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Liang S, Zhao S, Liu H, Liu J, Xie X, Chen R, Chen B, Luan T. A quantitative method for aquaporin-1 protein using magnetic preconcentration and probe-based immunoassay coupling to inductively coupled plasma mass spectrometry in urine analysis. Anal Chim Acta 2024; 1324:343101. [PMID: 39218579 DOI: 10.1016/j.aca.2024.343101] [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: 03/16/2024] [Revised: 06/26/2024] [Accepted: 08/12/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Aquaporin-1 (AQP1) protein plays a crucial role in intracellular and extracellular water homeostasis and fluid transport in organs and tissues associated with diverse life activities and is extremely abundant in the kidney. Accurate detection of AQP1 in urine can be applied as screening of early-stage disease. Application of magnetic preconcentration and probe-based signal amplification strategy coupling to inductively coupled plasma mass spectrometry (ICP-MS) is a more accurate, sensitive and specific detection method for AQP1 in complex biological samples compared to conventional methods. RESULTS We described an element-labelling strategy based on magnetic preconcentration and probe-based immunoassay coupling to ICP-MS detection. The magnetic beads (MBs) modified with epoxy groups were capable of enriching AQP1 proteins and separating them from complex matrices. The probe constructed by conjugating anti-AQP1 antibody molecules on the surface of gold nanoparticles could specifically recognize AQP1 proteins attached on MBs and be analyzed by ICP-MS. The concentration of AQP1 protein could be precisely quantified and amplified by 14,000 times through the corresponding signal of Au atoms. This assay for AQP1 protein quantification achieved a detection limit down to 0.023 ng mL-1, a broad linear calibration curve between 0.3 ng mL-1 and 30 ng mL-1, as well as outstanding specificity. SIGNIFICANCE The proposed method was successfully applied to detect AQP1 protein in human urine samples, showing the potential for its applications concerning accurate AQP1 quantification. It can also screen a wide range of proteins provided the antibodies specific to these target proteins are available.
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Affiliation(s)
- Shuqi Liang
- Instrumental Analysis & Research Center, Sun Yat-Sen University, Guangzhou, 510275, China; MOE Key Laboratory of Bioinorganic and Synthetic Chemistry/KLGHEI of Environment and Energy Chemistry, School of Chemistry, School of Environmental Science and Engineering, Sun Yat-sen University, Guangzhou, 510006, China
| | - Shuang Zhao
- Sate Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, China
| | - Hongtao Liu
- Instrumental Analysis & Research Center, Sun Yat-Sen University, Guangzhou, 510275, China
| | - Jiahui Liu
- Sate Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, China
| | - Xiuqin Xie
- Southern Marine Science and Engineering Guangdong Laboratory, School of Marine Sciences, Sun Yat-Sen University, Zhuhai, 519082, China
| | - Ruohong Chen
- Sate Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, China; Guangdong Provincial Laboratory of Chemistry and Fine Chemical Engineering Jieyang Center, Jieyang, 515200, China.
| | - Baowei Chen
- Southern Marine Science and Engineering Guangdong Laboratory, School of Marine Sciences, Sun Yat-Sen University, Zhuhai, 519082, China
| | - Tiangang Luan
- Sate Key Laboratory of Biocontrol, School of Life Sciences, Sun Yat-Sen University, Guangzhou 510275, China; Guangdong Provincial Laboratory of Chemistry and Fine Chemical Engineering Jieyang Center, Jieyang, 515200, China; School of Environmental and Chemical Engineering, Wuyi University, Jiangmen, 529020, China
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Legge AC, Hanly JG. Recent advances in the diagnosis and management of neuropsychiatric lupus. Nat Rev Rheumatol 2024:10.1038/s41584-024-01163-z. [PMID: 39358609 DOI: 10.1038/s41584-024-01163-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 10/04/2024]
Abstract
Neuropsychiatric manifestations of systemic lupus erythematosus (SLE) are common and frequently associated with a substantial negative impact on health outcomes. The pathogenesis of neuropsychiatric SLE (NPSLE) remains largely unknown, but a single pathogenic mechanism is unlikely to be responsible for the heterogeneous array of clinical manifestations, and a combination of inflammatory and ischaemic mechanistic pathways have been implicated. Currently, valid and reliable biomarkers for the diagnosis of NPSLE are lacking, and differentiating NPSLE from nervous system dysfunction not caused by SLE remains a major challenge for clinicians. However, correct attribution is essential to ensure timely institution of appropriate treatment. In the absence of randomized clinical trials on NPSLE, current treatment strategies are derived from clinical experience with different therapeutic modalities and their efficacy in the management of other manifestations of SLE or of neuropsychiatric disease in non-SLE populations. This Review describes recent advances in the understanding of NPSLE that can inform diagnosis and management, as well as unanswered questions that necessitate further research.
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Affiliation(s)
- Alexandra C Legge
- Division of Rheumatology, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine, Dalhousie University and Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada.
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Ye XF, Huang ZP, Li MM, Liu SF, Huang WL, Hamud AMS, Ye LC, Li LY, Wu SJ, Zhuang JL, Chen YH, Chen XR, Lin S, Wei XF, Chen CN. Update on aquaporin-4 antibody detection: the early diagnosis of neuromyelitis optica spectrum disorders. Mult Scler Relat Disord 2024; 90:105803. [PMID: 39128164 DOI: 10.1016/j.msard.2024.105803] [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: 03/17/2024] [Revised: 07/06/2024] [Accepted: 08/03/2024] [Indexed: 08/13/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune-mediated primary inflammatory myelinopathy of the central nervous system that primarily affects the optic nerve and spinal cord. The aquaporin 4 antibody (AQP4-Ab) is a specific autoantibody marker for NMOSD. Most patients with NMOSD are seropositive for AQP4-Ab, thus aiding physicians in identifying ways to treat NMOSD. AQP4-Ab has been tested in many clinical and laboratory studies, demonstrating effectiveness in diagnosing NMOSD. Recently, novel assays have been developed for the rapid and accurate detection of AQP4-Ab, providing further guidance for the diagnosis and treatment of NMOSD. This article summarizes the importance of rapid and accurate diagnosis for treating NMOSD based on a review of the latest relevant literature. We discussed current challenges and methods for improvement to offer new ideas for exploring rapid and accurate AQP4-Ab detection methods, aiming for early diagnosis of NMOSD.
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Affiliation(s)
- Xiao-Fang Ye
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Zheng-Ping Huang
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Mi-Mi Li
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Shu-Fen Liu
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Wan-Li Huang
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Abdullahi Mukhtar Sheik Hamud
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Li-Chao Ye
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Lin-Yi Li
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Shu-Juan Wu
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China
| | - Jian-Long Zhuang
- Prenatal Diagnosis Centre, Quanzhou Women's and Children's Hospital, Quanzhou 362000, Fujian China
| | - Yan-Hong Chen
- Department of Neurology, Shishi General Hospital, Quanzhou 362000, Fujian Province, China
| | - Xiang-Rong Chen
- The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China; Department of Neurosurgery, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Shu Lin
- Centre of Neurological and Metabolic Research, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China; Group of Neuroendocrinology, Garvan Institute of Medical Research, 384 Victoria St, Sydney, Australia.
| | - Xiao-Feng Wei
- College of Materials Science and Engineering, Huaqiao University, Xiamen 361021, Fujian Province, China.
| | - Chun-Nuan Chen
- Department of Neurology, The Second Affiliated Hospital, Fujian Medical University, Quanzhou 362000, Fujian Province, China; The Second Clinical Medical College of Fujian Medical University, Quanzhou 362000Fujian Province, China.
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Jakuszyk P, Podlecka-Piętowska A, Kossowski B, Nojszewska M, Zakrzewska-Pniewska B, Juryńczyk M. Patterns of cerebral damage in multiple sclerosis and aquaporin-4 antibody-positive neuromyelitis optica spectrum disorders-major differences revealed by non-conventional imaging. Brain Commun 2024; 6:fcae295. [PMID: 39258257 PMCID: PMC11384145 DOI: 10.1093/braincomms/fcae295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 07/17/2024] [Accepted: 08/29/2024] [Indexed: 09/12/2024] Open
Abstract
Multiple sclerosis and aquaporin-4 antibody neuromyelitis optica spectrum disorders are distinct autoimmune CNS disorders with overlapping clinical features but differing pathology. Multiple sclerosis is primarily a demyelinating disease with the presence of widespread axonal damage, while neuromyelitis optica spectrum disorders is characterized by astrocyte injury with secondary demyelination. Diagnosis is typically based on lesion characteristics observed on standard MRI imaging and antibody testing but can be challenging in patients with in-between clinical presentations. Non-conventional MRI techniques can provide valuable diagnostic information by measuring disease processes at the microstructural level. We used non-conventional MRI to measure markers of axonal loss in specific white matter tracts in multiple sclerosis and neuromyelitis optica spectrum disorders, depending on their relationship with focal lesions. Patients with relapsing-remitting multiple sclerosis (n = 20), aquaporin-4 antibody-associated neuromyelitis optica spectrum disorders (n = 20) and healthy controls (n = 20) underwent a 3T brain MRI, including T1-, T2- and diffusion-weighted sequences, quantitative susceptibility mapping and phase-sensitive inversion recovery sequence. Tractometry was used to differentiate tract fibres traversing through white matter lesions from those that did not. Neurite density index was assessed using neurite orientation dispersion and density imaging model. Cortical damage was evaluated using T1 relaxation rates. Cortical lesions and paramagnetic rim lesions were identified using phase-sensitive inversion recovery and quantitative susceptibility mapping. In tracts traversing lesions, only one out of 50 tracts showed a decreased neurite density index in multiple sclerosis compared with neuromyelitis optica spectrum disorders. Among 50 tracts not traversing lesions, six showed reduced neurite density in multiple sclerosis (including three in the cerebellum and brainstem) compared to neuromyelitis optica spectrum disorders. In multiple sclerosis, reduced neurite density was found in the majority of fibres traversing (40/50) and not traversing (37/50) white matter lesions when compared to healthy controls. A negative correlation between neurite density in lesion-free fibres and cortical lesions, but not paramagnetic rim lesions, was observed in multiple sclerosis (39/50 tracts). In neuromyelitis optica spectrum disorders compared to healthy controls, decreased neurite density was observed in a subset of fibres traversing white matter lesions, but not in lesion-free fibres. In conclusion, we identified significant differences between multiple sclerosis and neuromyelitis optica spectrum disorders corresponding to their distinct pathologies. Specifically, in multiple sclerosis, neurite density reduction was widespread across fibres, regardless of their relationship to white matter lesions, while in neuromyelitis optica spectrum disorders, this reduction was limited to fibres passing through white matter lesions. Further studies are needed to evaluate the discriminatory potential of neurite density measures in white matter tracts for differentiating multiple sclerosis from neuromyelitis optica spectrum disorders.
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Affiliation(s)
- Paweł Jakuszyk
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
| | | | - Bartosz Kossowski
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
| | - Monika Nojszewska
- Department of Neurology, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | - Maciej Juryńczyk
- Laboratory of Brain Imaging, Polish Academy of Sciences, Nencki Institute of Experimental Biology, 02-093 Warsaw, Poland
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Irani SR. Autoimmune Encephalitis. Continuum (Minneap Minn) 2024; 30:995-1020. [PMID: 39088286 DOI: 10.1212/con.0000000000001448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVE This article focuses on the clinical features and diagnostic evaluations that accurately identify patients with ever-expanding forms of antibody-defined encephalitis. Forms of autoimmune encephalitis are more prevalent than infectious encephalitis and represent treatable neurologic syndromes for which early immunotherapies lead to the best outcomes. LATEST DEVELOPMENTS A clinically driven approach to identifying many autoimmune encephalitis syndromes is feasible, given the typically distinctive features associated with each antibody. Patient demographics alongside the presence and nature of seizures, cognitive impairment, psychiatric disturbances, movement disorders, and peripheral features provide a valuable set of clinical tools to guide the detection and interpretation of highly specific antibodies. In turn, these clinical features in combination with serologic findings and selective paraclinical testing, direct the rationale for the administration of immunotherapies. Observational studies provide the mainstay of evidence guiding first- and second-line immunotherapy administration in autoimmune encephalitis and, whereas these typically result in some clinical improvements, almost all patients have residual neuropsychiatric deficits, and many experience clinical relapses. An improved pathophysiologic understanding and ongoing clinical trials can help to address these unmet medical needs. ESSENTIAL POINTS Antibodies against central nervous system proteins characterize various autoimmune encephalitis syndromes. The most common targets include leucine-rich glioma inactivated protein 1 (LGI1), N-methyl-d-aspartate (NMDA) receptors, contactin-associated proteinlike 2 (CASPR2), and glutamic acid decarboxylase 65 (GAD65). Each antibody-associated autoimmune encephalitis typically presents with a recognizable blend of clinical and investigation features, which help differentiate each from alternative diagnoses. The rapid expansion of recognized antibodies and some clinical overlaps support panel-based antibody testing. The clinical-serologic picture guides the immunotherapy regime and offers valuable prognostic information. Patient care should be delivered in conjunction with autoimmune encephalitis experts.
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Sechi E. NMOSD and MOGAD. Continuum (Minneap Minn) 2024; 30:1052-1087. [PMID: 39088288 DOI: 10.1212/con.0000000000001454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
OBJECTIVE This article reviews the clinical features, MRI characteristics, diagnosis, and treatment of aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). The main differences between these disorders and multiple sclerosis (MS), the most common demyelinating disease of the central nervous system (CNS), are also highlighted. LATEST DEVELOPMENTS The past 20 years have seen important advances in understanding rare demyelinating CNS disorders associated with AQP4 IgG and myelin oligodendrocyte glycoprotein (MOG) IgG. The rapidly expanding repertoire of immunosuppressive agents approved for the treatment of AQP4-NMOSD and emerging as potentially beneficial in MOGAD mandates prompt recognition of these diseases. Most of the recent literature has focused on the identification of clinical and MRI features that help distinguish these diseases from each other and MS, simultaneously highlighting major diagnostic pitfalls that may lead to misdiagnosis. An awareness of the limitations of currently available assays for AQP4 IgG and MOG IgG detection is fundamental for identifying rare false antibody positivity and avoiding inappropriate treatments. For this purpose, diagnostic criteria have been created to help the clinician interpret antibody testing results and recognize the clinical and MRI phenotypes associated with AQP4-NMOSD and MOGAD. ESSENTIAL POINTS An awareness of the specific clinical and MRI features associated with AQP4-NMOSD and MOGAD and the limitations of currently available antibody testing assays is crucial for a correct diagnosis and differentiation from MS. The growing availability of effective treatment options will lead to personalized therapies and improved outcomes.
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Francis A, Gibbons E, Yu J, Johnston K, Rochon H, Powell L, Leite MI, Huda S, Kielhorn A, Palace J. Characterizing mortality in patients with AQP4-Ab+ neuromyelitis optica spectrum disorder. Ann Clin Transl Neurol 2024; 11:1942-1947. [PMID: 38884180 PMCID: PMC11251462 DOI: 10.1002/acn3.52092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/04/2024] [Indexed: 06/18/2024] Open
Abstract
Neuromyelitis optica spectrum disorder is an autoimmune disease, causing severe disability due to relapses, but recent mortality data are limited. Among 396 patients seropositive for anti-aquaporin-4 antibody from 2014 to 2020 in the United Kingdom, 39 deaths occurred: 19 (48.7%) were unrelated to disease; 14 (35.9%) were severe disability- or relapse-related; and 4 (10.3%) were attributed to malignancy/infection. Mean annual mortality was 1.92% versus 0.63% in the matched population. The standardized mortality ratio was 3.04 (95% confidence interval 1.67-5.30) with 1.29% excess mortality per year in patients. Median Expanded Disability Status Scale before death was 7.0. Results highlight the importance of preventing relapses that drive disability.
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Affiliation(s)
| | | | - Jeffrey Yu
- Alexion, AstraZeneca Rare DiseaseBostonMassachusettsUSA
| | - Karissa Johnston
- Broadstreet Health Economics & Outcomes ResearchVancouverBritish ColumbiaCanada
| | - Hannah Rochon
- Broadstreet Health Economics & Outcomes ResearchVancouverBritish ColumbiaCanada
| | - Lauren Powell
- Broadstreet Health Economics & Outcomes ResearchVancouverBritish ColumbiaCanada
| | | | - Saif Huda
- Guy's and St Thomas's NHS Foundation TrustLiverpoolUK
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Etemadifar M, Norouzi M, Alaei SA, Karimi R, Salari M. The diagnostic performance of AI-based algorithms to discriminate between NMOSD and MS using MRI features: A systematic review and meta-analysis. Mult Scler Relat Disord 2024; 87:105682. [PMID: 38781885 DOI: 10.1016/j.msard.2024.105682] [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: 11/24/2023] [Revised: 04/28/2024] [Accepted: 05/10/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Magnetic resonance imaging [MRI] findings in Neuromyelitis optica spectrum disorder [NMOSD] and Multiple Sclerosis [MS] patients could lead us to discriminate toward them. For instance, U-fiber and Dawson's finger-type lesions are suggestive of MS, however linear ependymal lesions raise the possibility of NMOSD. Recently, artificial intelligence [AI] models have been used to discriminate between NMOSD and MS based on MRI features. In this study, we aim to systematically review the capability of AI algorithms in NMOSD and MS discrimination based on MRI features. METHOD We searched PubMed, Scopus, Web of Sciences, Embase, and IEEE databases up to August 2023. All studies that used AI-based algorithms to discriminate between NMOSD and MS using MRI features were included, without any restriction in time, region, race, and age. Data on NMOSD and MS patients, Aquaporin-4 antibodies [AQP4-Ab] status, diagnosis criteria, performance metrics (accuracy, sensitivity, specificity, and AUC), artificial intelligence paradigm, MR imaging, and used features were extracted. This study is registered with PROSPERO, CRD42023465265. RESULTS Fifteen studies were included in this systematic review, with sample sizes ranging between 53 and 351. 1,362 MS patients and 1,118 NMOSD patients were included in our systematic review. AQP4-Ab was positive in 94.9% of NMOSD patients in 9 studies. Eight studies used machine learning [ML] as a classifier, while 7 used deep learning [DL]. AI models based on only MRI or MRI and clinical features yielded a pooled accuracy of 82% (95% CI: 78-86%), sensitivity of 83% (95% CI: 79-88%), and specificity of 80% (95% CI: 75-86%). In subgroup analysis, using only MRI features yielded an accuracy, sensitivity, and specificity of 83% (95% CI: 78-88%), 81% (95% CI: 76-87%), and 84% (95% CI: 79-89%), respectively. CONCLUSION AI models based on MRI features showed a high potential to discriminate between NMOSD and MS. However, heterogeneity in MR imaging, model evaluation, and reporting performance metrics, among other confounders, affected the reliability of our results. Well-designed studies on multicentric datasets, standardized imaging and evaluation protocols, and detailed transparent reporting of results are needed to reach optimal performance.
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Affiliation(s)
- Masoud Etemadifar
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahdi Norouzi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Seyyed-Ali Alaei
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Karimi
- Department of Epidemiology and Biostatistics, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zhong X, Yuan Y, Zhan Q, Yin T, Ku C, Liu Y, Wang F, Ding Y, Deng L, Wu W, Xie L. Cell-based vs enzyme-linked immunosorbent assay for detection of anti-Tribbles homolog 2 autoantibodies in Chinese patients with narcolepsy. J Clin Sleep Med 2024; 20:941-946. [PMID: 38318919 PMCID: PMC11145039 DOI: 10.5664/jcsm.11056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/07/2024]
Abstract
STUDY OBJECTIVES Narcolepsy type 1 is attributed to a deficiency in cerebrospinal fluid orexin and is considered linked to autoimmunity. The levels of anti-Tribbles homolog 2 (TRIB2) autoantibodies are elevated in the sera of some patients with narcolepsy with cataplexy. Additionally, injecting mice with serum immunoglobulin from patients with narcolepsy with positive anti-TRIB2 antibodies can induce hypothalamic neuron loss and alterations in sleep patterns. Consequently, we hypothesized the existence of a potential association between anti-TRIB2 antibodies and narcolepsy. To test this possibility, we used cell-based assays (CBAs) and enzyme-linked immunosorbent assays (ELISAs) to detect the presence of anti-TRIB2 antibodies in Chinese patients with narcolepsy. METHODS We included 68 patients with narcolepsy type 1, 39 patients with other central disorders of hypersomnolence, and 43 healthy controls. A CBA and a conventional ELISA were used to detect anti-TRIB2 antibody levels in patients' sera. RESULTS CBA was used to detect serum anti-TRIB2 antibodies in Chinese patients with narcolepsy, and the results were negative. However, when the ELISA was used, only 2 patients with narcolepsy type 1 had TRIB2 antibody titers higher than the mean titer plus 2 standard deviations of the healthy controls. CONCLUSIONS In our study, ELISA identified TRIB2 autoantibodies in sera of patients with narcolepsy where CBA failed to demonstrate them. Contrary to our hypothesis, this intriguing finding deserves further research to elucidate the potential association between TRIB2 and narcolepsy type 1. Exploring the implications of TRIB2 autoantibodies in narcolepsy and disparate outcomes between ELISA and CBA could provide crucial insights. CITATION Zhong X, Yuan Y, Zhan Q, et al. Cell-based vs enzyme-linked immunosorbent assay for detection of anti-Tribbles homolog 2 autoantibodies in Chinese patients with narcolepsy. J Clin Sleep Med. 2024;20(6):941-946.
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Affiliation(s)
- Xianhui Zhong
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
| | - Yuqing Yuan
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
| | - Qingqing Zhan
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
| | - Tiantian Yin
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
| | - Chengxin Ku
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
| | - Yuxin Liu
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
| | - Fen Wang
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, China
- Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, China
| | - Yongmin Ding
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, China
- Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, China
| | - Liying Deng
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, China
- Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, China
| | - Wei Wu
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, China
- Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, China
| | - Liang Xie
- Department of Neurology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, China
- Institute of Neuroscience, Nanchang University, Nanchang, China
- Jiangxi Key Laboratory of Neurological Tumors and Cerebrovascular Diseases, Nanchang, China
- Jiangxi Health Commission Key Laboratory of Neurological Medicine, Nanchang, China
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10
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Cacciaguerra L, Abdel-Mannan O, Champsas D, Mankad K, Krecke KN, Chen JJ, Syc-Mazurek SB, Redenbaugh V, Lopez-Chiriboga AS, Valencia-Sanchez C, Hemingway C, Tillema JM, Ciccarelli O, Pittock SJ, Hacohen Y, Flanagan EP. Radiologic Lag and Brain MRI Lesion Dynamics During Attacks in MOG Antibody-Associated Disease. Neurology 2024; 102:e209303. [PMID: 38710000 PMCID: PMC11177594 DOI: 10.1212/wnl.0000000000209303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/31/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Knowledge of the evolution of CNS demyelinating lesions within attacks could assist diagnosis. We evaluated intra-attack lesion dynamics in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) vs multiple sclerosis (MS) and aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorder (AQP4+NMOSD). METHODS This retrospective observational multicenter study included consecutive patients from Mayo Clinic (USA) and Great Ormond Street Hospital for Children (UK). Inclusion criteria were as follows: (1) MOGAD, MS, or AQP4+NMOSD diagnosis; (2) availability of ≥2 brain MRIs (within 30 days of attack onset); and (3) brain involvement (i.e., ≥1 T2 lesion) on ≥1 brain MRI. The initial and subsequent brain MRIs within a single attack were evaluated for the following: new T2 lesions(s); resolved T2 lesion(s); both; or no change. This was compared between MOGAD, MS, and AQP4+NMOSD attacks. We used the Mann-Whitney U test and χ2/Fisher exact test for statistical analysis. RESULTS Our cohort included 55 patients with MOGAD (median age, 14 years; interquartile range [IQR] 5-34; female sex, 29 [53%]) for a total of 58 attacks. The comparison groups included 38 patients with MS, and 19 with AQP4+NMOSD. In MOGAD, the initial brain MRI (median of 5 days from onset [IQR 3-9]) was normal in 6/58 (10%) attacks despite cerebral symptoms (i.e., radiologic lag). The commonest reason for repeat MRI was clinical worsening or no improvement (33/56 [59%] attacks with details available). When compared with the first MRI, the second intra-attack MRI (median of 8 days from initial scan [IQR 5-13]) showed the following: new T2 lesion(s) 27/58 (47%); stability 24/58 (41%); resolution of T2 lesion(s) 4/58 (7%); or both new and resolved T2 lesions 3/58 (5%). Findings were similar between children and adults. Steroid treatment was associated with resolution of ≥1 T2 lesion (6/28 [21%] vs 1/30 [3%], p = 0.048) and reduced the likelihood of new T2 lesions (9/28 vs 18/30, p = 0.03). Intra-attack MRI changes favored MOGAD (34/58 [59%]) over MS (10/38 [26%], p = 0.002) and AQP4+NMOSD (4/19 [21%], p = 0.007). Resolution of ≥1 T2 lesions was exclusive to MOGAD (7/58 [12%]). DISCUSSION Radiologic lag is common within MOGAD attacks. Dynamic imaging with frequent appearance and occasional disappearance of lesions within a single attack suggest MOGAD diagnosis over MS and AQP4+NMOSD. These findings have implications for clinical practice, clinical trial attack adjudication, and understanding of MOGAD pathogenesis.
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Affiliation(s)
- Laura Cacciaguerra
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Omar Abdel-Mannan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Dimitrios Champsas
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Kshitij Mankad
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Karl N Krecke
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - John J Chen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Stephanie B Syc-Mazurek
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Vyanka Redenbaugh
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Alfonso S Lopez-Chiriboga
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Cristina Valencia-Sanchez
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Cheryl Hemingway
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Jan-Mendelt Tillema
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Olga Ciccarelli
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Sean J Pittock
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Yael Hacohen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
| | - Eoin P Flanagan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., J.J.C., S.B.S.-M., V.R., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Queen Square MS Centre (O.A.-M., D.C., C.H., O.C., Y.H.), UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London; Department of Neurology (O.A.-M., D.C., C.H., Y.H.), and Department of Neuroradiology (K.M.), Great Ormond Street Hospital for Children, London, United Kingdom; Department of Radiology (K.N.K.), Department of Ophthalmology (J.J.C.), and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (C.V.-S.), Mayo Clinic, Phoenix, AZ; and NIHR University College London Hospitals Biomedical Research Centre (O.C.), United Kingdom
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11
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Sechi E, Puci M, Pateri MI, Zara P, Othmani S, Sotgiu S, Saddi MV, Leoni S, Fenu G, Melis M, Sotgiu G, Solla P, Cocco E, Frau J. Epidemiology of aquaporin-4-IgG-positive NMOSD in Sardinia. Mult Scler Relat Disord 2024; 85:105522. [PMID: 38461730 DOI: 10.1016/j.msard.2024.105522] [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: 11/08/2023] [Revised: 02/20/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
PURPOSE The Italian Island of Sardinia (population, 1,578,146) is recognized for the high risk of multiple sclerosis (MS) but the epidemiological burden of other less common demyelinating diseases of the central nervous system (CNS), such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD), is unknown. In this study, we determined the incidence and prevalence of AQP4-IgG+NMOSD in Sardinia over a ten-year study period (2013-2022). METHODS Patients with a diagnosis of AQP4-IgG+NMOSD (per 2015 IPND diagnostic criteria) were retrospectively identified using two sources: (1) Archives of the reference and only laboratory for AQP4-IgG testing in Sardinia; and (2) medical records of the four MS units in the island. Incidence (January 2013-December 2022) and prevalence (December 31, 2022) were calculated. RESULTS A total of 45 cases were included: incident, 31; prevalent, 41. The median age (range) at disease presentation was 51 (6-78) years; female/male ratio was 9:1. The crude (95 % CI) incidence and prevalence were 1.9 (1.3-2.7) per million and 2.6 (1.9-3.5) per 100,000, respectively. Prevalence increased from 2013 (1.1 per 100,000) to 2022 (2.6 per 100,000); p = 0.002. After age-standardization to the world, incidence and prevalence (95 % CI) decreased to 1.3 (0.7-2) per million and 1.8 (1.3-2.3) per 100,000, respectively. Coexisting immune-mediated disorders, mostly autoimmune thyroiditis, were reported in 50 % of patients. CONCLUSIONS The epidemiology of AQP4-IgG+NMOSD in Sardinia is overall in line with other Caucasian populations. The high MS risk in the island seems disease-specific and not associated with an increased risk of other CNS demyelinating disorders, confirming different pathophysiology.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, University Hospital of Sassari, Sassari, Italy.
| | - Mariangela Puci
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Maria Ida Pateri
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Pietro Zara
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Sabrine Othmani
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Stefano Sotgiu
- Child Neuropsychiatry Unit, University Hospital of Sassari, Sassari, Italy
| | | | - Stefania Leoni
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Giuseppe Fenu
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Maurizio Melis
- Neurology Unit, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, University Hospital of Sassari, Sassari, Italy
| | - Paolo Solla
- Neurology Unit, University Hospital of Sassari, Sassari, Italy
| | - Eleonora Cocco
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
| | - Jessica Frau
- Multiple Sclerosis Center, ASL Cagliari-University of Cagliari, Cagliari, Italy
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12
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Chatanaka MK, Avery LM, Pasic MD, Sithravadivel S, Rotstein D, Demos C, Cohen R, Gorham T, Wang M, Stengelin M, Mathew A, Sigal G, Wohlstadter J, Prassas I, Diamandis EP. The relationship between serum astroglial and neuronal markers and AQP4 and MOG autoantibodies. Clin Proteomics 2024; 21:28. [PMID: 38580905 PMCID: PMC10998414 DOI: 10.1186/s12014-024-09466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/14/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Certain demyelinating disorders, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) exhibit serum autoantibodies against aquaporin-4 (αAQP4) and myelin oligodendrocyte glycoprotein (αMOG). The variability of the autoantibody presentation warrants further research into subtyping each case. METHODS To elucidate the relationship between astroglial and neuronal protein concentrations in the peripheral circulation with occurrence of these autoantibodies, 86 serum samples were analyzed using immunoassays. The protein concentration of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL) and tau protein was measured in 3 groups of subcategories of suspected NMOSD: αAQP4 positive (n = 20), αMOG positive (n = 32) and αMOG/αAQP4 seronegative (n = 34). Kruskal-Wallis analysis, univariate predictor analysis, and multivariate logistic regression with ROC curves were performed. RESULTS GFAP and NFL concentrations were significantly elevated in the αAQP4 positive group (p = 0.003; p = 0.042, respectively), and tau was elevated in the αMOG/αAQP4 seronegative group (p < 0.001). A logistic regression model to classify serostatus was able to separate αAQP4 seropositivity using GFAP + tau, and αMOG seropositivity using tau. The areas under the ROC curves (AUCs) were 0.77 and 0.72, respectively. Finally, a combined seropositivity versus negative status logistic regression model was generated, with AUC = 0.80. CONCLUSION The 3 markers can univariately and multivariately classify with moderate accuracy the samples with seropositivity and seronegativity for αAQP4 and αMOG.
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Affiliation(s)
- Miyo K Chatanaka
- Department of Laboratory and Medicine Pathobiology, University of Toronto, 60 Murray St. Box 32, Floor 6, Rm L6-201, Toronto, ON, M5T 3L9, Canada
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Lisa M Avery
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Biostatistics, The Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Maria D Pasic
- Department of Laboratory and Medicine Pathobiology, University of Toronto, 60 Murray St. Box 32, Floor 6, Rm L6-201, Toronto, ON, M5T 3L9, Canada
- Department of Laboratory Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada
| | - Shanthan Sithravadivel
- Department of Laboratory Medicine, St. Joseph's Health Centre, Unity Health Toronto, Toronto, Canada
| | | | | | | | | | | | | | - Anu Mathew
- Meso Scale Diagnostics, LLC, Rockville, MD, USA
| | | | | | - Ioannis Prassas
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Eleftherios P Diamandis
- Laboratory Medicine Program, University Health Network, Toronto, ON, Canada.
- Lunenfeld- Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada.
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13
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Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Vlahovic L, McDonald J, Hinman J, Tomczak A, Lock C, Palmer CA, Cook LJ, Yeaman MR, Burnett MK, Deutsch GK, Nelson LM, Han MH. Prevalence, Demographic, and Clinical Factors Associated With Cognitive Dysfunction in Patients With Neuromyelitis Optica Spectrum Disorder. Neurology 2024; 102:e207965. [PMID: 38165361 PMCID: PMC10834131 DOI: 10.1212/wnl.0000000000207965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 09/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Neuromyelitis optica spectrum disorder (NMOSD) is a chronic CNS demyelinating autoimmune disorder targeting the astrocyte antigen aquaporin-4 (AQP4), typically presenting with optic neuritis, transverse myelitis, and brain syndromes. Cognitive dysfunction (CD) in NMOSD is under-recognized and poorly understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with CD in NMOSD. METHODS This observational retrospective study with longitudinal follow-up describes a clinical cohort seen in the Collaborative International Research in Clinical and Longitudinal Experience Study in NMOSD. Serial Montreal Cognitive Assessments (MoCAs) were performed upon enrollment and at 6-month intervals to evaluate longitudinal cognitive function relative to demographic and disease-related factors. We used 2-tailed t test, analysis of variance, the χ2 test, linear regression for univariable and adjusted analyses and simultaneous linear regression and mixed-effects model for multivariable analyses. RESULTS Thirty-four percent (75/219) of patients met criteria for CD (MoCA <26); 29% (64/219) showed mild dysfunction (MoCA 20-26/30), and 5% (11/219) showed moderate (MoCA <20/30) dysfunction. Patients with less neurologic disability and lower pain scores had higher MoCA scores (95% CI 0.24-0.65 and 95% CI 0.09-0.42, respectively). Patients with at least high school education scored higher on the MoCA (95% CI 2.2-5). When comparing patients dichotomized for CD, patients never on rituximab scored higher than patients only treated with rituximab (p < 0.029). There was no significant association between annualized relapse rate, age, sex, disease duration, AQP4 serostatus or brain lesions, and CD. CD was more pronounced among Black than White patients (95% CI -2.7 to -0.7). Multivariable analysis of serial MoCA did not indicate change (p = 0.715). Descriptive analysis of serial MoCA showed 30% (45/150) of patients with worsening MoCA performance had impaired language and verbal recall. DISCUSSION To our knowledge, this is the largest study of diverse cohort to investigate CD in patients with NMOSD. Our findings demonstrate 34% of patients with NMOSD experience mild-to-moderate CD, while 30% of patients demonstrated decline on serial testing. The substantial prevalence of CD in this pilot report highlights the need for improved and validated screening tools and comprehensive measures to investigate CD in NMOSD.
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Affiliation(s)
- Luka Vlahovic
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jamie McDonald
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Jessica Hinman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Anna Tomczak
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Christopher Lock
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Chella A Palmer
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lawrence J Cook
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Michael R Yeaman
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Melinda K Burnett
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Gayle K Deutsch
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - Lorene M Nelson
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
| | - May H Han
- From the Providence Multiple Sclerosis Center (L.V.), Providence Brain and Spine Institute, Portland, OR; Departments of Neurology and Neurological Sciences (J.M., A.T., C.L., G.D., M.H.H.), and Epidemiology and Population Health (J.H., L.M.N.), Stanford University School of Medicine; Sparta Science (J.H.), Menlo Park, CA; Department of Pediatrics (C.P., L.J.C.), Data Coordinating Center, University of Utah School of Medicine, Salt Lake City; Department of Medicine (M.R.Y.), Geffen School of Medicine, University of California, Los Angeles; Division of Molecular Medicine (M.R.Y.), and The Lundquist Institute for Infection & Immunity, Harbor-UCLA Medical Center (M.R.Y.), Torrance, CA; and Department of Neurology (M.B.), Creighton University School of Medicine, Omaha, NE
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15
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Belova AN, Sheiko GE, Ruina EA, Makarova AE, Dubchenko EA, Kukushkina AD, Ponevezhskaya EV, Lisogorskaya EV, Boyko AN. [The diagnostic effectiveness of criteria for neuromyelitis optica spectrum disorders in the Russian clinical practice]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:16-25. [PMID: 39175235 DOI: 10.17116/jnevro202412407216] [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: 08/24/2024]
Abstract
OBJECTIVE To compare the diagnostic criteria of 2006 (DC 2006) and 2015 (DC 2015) in the Russian population of patients with suspected neuromyelitis optica spectrum disorders (NMOSD), with the calculation of their sensitivity, specificity, accuracy and predictive value. MATERIAL AND METHODS We reviewed medical records of suspected NMOSD patients who were therefore examined for the presence of serum autoantibodies targeting the aquaporin-4 water channel protein (AQP4-IgG) in 6 specialized Russian (Nizhny Novgorod and Moscow) medical centers. One hundred patients (78 female), aged 17 to 74 years (mean 38.1±13.3 years), were included. The follow-up period ranged from 4 to 108 months (mean 59.7±31.6 months). RESULTS During the follow-up the diagnosis of NMOSD was confirmed in 32 people, and 68 patients had diagnoses different from NMOSD. At the disease onset, 68.8% of patients were seropositive for AQP4-IgG. The mean time for confirming NMOSD diagnosis was 15.2±14.2 months. At the disease onset, 36% of patients fulfilled the DC 2015, the diagnosis was subsequently confirmed in 77.8% out of them. 26% of the patients fulfilled the DC 2006, the diagnosis was subsequently confirmed in 84.6% out of them. The sensitivity of DC 2006/DC 2015 was 69%/88%, specificity 94%/88%, accuracy 86%/88%, negative predictive value 85%/94%, positive predictive value 86%/78%. CONCLUSION The specificity, sensitivity and accuracy of modern diagnostic criteria for NMOSD In Russian patients is comparable to those obtained in foreign studies. DC 2015 helps to diagnose NMOSD earlier than DC 2006, but they have a lower specificity.
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Affiliation(s)
- A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - G E Sheiko
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E A Ruina
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A E Makarova
- City Clinical Hospital No. 3, Nizhny Novgorod, Russia
| | | | - A D Kukushkina
- Zhadkevich City Clinical Hospital, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | | | | | - A N Boyko
- Pirogov Russian National Research Medical University, Moscow, Russia
- Federal Center of Brain Research and Neurotechnologies, Moscow, Russia
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16
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Budhram A, Flanagan EP. Optimizing the diagnostic performance of neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice. HANDBOOK OF CLINICAL NEUROLOGY 2024; 200:365-382. [PMID: 38494290 DOI: 10.1016/b978-0-12-823912-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The detection of neural antibodies in patients with paraneoplastic and autoimmune encephalitis has majorly advanced the diagnosis and management of neural antibody-associated diseases. Although testing for these antibodies has historically been restricted to specialized centers, assay commercialization has made this testing available to clinical chemistry laboratories worldwide. This improved test accessibility has led to reduced turnaround time and expedited diagnosis, which are beneficial to patient care. However, as the utilization of these assays has increased, so too has the need to evaluate how they perform in the clinical setting. In this chapter, we discuss assays for neural antibody detection that are in routine use, draw attention to their limitations and provide strategies to help clinicians and laboratorians overcome them, all with the aim of optimizing neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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17
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Abdel-Mannan O, Hacohen Y. Pediatric inflammatory leukoencephalopathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 204:369-398. [PMID: 39322390 DOI: 10.1016/b978-0-323-99209-1.00001-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Abstract
Acquired demyelinating syndromes (ADS) represent acute neurologic illnesses characterized by deficits persisting for at least 24hours and involving the optic nerve, brain, or spinal cord, associated with regional areas of increased signal on T2-weighted images. In children, ADS may occur as a monophasic illness or as a relapsing condition, such as multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). Almost all young people with MS have a relapsing-remitting course with clinical relapses. Important strides have been made in delineating MS from other ADS subtypes. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) and aquaporin 4-antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) were once considered variants of MS; however, studies in the last decade have established that these are in fact distinct entities. Although there are clinical phenotypic overlaps between MOGAD, AQP4-NMOSD, and MS, cumulative biologic, clinical, and pathologic evidence allows discrimination between these conditions. There has been a rapid increase in the number of available disease-modifying therapies for MS and novel treatment strategies are starting to appear for both MOGAD and AQP4-NMOSD. Importantly, there are a number of both inflammatory and noninflammatory mimics of ADS in children with implications of management for these patients in terms of treatment.
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Affiliation(s)
- Omar Abdel-Mannan
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology, Great Ormond Street Hospital, London, United Kingdom.
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, London, United Kingdom; Department of Neurology, Great Ormond Street Hospital, London, United Kingdom
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18
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Nwaze C, Eghwrudjakpor Y, Chinedu-Anunaso N. AQUAPORIN-4 (AQP-4) IMMUNOGLOBULIN G SEROPOSITIVE NEUROMYELITIS OPTICA: A REVIEW AND CASE REPORT. Ann Ib Postgrad Med 2023; 21:79-84. [PMID: 38706629 PMCID: PMC11065186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 12/30/2023] [Indexed: 05/07/2024] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) is a relatively new terminology composed to encompass patients with neuromyelitis optica (NMO) and related immunological conditions. The diagnosis of this condition requires a seropositive aquaporin-4 immunoglobulin G (AQP-4 IgG), the presence of at least one core clinical characteristic and the exclusion of alternative diagnoses. Very few cases have been reported in sub-Saharan Africa. Objective The aim of this article is to report a classical case of NMOSD with AQP-4 IgG seropositivity and normal brain, cervical and thoracic MRI findings. Result We report a 25-year-old Nigerian woman who presented with recurrent and alternating weakness, pain and numbness of all limbs, associated with episodic painful left-sided tonic spasms and urinary incontinence. She had earlier had symptoms of recurrent, episodic and alternating loss of vision in both eyes, associated with ocular pain.Examination findings revealed an intact mental status, no cranial nerve deficit and no focal limb weakness. Right-sided deep tendon reflexes were exaggerated. Vital signs were within normal limits. Brain MRI, Cervical spine MRI and Thoracic spine MRI all revealed normal findings. Serum aquaporin-4 IgG assay returned positive with a titer of 1:32.She was commenced on high dose steroids and there was gradual improvement of symptoms. Conclusion These findings confirmed the diagnosis of neuromyelitis optica spectrum disorder, and satisfies the diagnostic criteria published in 2015 by the International Panel for NMO Diagnosis (IPND).
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Affiliation(s)
- C Nwaze
- Regions Stroke and Neuroscience Hospital, Owerri, Imo State, Nigeria
| | - Y Eghwrudjakpor
- Regions Stroke and Neuroscience Hospital, Owerri, Imo State, Nigeria
| | - N Chinedu-Anunaso
- Regions Stroke and Neuroscience Hospital, Owerri, Imo State, Nigeria
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Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. A comprehensive review of the advances in neuromyelitis optica spectrum disorder. Autoimmun Rev 2023; 22:103465. [PMID: 37852514 DOI: 10.1016/j.autrev.2023.103465] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 10/13/2023] [Indexed: 10/20/2023]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare relapsing neuroinflammatory autoimmune astrocytopathy, with a predilection for the optic nerves and spinal cord. Most cases are characterised by aquaporin-4-antibody positivity and have a relapsing disease course, which is associated with accrual of disability. Although the prognosis in NMOSD has improved markedly over the past few years owing to advances in diagnosis and therapeutics, it remains a severe disease. In this article, we review the evolution of our understanding of NMOSD, its pathogenesis, clinical features, disease course, treatment options and associated symptoms. We also address the gaps in knowledge and areas for future research focus.
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Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
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20
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Tsumura R, Harada Y, Chuman H, Kiuchi Y. Assessing the Correlation Between Visual Acuity and Critical Fusion Frequency in Acute Optic Neuritis Before and After Steroid Therapy. Cureus 2023; 15:e49965. [PMID: 38179351 PMCID: PMC10765964 DOI: 10.7759/cureus.49965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2023] [Indexed: 01/06/2024] Open
Abstract
Background Optic nerve diseases include inflammatory optic nerve diseases such as vasculitis, metabolic optic neuropathy, ischemic optic neuropathy, and optic neuritis. In this study, patients with acute optic neuritis are classified with better and poor visual acuity based on visual acuity after one month of steroid pulse therapy. To determine prognosis, initial visual acuity and critical fusion frequency (CFF) values will be compared with those recorded one month after treatment and at the last visit. Methods Visual acuity and CFF were evaluated one month after the start of treatment in patients diagnosed with acute optic neuritis, and follow-up was available for at least three months at Hiroshima University Hospital. Results All patients received steroid pulse therapy as initial treatment. After one month of treatment, visual acuity and CFF at the last visit were significantly improved in the group with improved visual acuity compared to the group with impaired visual acuity. Conclusions Visual acuity at the initial visit did not affect treatment outcome, and final visual acuity and CFF after one month of treatment for acute optic neuritis were better in patients with better visual acuity. Therefore, visual acuity values one month after treatment initiation may affect treatment outcomes.
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Affiliation(s)
- Ryo Tsumura
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Yosuke Harada
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
| | - Hideki Chuman
- Department of Ophthalmology, Faculty of Medicine, University of Miyazaki Hospital, Miyazaki, JPN
| | - Yoshiaki Kiuchi
- Department of Ophthalmology, Hiroshima University, Hiroshima, JPN
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21
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Chatanaka MK, Avery LM, Pasic MD, Sithravadivel S, Rotstein D, Demos C, Cohen R, Gorham T, Wang M, Stengelin M, Mathew A, Wohlstadter J, Prassas I, Diamandis EP. The relationship between serum astroglial and neuronal markers and AQP4 and MOG autoantibodies. RESEARCH SQUARE 2023:rs.3.rs-3659922. [PMID: 38077014 PMCID: PMC10705596 DOI: 10.21203/rs.3.rs-3659922/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
Background Certain demyelinating disorders, such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) exhibit serum autoantibodies against aquaporin-4 (αAQP4) and myelin oligodendrocyte glycoprotein (αMOG). The variability of the autoantibody presentation warrants further research into subtyping each case. Methods To elucidate the relationship between astroglial and neuronal protein concentrations in the peripheral circulation with occurrence of these autoantibodies, 86 serum samples were analyzed using immunoassays. The protein concentration of glial fibrillary acidic protein (GFAP), neurofilament light chain (NFL) and tau protein was measured in 3 groups of subcategories of suspected NMOSD: αAQP4 positive (n = 20), αMOG positive (n = 32) and αMOG/αAQP4 seronegative (n = 34). Kruskal-Wallis analysis, univariate predictor analysis, and multivariate logistic regression with ROC curves were performed. Results GFAP and NFL concentrations were significantly elevated in the αAQP4 positive group (p = 0.003; p = 0.042, respectively), and tau was elevated in the αMOG/αAQP4 seronegative group (p < 0.001). A logistic regression model to classify serostatus was able to separate αAQP4 seropositivity using GFAP + tau, and αMOG seropositivity using tau. The areas under the ROC curves (AUCs) were 0.77 and 0.72, respectively. Finally, a combined seropositivity versus negative status logistic regression model was generated, with AUC = 0.80. Conclusion The 3 markers can univariately and multivariately classify with moderate accuracy the samples with seropositivity and seronegativity for αAQP4 and αMOG.
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22
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Giorgio A, Del Gatto A, Pennacchio S, Saviano M, Zaccaro L. Peptoids: Smart and Emerging Candidates for the Diagnosis of Cancer, Neurological and Autoimmune Disorders. Int J Mol Sci 2023; 24:16333. [PMID: 38003529 PMCID: PMC10671428 DOI: 10.3390/ijms242216333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 11/10/2023] [Accepted: 11/12/2023] [Indexed: 11/26/2023] Open
Abstract
Early detection of fatal and disabling diseases such as cancer, neurological and autoimmune dysfunctions is still desirable yet challenging to improve quality of life and longevity. Peptoids (N-substituted glycine oligomers) are a relatively new class of peptidomimetics, being highly versatile and capable of mimicking the architectures and the activities of the peptides but with a marked resistance to proteases and a propensity to cross the cellular membranes over the peptides themselves. For these properties, they have gained an ever greater interest in applications in bioengineering and biomedical fields. In particular, the present manuscript is to our knowledge the only review focused on peptoids for diagnostic applications and covers the last decade's literature regarding peptoids as tools for early diagnosis of pathologies with a great impact on human health and social behavior. The review indeed provides insights into the peptoid employment in targeted cancer imaging and blood-based screening of neurological and autoimmune diseases, and it aims to attract the scientific community's attention to continuing and sustaining the investigation of these peptidomimetics in the diagnosis field considering their promising peculiarities.
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Affiliation(s)
- Anna Giorgio
- Department of Chemical Sciences, University of Padova, 35131 Padova, Italy;
| | - Annarita Del Gatto
- Institute of Biostructure and Bioimaging (IBB), CNR, 80131 Naples, Italy;
- Interuniversity Research Centre on Bioactive Peptides (CIRPeB) “Carlo Pedone”, University of Naples “Federico II”, 80131 Naples, Italy
| | - Simone Pennacchio
- Institute of Condensed Matter Chemistry and Technologies for Energy (ICMATE), CNR, 35127 Padova, Italy;
| | | | - Laura Zaccaro
- Institute of Biostructure and Bioimaging (IBB), CNR, 80131 Naples, Italy;
- Interuniversity Research Centre on Bioactive Peptides (CIRPeB) “Carlo Pedone”, University of Naples “Federico II”, 80131 Naples, Italy
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23
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Alqwaifly M, Althobaiti AH, AlAibani NS, Banjar RZ, Alayed RS, Alsubaie SM, Alrashed AT. Patterns of Adult Neuromyelitis Optica Spectrum Disorder Patients Compared to Multiple Sclerosis: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e47565. [PMID: 38021935 PMCID: PMC10666196 DOI: 10.7759/cureus.47565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are central nervous system inflammatory conditions, now recognized to involve the brain, often identified by aquaporin-4 (AQP4) antibodies. We aimed to summarize the characteristics of adult NMOSD patients compared to multiple sclerosis (MS). A computerized search was conducted on MEDLINE via PubMed, Web of Science, and ProQuest using the relevant keywords. Three independent reviewers performed two-stage screening and data extraction. The Review Manager 5.4 program (Cochrane Collaboration, Windows, London, UK) was used for the analysis. The Joanna Briggs Institute (JIB) tool was used for the quality of included studies. Twenty-three articles were included. NMOSD patients were associated with older age at presentation and higher Expanded Disability Status Scale (MD = 3.88, 95% CI: 1.80 to 5.97, P = 0.0003) and (MD = 1.15, 95% CI: 0.58 to 1.72, P < 0.0001), respectively. The risk of NMOSD in females was significantly higher than MS (OR = 2.21, 95% CI: 1.41 to 3.46, P = 0.0005). Patients with NMOSD were associated with a lower risk of extrapyramidal symptoms (OR = 0.26, 95% CI: 0.11 to 0.60, P < 0.01), brainstem involvement symptoms (OR = 0.32, 95% CI: 0.16 to 0.64, P < 0.01), and developing brain lesions compared to MS (OR = 0.08, 95% CI: 0.03 to 0.18, P < 0.00001). The current evidence suggests that both NMOSD and MS have different demographic, clinical, and lesion characteristics. There is a need for additional validation of the identified differences compared with MS due to the lack of long-term systematic imaging investigations in NMOSD.
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Affiliation(s)
- Mohammed Alqwaifly
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah, SAU
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24
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Fu Y, Bi J, Yan Y, Sun X, Li K, Kim SY, Han SM, Zhou L, Li R, Huang Q, Wang N, Lin A, Kim HJ, Qiu W. Rapid Immunodot AQP4 Assay for Neuromyelitis Optica Spectrum Disorder. JAMA Neurol 2023; 80:1105-1112. [PMID: 37669037 PMCID: PMC10481325 DOI: 10.1001/jamaneurol.2023.2974] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 06/25/2023] [Indexed: 09/06/2023]
Abstract
Importance Immunoglobulin G autoantibodies for aquaporin 4 (AQP4-IgG) serve as diagnostic biomarkers for neuromyelitis optica spectrum disorder (NMOSD), and the most sensitive and specific laboratory tests for their detection are cell-based assays (CBAs). Nevertheless, the limited availability of special instruments limits the widespread use of CBAs in routine laboratories. Objective To validate an enzyme immunodot assay for simple and rapid detection of AQP4-IgG. Design, Setting, and Participants This multicenter case-control study, conducted from May 2020 to February 2023, involved 4 medical centers (3 in China and 1 in Korea). The study included patients with AQP4-IgG-positive NMOSD, patients with other immune-related diseases, and healthy control individuals. Participants were excluded if they did not agree to participate or if their serum sample had turbidity. Exposures Serum AQP4 antibodies measured with immunodot assay. Main Outcomes and Measures The main outcome was performance of the immunodot assay compared with the gold standard CBA for detecting AQP4-IgG. To examine generalizability, cross-validation in Korea and at a second site in China, validation of patients with other immune-related diseases, and follow-up validation of the original cohort were performed. Results A total of 836 serum samples were collected; 400 were included in the diagnostic study and 436 in the validation sets. In a head-to-head diagnostic study involving 200 patients with NMOSD with AQP4-IgG (mean [SD] age, 43.1 [13.5] years; 188 [94%] female) and 200 healthy controls, use of an immunodot assay demonstrated antibody detection performance comparable to that of the gold standard (κ = 98.0%). The validation sets included 47 patients with NMOSD and 26 patients with other autoimmune diseases from Korea, 31 patients with NMOSD at a second site in China, 275 patients with other diseases, and 57 patients with NMOSD at follow-up. In the validation study, of 436 cases, 2 (<1%) were false positive and none were false negative. The CBA identified 332 AQP4-IgG-positive samples and 504 negative samples (200 [40%] in controls and 304 [60%] in patients with other diseases); 2 of the positive cases (<1%) were false negative and 4 of the negative cases (<1%) were false positive. The overall sensitivity of the immunodot assay was 99.4% (95% CI, 97.8%-99.9%), and the specificity was 99.2% (95% CI, 98.0%-99.8%). Conclusions and Relevance This case-control study found that the immunodot assay was comparable to CBA for detecting AQP4-IgG. With its time- and cost-efficient characteristics, the immunodot assay may be a practical option for AQP4-IgG detection.
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Affiliation(s)
- Ying Fu
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Jin Bi
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Yaping Yan
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, College of Life Sciences, Shaanxi Normal University, Xi’an, China
| | - Xiaobo Sun
- Department of Neurology of The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ke Li
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, College of Life Sciences, Shaanxi Normal University, Xi’an, China
| | - So Yeon Kim
- Immuno-oncology Branch, Research Institute of the National Cancer Center, Goyang, Korea
| | - Sang-Min Han
- Immuno-oncology Branch, Research Institute of the National Cancer Center, Goyang, Korea
| | - Luyao Zhou
- Department of Neurology of The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Department of Neurology of The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qiao Huang
- Department of Neurology of The Second People’s Hospital of Zhaoqing, Zhaoqing, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Aiyu Lin
- Department of Neurology and Institute of Neurology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China
| | - Ho Jin Kim
- Immuno-oncology Branch, Research Institute of the National Cancer Center, Goyang, Korea
- Department of Neurology, Hospital of the National Cancer Center, Goyang, Korea
| | - Wei Qiu
- Department of Neurology of The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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25
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Kraker JA, Chen JJ. An update on optic neuritis. J Neurol 2023; 270:5113-5126. [PMID: 37542657 DOI: 10.1007/s00415-023-11920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
Optic neuritis (ON) is the most common cause of subacute optic neuropathy in young adults. Although most cases of optic neuritis (ON) are classified as typical, meaning idiopathic or associated with multiple sclerosis, there is a growing understanding of atypical forms of optic neuritis such as antibody mediated aquaporin-4 (AQP4)-IgG neuromyelitis optica spectrum disorder (NMOSD) and the recently described entity, myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). Differentiating typical ON from atypical ON is important because they have different prognoses and treatments. Findings of atypical ON, including severe vision loss with poor recovery with steroids or steroid dependence, prominent optic disc edema, bilateral vision loss, and childhood or late adult onset, should prompt serologic testing for AQP4-IgG and MOG-IgG. Although the traditional division of typical and atypical ON can be helpful, it should be noted that there can be severe presentations of otherwise typical ON and mild presentations of atypical ON that blur these traditional lines. Rare causes of autoimmune optic neuropathies, such as glial fibrillary acidic protein (GFAP) and collapsin response-mediator protein 5 (CRMP5) autoimmunity also should be considered in patients with bilateral painless optic neuropathy associated with optic disc edema, especially if there are other accompanying suggestive neurologic symptoms/signs. Typical ON usually recovers well without treatment, though recovery may be expedited by steroids. Atypical ON is usually treated with intravenous steroids, and some forms, such as NMOSD, often require plasma exchange for acute attacks and long-term immunosuppressive therapy to prevent relapses. Since treatment is tailored to the cause of the ON, elucidating the etiology of the ON is of the utmost importance.
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Affiliation(s)
- Jessica A Kraker
- Department of Ophthalmology, Mayo Clinic Hospital, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic Hospital, Rochester, MN, USA.
- Department of Neurology, Mayo Clinic Hospital, Rochester, MN, USA.
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26
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Fereidan‐Esfahani M, Decker PA, Weigand SD, Lopez Chiriboga AS, Flanagan EP, Tillema J, Lucchinetti CF, Eckel‐Passow JE, Tobin WO. Defining the natural history of tumefactive demyelination: A retrospective cohort of 257 patients. Ann Clin Transl Neurol 2023; 10:1544-1555. [PMID: 37443413 PMCID: PMC10502639 DOI: 10.1002/acn3.51844] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To describe demographic, clinical, and radiographic features of tumefactive demyelination (TD) and identify factors associated with severe attacks and poor outcomes. METHODS Retrospective review of TD cases seen at Mayo Clinic, 1990-2021. RESULTS Of 257 patients with TD, 183/257 (71%) fulfilled the 2017 multiple sclerosis (MS) McDonald criteria at the last follow-up, 12/257 (5%) had myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), 0 had aquaporin-4-IgG seropositive neuromyelitis optic spectrum disorders (AQP4+ NMOSD), and 62/257 (24%) were cryptogenic. Onset before age 18 was present in 18/257 (7%). Female to male ratio was 1.3:1. Cerebrospinal fluid oligoclonal (CSF) bands were present in 95/153 (62%). TD was the first demyelinating attack in 176/257 (69%). At presentation, 59/126 (47%) fulfilled Barkhof criteria for dissemination in space, 59/100 (59%) had apparent diffusion coefficient (ADC) restriction, and 57/126 (45%) had mass effect. Despite aggressive clinical presentation at onset, 181/257 (70%) of patients remained fully ambulatory (Expanded Disability Status Scale [EDSS] ≤4) after a 3.0-year median follow-up duration. Severe initial attack-related disability (EDSS ≥4) was more common in patients with motor symptoms (81/143 vs. 35/106, p < 0.0001), encephalopathy (20/143 vs. 2/106, p < 0.0001) and ADC restriction on initial MRI (42/63 vs. 15/33, p = 0.04). Poor long-term outcome (EDSS ≥4) was more common in patients with older onset age (41.9 ± 15 vs. 36.8 ± 15.6, p = 0.02) and motor symptoms at onset (49/76 vs. 66/171, p < 0.0001). INTERPRETATION Most TD patients should be considered part of the MS spectrum after excluding MOGAD and NMOSD. Motor symptoms and older age at presentation portend a poor outcome.
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Affiliation(s)
- Mahboubeh Fereidan‐Esfahani
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Dell Medical SchoolUniversity of TexasAustinTexasUSA
| | - Paul A Decker
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Stephen D. Weigand
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Eoin P Flanagan
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Laboratory Medicine and PathologyMinneapolisMinnesotaUSA
| | - Jan‐Mendelt Tillema
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Claudia F Lucchinetti
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - W. Oliver Tobin
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
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27
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Huang R, Huang X, Wang Y, Xie Y, Chen K, Ma S, Zhou X, Li W, Tan S, Yang L. The nutritional risk in patients with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2023; 77:104900. [PMID: 37487344 DOI: 10.1016/j.msard.2023.104900] [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: 03/16/2023] [Revised: 06/18/2023] [Accepted: 07/16/2023] [Indexed: 07/26/2023]
Abstract
BACKGROUND The effect of nutrition on chronic autoimmune diseases is well known. This study is the first to assess the nutritional status of patients with neuromyelitis optica spectrum disorder (NMOSD) by administering the Mini Nutritional Assessment (MNA), to explore the impacts of nutrition on patients' quality of life and to identify the factors associated with the nutritional status of NMOSD patients. METHODS Our study enrolled 70 NMOSD patients and 66 healthy controls. The following data were assessed: demographic information, disease features, and composite evaluations of life status, including nutrition, sleep, anxiety/depression, fatigue, and quality of life. Then, statistical analysis was performed. RESULTS The MNA score of NMOSD patients was 20.4 ± 3.3, which was significantly lower than that of HCs (23.3 ± 2.5, P = 0.002), especially for the dimensions of global evaluation and anthropometric assessment. Nearly 85% of patients were at risk of malnutrition or had definite malnutrition. The total MNA score was positively correlated with the patient's quality of life (P<0.01). Lower MNA scores were correlated with gender (P = 0.02), longer disease duration (P<0.001), more severe anxiety (P = 0.004), more severe depression (P = 0.003), more severe sleep disturbances (P<0.001), and more severe fatigue (P = 0.01). Sleep disturbance was revealed to be a significant independent factor for the NMOSD patients' malnutritional risk (P = 0.001). CONCLUSIONS These results suggest that the risk of malnutrition is very high in NMOSD patients and that malnutrition is closely related to their quality of life. Malnutrition among NMOSD patients is caused by a combination of various physiological and psychological factors. A multifaceted and personalized intervention is required to improve the prognosis of NMOSD.
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Affiliation(s)
- Rui Huang
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Xinyue Huang
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Yuan Wang
- Department of Clinical Nutrition, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Xie
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Kai Chen
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Shuai Ma
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Xiaobo Zhou
- Department of Psychosomatic, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu 611731, China
| | - Wenjing Li
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China
| | - Song Tan
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China; Sichuan Provincial Key Laboratory for Human Disease Gene Study, Chengdu, China; Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China.
| | - Lili Yang
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu 611731, China.
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Moheb N, Chen JJ. The neuro-ophthalmological manifestations of NMOSD and MOGAD-a comprehensive review. Eye (Lond) 2023; 37:2391-2398. [PMID: 36928226 PMCID: PMC10397275 DOI: 10.1038/s41433-023-02477-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/07/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Optic neuritis (ON) is one of the most frequently seen neuro-ophthalmic causes of vision loss worldwide. Typical ON is often idiopathic or seen in patients with multiple sclerosis, which is well described in the landmark clinical trial, the Optic Neuritis Treatment Trial (ONTT). However, since the completion of the ONTT, there has been the discovery of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies, which are biomarkers for neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody-associated disease (MOGAD), respectively. These disorders are associated with atypical ON that was not well characterised in the ONTT. The severity, rate of recurrence and overall outcome differs in these two entities requiring prompt and accurate diagnosis and management. This review will summarise the characteristic neuro-ophthalmological signs in NMOSD and MOGAD, serological markers and radiographic findings, as well as acute and long-term therapies used for these disorders.
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Affiliation(s)
- Negar Moheb
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA.
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29
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Seok JM, Cho W, Chung YH, Ju H, Kim ST, Seong JK, Min JH. Differentiation between multiple sclerosis and neuromyelitis optica spectrum disorder using a deep learning model. Sci Rep 2023; 13:11625. [PMID: 37468553 DOI: 10.1038/s41598-023-38271-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 07/06/2023] [Indexed: 07/21/2023] Open
Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are autoimmune inflammatory disorders of the central nervous system (CNS) with similar characteristics. The differential diagnosis between MS and NMOSD is critical for initiating early effective therapy. In this study, we developed a deep learning model to differentiate between multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) using brain magnetic resonance imaging (MRI) data. The model was based on a modified ResNet18 convolution neural network trained with 5-channel images created by selecting five 2D slices of 3D FLAIR images. The accuracy of the model was 76.1%, with a sensitivity of 77.3% and a specificity of 74.8%. Positive and negative predictive values were 76.9% and 78.6%, respectively, with an area under the curve of 0.85. Application of Grad-CAM to the model revealed that white matter lesions were the major classifier. This compact model may aid in the differential diagnosis of MS and NMOSD in clinical practice.
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Affiliation(s)
- Jin Myoung Seok
- Department of Neurology, Soonchunhyang University Hospital Cheonan, Soonchunhyang University College of Medicine, Cheonan, South Korea
| | - Wanzee Cho
- Department of Artificial Intelligence, Korea University, Seoul, South Korea
| | - Yeon Hak Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Hyunjin Ju
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea
| | - Sung Tae Kim
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Joon-Kyung Seong
- Department of Artificial Intelligence, Korea University, Seoul, South Korea.
- School of Biomedical Engineering, Korea University, Seoul, South Korea.
- Interdisciplinary Program in Precision Public Health, Korea University, Seoul, South Korea.
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Seoul, South Korea.
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, 50 Irwon-dong, Gangnam-gu, Seoul, 135-710, South Korea.
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30
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Poisson K, Moeller K, Fisher KS. Pediatric Neuromyelitis Optica Spectrum Disorder. Semin Pediatr Neurol 2023; 46:101051. [PMID: 37451749 DOI: 10.1016/j.spen.2023.101051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/02/2023] [Accepted: 04/23/2023] [Indexed: 07/18/2023]
Abstract
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a demyelinating disease with a high relapse rate and risk of disability accrual. The condition is an astrocytopathy, with antibodies to the aquaporin-4 (AQP4) water channel being detected in AQP4-IgG seropositive disease. Presentation is uncommon in the pediatric age range, accounting for about 3%-5% of cases. NMOSD is more prevalent in populations of Black or East Asian ancestry. Core clinical syndromes include optic neuritis, acute myelitis, area postrema syndrome, acute brainstem syndrome, acute diencephalic syndrome, and symptomatic cerebral syndrome. First-line treatment options in pediatrics include rituximab, azathioprine, and mycophenolate mofetil. Over half of children with AQP4-IgG seropositive NMOSD develop permanent disability, particularly in visual and motor domains. Novel therapeutic targets in the adult population have been developed and are changing the treatment landscape for this disorder.
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Affiliation(s)
- Kelsey Poisson
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL; Department of Pediatrics, Division of Pediatric Neurology, Children's of Alabama, Birmingham, AL
| | - Karen Moeller
- Department of Radiology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Kristen S Fisher
- Department of Pediatrics, Division of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
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Alkabie S, Casserly CS, Morrow SA, Racosta JM. Identifying specific myelopathy etiologies in the evaluation of suspected myelitis: A retrospective analysis. J Neurol Sci 2023; 450:120677. [PMID: 37207546 DOI: 10.1016/j.jns.2023.120677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/13/2023] [Accepted: 05/09/2023] [Indexed: 05/21/2023]
Abstract
BACKGROUND Myelopathies require prompt etiologic diagnosis. We aimed to identify a specific myelopathy diagnosis in cases of suspected myelitis to highlight clinicoradiologic differences. METHODS In this retrospective, single-centre cohort of subjects with suspected myelitis referred to London Multiple Sclerosis (MS) Clinic between 2006 and 2021, we identified those with MS and reviewed the remaining charts for etiologic diagnosis based on clinical, serologic, and imaging details. RESULTS Of 333 included subjects, 318/333 (95.5%) received an etiologic diagnosis. Most (274/333, 82%) had MS or clinically isolated syndrome. Spinal cord infarction (n = 10) was the commonest non-inflammatory myelitis mimic characterized by hyperacute decline (n = 10/10, 100%), antecedent claudication (n = 2/10, 20%), axial owl/snake eye (n = 7/9, 77%) and sagittal pencillike (n = 8/9, 89%) MRI patterns, vertebral artery occlusion/stenosis (n = 4/10, 40%), and concurrent acute cerebral infarct (n = 3/9, 33%). Longitudinal lesions were frequent in aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) (n = 7/7, 100%) and myelin oligodendrocyte glycoprotein-IgG-associated disorder (MOGAD) (n = 6/7, 86%), accompanied by bright spotty (n = 5/7, 71%) and central-grey-restricted (n = 4/7, 57%) T2-lesions on axial sequences, respectively. Leptomeningeal (n = 4/4, 100%), dorsal subpial (n = 4/4, 100%) enhancement, and positive body PET/CT (n = 4/4, 100%) aided the diagnosis of sarcoidosis. Spondylotic myelopathies had chronic sensorimotor presentations (n = 4/6, 67%) with relative bladder sparing (n = 5/6, 83%), localizable to sites of disc herniation (n = 6/6, 100%). Metabolic myelopathies showed dorsal column or inverted 'V' sign (n = 2/3, 67%) MRI T2-abnormality with B12 deficiency. CONCLUSIONS Although no single feature reliably confirms or refutes a specific myelopathy diagnosis, this study highlights patterns that narrow the differential diagnosis of myelitis and facilitate early recognition of mimics.
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Affiliation(s)
- Samir Alkabie
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Courtney S Casserly
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Sarah A Morrow
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Juan M Racosta
- Department of Clinical Neurological Sciences, London Health Sciences Centre, Schulich Medicine and Dentistry, Western University, London, Ontario, Canada; MS Epidemiology Lab, London, Ontario, Canada.
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32
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Kim HJ, Lee EJ, Kim SY, Kim H, Kim KW, Kim S, Kim H, Seo D, Lee BJ, Lim HT, Kim KK, Lim YM. Serum proteins for monitoring and predicting visual function in patients with recent optic neuritis. Sci Rep 2023; 13:5609. [PMID: 37019946 PMCID: PMC10076295 DOI: 10.1038/s41598-023-32748-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 04/07/2023] Open
Abstract
It is unclear whether serum proteins can serve as biomarkers to reflect pathological changes and predict recovery in inflammation of optic nerve. We evaluated whether serum proteins could monitor and prognosticate optic neuritis (ON). We prospectively recruited consecutive patients with recent ON, classified as ON with anti-aquaporin-4 antibody (AQP4-ON), ON with anti-myelin oligodendrocyte glycoprotein antibody (MOG-ON), and double-seronegative ON (DSN-ON). Using ultrasensitive single-molecule array assays, we measured serum neurofilament light chain and glial fibrillary acidic protein (GFAP), and brain-derived neurotrophic factor (BDNF). We analyzed the markers according to disease group, state, severity, and prognosis. We enrolled 60 patients with recent ON (15 AQP4-ON; 14 MOG-ON; 31 DSN-ON). At baseline, AQP4-ON group had significantly higher serum GFAP levels than did other groups. In AQP4-ON group, serum GFAP levels were significantly higher in the attack state than in the remission state and correlated with poor visual acuity. As a prognostic indicator, serum BDNF levels were positively correlated with follow-up visual function in the AQP4-ON group (r = 0.726, p = 0.027). Serum GFAP reflected disease status and severity, while serum BDNF was identified as a prognostic biomarker in AQP4-ON. Serum biomarkers are potentially helpful for patients with ON, particularly those with AQP4-ON.
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Affiliation(s)
- Hyo Jae Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea.
- Translational Biomedical Research Group, Asan Institute for Life Science, Asan Meidcal Center, Seoul, South Korea.
| | - Sang-Yeob Kim
- Department of Convergence Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunjin Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Keon-Woo Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Seungmi Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyunji Kim
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Dayoung Seo
- Department of Medicine, Asan Medical Institute of Convergence Science and Technology, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Joo Lee
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Hyun Taek Lim
- Department of Ophthalmology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
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Cacciaguerra L, Morris P, Tobin WO, Chen JJ, Banks SA, Elsbernd P, Redenbaugh V, Tillema JM, Montini F, Sechi E, Lopez-Chiriboga AS, Zalewski N, Guo Y, Rocca MA, Filippi M, Pittock SJ, Lucchinetti CF, Flanagan EP. Tumefactive Demyelination in MOG Ab-Associated Disease, Multiple Sclerosis, and AQP-4-IgG-Positive Neuromyelitis Optica Spectrum Disorder. Neurology 2023; 100:e1418-e1432. [PMID: 36690455 PMCID: PMC10065219 DOI: 10.1212/wnl.0000000000206820] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies on tumefactive brain lesions in myelin oligodendrocyte glycoprotein-immunoglobulin G (IgG)-associated disease (MOGAD) are lacking. We sought to characterize the frequency clinical, laboratory, and MRI features of these lesions in MOGAD and compare them with those in multiple sclerosis (MS) and aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). METHODS We retrospectively searched 194 patients with MOGAD and 359 patients with AQP4+NMOSD with clinical/MRI details available from the Mayo Clinic databases and included those with ≥1 tumefactive brain lesion (maximum transverse diameter ≥2 cm) on MRI. Patients with tumefactive MS were identified using the Mayo Clinic medical record linkage system. Binary multivariable stepwise logistic regression identified independent predictors of MOGAD diagnosis; Cox proportional regression models were used to assess the risk of relapsing disease and gait aid in patients with tumefactive MOGAD vs those with nontumefactive MOGAD. RESULTS We included 108 patients with tumefactive demyelination (MOGAD = 43; AQP4+NMOSD = 16; and MS = 49). Tumefactive lesions were more frequent among those with MOGAD (43/194 [22%]) than among those with AQP4+NMOSD (16/359 [5%], p < 0.001). Risk of relapse and need for gait aid were similar in tumefactive and nontumefactive MOGAD. Clinical features more frequent in MOGAD than in MS included headache (18/43 [42%] vs 10/49 [20%]; p = 0.03) and somnolence (12/43 [28%] vs 2/49 [4%]; p = 0.003), the latter also more frequent than in AQP4+NMOSD (0/16 [0%]; p = 0.02). The presence of peripheral T2-hypointense rim, T1-hypointensity, diffusion restriction (particularly an arc pattern), ring enhancement, and Baló-like or cystic appearance favored MS over MOGAD (p ≤ 0.001). MRI features were broadly similar in MOGAD and AQP4+NMOSD, except for more frequent diffusion restriction in AQP4+NMOSD (10/15 [67%]) than in MOGAD (11/42 [26%], p = 0.005). CSF analysis revealed less frequent positive oligoclonal bands in MOGAD (2/37 [5%]) than in MS (30/43 [70%], p < 0.001) and higher median white cell count in MOGAD than in MS (33 vs 6 cells/μL, p < 0.001). At baseline, independent predictors of MOGAD diagnosis were the presence of somnolence/headache, absence of T2-hypointense rim, lack of T1-hypointensity, and no diffusion restriction (Nagelkerke R 2 = 0.67). Tumefactive lesion resolution was more common in MOGAD than in MS or AQP4+NMOSD and improved model performance. DISCUSSION Tumefactive lesions are frequent in MOGAD but not associated with a worse prognosis. The clinical, MRI, and CSF attributes of tumefactive MOGAD differ from those of tumefactive MS and are more similar to those of tumefactive AQP4+NMOSD with the exception of lesion resolution, which favors MOGAD.
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Affiliation(s)
- Laura Cacciaguerra
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pearse Morris
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - W Oliver Tobin
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Samantha A Banks
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Paul Elsbernd
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Vyanka Redenbaugh
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Jan-Mendelt Tillema
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Federico Montini
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elia Sechi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Nicholas Zalewski
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Yong Guo
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Maria A Rocca
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Massimo Filippi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Claudia F Lucchinetti
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN.
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Rajput HM, Hassan M, Badshah M. Clinical and radiological profile of neuromyelitis optica spectrum disorders in a Pakistani cohort. Mult Scler Relat Disord 2023; 74:104656. [PMID: 37068371 DOI: 10.1016/j.msard.2023.104656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/14/2023] [Accepted: 03/21/2023] [Indexed: 04/19/2023]
Abstract
BACKGROUND The clinical and radiological characteristics of neuromyelitis optica spectrum disorder (NMOSD) from Pakistan is unknown. Our study aimed to describe the clinical and radiological features of NMOSD patients presenting to a Pakistani tertiary care center. MATERIALS AND METHODS This retrospective, observational study was conducted at the Neurology Department, Pakistan Institute of Medical Sciences between January 2017 and September 2021 (56 months). The study included patients diagnosed with neuromyelitis optica spectrum disorder (NMOSD) according to the 2015 International Panel for NMO Diagnosis (IPND) criteria, with the exclusion of patients under 12 years of age and those who tested positive for Myelin oligodendrocyte glycoprotein (MOG) IgG antibody. The patients were divided into two groups based on clinical presentation and the presence of NMO-IgG antibodies: NMO-IgG positive NMO (Seropositive NMO) and NMO-IgG negative (Seronegative NMO). The clinical features of NMOSD were recorded, and data was analyzed using SPSS version 26.0. RESULTS Among 204 patients with suspected demyelination, multiple sclerosis was diagnosed in 100 individuals (49.02%), while acute disseminated encephalomyelitis (ADEM), clinically isolated syndrome (CIS), and neuromyelitis optica (NMO) were found in 5 patients each (2.45%, 2.45%, and 17.65%, respectively). Out of 36 patients with NMO, 32 (88.89%) tested positive for NMO-Ab, while the remaining 4 (11.11%) were seronegative for both NMO and anti-MOG Abs. The mean age of NMO-positive patients who tested positive for NMO antibodies was 31.03±10.12 years, compared to 27.95±2.5 years for NMO-negative patients, though this difference was not statistically significant (p>0.05). Females were more commonly affected by NMO, accounting for 72.2% of the NMO-positive group, and there was a significant difference in clinical phenotypes between the two groups (p<0.05). The NMO-positive group predominantly had relapsing NMO presentation (75%), and 72.8% of these patients showed longitudinally extensive transverse myelitis on the MRI spine. Azathioprine was the most frequently administered treatment for positive NMO patients (69.44%), followed by rituximab and MMF. The follow-up period for the study participants lasted 24 months. CONCLUSION This is the first study on NMOSD cases in Pakistan. According to the present study, NMOSD is most prevalent among women in their forties. Relapsing NMO was the most common form of presentation. 89% of patients had antibodies against AQP4. 72.8% of patients suffered from LETM during the course of their disease. There are some features of our NMOSD cases that appear comparable with those around the world, despite some limitations in testing and access to care. It is clear that the clinical and radiological spectrums of patients with NMO and NMOSD in this cohort are similar. It is reasonable to suspect NMO if demyelinating episodes are not characteristic of MS.
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Affiliation(s)
- Haris Majid Rajput
- Department of Neurology, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan
| | - Muhammad Hassan
- Department of Neurology, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan.
| | - Mazhar Badshah
- Department of Neurology, Shaheed Zulfiqar Ali Bhutto Medical University (SZABMU), Islamabad, Pakistan
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Yang L, Li W, Xie Y, Ma S, Zhou X, Huang X, Tan S. Impact of dysautonomic symptom burden on the quality of life in Neuromyelitis optica spectrum disorder patients. BMC Neurol 2023; 23:112. [PMID: 36941592 PMCID: PMC10026430 DOI: 10.1186/s12883-023-03162-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/14/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND This study aimed to investigate the clinical risk factors of dysautonomic symptom burden in neuromyelitis optica spectrum disorder (NMOSD) and its impact on patients' quality of life. METHODS A total of 63 NMOSD patients and healthy controls were enrolled. All participants completed the Composite Autonomic Symptom Score 31 (COMPASS-31) to screen for symptoms of autonomic dysfunction. A comprehensive clinical evaluation was performed on NMOSD patients, such as disease characteristics and composite evaluations of life status, including quality of life, anxiety/depression, sleep, and fatigue. Correlated factors of dysautonomic symptoms and quality of life were analyzed. RESULTS The score of COMPASS-31 in the NMOSD group was 17.2 ± 10.3, significantly higher than that in healthy controls (P = 0.002). In NMOSD patients, the higher COMPASS-31 score was correlated with more attacks (r = 0.49, P < 0.001), longer disease duration (r = 0.52, P < 0.001), severer disability (r = 0.50, P < 0.001), more thoracic cord lesions (r = 0.29, P = 0.02), more total spinal cord lesions (r = 0.35, P = 0.005), severer anxiety (r = 0.55, P < 0.001), severer depression (r = 0.48, P < 0.001), severer sleep disturbances (r = 0.59, P < 0.001), and severer fatigue (r = 0.56, P < 0.001). The disability, total spinal cord lesions, and fatigue were revealed to be independently associated factors. Further analysis revealed that the COMPASS-31 score was independently correlated with scores of all the domains of patients' quality of life scale (P < 0.05). CONCLUSIONS Dysautonomic symptom burden is correlated with decreased quality of life and certain clinical characteristics such as disability, the burden of spinal cord lesions, and fatigue in NMOSD patients. Investigation and proper management of autonomic dysfunction may help to improve the quality of life in patients with NMOSD.
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Affiliation(s)
- Lili Yang
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu, 610072, China
| | - Wenjing Li
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu, 610072, China
| | - Yan Xie
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu, 610072, China
| | - Shuai Ma
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu, 610072, China
| | - Xiaobo Zhou
- Department of Psychosomatic, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 611731, China
| | - Xinyue Huang
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu, 610072, China.
| | - Song Tan
- Department of Neurology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 32 West Second Section of First Ring Road, Chengdu, 610072, China.
- Sichuan Provincial Key Laboratory for Human Disease Gene Study, Chengdu, China.
- Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, Sichuan, China.
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Boyko AN. Comments on the article “Consensus opinion on the management of patients with neuromyelitis optica spectrum diseases: issues of terminology and therapy”. NEUROLOGY, NEUROPSYCHIATRY, PSYCHOSOMATICS 2023. [DOI: 10.14412/2074-2711-2023-1-119-122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- A. N. Boyko
- Department of Neurology, Neurosurgery and Medical Genetics, N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia; Institute of Clinical Neurology, Federal Center for Brain and Neurotechnologies, Federal Medical and Biological Agency of Russia
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Li H, Yang M, Song H, Sun M, Zhou H, Fu J, Zhou D, Bai W, Chen B, Lai M, Kang H, Wei S. ACT001 Relieves NMOSD Symptoms by Reducing Astrocyte Damage with an Autoimmune Antibody. Molecules 2023; 28:molecules28031412. [PMID: 36771078 PMCID: PMC9918908 DOI: 10.3390/molecules28031412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 01/18/2023] [Accepted: 01/24/2023] [Indexed: 02/05/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a central nervous system inflammatory demyelinating disease, the pathogenesis of which involves autoantibodies targeting the extracellular epitopes of aquaporin-4 on astrocytes. We neutralized the AQP4-IgG from NMOSD patient sera using synthesized AQP4 extracellular epitope peptides and found that the severe cytotoxicity produced by aquaporin-4 immunoglobin (AQP4-IgG) could be blocked by AQP4 extracellular mimotope peptides of Loop A and Loop C in astrocyte protection and animal models. ACT001, a natural compound derivative, has shown anti-tumor activity in various cancers. In our study, the central nervous system anti-inflammatory effect of ACT001 was investigated. The results demonstrated the superior astrocyte protection activity of ACT001 at 10 µM. Furthermore, ACT001 decreases the behavioral score in the mouse NMOSD model, which was not inferior to Methylprednisolone Sodium Succinate, the first-line therapy of NMOSD in clinical practice. In summary, our study showed that astrocytes are protected by specific peptides, or small molecular drugs, which is a new strategy for the treatment of NMOSD. It is possible for ACT001 to be a promising therapy for NMOSD.
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Affiliation(s)
- Hongen Li
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Mo Yang
- Department of Neuro-Ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing 100091, China
| | - Honglu Song
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
- Department of Ophthalmology, The 980th Hospital of the Chinese PLA Joint Logistics Support Force, Shijiazhuang 050082, China
| | - Mingming Sun
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Huanfen Zhou
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Junxia Fu
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Di Zhou
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Wenhao Bai
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Biyue Chen
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
| | - Mengying Lai
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
- Department of Public Health and Preventive Medicine, Shantou University Medical College, Shantou 515041, China
| | - Hao Kang
- Department of Ophthalmology, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, China
- Correspondence: (H.K.); (S.W.)
| | - Shihui Wei
- Department of Ophthalmology, The Chinese People’s Liberation Army General Hospital & The Chinese People’s Liberation Army Medical School, Beijing 100853, China
- Correspondence: (H.K.); (S.W.)
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Gaudioso CM, Mar S, Casper TC, Codden R, Nguyen A, Aaen G, Benson L, Chitnis T, Francisco C, Gorman MP, Goyal MS, Graves J, Greenberg BM, Hart J, Krupp L, Lotze T, Narula S, Pittock SJ, Rensel M, Rodriguez M, Rose J, Schreiner T, Tillema JM, Waldman A, Weinstock-Guttman B, Wheeler Y, Waubant E, Flanagan EP. MOG and AQP4 Antibodies among Children with Multiple Sclerosis and Controls. Ann Neurol 2023; 93:271-284. [PMID: 36088544 PMCID: PMC10576841 DOI: 10.1002/ana.26502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the frequency of myelin oligodendrocyte glycoprotein (MOG)-IgG and aquaporin-4 (AQP4)-IgG among patients with pediatric-onset multiple sclerosis (POMS) and healthy controls, to determine whether seropositive cases fulfilled their respective diagnostic criteria, to compare characteristics and outcomes in children with POMS versus MOG-IgG-associated disease (MOGAD), and identify clinical features associated with final diagnosis. METHODS Patients with POMS and healthy controls were enrolled at 14 US sites through a prospective case-control study on POMS risk factors. Serum AQP4-IgG and MOG-IgG were assessed using live cell-based assays. RESULTS AQP4-IgG was negative among all 1,196 participants, 493 with POMS and 703 healthy controls. MOG-IgG was positive in 30 of 493 cases (6%) and zero controls. Twenty-five of 30 patients positive with MOG-IgG (83%) had MOGAD, whereas 5 of 30 (17%) maintained a diagnosis of multiple sclerosis (MS) on re-review of records. MOGAD cases were more commonly in female patients (21/25 [84%] vs 301/468 [64%]; p = 0.044), younger age (mean = 8.2 ± 4.2 vs 14.7 ± 2.6 years; p < 0.001), more commonly had initial optic nerve symptoms (16/25 [64%] vs 129/391 [33%]; p = 0.002), or acute disseminated encephalomyelitis (ADEM; 8/25 [32%] vs 9/468 [2%]; p < 0.001), and less commonly had initial spinal cord symptoms (3/20 [15%] vs 194/381 [51%]; p = 0.002), serum Epstein-Barr virus (EBV) positivity (11/25 [44%] vs 445/468 [95%]; p < 0.001), or cerebrospinal fluid oligoclonal bands (5/25 [20%] vs 243/352 [69%]; p < 0.001). INTERPRETATION MOG-IgG and AQP4-IgG were not identified among healthy controls confirming their high specificity for pediatric central nervous system (CNS) demyelinating disease. Five percent of those with prior POMS diagnoses ultimately had MOGAD; and none had AQP4-IgG positivity. Clinical features associated with a final diagnosis of MOGAD in those with suspected MS included initial ADEM phenotype, younger age at disease onset, and lack of EBV exposure. ANN NEUROL 2023;93:271-284.
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Affiliation(s)
- Cristina M Gaudioso
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - Soe Mar
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - T Charles Casper
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Rachel Codden
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Adam Nguyen
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Gregory Aaen
- Pediatric Multiple Sclerosis Center at Loma Linda University Children’s Hospital, Loma Linda University, Loma Linda, CA, United States
| | - Leslie Benson
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Tanuja Chitnis
- Partners Pediatric MS Center, Massachusetts General Hospital, Boston, MA, United States
| | - Carla Francisco
- UCSF Regional Pediatric MS Center, San Francisco, CA, United States
| | - Mark P Gorman
- Pediatric Multiple Sclerosis and Related Disorders Program at Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States
| | - Manu S Goyal
- Washington University Pediatric MS and other Demyelinating Disease Center, St. Louis, MO, United States
| | - Jennifer Graves
- University of California San Diego Health, Rady Children’s Hospital San Diego
| | - Benjamin M Greenberg
- Department of Neurology, University of Texas Southwestern and Children’s Health, Dallas, TX, United States
| | - Janace Hart
- UCSF Regional Pediatric MS Center, San Francisco, CA, United States
| | - Lauren Krupp
- New York University, Pediatric MS Center, Neurology
| | - Timothy Lotze
- The Blue Bird Circle Clinic for Multiple Sclerosis, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, United States
| | - Sona Narula
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Sean J. Pittock
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
| | - Mary Rensel
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, United States
| | - Moses Rodriguez
- Mayo Clinic Pediatric MS Center, Mayo Clinic, Rochester, MN, United States
| | - John Rose
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Teri Schreiner
- Rocky Mountain MS Center, Children’s Hospital Colorado, University of Colorado, Aurora, CO, United States
| | | | - Amy Waldman
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Bianca Weinstock-Guttman
- The Pediatric MS Center at the Jacobs Neurological Institute, State University of New York at Buffalo, Buffalo, NY, United States
| | - Yolanda Wheeler
- Center for Pediatric-Onset Demyelinating Disease at the Children’s of Alabama, University of Alabama, Birmingham, AL, United States
| | | | - Eoin P Flanagan
- Department of Neurology and Laboratory Medicine and Pathology and the Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States
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Cortese R, Prados Carrasco F, Tur C, Bianchi A, Brownlee W, De Angelis F, De La Paz I, Grussu F, Haider L, Jacob A, Kanber B, Magnollay L, Nicholas RS, Trip A, Yiannakas M, Toosy AT, Hacohen Y, Barkhof F, Ciccarelli O. Differentiating Multiple Sclerosis From AQP4-Neuromyelitis Optica Spectrum Disorder and MOG-Antibody Disease With Imaging. Neurology 2023; 100:e308-e323. [PMID: 36192175 PMCID: PMC9869760 DOI: 10.1212/wnl.0000000000201465] [Citation(s) in RCA: 27] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/09/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Relapsing-remitting multiple sclerosis (RRMS), aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) may have overlapping clinical features. There is an unmet need for imaging markers that differentiate between them when serologic testing is unavailable or ambiguous. We assessed whether imaging characteristics typical of MS discriminate RRMS from AQP4-NMOSD and MOGAD, alone and in combination. METHODS Adult, nonacute patients with RRMS, APQ4-NMOSD, and MOGAD and healthy controls were prospectively recruited at the National Hospital for Neurology and Neurosurgery (London, United Kingdom) and the Walton Centre (Liverpool, United Kingdom) between 2014 and 2019. They underwent conventional and advanced brain, cord, and optic nerve MRI and optical coherence tomography (OCT). RESULTS A total of 91 consecutive patients (31 RRMS, 30 APQ4-NMOSD, and 30 MOGAD) and 34 healthy controls were recruited. The most accurate measures differentiating RRMS from AQP4-NMOSD were the proportion of lesions with the central vein sign (CVS) (84% vs 33%, accuracy/specificity/sensitivity: 91/88/93%, p < 0.001), followed by cortical lesions (median: 2 [range: 1-14] vs 1 [0-1], accuracy/specificity/sensitivity: 84/90/77%, p = 0.002) and white matter lesions (mean: 39.07 [±25.8] vs 9.5 [±14], accuracy/specificity/sensitivity: 78/84/73%, p = 0.001). The combination of higher proportion of CVS, cortical lesions, and optic nerve magnetization transfer ratio reached the highest accuracy in distinguishing RRMS from AQP4-NMOSD (accuracy/specificity/sensitivity: 95/92/97%, p < 0.001). The most accurate measures favoring RRMS over MOGAD were white matter lesions (39.07 [±25.8] vs 1 [±2.3], accuracy/specificity/sensitivity: 94/94/93%, p = 0.006), followed by cortical lesions (2 [1-14] vs 1 [0-1], accuracy/specificity/sensitivity: 84/97/71%, p = 0.004), and retinal nerve fiber layer thickness (RNFL) (mean: 87.54 [±13.83] vs 75.54 [±20.33], accuracy/specificity/sensitivity: 80/79/81%, p = 0.009). Higher cortical lesion number combined with higher RNFL thickness best differentiated RRMS from MOGAD (accuracy/specificity/sensitivity: 84/92/77%, p < 0.001). DISCUSSION Cortical lesions, CVS, and optic nerve markers achieve a high accuracy in distinguishing RRMS from APQ4-NMOSD and MOGAD. This information may be useful in clinical practice, especially outside the acute phase and when serologic testing is ambiguous or not promptly available. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that selected conventional and advanced brain, cord, and optic nerve MRI and OCT markers distinguish adult patients with RRMS from AQP4-NMOSD and MOGAD.
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Affiliation(s)
- Rosa Cortese
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Ferran Prados Carrasco
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Carmen Tur
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Alessia Bianchi
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Wallace Brownlee
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Floriana De Angelis
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Isabel De La Paz
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Francesco Grussu
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Lukas Haider
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Anu Jacob
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Baris Kanber
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Lise Magnollay
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Richard S Nicholas
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Anand Trip
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Marios Yiannakas
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Ahmed T Toosy
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Yael Hacohen
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Frederik Barkhof
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands
| | - Olga Ciccarelli
- From the Department of Neuroinflammation (R.C., F.P.C., C.T., A.B., W.B., F.D.A., I.D.L.P., F.G., L.H., L.M., A.T., M.Y., A.T.T., Y.H.R.C.P.C.H., F.B., O.C.), Queen Square MS Centre, UCL Queen Square Institute of Neurology, Faculty of Brain Science, University College of London; Department of Medicine (R.C.), Surgery and Neuroscience, University of Siena, Italy; Department of Medical Physics and Biomedical Engineering (F.P.C., B.K., F.B.), Centre for Medical Imaging Computing, University College of London; Universitat Oberta de Catalunya (F.P.C.), Barcelona, Spain; MS Centre of Catalonia (Cemcat) (C.T.), Vall d'Hebron Institute of Research, Spain; Radiomics Group (F.G.), Vall d'Hebron Institute of Oncology, Vall d'Hebron Barcelona Barcelona, Spain; Department of Biomedical Imaging and Image Guided Therapy (L.H.), Medical University of Vienna, Austria; NMO Clinical Service at the Walton Centre (A.J.), Liverpool, United Kingdom; Division of Multiple Sclerosis and Autoimmune Neurology (A.J.), Neurological Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates; Division of Brain Sciences (R.S.N.), Department of Medicine, Imperial College London; National Institute for Health Research (NIHR) (A.T., F.B., O.C.), University College London Hospitals (UCLH), Biomedical Research Centre; and Department of Radiology and Nuclear Medicine (F.B.), Amsterdam University Medical Centre, the Netherlands.
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Rojas JI, López PA, Criniti J, Pettinicchi JP, Caride A, Correa Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Andrade JSP, Daccach Marques V, Bribiesca Contreras E, Gómez Figueroa E, Flores Rivera J, Galleguillos L, Navas C, Soares Neto HR, Gracia F, Cristiano E, Patrucco L, Becker J, Hamuy F, Alonso R, Man F, Tkachuk V, Nadur D, Lana-Peixoto M, Castillo ISD, Carnero Contentti E. Therapeutic strategies in NMOSD and MOGAD patients: A multicenter cohort study in Latin America. Mult Scler Relat Disord 2023; 71:104508. [PMID: 36738691 DOI: 10.1016/j.msard.2023.104508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 12/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
PURPOSE This study describes the therapeutic strategies in NMOSD and MOGAD adopted by neurologists to treat both conditions in Latin America (LATAM) with main focus on rituximab (RTX) and the disease outcome. METHODS retrospective study in a cohort of NMOSD and MOGAD patients followed in specialized MS/NMOSD centers from eight countries and 14 LATAM reference centers. Demographics and clinical characteristics were collected. RTX strategies on naïve (for rituximab) patients were summarized as follows: scheme A: two 1000 mg infusions 15 days apart and repeated every 6 months; scheme B: four 375 mg/m2 infusions every week for 4 weeks and repeated every 6 months; scheme C: one 1000 mg infusions and repeated every 6 months; scheme D: other scheme used. Relapse rate and adverse events during follow-up were analyzed considering the different RTX schemes. Poisson and logistic regression analysis were used to assess baseline aspects and disease activity during follow-up. RESULTS A total of 217 patients were included. 197 were NMOSD patients (164, 83.2% AQP4-IgG seropositive and 16.7% seronegative) and 20 were MOGAD patients. The most frequent long-term treatment was RTX in both groups (48.2% and 65% for NMOSD and MOGAD patients, respectively). The most common RTX regimen used in 79 (83.1%) patients was two 1000 mg infusions 15 days apart and repeat every 6 months. Relapses under RTX treatment were observed in 21 (22.1%) patients. Relapses after RTX treatment were associated with higher EDSS (OR 1.75, 95%CI 1.44-2.34, p = 0.03) and higher ARR pre-RTX (OR = 2.17, 95% CI 1.72-3.12, p = 0.002) but not with RTX regimen (OR = 1.10, 95% CI 0.89-1.21, p = 0.60). CONCLUSION the most strategy used in LATAM was RTX with two 1000 mg infusions 15 days apart. Relapses during follow up were not associated with RTX regimen used.
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Affiliation(s)
- Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina.
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | | | | | | | | | | | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil
| | | | - Enrique Gómez Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - Lorna Galleguillos
- Universidad Del Desarrollo y Clínica Alemana de Santiago de Chile, Chile
| | - Carlos Navas
- Clinica Enfermedad Desmielinizante Clinica Universitaria Colombia, Colombia
| | - Herval R Soares Neto
- Division of Neurology, Hospital do Servidor Estadual de São Paulo (IAMSPE), São Paulo, Brasil
| | - Fernando Gracia
- Clinica de Esclerosis Multiple, Servicio de Neurologia Hospital Santo Tomas, Universidad Interamericana de Panamá, Panamá
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Jefferson Becker
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brasil
| | | | - Ricardo Alonso
- Faculty of Medicine, Centro Universitario de Esclerosis Múltiple (CUEM), Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Federico Man
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Verónica Tkachuk
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Débora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- CIEM MS Center, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Ibis Soto de Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Bolivarian Republic of Venezuela
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Miao Y, Zhong X, Jia S, Bian Y, Han J, Qiu F. The Characteristics of Cognitive Proficiency in Patients with Acute Neuromyelitis Optica Spectrum Disease and its Correlation with Serum Aquaporin-4 Antibody Titer. Brain Sci 2023; 13:brainsci13010090. [PMID: 36672071 PMCID: PMC9857218 DOI: 10.3390/brainsci13010090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/17/2022] [Accepted: 12/29/2022] [Indexed: 01/04/2023] Open
Abstract
Objective: To explore the characteristics and dynamic evolution of cognitive impairment in patients with neuromyelitis optica spectrum disorder (NMOSD). Methods: Twenty-five patients with acute NMOSD and 30 age-matched healthy individuals were consecutively recruited in this study. The Montreal Cognitive Assessment (MoCA), Chinese Version of Rey Auditory Vocabulary Learning Test (CRAVLT), Verbal Fluency Test (VFT), Digital Span Test (DST), Paced Auditory Serial Addition Task 3/2s version (PASAT-3/2), Rey−Osterrieth Complex Figure Test (ROCF) and Stroop Color and Word Test (CWT) were used to evaluate cognitive function. The correlations between cognitive function and serum aquaporin-4 (AQP-4) antibody titer were analyzed. Results: Sixty-four percent of patients with acute NMOSD had cognitive dysfunction. MoCA (p < 0.001), CRAVLT-N7 (p = 0.004), CRAVLT-N8 (p = 0.011), ROCF-C (p = 0.005), ROCF-R (p < 0.001), PASAT-3 (p = 0.013), PASAT-2 (p = 0.001) and CWT-A (p = 0.017) were significantly worse in patients with acute NMOSD than those in control group. During follow-up visits, significant differences of serum AQP-4 antibody titers were still noted in NMOSD patients (p < 0.001), while no significant differences were found by MoCA. Conclusion: A high number of patients with acute NMOSD suffer from cognitive dysfunction. Serum AQP-4 antibody titers can decrease during disease remission, while obvious cognitive decline in these patients still exists.
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Affiliation(s)
- Yan Miao
- Department of Neurology, The Third Xiangya Hospital, Central South University, Changsha 410008, China
| | - Xiaoling Zhong
- Department of Neurology, School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital of Beijing, Beijing 100048, China
| | - Shuangshuang Jia
- Department of Neurology, Naval Clinical College, Anhui Medical University, Hefei 230032, China
| | - Yang Bian
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital of Beijing, Beijing 100048, China
| | - Jinming Han
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing 100053, China
- Correspondence: (J.H.); (F.Q.); Tel.: +86-1055473163 (F.Q.)
| | - Feng Qiu
- Department of Neurology, School of Medicine, South China University of Technology, Guangzhou 510006, China
- Department of Neurology, The Sixth Medical Center of Chinese PLA General Hospital of Beijing, Beijing 100048, China
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing 100853, China
- Correspondence: (J.H.); (F.Q.); Tel.: +86-1055473163 (F.Q.)
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Rojas JI, Pappolla A, Patrucco L, Cristiano E, Miguez J, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Fiol M, Leguizamon F, Luetic G, Menichini ML, Lopez PA, Pettinicchi JP, Criniti J, Caride A, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Silva B, Fernández Liguori N, Nadur D, Chercoff A, Martinez A, Steinberg J, Garcea O, Carrá A, Alonso Serena M, Carnero Contentti E. Disability outcomes in NMOSD and MOGAD patients: data from a nationwide registry in Argentina. Neurol Sci 2023; 44:281-286. [PMID: 36166174 DOI: 10.1007/s10072-022-06409-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 09/13/2022] [Indexed: 01/10/2023]
Abstract
The objective was to evaluate time to reach an EDSS of 4, 6, and 7 in NMOSD and MOGAD patients included in the Argentinean MS and NMOSD registry (RelevarEM, NCT 03,375,177). METHODS NMOSD patients diagnosed according to 2015 criteria and with MOGAD were identified. Patients with at least 3 years of follow-up and periodic clinical evaluations with EDSS outcomes were included. AQP4-antibody and MOG-antibody status was recorded, and patients were stratified as seropositive and seronegative for AQP4-antibody. EDSS of 4, 6, and 7 were defined as dependent variables. Log rank test was used to identify differences between groups. RESULTS Registry data was provided for a total of 137 patients. Of these, seventy-five presented AQP4-ab-positive NMOSD, 45 AQP4-ab-negative NMOSD, and 11 MOGAD. AQP4-ab status was determined by cell-based assay (CBA) in 72% of NMOSD patients. MOG-ab status was tested by CBA in all cases. Mean time to EDSS of 4 was 53.6 ± 24.5 vs. 63.1 ± 32.2 vs. 44.7 ± 32 months in seropositive, seronegative NMOSD, and MOGAD, respectively (p = 0.76). Mean time to EDSS of 6 was 79.2 ± 44.3 vs. 75.7 ± 48.6 vs. 54.7 ± 50 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.23), while mean time to EDSS of 7 was 86.8 ± 54 vs. 80.4 ± 51 vs. 58.5 ± 47 months in seropositive, seronegative NMOSD, and MOGAD (p = 0.39). CONCLUSION No differences were observed between NMOSD (seropositive and seronegative) and MOGAD in survival curves.
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Affiliation(s)
- Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Argentina. .,Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina. .,Centro de Esclerosis Múltiple de Buenos Aires, (CEMBA), Billinghurst 1611, CP 1181, Buenos Aires, Argentina.
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Cordoba, Argentina.,Servicio de Neurología - Hospital Córdoba, Cordoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades Desmielinizantes - Sanatorio Allende, Cordoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | - Marcela Fiol
- Departamento de Neurología - FLENI, CABA, Argentina
| | | | | | | | - Pablo A Lopez
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina.,Sanatorio Güemes, CABA, Argentina
| | - Berenice Silva
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | | | - Débora Nadur
- Sección de Neuroinmunología Y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina.,Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Alejandra Martinez
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Judith Steinberg
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital Ramos Mejía, Buenos Aires, Argentina
| | - Adriana Carrá
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
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Spagni G, Gastaldi M, Businaro P, Chemkhi Z, Carrozza C, Mascagna G, Falso S, Scaranzin S, Franciotta D, Evoli A, Damato V. Comparison of Fixed and Live Cell-Based Assay for the Detection of AChR and MuSK Antibodies in Myasthenia Gravis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:10/1/e200038. [PMID: 36270951 PMCID: PMC9621337 DOI: 10.1212/nxi.0000000000200038] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 08/18/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Live cell-based assay (CBA) can detect acetylcholine receptors (AChRs) or muscle-specific tyrosine kinase (MuSK) antibodies (Abs) in a proportion of patients with radioimmunoassay (RIA)-double seronegative myasthenia gravis (dSN-MG). A commercial fixed CBA for AChR and MuSK Abs has recently become available; however, comparative studies on fixed and live CBAs are lacking. In this study, we compared the performance of fixed and live CBAs in patients with RIA-dSN MG and assessed their sensitivity in RIA-positive MG samples and their specificity. METHODS AChR and MuSK Abs were tested in 292 serum samples from 2 Italian MG referral centers by live and fixed CBAs: 192 from patients with MG and 100 from controls. All samples had been previously assessed by RIA: 66 were AChR positive, 40 MuSK positive, and 86 dSN. All controls were negative. Two independent raters assessed the CBA results. Fixed and live CBAs were compared with the McNemar test; interrater and interlaboratory agreement were assessed with Cohen's kappa or interclass correlation coefficient (ICC), as appropriate. RESULTS In 86 RIA-dSN samples, fixed CBA detected Abs in 10 cases (11.6%, 95% CI 5.7-20.3), whereas live CBA detected Abs in 16 (18.6%, 95% CI 11.0-28.5) (p = 0.0143). Of these sera, those positive by fixed CBA were also positive by live CBA. In addition, live CBA could detect MuSK Abs in 4 and AChR Abs in 2 samples that were negative by fixed CBA, providing an 8% (95% CI 2.9-16.6) further increase in the Ab detection rate. These results were confirmed by flow cytometry. In the RIA-positive cohort, the sensitivity for AChR Abs was 98.5% (95% CI 91.9%-99.9%) for fixed CBA and 100% (95% CI 94.6-100) for live CBA (p = 0.1573). For both assays, the sensitivity for MuSK Abs was 100% (95% CI 91.2-100), and the specificity was 100% (95% CI 96.4-100). Interrater agreement was almost perfect for live and fixed CBAs (Cohen's kappa 0.972 and 0.978, respectively), alike interlaboratory agreement. Interrater agreement for the CBA score ranged from good to excellent (ICC: 0.832-0.973). DISCUSSION Fixed CBA represents a valuable alternative to RIA for AChR and MuSK Ab detection in patients with MG and could be considered as a first-step diagnostic test. Live CBA can be useful in the serologic evaluation of RIA- and fixed CBA-negative samples.
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Affiliation(s)
- Gregorio Spagni
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Matteo Gastaldi
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Pietro Businaro
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Zeineb Chemkhi
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Cinzia Carrozza
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Giovanni Mascagna
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Silvia Falso
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Silvia Scaranzin
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Diego Franciotta
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
| | - Amelia Evoli
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy.
| | - Valentina Damato
- From the Department of Neuroscience (G.S., Z.C., S.F., A.E., V.D.), Università Cattolica del Sacro Cuore; Fondazione Policlinico Universitario "A. Gemelli" IRCCS (G.S., A.E.), Rome; Neuroimmunology Laboratory (M.G., P.B., S.S.), IRCCS Mondino Foundation; Department of Brain and Behavioral Sciences (P.B.), University of Pavia, Italy; Chemistry, Biochemistry and Clinical Molecular Biology Unit (C.C., G.M.), Fondazione Policlinico "Gemelli," IRCCS, Rome; Autoimmunology Laboratory (D.F.), IRCCS Ospedale Policlinico San Martino, Genoa; and Department of Neurosciences, Drugs and Child Health (V.D.), University of Florence, Italy
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Schindler P, Aktas O, Ringelstein M, Wildemann B, Jarius S, Paul F, Ruprecht K. Glial fibrillary acidic protein as a biomarker in neuromyelitis optica spectrum disorder: a current review. Expert Rev Clin Immunol 2023; 19:71-91. [PMID: 36378751 DOI: 10.1080/1744666x.2023.2148657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a relapsing, often debilitating neuroinflammatory disease, whose predominant clinical manifestations are longitudinally extensive transverse myelitis and optic neuritis. About 80% of the patients with an NMOSD phenotype have pathogenic autoantibodies against the astrocyte water channel aquaporin-4 (AQP4-IgG). While therapeutic options for NMOSD have greatly expanded in recent years, well-established biomarkers for prognosis or treatment response are still lacking. Glial fibrillary acidic protein (GFAP) is mainly expressed in astrocytes and can be detected in cerebrospinal fluid (CSF) and blood of patients with NMOSD. AREAS COVERED Here, we comprehensively review the current knowledge on GFAP as a biomarker in NMOSD. EXPERT OPINION In patients with AQP4-IgG+ NMOSD, GFAP levels are elevated in CSF and serum during acute attacks and correlate with disability, consistent with the pathophysiology of this antibody-mediated astrocytopathy. Serum GFAP levels tend to be higher in AQP4-IgG+ NMOSD than in its differential diagnoses, multiple sclerosis, and myelin oligodendrocyte antibody-associated disease. Importantly, serum GFAP levels in AQP4-IgG+ NMOSD during remission may be predictive of future disease activity. Serial serum GFAP measurements are emerging as a biomarker to monitor disease activity in AQP4-IgG+ NMOSD and could have the potential for application in clinical practice.
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Affiliation(s)
- Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Orhan Aktas
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, A Cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.,Max-Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany
| | - Klemens Ruprecht
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Harahsheh E, Callister M, Hasan S, Gritsch D, Valencia-Sanchez C. Aquaporin-4 IgG neuromyelitis optica spectrum disorder onset after Covid-19 vaccination: Systematic review. J Neuroimmunol 2022; 373:577994. [PMID: 36332464 DOI: 10.1016/j.jneuroim.2022.577994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 10/14/2022] [Accepted: 10/24/2022] [Indexed: 11/29/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is rarely reported following Coronavirus disease 2019 (COVID-19) vaccination. We identified 16 cases of new onset NMOSD with positive aquaporin-4 IgG (AQP4-IgG) following COVID-19 vaccination. Transverse myelitis was the most common clinical presentation (75%). Most patients received high dose steroids for acute treatment and maintenance therapy was started in 12 patients (75%). Twelve patients (75%) had improvement of their symptoms at the time of discharge or follow-up. The included cases share similar epidemiology and natural course to non-vaccine related cases. Clinicians should be aware of possible post-vaccination NMOSD to help with earlier diagnosis and treatment.
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Affiliation(s)
- Ehab Harahsheh
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA.
| | | | - Shemonti Hasan
- Department of Neurology, Mayo Clinic, Scottsdale, AZ, USA
| | - David Gritsch
- Division of Neuro-Oncology, Department of Neurology, Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA, USA
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Wingerchuk DM, Weinshenker BG, McCormick D, Barron S, Simone L, Jarzylo L. Aligning payer and provider strategies with the latest evidence to optimize clinical outcomes for patients with neuromyelitis optica spectrum disorder. J Manag Care Spec Pharm 2022; 28:S3-S27. [DOI: 10.18553/jmcp.2022.28.12-a.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Binks S, Lamquet S, Crawford AH, Meurs A, Irani SR, Pakozdy A. Parallel roles of neuroinflammation in feline and human epilepsies. Vet J 2022; 290:105912. [PMID: 36209994 PMCID: PMC10912827 DOI: 10.1016/j.tvjl.2022.105912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 09/28/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022]
Abstract
Autoimmune encephalitis refers to a group of disorders characterised by a non-infectious encephalitis, often with prominent seizures and surface neuronal autoantibodies. AE is an important cause of new-onset refractory status epilepticus in humans and is frequently responsive to immunotherapies including corticosteroids, plasma exchange, intravenous immunoglobulin G and rituximab. Recent research suggests that parallel autoantibodies can be detected in non-human mammalian species. The best documented example is leucine-rich glioma-inactivated 1 (LGI1)-antibodies in domestic cats with limbic encephalitis (LE). In this review, we discuss the role of neuroinflammation and autoantibodies in human and feline epilepsy and LE.
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Affiliation(s)
- Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK.
| | - Simon Lamquet
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Abbe H Crawford
- Clinical Science and Services, The Royal Veterinary College, Hertfordshire AL9 7TA, UK
| | - Alfred Meurs
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK
| | - Akos Pakozdy
- University Clinic for Small Animals, University of Veterinary Medicine Vienna, Austria
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Molinares DM, Gater DR, Daniel S, Pontee NL. Nontraumatic Spinal Cord Injury: Epidemiology, Etiology and Management. J Pers Med 2022; 12:1872. [PMID: 36579590 PMCID: PMC9694799 DOI: 10.3390/jpm12111872] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 11/10/2022] Open
Abstract
The spinal cord is a conduit within the central nervous system (CNS) that provides ongoing communication between the brain and the rest of the body, conveying complex sensory and motor information necessary for safety, movement, reflexes, and optimization of autonomic function. After a traumatic spinal cord injury (SCI), supraspinal influences on the peripheral nervous system and autonomic nervous system (ANS) are disrupted, leading to spastic paralysis, sympathetic blunting, and parasympathetic dominance, resulting in cardiac dysrhythmias, systemic hypotension, bronchoconstriction, copious respiratory secretions, and uncontrolled bowel, bladder, and sexual dysfunction. This article outlines the pathophysiology of the less reported nontraumatic SCI (NTSCI), its classification, its influence on sensory/motor function, and introduces the probable comorbidities associated with SCI that will be discussed in more detail in the accompanying manuscripts of this special issue. Finally, management strategies for NTSCI will be provided.
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Affiliation(s)
- Diana M. Molinares
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Scott Daniel
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
| | - Nicole L. Pontee
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, 1611 1095 NW 14th Terrace, Miami, FL 33136, USA
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
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Tabansky I, Tanaka AJ, Wang J, Zhang G, Dujmovic I, Mader S, Jeganathan V, DeAngelis T, Funaro M, Harel A, Messina M, Shabbir M, Nursey V, DeGouvia W, Laurent M, Blitz K, Jindra P, Gudesblatt M, King A, Drulovic J, Yunis E, Brusic V, Shen Y, Keskin DB, Najjar S, Stern JNH. Rare variants and HLA haplotypes associated in patients with neuromyelitis optica spectrum disorders. Front Immunol 2022; 13:900605. [PMID: 36268024 PMCID: PMC9578444 DOI: 10.3389/fimmu.2022.900605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 07/21/2022] [Indexed: 11/30/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are rare, debilitating autoimmune diseases of the central nervous system. Many NMOSD patients have antibodies to Aquaporin-4 (AQP4). Prior studies show associations of NMOSD with individual Human Leukocyte Antigen (HLA) alleles and with mutations in the complement pathway and potassium channels. HLA allele associations with NMOSD are inconsistent between populations, suggesting complex relationships between the identified alleles and risk of disease. We used a retrospective case-control approach to identify contributing genetic variants in patients who met the diagnostic criteria for NMOSD and their unaffected family members. Potentially deleterious variants identified in NMOSD patients were compared to members of their families who do not have the disease and to existing databases of human genetic variation. HLA sequences from patients from Belgrade, Serbia, were compared to the frequency of HLA haplotypes in the general population in Belgrade. We analyzed exome sequencing on 40 NMOSD patients and identified rare inherited variants in the complement pathway and potassium channel genes. Haplotype analysis further detected two haplotypes, HLA-A*01, B*08, DRB1*03 and HLA-A*01, B*08, C*07, DRB1*03, DQB1*02, which were more prevalent in NMOSD patients than in unaffected individuals. In silico modeling indicates that HLA molecules within these haplotypes are predicted to bind AQP4 at several sites, potentially contributing to the development of autoimmunity. Our results point to possible autoimmune and neurodegenerative mechanisms that cause NMOSD, and can be used to investigate potential NMOSD drug targets.
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Affiliation(s)
- Inna Tabansky
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Department of Neurobiology and Behavior, The Rockefeller University, New York, NY, United States
| | - Akemi J. Tanaka
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, United States
| | - Jiayao Wang
- Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, NY, United States
- Department of Biomedical Informatics and Department of Systems Biology, Columbia University, New York, NY, United States
| | - Guanglan Zhang
- Department of Computer Science, Boston University, Boston, MA, United States
| | - Irena Dujmovic
- Clinical Center of Serbia University School of Medicine, Belgrade, Serbia
- Department of Neurology, University of North Carolina School of Medicine, Chapel Hill, NC, United States
| | - Simone Mader
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- Biomedical Center and University Hospitals, Ludwig Maximilian University Munich, Munich, Germany
| | - Venkatesh Jeganathan
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Tracey DeAngelis
- Department of Neurology, Neurological Associates of Long Island, New Hyde Park, NY, United States
| | - Michael Funaro
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Asaff Harel
- Department of Neurology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Mark Messina
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Maya Shabbir
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Vishaan Nursey
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - William DeGouvia
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Micheline Laurent
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
| | - Karen Blitz
- Department of Neurology, South Shore Neurologic Associates, Patchogue, NY, United States
| | - Peter Jindra
- Division of Abdominal Transplantation, Baylor College of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Mark Gudesblatt
- Biomedical Center and University Hospitals, Ludwig Maximilian University Munich, Munich, Germany
| | | | - Alejandra King
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc., Tarrytown, NY, United States
| | - Jelena Drulovic
- Clinical Center of Serbia University School of Medicine, Belgrade, Serbia
| | - Edmond Yunis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Vladimir Brusic
- School of Computer Science, University of Nottingham Ningbo China, Ningbo, China
| | - Yufeng Shen
- Department of Biomedical Informatics and Department of Systems Biology, Columbia University, New York, NY, United States
| | - Derin B. Keskin
- Department of Translational Immuno-Genomics for Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA, United States
- Department of Medicine, Brigham and Women’s Hospital, Boston, MA, United States
| | - Souhel Najjar
- Department of Neurology, Lenox Hill Hospital, Northwell Health, New York, NY, United States
| | - Joel N. H. Stern
- Department of Neurology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Urology, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Molecular Medicine, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Department of Science Education, Donald and Barbra Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, United States
- Institute of Molecular Medicine, The Feinstein Institutes for Medical Research, Manhasset, NY, United States
- *Correspondence: Joel N. H. Stern, ;
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Passeri M, Matthews E, Kammeyer R, Piquet AL. Update in autoimmune and paraneoplastic myelopathies: Newly described antigen targets and antibody testing. Front Neurol 2022; 13:972143. [PMID: 35968301 PMCID: PMC9366192 DOI: 10.3389/fneur.2022.972143] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Myelopathy is an increasingly recognized presentation of many antibody-mediated neuroinflammatory disorders. While specific features of certain autoimmune myelopathies such as aquaporin-4 antibody associated neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein associated disorder (MOGAD) are well-characterized, other less commonly seen antibody-associated myelopathies are not as well-defined. These include but are not limited to, Hu/ANNA1, anti-glial fibrillary acidic protein (GFAP), anti-CV2/collapsin response mediator protein (CRMP5), and amphiphysin. Here, we review the mentioned more common antibody mediated myelopathies as well those that as less common, followed by a review of differentials that may mimic these disorders.
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Affiliation(s)
- Michlene Passeri
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Elizabeth Matthews
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ryan Kammeyer
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Department of Pediatrics and Neurology, Children's Hospital Anschutz Medical Campus, Aurora, CO, United States
| | - Amanda L. Piquet
- Department of Neurology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- *Correspondence: Amanda L. Piquet
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