD. Methods: We retrospectively analyzed a cohort of 230 subjects, comprising 55 healthy controls (HCs), 85 multiple sclerosis (MS), and 90 NMOSD patients from Tianjin Medical University General Hospital and Beijing Tiantan Hospital. Different compartments of the brain (total gray, cortex, subcortex gray, and ventricle volume) were evaluated with the FreeSurfer. Multiple linear regressions were adopted to explore associations between cortex volume and predict factors. Results: Compared with HCs, NMOSD, and MS displayed an enlarged lateral and third ventricle (p < 0.001), whereas expansion of the fourth ventricle was observed in MS rather than NMOSD (p = 0.321). MS and NMOSD patients exhibited cortical thinning in comparison with HCs. However, pronounced cortical atrophy were only significant in pre-cuneus, parahippocampal, and lateral occipital lobe between MS and NMOSD. Patients with NMOSD had decreased local gyrification index in orbitofrontal and pre-cuneus lobe, and reduced pial surface area. Linear regression analysis revealed cortex volume were predicated by advanced age (standardized β = −0.404, p = 0.001) as well as prolonged disease history (standardized β = −0.311, p = 0.006). Conclusion: NMOSD exhibited global cortex atrophy with enlarged lateral and third ventricles. Moreover, cortex volume is associated with age and disease duration.
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Affiliation(s)
- De-Cai Tian
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuwen Xiu
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinli Wang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Kaibin Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Moli Fan
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Ting Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Huining Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lei Su
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuetao Ma
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Wangshu Xu
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Tian Song
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Fu-Dong Shi
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Xinghu Zhang
- Center for Neuroinflammation, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
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7
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de Laurentis C, Cristaldi P, Arighi A, Cavandoli C, Trezza A, Sganzerla EP, Giussani CG, Di Cristofori A. Role of aquaporins in hydrocephalus: what do we know and where do we stand? A systematic review. J Neurol 2020; 268:4078-4094. [PMID: 32747978 DOI: 10.1007/s00415-020-10122-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 07/25/2020] [Accepted: 07/27/2020] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Glymphatic fluid circulation may be considered the lymphatic system of the brain and the main role of such system seems to be played by aquaporins (AQPs), a family of proteins which regulates water exchange, in particular AQP4 and 1. Alterations of glymphatic fluid circulation through AQPs variations are now emerging as central elements in the pathophysiology of different brain conditions, like hydrocephalus. This systematic review provides an insight about the role of AQPs in hydrocephalus establishment and compensation, investigating their possible role as diagnostic tools or therapeutic targets. METHODS PubMed database was screened searching for the relevant existing literature in English language published until February 29th 2020, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement. RESULTS A total of 40 articles met the inclusion criteria for our systematic analysis. AQP4 resulted the most studied water channel, followed by AQP1. The changes in cerebrospinal fluid (CSF), brain parenchyma and choroid plexus (CP) in different hydrocephalus type were analyzed. Moreover, important pharmacological interactions regarding AQP and molecules or conditions were discussed. A very interesting result is the general consensus on increase of AQP4 in hydrocephalic patients, unless in patients suffering from idiopathic normal pressure hydrocephalus, where AQP4 shows a tendency in reduction. CONCLUSION AQP seem to play a central role in the pathophysiology of hydrocephalus and in its compensation mechanisms. Further studies are required to definitively establish their precise roles and their quantitative changes to allow their utilization as diagnostic tools or therapeutic targets.
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Affiliation(s)
- Camilla de Laurentis
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Paola Cristaldi
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Andrea Arighi
- Unit of Neurology - UOSD Malattie Neurodegenerative, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, MI, Italy.,Dino Ferrari Center - Università degli Studi di Milano, Milan, MI, Italy
| | - Clarissa Cavandoli
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Università degli Studi di Milano, Milan, MI, Italy
| | - Andrea Trezza
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy
| | - Erik P Sganzerla
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Carlo G Giussani
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.,Department of Surgery and Medicine, Università degli Studi Milano-Bicocca, Milan, MI, Italy
| | - Andrea Di Cristofori
- Unit of Neurosurgery, Ospedale San Gerardo, Azienda Socio Sanitaria Territoriale Monza, Via G. B. Pergolesi 33, 20900, Monza, MB, Italy.
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8
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Filippi M, Preziosa P, Banwell BL, Barkhof F, Ciccarelli O, De Stefano N, Geurts JJG, Paul F, Reich DS, Toosy AT, Traboulsee A, Wattjes MP, Yousry TA, Gass A, Lubetzki C, Weinshenker BG, Rocca MA. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain 2020; 142:1858-1875. [PMID: 31209474 PMCID: PMC6598631 DOI: 10.1093/brain/awz144] [Citation(s) in RCA: 288] [Impact Index Per Article: 72.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 04/29/2019] [Accepted: 05/01/2019] [Indexed: 12/19/2022] Open
Abstract
MRI has improved the diagnostic work-up of multiple sclerosis, but inappropriate image interpretation and application of MRI diagnostic criteria contribute to misdiagnosis. Some diseases, now recognized as conditions distinct from multiple sclerosis, may satisfy the MRI criteria for multiple sclerosis (e.g. neuromyelitis optica spectrum disorders, Susac syndrome), thus making the diagnosis of multiple sclerosis more challenging, especially if biomarker testing (such as serum anti-AQP4 antibodies) is not informative. Improvements in MRI technology contribute and promise to better define the typical features of multiple sclerosis lesions (e.g. juxtacortical and periventricular location, cortical involvement). Greater understanding of some key aspects of multiple sclerosis pathobiology has allowed the identification of characteristics more specific to multiple sclerosis (e.g. central vein sign, subpial demyelination and lesional rims), which are not included in the current multiple sclerosis diagnostic criteria. In this review, we provide the clinicians and researchers with a practical guide to enhance the proper recognition of multiple sclerosis lesions, including a thorough definition and illustration of typical MRI features, as well as a discussion of red flags suggestive of alternative diagnoses. We also discuss the possible place of emerging qualitative features of lesions which may become important in the near future.
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Affiliation(s)
- Massimo Filippi
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Paolo Preziosa
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Brenda L Banwell
- Division of Neurology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Institutes of Neurology and Healthcare Engineering, University College London, London, UK
| | - Olga Ciccarelli
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK.,National Institute for Health Research University College London Hospitals Biomedical Research Center, National Institute for Health Research, London, UK
| | - Nicola De Stefano
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Jeroen J G Geurts
- Department of Anatomy and Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Friedemann Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité -Universitätsmedizin Berlin, Berlin, Germany
| | - Daniel S Reich
- Translational Neuroradiology Section, Division of Neuroimmunology and Neurovirology, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD, USA
| | - Ahmed T Toosy
- Queen Square MS Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, UK
| | - Anthony Traboulsee
- MS/MRI Research Group, Djavad Mowafaghian Centre for Brain Health, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada.,Faculty of Medicine, Division of Neurology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mike P Wattjes
- Department of Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Tarek A Yousry
- Division of Neuroradiology and Neurophysics, UCL Institute of Neurology, London, UK.,Lysholm Department of Neuroradiology, London, UK
| | - Achim Gass
- Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
| | - Catherine Lubetzki
- Sorbonne University, AP-HP Pitié-Salpétriére Hospital, Department of Neurology, 75013 Paris, France
| | | | - Maria A Rocca
- Neuroimaging Research Unit, Institute of Experimental Neurology, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neurology Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy
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9
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Maroli N, Kalagatur NK, Bhasuran B, Jayakrishnan A, Manoharan RR, Kolandaivel P, Natarajan J, Kadirvelu K. Molecular Mechanism of T-2 Toxin-Induced Cerebral Edema by Aquaporin-4 Blocking and Permeation. J Chem Inf Model 2019; 59:4942-4958. [DOI: 10.1021/acs.jcim.9b00711] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | - Jeyakumar Natarajan
- Data Mining and Text Mining Laboratory, Department of Bioinformatics, Bharathiar University, Coimbatore 641046, Tamil Nadu, India
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10
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Close LN, Zanaty M, Kirby P, Dlouhy BJ. Acute Hydrocephalus Resulting from Neuromyelitis Optica: A Case Report and Review of the Literature. World Neurosurg 2019; 129:367-371. [PMID: 31200081 DOI: 10.1016/j.wneu.2019.05.177] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Neuromyelitis optica is an autoimmune disorder of the central nervous system that predominantly affects the optic nerves and spinal cord. The neuropathologic hallmark of the disease is deposits of antibodies and complement, loss of astrocytes, secondary degeneration of oligodendrocytes and neurons, and necrotic lesions with infiltration of neutrophilic and eosinophilic granulocytes. It can rarely be associated with hydrocephalus, but the cause and mechanisms that result in hydrocephalus are not clear. CASE DESCRIPTION A 35-year-old woman with a history of neuromyelitis optica presented with a 5-day history of progressively worsening lethargy, fatigue, somnolence, and headaches. Imaging demonstrated new hydrocephalus without evidence of obstruction, and extensive periventricular enhancement concerning for active demyelination. She underwent placement of a ventriculostomy, and subsequently underwent endoscopic biopsy and ventriculoperitoneal shunt placement. Pathology confirmed demyelination secondary to neuromyelitis optica. CONCLUSIONS This case provides evidence of the rapid development of hydrocephalus in association with periventricular inflammation, without aqueductal stenosis. In a state of aquaporin-4 dysfunction such as in neuromyelitis optica, altered cerebrospinal fluid resorption could lead to acute hydrocephalus by a nonobstructive mechanism.
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Affiliation(s)
- Liesl N Close
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Mario Zanaty
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Patricia Kirby
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Brian J Dlouhy
- Department of Neurosurgery, University of Iowa Hospitals and Clinics, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA; Iowa Neuroscience Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA; Pappajohn Biomedical Institute, University of Iowa Carver College of Medicine, Iowa City, Iowa, USA.
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11
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Aquaporin-4 Water Channel in the Brain and Its Implication for Health and Disease. Cells 2019; 8:cells8020090. [PMID: 30691235 PMCID: PMC6406241 DOI: 10.3390/cells8020090] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 01/23/2019] [Accepted: 01/23/2019] [Indexed: 02/08/2023] Open
Abstract
Aquaporin-4 (AQP4) is a water channel expressed on astrocytic endfeet in the brain. The role of AQP4 has been studied in health and in a range of pathological conditions. Interest in AQP4 has increased since it was discovered to be the target antigen in the inflammatory autoimmune disease neuromyelitis optica spectrum disorder (NMOSD). Emerging data suggest that AQP4 may also be implicated in the glymphatic system and may be involved in the clearance of beta-amyloid in Alzheimer’s disease (AD). In this review, we will describe the role of AQP4 in the adult and developing brain as well as its implication for disease.
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12
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Baghbanian SM, Asgari N, Sahraian MA, Moghadasi AN. A comparison of pediatric and adult neuromyelitis optica spectrum disorders: A review of clinical manifestation, diagnosis, and treatment. J Neurol Sci 2018; 388:222-231. [DOI: 10.1016/j.jns.2018.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022]
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Abstract
PURPOSE OF REVIEW This article provides a practical approach for providers caring for patients with neuromyelitis optica (NMO) spectrum disorders. Clinical and imaging features, diagnostic criteria, treatment of acute exacerbations, chronic preventive therapy, and symptom management in NMO spectrum disorders are discussed. RECENT FINDINGS The rapid pace of research in NMO spectrum disorders has led to many recent advances. A broader understanding of the clinical spectrum of the disease as well as improvements in anti-aquaporin-4 antibody assays have led to recent revision of the diagnostic criteria. Several recent studies have expanded the knowledge base regarding the efficacy and safety of current therapies for NMO spectrum disorders. SUMMARY An NMO spectrum disorder is an inflammatory disorder affecting the central nervous system, previously thought to be closely related to multiple sclerosis but more recently demonstrated to represent a distinct clinical and pathophysiologic entity. As NMO spectrum disorders carry significant morbidity and, at times, mortality, prompt and accurate diagnosis followed by swift initiation of therapy for both treatment of acute exacerbations and prevention of further relapses is critical. This article provides a practical approach to the diagnosis and management of NMO spectrum disorders.
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Rosales D, Kister I. Common and Rare Manifestations of Neuromyelitis Optica Spectrum Disorder. Curr Allergy Asthma Rep 2017; 16:42. [PMID: 27167974 DOI: 10.1007/s11882-016-0619-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The discovery of a highly specific biomarker of neuromyelitis optica (NMO)-the anti-aquaporin-4 (AQP4) antibody-has opened new paths to understanding disease pathogenesis and afforded a way to confirm the diagnosis in clinical practice. An important consequence of the discovery is the broadening of the spectrum of syndromes seen in the context of AQP4 autoimmunity. These syndromes have been subsumed under the rubric of NMO spectrum disorder (NMOSD). The current classification recognizes not only optic neuritis and myelitis as core syndromes of NMOSD but also cerebral, diencephalic, brainstem, and area postrema syndromes. These neurologic syndromes are the focus of our review. AQP4 is also expressed in many organs outside of the central nervous system, and this may explain some of the unusual, non-neurologic features that have been occasionally reported in NMOSD. Our review catalogues non-neurologic manifestations seen in NMOSD and concludes with a discussion of frequently associated autoimmune and neoplastic comorbidities of NMOSD.
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Affiliation(s)
- Dominique Rosales
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU School of Medicine, 240 E 38th St, New York, NY, 10016, USA.
| | - Ilya Kister
- NYU Multiple Sclerosis Comprehensive Care Center, Department of Neurology, NYU School of Medicine, 240 E 38th St, New York, NY, 10016, USA
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Guo Y, Weigand SD, Popescu BF, Lennon VA, Parisi JE, Pittock SJ, Parks NE, Clardy SL, Howe CL, Lucchinetti CF. Pathogenic implications of cerebrospinal fluid barrier pathology in neuromyelitis optica. Acta Neuropathol 2017; 133:597-612. [PMID: 28184993 PMCID: PMC5348570 DOI: 10.1007/s00401-017-1682-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 01/12/2017] [Accepted: 01/25/2017] [Indexed: 02/06/2023]
Abstract
Pathogenic autoantibodies associated with neuromyelitis optica (NMO) induce disease by targeting aquaporin-4 (AQP4) water channels enriched on astrocytic endfeet at blood–brain interfaces. AQP4 is also expressed at cerebrospinal fluid (CSF)–brain interfaces, such as the pial glia limitans and the ependyma and at the choroid plexus blood–CSF barrier. However, little is known regarding pathology at these sites in NMO. Therefore, we evaluated AQP4 expression, microglial reactivity, and complement deposition at pial and ependymal surfaces and in the fourth ventricle choroid plexus in 23 autopsy cases with clinically and/or pathologically confirmed NMO or NMO spectrum disorder. These findings were compared to five cases with multiple sclerosis, five cases of choroid plexus papilloma, and five control cases without central nervous system disease. In the NMO cases, AQP4 immunoreactivity was reduced relative to control levels in the pia (91%; 21/23), ependyma (56%; 9/16), and choroid plexus epithelium (100%; 12/12). AQP4 immunoreactivity was normal in MS cases in these regions. Compared to MS, NMO cases also showed a focal pattern of pial and ependymal complement deposition and more pronounced microglial reactivity. In addition, AQP4 loss, microglial reactivity, and complement deposition colocalized along the pia and ependyma only in NMO cases. Within the choroid plexus, AQP4 loss was coincident with C9neo immunoreactivity on epithelial cell membranes only in NMO cases. These observations demonstrate that NMO immunopathology extends beyond perivascular astrocytic foot processes to include the pia, ependyma, and choroid plexus, suggesting that NMO IgG-induced pathological alterations at CSF–brain and blood–CSF interfaces may contribute to the occurrence of ventriculitis, leptomeningitis, and hydrocephalus observed among NMO patients. Moreover, disruption of the blood–CSF barrier induced by binding of NMO IgG to AQP4 on the basolateral surface of choroid plexus epithelial cells may provide a unique portal for entry of the pathogenic antibody into the central nervous system.
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Affiliation(s)
- Yong Guo
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stephen D Weigand
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Bogdan F Popescu
- Department of Anatomy and Cell Biology, Cameco MS Neuroscience Research Center, University of Saskatchewan, Saskatoon, SK, Canada
| | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Joseph E Parisi
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Natalie E Parks
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Stacey L Clardy
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Charles L Howe
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Department of Immunology, Mayo Clinic, Rochester, MN, USA.
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
- Department of Neuroscience, Mayo Clinic, Rochester, MN, USA.
| | - Claudia F Lucchinetti
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA.
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Han J, Yang MG, Zhu J, Jin T. Complexity and wide range of neuromyelitis optica spectrum disorders: more than typical manifestations. Neuropsychiatr Dis Treat 2017; 13:2653-2660. [PMID: 29118581 PMCID: PMC5659226 DOI: 10.2147/ndt.s147360] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Neuromyelitis optica (NMO), considered to be mediated by autoantibodies, often cause severely disabling disorders of the central nervous system, and predominantly cause optic nerve damage and longitudinally extensive transverse myelitis. Remarkable progress has been made in deciphering NMO pathogenesis during the past decade. In 2015, the International Panel for NMO Diagnosis proposed the unifying term "NMO spectrum disorders" (NMOSD) and the updated NMOSD criteria reflects a wide range of disease and maintains reasonable specificity. Moreover, cumulative findings have indicated that NMOSD are frequently associated with multiple autoimmune diseases, thereby presenting complex clinical symptoms that make this disease more difficult to recognize. Notably, most neurologists do not heed these symptoms or comorbid conditions in patients with NMOSD. Whereas previous reviews have focused on pathogenesis, treatment, and prognosis in NMOSD, we summarize the present knowledge with particular emphasis on atypical manifestations and autoimmune comorbidities in patients with NMOSD. Furthermore, we emphasized the identification of these atypical characteristics to enable a broader and better understanding of NMOSD, and improve early accurate diagnosis and therapeutic decision making.
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Affiliation(s)
- Jinming Han
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Meng-Ge Yang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tao Jin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Changchun, China
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Visual impairment. HANDBOOK OF CLINICAL NEUROLOGY 2016. [PMID: 27430448 DOI: 10.1016/b978-0-444-53486-6.00045-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register]
Abstract
This chapter can guide the use of imaging in the evaluation of common visual syndromes: transient visual disturbance, including migraine and amaurosis fugax; acute optic neuropathy complicating multiple sclerosis, neuromyelitis optica spectrum disorder, Leber hereditary optic neuropathy, and Susac syndrome; papilledema and pseudotumor cerebri syndrome; cerebral disturbances of vision, including posterior cerebral arterial occlusion, posterior reversible encephalopathy, hemianopia after anterior temporal lobe resection, posterior cortical atrophy, and conversion blindness. Finally, practical efforts in visual rehabilitation by sensory substitution for blind patients can improve their lives and disclose new information about the brain.
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Abstract
PURPOSE OF REVIEW The increasing availability of effective therapies for multiple sclerosis as well as research demonstrating the benefits of early treatment highlights the importance of expedient and accurate multiple sclerosis diagnosis. This review will discuss the classification, diagnosis, and differential diagnosis of multiple sclerosis. RECENT FINDINGS An international panel of multiple sclerosis experts, the MS Phenotype Group, recently revised the multiple sclerosis phenotypic classifications and published their recommendations in 2014. Recent research developments have helped improve the accuracy of multiple sclerosis diagnosis, especially with regard to differentiating multiple sclerosis from neuromyelitis optica spectrum disorders. SUMMARY Current multiple sclerosis phenotypic classifications include relapsing-remitting multiple sclerosis, clinically isolated syndrome, radiologically isolated syndrome, primary-progressive multiple sclerosis, and secondary-progressive multiple sclerosis. The McDonald 2010 diagnostic criteria provide formal guidelines for the diagnosis of relapsing-remitting multiple sclerosis and primary-progressive multiple sclerosis. These require demonstration of dissemination in space and time, with consideration given to both clinical findings and imaging data. The criteria also require that there exist no better explanation for the patient's presentation. The clinical history, examination, and MRI should be most consistent with multiple sclerosis, including the presence of features typical for the disease as well as the absence of features that suggest an alternative cause, for a diagnosis of multiple sclerosis to be proposed.
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Nour MM, Nakashima I, Coutinho E, Woodhall M, Sousa F, Revis J, Takai Y, George J, Kitley J, Santos ME, Nour JM, Cheng F, Kuroda H, Misu T, Martins-da-Silva A, DeLuca GC, Vincent A, Palace J, Waters P, Fujihara K, Leite MI. Pregnancy outcomes in aquaporin-4-positive neuromyelitis optica spectrum disorder. Neurology 2015; 86:79-87. [PMID: 26581304 DOI: 10.1212/wnl.0000000000002208] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 08/25/2015] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the association between neuromyelitis optica spectrum disorder (NMOSD) and pregnancy outcome. METHODS An international cohort of women with aquaporin-4 antibody-positive NMOSD and ≥1 pregnancy was studied retrospectively. Multivariate logistic regression was used to investigate whether pregnancy after NMOSD onset was associated with an increased risk of miscarriage (cohort of 40 women) or preeclampsia (cohort of 57 women). RESULTS Miscarriage rate was higher in pregnancies after NMOSD onset (42.9% [95% confidence interval 17.7%-71.1%] vs. 7.04% [2.33%-15.7%]). Pregnancies conceived after, or up to 3 years before, NMOSD onset had an increased odds ratio of miscarriage (7.28 [1.03-51.6] and 11.6 [1.05-128], respectively), independent of maternal age or history of miscarriage. Pregnancies after, or up to 1 year before, NMOSD onset ending in miscarriage were associated with increased disease activity from 9 months before conception to the end of pregnancy, compared to viable pregnancies (mean annualized relapse rate 0.707 vs. 0.100). The preeclampsia rate (11.5% [6.27%-18.9%]) was significantly higher than reported in population studies. The odds of preeclampsia were greater in women with multiple other autoimmune disorders or miscarriage in the most recent previous pregnancy, but NMOSD onset was not a risk factor. CONCLUSIONS Pregnancy after NMOSD onset is an independent risk factor for miscarriage, and pregnancies conceived at times of high disease activity may be at increased risk of miscarriage. Women who develop NMOSD and have multiple other autoimmune disorders have greater odds of preeclampsia, independent of NMOSD onset timing.
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Affiliation(s)
- Matthew M Nour
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Ichiro Nakashima
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Ester Coutinho
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Mark Woodhall
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Filipa Sousa
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Jon Revis
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Yoshiki Takai
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Jithin George
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Joanna Kitley
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Maria Ernestina Santos
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Joseph M Nour
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Fan Cheng
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Hiroshi Kuroda
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Tatsuro Misu
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Ana Martins-da-Silva
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Gabriele C DeLuca
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Angela Vincent
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Jacqueline Palace
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Patrick Waters
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Kazuo Fujihara
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal
| | - Maria Isabel Leite
- From the Nuffield Department of Clinical Neurosciences (M.M.N., E.C., M.W., J.R., J.G., J.K., J.M.N., F.C., G.C.D., A.V., J.P., P.W., M.I.L.), John Radcliffe Hospital, University of Oxford, UK; Departments of Neurology (I.N., Y.T., H.K.) and Multiple Sclerosis Therapeutics (T.M., K.F.), Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Clinical Neurology (F.S.), Hospital de São Marcos, Braga; and Department of Clinical Neurology (A.M.-d.-S., M.E.S.), Hospital Geral Santo Antonio, Porto, Portugal.
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The Neuroepithelium Disruption Could Generate Autoantibodies against AQP4 and Cause Neuromyelitis Optica and Hydrocephalus. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2014; 2014:580572. [PMID: 27379319 PMCID: PMC4897238 DOI: 10.1155/2014/580572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/11/2014] [Accepted: 09/14/2014] [Indexed: 12/02/2022]
Abstract
Neuromyelitis optica is an inflammatory disease characterized by neuritis and myelitis of the optic nerve. Its physiopathology is connected with the aquaporin-4 water channel, since antibodies against aquaporin-4 have been found in the cerebrospinal fluid and blood of neuromyelitis optica patients. The seropositivity for aquaporin-4 antibodies is used for the diagnosis of neuromyelitis optica or neuromyelitis optica spectrum disease. On the other hand, aquaporin-4 is expressed in astrocyte feet in the brain-blood barrier and subventricular zones of the brain ventricles. Aquaporin-4 expression is high in cerebrospinal fluid in hydrocephalus. Furthermore, neuroepithelial denudation precedes noncommunicating hydrocephalus and this neuroepithelial disruption could allow aquaporin-4 to reach anomalous brain areas where it is unrecognized and induce the generation of aquaporin-4 antibodies which could cause the neuromyelitis optica and certain types of hydrocephalus.
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