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Bolakale-Rufai IK, Chukwuocha I, Makanjuola A, Enigbokan O, Yaria J. Skin Manifestations of Neuromyelitis Optica Spectrum Disorder With Secondary Systemic Lupus Erythematosus During Pregnancy: A Three-Year Follow-Up. Cureus 2023; 15:e40260. [PMID: 37440821 PMCID: PMC10335814 DOI: 10.7759/cureus.40260] [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: 06/10/2023] [Indexed: 07/15/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a disease of the central nervous system and the optic nerves that disproportionately affects women and occasionally coexists with other autoimmune diseases. NMOSD manifesting as skin lesions is a rare phenomenon. Furthermore, these skin lesions in the setting of NMOSD during pregnancy have not been described. We report the case of a 31-year-old woman from sub-Saharan Africa who presented with initial recurrent skin lesions followed by paraparesis during her second trimester of pregnancy. Her next pregnancy was associated with sudden vision loss. She had positive serology for aquaporin-4 antibodies and subsequently developed a positive dsDNA antibody two years after the initial NMOSD diagnosis. Her skin lesions and symptoms improved following the administration of azathioprine. This case highlights the impact of pregnancy on NMOSD and the significance of a heightened level of suspicion for NMOSD in patients who exhibit recurring skin lesions preceding paraparesis events.
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Affiliation(s)
| | | | | | | | - Joseph Yaria
- Medicine, University College Hospital, Ibadan, NGA
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2
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Sheiko GE, Belova AN, Rakhmanova EM, Boyko AN. [Combination of post-infectious optic neuritis and Guillain-Barré syndrome]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:106-110. [PMID: 37796076 DOI: 10.17116/jnevro2023123091106] [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: 10/06/2023]
Abstract
The coexistence of optic neuritis and Guillain-Barré syndrome is a rare combination of neurological diseases. The trigger of an autoimmune inflammatory process is often a respiratory mycoplasma infection. Ignorance of such combination can lead to diagnostic and therapy mistakes. This article describes the case of a rare combination of overlapping optic neuritis and Guillain-Barré syndrome, associated with Mycoplasma pneumoniae and provides the short literature review. Further studies are required to identify common pathogenetic mechanisms of combined inflammatory lesions of the optic nerves and peripheral nervous system.
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Affiliation(s)
- G E Sheiko
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - A N Belova
- Privolzhsky Research Medical University, Nizhny Novgorod, Russia
| | - E M Rakhmanova
- Privolzhsky Research Medical University, Nizhny Novgorod, 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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3
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Tugizova M, Vlahovic L, Tomczak A, Wetzel NS, Han MH. New Therapeutic Landscape in Neuromyelitis Optica. Curr Treat Options Neurol 2021; 23:13. [PMID: 33814893 PMCID: PMC8008025 DOI: 10.1007/s11940-021-00667-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2021] [Indexed: 12/11/2022]
Abstract
Purpose of review This review discusses the current treatment trends and emerging therapeutic landscape for patients with neuromyelitis optica spectrum disorder (NMOSD). Recent findings Conventional immune suppressive therapies, such as B cell depletion, have been used for long-term treatment. However, the availability of recent FDA-approved and investigational drugs has made therapeutic choices for NMOSD more complex. Summary Recent randomized clinical trials have shown that eculizumab, inebilizumab, and satralizumab are efficacious therapies for AQP4 seropositive NMOSD. These therapies may not have the same benefit in patients with seronegative NMOSD, including MOG-associated disease, and further investigation is required in this population. Reliable biomarkers to guide therapy decisions are urgently needed. There is a plethora of promising investigational therapies currently in the pipeline with exciting and novel mechanisms of action.
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Affiliation(s)
- Madina Tugizova
- Department of Neurology, Division of Neuroimmunology, Stanford University, 1201 Welch Road, MSLS p212, Stanford, CA 94305 USA.,Multiple Sclerosis Center, Stanford Hospital and Clinics, Palo Alto, CA USA
| | - Luka Vlahovic
- Department of Neurology, Creighton University School of Medicine, Omaha, NE USA
| | - Anna Tomczak
- Department of Neurology, Division of Neuroimmunology, Stanford University, 1201 Welch Road, MSLS p212, Stanford, CA 94305 USA.,Multiple Sclerosis Center, Stanford Hospital and Clinics, Palo Alto, CA USA
| | - Nora Sandrine Wetzel
- Department of Neurology, Division of Neuroimmunology, Stanford University, 1201 Welch Road, MSLS p212, Stanford, CA 94305 USA.,Faculty of Medicine, University of Zurich, Zürich, Switzerland
| | - May Htwe Han
- Department of Neurology, Division of Neuroimmunology, Stanford University, 1201 Welch Road, MSLS p212, Stanford, CA 94305 USA.,Multiple Sclerosis Center, Stanford Hospital and Clinics, Palo Alto, CA USA
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4
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Raju GB, Lavanya ML, Gopi S, Kumar TS, Kumari UA. Relapsing neuromyelitis optica spectrum disorder. JOURNAL OF DR. NTR UNIVERSITY OF HEALTH SCIENCES 2021. [DOI: 10.4103/jdrntruhs.jdrntruhs_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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5
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Ferrante P, Mora JA, Salazar L, Sáez EM, Auger C, Rovira À. MR imaging findings in primary spinal cord glioblastoma. Radiol Case Rep 2020; 16:72-77. [PMID: 33193932 PMCID: PMC7642760 DOI: 10.1016/j.radcr.2020.10.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 01/17/2023] Open
Abstract
Spinal cord glioblastoma is a rare disease, with an aggressive course and a poor prognosis. We describe magnetic resonance imaging (MRI) findings, in 3 adult cases of biopsy-confirmed glioblastoma. Conventional MRI findings were unclear with regard to the differential diagnosis between this rare tumor and other more common spinal cord lesions, including less aggressive tumors such as ependymoma or pilocytic astrocytoma, abscesses or tumefactive demyelinating lesions. After reasonable exclusion of infectious/inflammatory conditions, a final diagnosis of glioblastoma was established based on histopathological analysis. The cases reported reflect the difficulty of early radiological diagnosis of spinal cord glioblastoma, and indicate the need to perform a biopsy once inflammatory-infectious conditions are excluded with appropriate laboratory tests.
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Affiliation(s)
- Paolo Ferrante
- Diagnostica per Immagini e Radiologia Interventistica, Policlinico Tor Vergata, University Rome “Tor Vergata”, Rome, Italy
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129 | 08035, Barcelona, Spain
| | - Juan Andres Mora
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129 | 08035, Barcelona, Spain
- Fundación Universitaria Sanitas, Clinica Reina Sofia, Bogotá, Colombia
| | - Lourdes Salazar
- Neuropathology Unit, Pathology Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron. Barcelona, Spain
| | - Elena Martínez Sáez
- Neuropathology Unit, Pathology Department, Vall d'Hebron University Hospital, Hospital Vall d'Hebron. Barcelona, Spain
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129 | 08035, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Vall d'Hebron University Hospital, Hospital Vall d'Hebron, Passeig de la Vall d'Hebron, 119-129 | 08035, Barcelona, Spain
- Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron University Hospital, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Corresponding author.
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6
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Czarnecka D, Oset M, Karlińska I, Stasiołek M. Cognitive impairment in NMOSD-More questions than answers. Brain Behav 2020; 10:e01842. [PMID: 33022898 PMCID: PMC7667314 DOI: 10.1002/brb3.1842] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/17/2020] [Accepted: 08/22/2020] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is a type of central nervous system antibody-mediated disease which affects mainly optic nerves and spinal cord, but may also present with acute brainstem syndrome, acute diencephalic syndrome, and cerebral syndrome with typical brain lesions. One of the most disabling symptoms, diagnosed in 29%-67% of cases, is cognitive dysfunction, with such processes as memory, processing speed, executive function, attention, and verbal fluency being predominantly affected. However, description of cognition in NMOSD patients is still a relatively new area of research. METHODS A systematic MEDLINE search was performed to retrieve all studies that investigated cognitive impairment and its clinical correlates in patients with NMOSD. RESULTS We summarize the current knowledge on cognitive impairment profile, neuropsychological tests used to examine NMOSD patients, clinical and demographical variables affecting cognition, and magnetic resonance imaging correlates. We provide a comparison of cognitive profile of patients with multiple sclerosis and NMOSD. CONCLUSION Patients with NMOSD are at significant risk of cognitive deficits. However, the knowledge of cognitive symptoms in NMOSD and potential modifying interventions is still scarce. Further accumulation of clinical data may facilitate effective therapeutic interventions.
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Affiliation(s)
| | - Magdalena Oset
- Department of Neurology, Medical University of Lodz, Lodz, Poland
| | - Iwona Karlińska
- Department of Neurology, Medical University of Lodz, Lodz, Poland
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Freiha J, Riachi N, Chalah MA, Zoghaib R, Ayache SS, Ahdab R. Paroxysmal Symptoms in Multiple Sclerosis-A Review of the Literature. J Clin Med 2020; 9:jcm9103100. [PMID: 32992918 PMCID: PMC7600828 DOI: 10.3390/jcm9103100] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 09/17/2020] [Accepted: 09/19/2020] [Indexed: 01/08/2023] Open
Abstract
Paroxysmal symptoms are well-recognized manifestations of multiple sclerosis (MS). These are characterized by multiple, brief, sudden onset, and stereotyped episodes. They manifest as motor, sensory, visual, brainstem, and autonomic symptoms. When occurring in the setting of an established MS, the diagnosis is relatively straightforward. Conversely, the diagnosis is significantly more challenging when they occur as the initial manifestation of MS. The aim of this review is to summarize the various forms of paroxysmal symptoms reported in MS, with emphasis on the clinical features, radiological findings and treatment options.
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Affiliation(s)
- Joumana Freiha
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Naji Riachi
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Moussa A. Chalah
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; (M.A.C.); (S.S.A.)
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
| | - Romy Zoghaib
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Samar S. Ayache
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique–Hôpitaux de Paris, 51 avenue de Lattre de Tassigny, 94010 Créteil, France; (M.A.C.); (S.S.A.)
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94010 Créteil, France
| | - Rechdi Ahdab
- Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (J.F.); (N.R.); (R.Z.)
- Neurology Department, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
- Hamidy Medical Center, Tripoli 1300, Lebanon
- Correspondence: ; Tel.: +961-1-200800 (ext. 5126)
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8
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Yang MG, Tian S, Zhang Q, Han J, Liu C, Zhou Y, Zhu J, Jin T. Elevated serum interleukin-39 levels in patients with neuromyelitis optica spectrum disorders correlated with disease severity. Mult Scler Relat Disord 2020; 46:102430. [PMID: 32853892 DOI: 10.1016/j.msard.2020.102430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/17/2020] [Accepted: 07/29/2020] [Indexed: 01/10/2023]
Abstract
AIMS Neuromyelitis optica spectrum disorders (NMOSD) is an inflammatory demyelinating autoimmune disorder in the central nervous system (CNS), which is mainly mediated by aquaporin 4 antibodies (AQP4-Ab). Interleukin (IL)-39 is a new pro-inflammatory cytokine which belongs to the IL-12 cytokine family. However, the role of IL-39 in patients with NMOSD is not completely understood. Therefore, the aim of this study is to explore the possible implication of IL-39 in the pathogenesis of NMOSD. METHODS In this study, 50 patients with NMOSD, 20 patients with relapsing-remitting multiple sclerosis (RRMS), 30 patients with non-inflammatory neurological disorders (NND) and 78 healthy controls (HCs) were recruited. The levels of serum IL-39 were measured using the enzyme-linked immunosorbent assay (ELISA). RESULTS Our study showed serum IL-39 levels in patients with NMOSD were significantly higher than that in RRMS patients, NND patients and HCs, and positively correlated with Expanded Disability Status Scale (EDSS) score. CONCLUSION These findings suggested that IL-39 may play a pro-inflammatory role in the pathogenesis of NMOSD and correlate with disease severity.
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Affiliation(s)
- Meng-Ge Yang
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Suyan Tian
- Division of Clinical Research, the First Hospital of Jilin University, Changchun, China
| | - Qingxiang Zhang
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Jinming Han
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Caiyun Liu
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Yang Zhou
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Tao Jin
- Department of Neurology and Neuroscience Center, the First Hospital of Jilin University, Changchun, China.
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9
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Zhou Y, Zhang Y, Han J, Yang M, Zhu J, Jin T. Transitional B cells involved in autoimmunity and their impact on neuroimmunological diseases. J Transl Med 2020; 18:131. [PMID: 32183811 PMCID: PMC7079408 DOI: 10.1186/s12967-020-02289-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/28/2020] [Indexed: 02/08/2023] Open
Abstract
Transitional B cells (TrB cells) represent a crucial link between immature B cells in the bone marrow and mature peripheral B cells. Although TrB cells represent one of the regulatory B cell subpopulations in healthy individuals, the frequency of CD24hiCD38hi TrB cells in circulation may be altered in individuals with autoimmune diseases, such as multiple sclerosis, neuromyelitisoptica spectrum disorders, systemic lupus erythematosus, Sjögren’s syndrome, rheumatoid arthritis, systemic sclerosis, and juvenile dermatomyositis. Although TrB cells play regulatory roles under inflammatory conditions, consequences of their functional impairment vary across autoimmune diseases. Since the origin, development, and function of TrB cells, especially in humans, remain unclear and controversial, this review aimed to discuss the characteristics of TrB cells at steady state and explore their role in various immune diseases, including autoimmune rheumatic diseases and neuroimmunological diseases.
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Affiliation(s)
- Yang Zhou
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Ying Zhang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jinming Han
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Mengge Yang
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China
| | - Jie Zhu
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.,Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Tao Jin
- Department of Neurology and Neuroscience Center, The First Hospital of Jilin University, Xinmin Street 71#, Changchun, 130021, China.
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10
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Fragoso YD, Ruocco HH, Dias RM, Cabeça H, Gonçalves R, de Carvalho Sousa NA, Spessotto CV, Tauil CB, Alves-Leon SV, Gomes S, Gonçalves MVM, Machado SCN, Anacleto A, Correa EC, Pimentel MLV, Santos GAC. Late Onset of Neuromyelitis Optica Spectrum Disorders. Neurol Ther 2019; 8:477-482. [PMID: 31267407 PMCID: PMC6858916 DOI: 10.1007/s40120-019-0143-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system. NMOSD starting after the age of 50 years is considered a "late onset" (LO-NMOSD) and seems to be particularly aggressive. The objective of this paper is to present a series of 37 Brazilian patients with LO-NMOSD. METHODS Retrospective data collection from medical records of patients with LO-NMOSD seen at 14 Brazilian specialized units. RESULTS The ratio of women to men in the sample was 4.3 to 1. The patients were followed up for a median period of 4 years. Sex, age at disease onset, and ethnic background were not associated with the number of relapses or disability outcomes. Extensive longitudinal myelitis affected 86% of patients, while optic neuritis affected 70%, and brainstem syndromes were present in only 16% of these patients. Six patients are currently using some type of support for walking or are wheelchair-bound. Three have died. Therapeutic options for NMOSD were particularly complicated for these elderly patients, since medications for controlling NMOSD are, in essence, immunosuppressive. Long-term use of corticosteroids can be an issue when the patients have high blood pressure, diabetes mellitus, or dyslipidemia (conditions often seen in elderly individuals). CONCLUSION This series of LO-NMOSD cases highlights the importance of prompt diagnosis and treatment for these patients.
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Affiliation(s)
- Yara Dadalti Fragoso
- Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil.
- MS and Headache Research, Santos, SP, Brazil.
| | - Heloisa Helena Ruocco
- Department of Neurology, Pontificia Universidade Catolica de Campinas, Campinas, SP, Brazil
| | - Ronaldo Maciel Dias
- Department of Neurology, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Hideraldo Cabeça
- Department of Neurology, Hospital Ophir Loyola, Belem, PA, Brazil
| | - Ricardo Gonçalves
- Department of Neurology, Hospital Pompeia, Caxias do Sul, RS, Brazil
| | | | | | | | | | - Sidney Gomes
- Department of Neurology, Hospital Beneficencia Portuguesa de Sao Paulo and Hospital Paulistano, Sao Paulo, SP, Brazil
| | | | | | - Andrea Anacleto
- Department of Neurology, Universidade Metropolitana de Santos, Santos, SP, Brazil
| | - Eber Castro Correa
- Department of Neurology, Hospital de Base do Distrito Federal, Brasilia, DF, Brazil
| | - Maria Lucia V Pimentel
- Department of Neurology, Santa Casa de Misericordia do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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11
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Bui ML, Gould JK, Mentreddy A, Sigsbee E, Lalama H. Neuromyelitis Optica Spectrum Disorder: A Rare Case of Isolated Brainstem Syndrome. Cureus 2019; 11:e5644. [PMID: 31700746 PMCID: PMC6822874 DOI: 10.7759/cureus.5644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Before 2006, neuromyelitis optica was hallmarked by optic neuritis and transverse myelitis. However, with the discovery of antibodies to water channel aquaporin-4 as a diagnostic criterion, our clinical knowledge of the disease manifested in the creation of new pathologies that fell under the diagnostic umbrella of neuromyelitis optica spectrum disorder (NMOSD). Still, brain involvement of the disease has remained rare, in particular, lesions of the brain stem. Specific to our report is a novel case of NMOSD with intriguing, isolated brainstem findings.
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Affiliation(s)
- Mai-Lynn Bui
- Neurology, Larkin Community Hospital-South Miami, Miami, USA
| | - Jordan K Gould
- Neurology, Larkin Community Hospital-South Miami, Miami, USA
| | - Akshay Mentreddy
- Ophthalmology, Larkin Community Hospital-South Miami, Miami, USA
| | - Emily Sigsbee
- Neurology, Larkin Community Hospital-South Miami, Miami, USA
| | - Hector Lalama
- Neurology, Nova Southeast / Larkin Community Hospital-South Miami, Miami, USA
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12
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Liang H, Gao W, Liu X, Liu J, Mao X, Yang M, Long X, Zhou Y, Zhang Q, Zhu J, Wang S, Jin T. The GTF2I rs117026326 polymorphism is associated with neuromyelitis optica spectrum disorder but not with multiple sclerosis in a Northern Han Chinese population. J Neuroimmunol 2019; 337:577045. [PMID: 31520790 DOI: 10.1016/j.jneuroim.2019.577045] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/27/2019] [Accepted: 08/27/2019] [Indexed: 01/18/2023]
Abstract
Multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) are common demyelinating disorders of the central nervous system. The etiology and pathogenesis of MS and NMOSD remain unclear. The pathogenesis of these two diseases involves a genetic predisposition as well as environmental factors. NMOSD sometimes co-exists with Sjögren's syndrome, systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA), and these diseases are frequently associated with central nervous system disorder involvement, as manifest in MS- and NMOSD-like clinical features. Genetic variant rs117026326 upstream of the general transcription factor II-I (GTF2I) has been associated with primary Sjögren's syndrome, SLE and RA in East Asian populations. In this study, we genotyped single nucleotide rs117026326 polymorphisms of the GTF2I gene in 168 patients with MS, 144 patients with NMOSD, and 1403 healthy controls. We observed a significant genetic association between the variant rs117026326 and NMOSD (P = 1.09 × 10-11, OR = 2.535), however, the association with MS was not significant (P = .4289, OR = 1.129). Gene expression analyses showed that there was no significant association between the messenger RNA expression of GTF2I and genotypes at the variant. We conclude that the risk T allele of rs117026326 increases the risk of NMOSD, suggesting that NMOSD and MS may have different genetic risk factors.
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Affiliation(s)
- Hudong Liang
- Department of Neurology, The First Hospital of Jilin University, China
| | - Wenjing Gao
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, China
| | - Xianjun Liu
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, China
| | - Jingyao Liu
- Department of Neurology, The First Hospital of Jilin University, China
| | - Xijing Mao
- Department of Neurology, The Second Hospital of Jilin University, China
| | - Mengge Yang
- Department of Neurology, The First Hospital of Jilin University, China
| | - Xixi Long
- Department of Neurology, The First Hospital of Jilin University, China
| | - Yang Zhou
- Department of Neurology, The First Hospital of Jilin University, China
| | - Qingxiang Zhang
- Department of Neurology, The First Hospital of Jilin University, China
| | - Jie Zhu
- Department of Neurology, The First Hospital of Jilin University, China; Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Stockholm, Sweden
| | - Shaofeng Wang
- The Bethune Institute of Epigenetic Medicine, The First Hospital of Jilin University, China.
| | - Tao Jin
- Department of Neurology, The First Hospital of Jilin University, China.
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13
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Bejerot S, Hesselmark E, Mobarrez F, Wallén H, Hietala MA, Nybom R, Wetterberg L. Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report. J Med Case Rep 2019; 13:27. [PMID: 30696485 PMCID: PMC6352324 DOI: 10.1186/s13256-018-1929-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 11/18/2018] [Indexed: 11/15/2022] Open
Abstract
Background Neuromyelitis optica spectrum disorders are severe autoimmune inflammatory diseases of the central nervous system associated with the presence of immunoglobulin G antibodies against the water channel protein aquaporin-4. During exacerbation, specific aquaporin-4 immunoglobulin G may be produced intrathecally. We measured extracellular aquaporin-4 microparticles in the cerebrospinal fluid of a patient who later developed the typical symptoms and signs of a neuromyelitis optica spectrum disorder. Case presentation A 17-year-old South American girl developed acute severe motor and vocal tics and difficulties in walking, peripheral numbness, muscle pain, and bilateral headache. At age 22, she had a multitude of motor and psychiatric symptoms. Over the years, she fulfilled the diagnostic criteria for anorexia nervosa, depression, sleep disorder, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, development coordination disorder, attention-deficit/hyperactivity disorder, hypomania, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, conversion disorder, psychosis, and schizotypal personality syndrome. At age 24, she was found to have elevated titers of aquaporin-4 antibodies in serum, suggestive of probable neuromyelitis optica. She subsequently developed visual impairment, and swollen optic nerves were verified by magnetic resonance imaging. She was thus treated with a chimeric monoclonal antibody targeted against the pan-B-cell marker CD20 (rituximab), and almost all symptoms, including the psychiatric symptoms, rapidly decreased. We found a significant increase of extracellular microparticles of aquaporin-4 in cerebrospinal fluid sampled from our patient when she was 22 years old, 2 years before the full clinical development of neuromyelitis optica. Conclusions Microparticles of aquaporin-4 represent subcellular arrangements that may influence the pathogenesis of neuromyelitis optica spectrum disorders and may serve as biomarkers for the underlying cellular disturbances. The increase of aquaporin-4 microparticles in cerebrospinal fluid may be used for early diagnostic purposes; for prevention; and for evaluation of effective treatment, long-term follow-up studies, and elucidating the pathophysiology in neuromyelitis optica spectrum disorders. Further studies of aquaporin-4 microparticles in cerebrospinal fluid of patients with neuromyelitis optica and similar neuropsychiatric disorders are thus called for. Electronic supplementary material The online version of this article (10.1186/s13256-018-1929-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanne Bejerot
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden.,Faculty of Medicine and Health, University Health Care Research Centre, Örebro University, Örebro, Sweden
| | - Eva Hesselmark
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden
| | - Fariborz Mobarrez
- Unit of Rheumatology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Håkan Wallén
- Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden
| | - Max Albert Hietala
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden
| | - Rolf Nybom
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden
| | - Lennart Wetterberg
- Department of Clinical Neuroscience, Karolinska Institutet, SE-112 81, Stockholm, Sweden.
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14
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Chroustová I, Mareš M, Ungermann L, Ehler E. Myelin Oligodendrocyte Glycoprotein Antibody Associated Transverse Myelitis. ACTA MEDICA (HRADEC KRALOVE) 2019; 62:123-126. [PMID: 31663506 DOI: 10.14712/18059694.2019.136] [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: 06/10/2023]
Abstract
Antibodies against myelin oligodendrocyte glycoprotein cause inflammatory lesions of central myelin - in optic nerves, of the brainstem, and spinal cord. There are characteristic changes of CNS white matter, protein-cytological association in cerebrospinal fluid, MOG IgG antibodies, a very important differential diagnosis and a relatively mild course.
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Affiliation(s)
- Iveta Chroustová
- Department of Neurology, Pardubice Regional Hospital, Czech Republic
| | - Miroslav Mareš
- Department of Neurology, Pardubice Regional Hospital, Czech Republic
| | - Leoš Ungermann
- Department of Radiology, Pardubice Regional Hospital, Czech Republic
- Faculty of Health Care Studies, Pardubice University, Czech Republic
| | - Edvard Ehler
- Department of Neurology, Pardubice Regional Hospital, Czech Republic.
- Faculty of Health Care Studies, Pardubice University, Czech Republic.
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15
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Campbell A, Ogundipe OA. Neuromyelitis optica spectrum disorder presenting in an octogenarian. BMJ Case Rep 2018; 2018:bcr-2018-225601. [PMID: 30196259 DOI: 10.1136/bcr-2018-225601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
This case describes an 81-year-old woman with a history of Sjögren's syndrome presenting with recurrent falls and poor balance. She subsequently developed new and rapidly evolving neurology including hyperaesthesia, spastic paraplegia and sphincteric dysfunction. Following serial clinical reviews and detailed investigations, MRI (brainstem and cervicothoracic spine) and a seropositive result for aquaporin 4 IgG, a diagnosis of neuromyelitis optica spectrum disorder (NMOSD) was made. This case describes the clinical course of this index patient with an unusual late age of onset. The report also includes a discussion on NMOSD. We review aspects of terminology, brief epidemiology, pathogenesis, notable autoimmune associations, variance in clinical presentation and current diagnostic criteria. We also review the importance of distinguishing NMOSD from multiple sclerosis in view of the significant implications for treatment and prognosis.
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Affiliation(s)
- Amy Campbell
- Medicine of the Elderly Department, Royal Infirmary of Edinburgh, Edinburgh, UK
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