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Li X, Miao X, Wang Y, Sun J, Gao H, Han J, Li Y, Wang Q, Sun C, Liu J. Central nervous system tumefactive demyelinating lesions: Risk factors of relapse and follow-up observations. Front Immunol 2022; 13:1052678. [PMID: 36532021 PMCID: PMC9752826 DOI: 10.3389/fimmu.2022.1052678] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022] Open
Abstract
Objective To track the clinical outcomes in patients who initially presented with tumefactive demyelinating lesions (TDLs), we summarized the clinical characteristics of various etiologies, and identified possible relapse risk factors for TDLs. Methods Between 2001 and 2021, 116 patients initially presented with TDLs in our hospital were retrospectively evaluated. Patients were followed for relapse and clinical outcomes, and grouped according to various etiologies. Demographic information, clinical data, imaging data, and laboratory results of patients were obtained and analyzed. The risk factors of relapse were analyzed by the Log-Rank test and the Cox proportional hazard model in multivariate analysis. Result During a median follow-up period of 72 months, 33 patients were diagnosed with multiple sclerosis (MS), 6 patients with Balo, 6 patients with neuromyelitis optica spectrum disorders (NMOSD), 10 patients with myelin oligodendrocyte glycoprotein antibody-associated demyelination (MOGAD), 1 patient with acute disseminated encephalomyelitis (ADEM), and the remaining 60 patients still have no clear etiology. These individuals with an unknown etiology were categorized independently and placed to the other etiology group. In the other etiology group, 13 patients had recurrent demyelinating phases, while 47 patients did not suffer any more clinical events. Approximately 46.6% of TDLs had relapses which were associated with multiple functional system involvement, first-phase Expanded Disability Status Scale score, lesions morphology, number of lesions, and lesions location (P<0.05). And diffuse infiltrative lesions (P=0.003, HR=6.045, 95%CI:1.860-19.652), multiple lesions (P=0.001, HR=3.262, 95%CI:1.654-6.435) and infratentorial involvement (P=0.006, HR=2.289, 95%CI:1.064-3.853) may be independent risk factors for recurrence. Relapse free survival was assessed to be 36 months. Conclusions In clinical practice, around 46.6% of TDLs relapsed, with the MS group showing the highest recurrence rate, and lesions location, diffuse infiltrative lesions, and multiple lesions might be independent risk factors for relapse. Nevertheless, despite extensive diagnostic work and long-term follow-up, the etiology of TDLs in some patients was still unclear. And these patients tend to have monophase course and a low rate of relapse.
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Affiliation(s)
- Xinnan Li
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiuling Miao
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yaming Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Junzhao Sun
- Senior Department of Neurosurgery, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Haifeng Gao
- Department of Neurology, Tangshan Gongren Hospital, Tangshan, China
| | - Jing Han
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yuxin Li
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Qingjun Wang
- Department of Radiology, Sixth Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
| | - Chenjing Sun
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
| | - Jianguo Liu
- Senior Department of Neurology, The First Medical Center of People's Liberation Army (PLA) General Hospital, Beijing, China,*Correspondence: Jianguo Liu, ; Chenjing Sun, ; Qingjun Wang,
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Optical Coherence Tomography in Chronic Relapsing Inflammatory Optic Neuropathy, Neuromyelitis Optica and Multiple Sclerosis: A Comparative Study. Brain Sci 2022; 12:brainsci12091140. [PMID: 36138876 PMCID: PMC9497092 DOI: 10.3390/brainsci12091140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 08/19/2022] [Accepted: 08/23/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To examine the optical coherence tomography (OCT) features of the retina in patients with chronic relapsing inflammatory optic neuropathy (CRION) and compare them with those of neuromyelitis optica spectrum disorder (NMOSD), relapsing-remitting multiple sclerosis (RRMS) with and without optic neuritis (ON), and healthy controls (HC). Methods: In this retrospective cross-sectional study, we used spectral domain OCT to evaluate the retinal structure of 14 participants with CRION, 22 with NMOSD, 40 with RRMS with unilateral ON, and 20 HC. The peripapillary retinal nerve fiber layer (pRNFL), total macular volume (TMV), and papillomacular bundle (PMB) were measured, and intra-retinal segmentation was performed to obtain the retinal nerve fiber (RNFL), ganglion cell (GCL), inner plexiform (IPL), inner nuclear (INL), outer plexiform (OPL) and outer nuclear (ONL) layer volumes. Results: The global pRNFL [39.33(±1.8) µm] and all its quadrants are significantly thinner in CRION compared with all other groups (p < 0.05). CRION patients have decreased volumes of TMV, RNFL, GCL, and IPL compared with all other groups (p < 0.05). Conclusion: Severe thinning in pRNFL and thinning in intra-retinal segments of IPL, GCL, RNFL, and TMV could be helpful in differentiating CRION from NMOSD and RRMS.
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NMOSD—Diagnostic Dilemmas Leading towards Final Diagnosis. Brain Sci 2022; 12:brainsci12070885. [PMID: 35884693 PMCID: PMC9313254 DOI: 10.3390/brainsci12070885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/31/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: The emergence of white matter lesions in the central nervous system (CNS) can lead to diagnostic dilemmas. They are a common radiological symptom and their patterns may overlap CNS or systemic diseases and provoke underdiagnosis or misdiagnosis. The aim of the study was to assess factors influencing the underdiagnosis of neuromyelitis optica spectrum disorder (NMOSD) as well as to estimate NMOSD epidemiology in Lubelskie voivodeship, Poland. (2) Methods: This retrospective study included 1112 patients, who were made a tentative or an established diagnosis of acute or subacute onset of neurological deficits. The evaluation was based on medical history, neurological examination, laboratory and radiographic results and fulfilment of diagnosis criteria. (3) Results: Up to 1.62 percent of patients diagnosed with white matter lesions and up to 2.2% of the patients previously diagnosed with MS may suffer from NMOSD. The duration of delayed diagnosis is longer for males, despite the earlier age of onset. Seropositive cases for antibodies against aquaporin-4 have worse prognosis for degree of disability. (4) Conclusions: Underdiagnosis or misdiagnosis in NMOSD still remains a problem in clinical practice and has important implications for patients. The incorrect diagnosis is caused by atypical presentation or NMOSD-mimics; however, covariates such as gender, onset and diagnosis age may also have an influence.
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Ji Q, Dong H, Lee H, Liu Z, Tong Y, Elkin K, Haddad Y, Geng X, Ding Y. Clinical Characteristics and Outcomes of Multiple Sclerosis and Neuromyelitis Optica Spectrum Disorder With Brainstem Lesions as Heralding Prodrome. Front Neurol 2022; 13:836337. [PMID: 35614913 PMCID: PMC9124782 DOI: 10.3389/fneur.2022.836337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/28/2022] [Indexed: 12/14/2022] Open
Abstract
ObjectiveThe present study sought to differentiate multiple sclerosis and neuromyelitis optica spectrum disorder patients at their first attack by describing and distinguishing their clinical features, radiographic characteristics, and immunologic characteristics of serum and cerebrospinal fluid.MethodsWe retrospectively studied 58 patients with multiple sclerosis (MS) and 52 patients with neuromyelitis optica spectrum disorder (NMOSD) by referencing brainstem lesions as the prodromal events. Their demographics and presentation at the time of the first attack was evaluated including their gender, age, clinical features of the first attack, the expanded disability status scale (EDSS), brainstem lesion(s) by head MRI, and immunological indices of serum and cerebrospinal fluid.ResultsThe NMOSD group had more female patients (4.8 vs. 1.9, p < 0.05), and was older than the MS group (37.81 ± 16.60 vs. 27.57 ± 11.17, p <0.001). NMOSD patients also had a significantly higher association with autoimmune diseases or positive autoimmune antibodies (p < 0.01). There was no significant difference in the EDSS scores between the two groups (p = 0.420). Central hiccups, vomiting, and pyramidal tract signs were more common in the NMOSD group than the MS group (p < 0.001, p < 0.001, p < 0.01), while eye movement abnormalities were more common with MS (p < 0.01). There were no significant differences in other clinical manifestations such as vertigo, diplopia, limb weakness, numbness, and eating difficulty. MS patients were more likely to have midbrain and pons imaging lesions (p < 0.001, p < 0.001), while NMOSD patients had more lesions in the medulla oblongata (p < 0.001). The lesions in the MS group were mostly located in the periphery, while those in the NMOSD group were centrally located (p < 0.001, p < 0.001). Patchy lesions were more common in MS patients (p < 0.001), while large lesions were more common in the NMOSD group (p < 0.001). Finally, serum AQP4 Ab was found only in the NMOSD group (p < 0.001).ConclusionPatients with MS and NMOSD have differentiating clinical manifestations at the time of their first brainstem lesions which include central hiccups, vomiting, pyramidal tract signs, and abnormal eye movements. Additionally, distinct imaging manifestations such as lesion location(s) and morphology may also aid in the development of pathognomonic criteria leading to timely initial diagnosis of MS and NMOSD.
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Affiliation(s)
- Qiling Ji
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Huiqing Dong
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
- *Correspondence: Huiqing Dong
| | - Hangil Lee
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Zheng Liu
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yanna Tong
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Kenneth Elkin
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Yazeed Haddad
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital, Capital Medical University, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
- Xiaokun Geng
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, Detroit, MI, United States
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Pediatric Optic Neuritis: Description of Four Cases and Review of the Literature. CHILDREN-BASEL 2021; 8:children8100855. [PMID: 34682120 PMCID: PMC8534428 DOI: 10.3390/children8100855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/21/2021] [Accepted: 09/24/2021] [Indexed: 11/17/2022]
Abstract
Pediatric optic neuritis (PON) may be a clinically isolated and self-limiting event or may present in the context of underlying neurologic, infective, or systemic disease. PON has a high impact on the quality of life as it may or may not evolve into other acquired demyelinating syndromes (ADSs), such as multiple sclerosis (MS), neuromyelitis optica (NMO), or other syndromes related to the myelin oligodendrocyte glycoprotein IgG antibodies (MOG-IgG). These different PON phenotypes present variable clinical and radiological features, plasma and liquor biomarkers, and prognosis. We describe four pediatric cases presenting clinically with ON, with different etiopathogenetic pictures: one case had a probable infective etiology, while the others were associated with different demyelinating disorders (MS, NMO, syndrome related to MOG-IgG). We discuss the possible evolution of presenting ON in other ADSs, based on recent literature. A careful evaluation of the clinical and investigation findings and the natural course of PON is necessary to define its pathogenic pathway and evolution. Further prolonged follow-up studies are needed to highlight the predictors of PON evolution, its potential sequelae, and the best treatment options.
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Kolonaite G, Vilkeviciute A, Kriauciuniene L, Gedvilaite G, Liutkeviciene R. Association of RAGE rs1800624 and rs1800625 gene polymorphisms with predisposition to optic neuritis and optic neuritis together with multiple sclerosis. Ophthalmic Genet 2021; 42:685-690. [PMID: 34338585 DOI: 10.1080/13816810.2021.1952619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Optic neuritis (ON) is demyelinating acute inflammatory disease which affects the optic nerve. ON is classified as a typical (demyelinating) or an atypical (idiopathic). Patients often complain having a periocular pain or a visual loss. The main factor causing the optic neuritis is still unknown. It is believed that it might be a combination of genetic and environmental factors. As the optic neuritis is an inflammation disease, the RAGE gene was selected as it is a part of the inflammation process. AIM to determine the relation between RAGE rs1800624 and rs1800625 genotypes of patients who have a manifestation of optic neuritis and optic neuritis with multiple sclerosis together in Lithuanian population and visual acuity recovery. OBJECTIVES patients with optic neuritis and healthy controls individuals were examined. Genotyping was carried out by using the instrument of real-time polymerase chain reaction called StepOnePlus (AppliedBiosystems). Statistical analysis was performed using IBM SPSS Statistics 20.0 software and free PLINK software (version 1.07). RESULTS Results indicate that rs1800624 polymorphism is not statistically significant in optic neuritis manifestation (p = .392), while rs1800625 GG genotype is associated with 7.5-fold increased odds of ON development under the codominant model (OR = 7.5; 95% CI:1.796-31.313; p = .006) and with 6.9-fold increased odds under the recessive model OR = 6.862; 95% CI:1.665-28.288; p = .008); and each allele G is associated with 1.9-fold increased odds of ON development under the additive model (OR = 1.879; 95% CI:1.149-3.072; p = .012). The haplotype containing A-G alleles in rs1800624 and rs1800625 was statistically significantly associated with increased risk for ON development (χ2 = 13.23; p < .001). Both polymorphisms do not have statistically significant importance in relation to visual acuity recovery. CONCLUSIONS RAGE rs1800625 AA genotype decreases the risk of optic neuritis. The single nucleotide polymorphisms RAGE rs1800624 and rs1800625 do not have a statistically significant importance in relation with visual acuity recovery.
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Affiliation(s)
- Gabriele Kolonaite
- Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Alvita Vilkeviciute
- Medical Academy, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Loresa Kriauciuniene
- Medical Academy, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Greta Gedvilaite
- Medical Academy, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Rasa Liutkeviciene
- Medical Academy, Neuroscience Institute, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Abstract
OBJECTIVE. Tumefactive demyelination mimics primary brain neoplasms on imaging, often necessitating brain biopsy. This article reviews the literature for the clinical and radiologic findings of tumefactive demyelination in various disease processes to facilitate identification of tumefactive demyelination on imaging. CONCLUSION. Both clinical and radiologic findings must be integrated to distinguish tumefactive demyelinating lesions from similarly appearing lesions on imaging. Further research on the immunopathogenesis of tumefactive demyelination and associated conditions will elucidate their interrelationship.
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MOGAD: How It Differs From and Resembles Other Neuroinflammatory Disorders. AJR Am J Roentgenol 2021; 216:1031-1039. [DOI: 10.2214/ajr.20.24061] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Asseyer S, Cooper G, Paul F. Pain in NMOSD and MOGAD: A Systematic Literature Review of Pathophysiology, Symptoms, and Current Treatment Strategies. Front Neurol 2020; 11:778. [PMID: 33473247 PMCID: PMC7812141 DOI: 10.3389/fneur.2020.00778] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 06/24/2020] [Indexed: 12/18/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD) are autoimmune inflammatory disorders of the central nervous system (CNS). Pain is highly prevalent and debilitating in NMOSD and MOGAD with a severe impact on quality of life, and there is a critical need for further studies to successfully treat and manage pain in these rare disorders. In NMOSD, pain has a prevalence of over 80%, and pain syndromes include neuropathic, nociceptive, and mixed pain, which can emerge in acute relapse or become chronic during the disease course. The impact of pain in MOGAD has only recently received increased attention, with an estimated prevalence of over 70%. These patients typically experience not only severe headache, retrobulbar pain, and/or pain on eye movement in optic neuritis but also neuropathic and nociceptive pain. Given the high relevance of pain in MOGAD and NMOSD, this article provides a systematic review of the current literature pertaining to pain in both disorders, focusing on the etiology of their respective pain syndromes and their pathophysiological background. Acknowledging the challenge and complexity of diagnosing pain, we also provide a mechanism-based classification of NMOSD- and MOGAD-related pain syndromes and summarize current treatment strategies.
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Affiliation(s)
- Susanna Asseyer
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
| | - Graham Cooper
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Berlin, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- NeuroCure Clinical Research Center, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
- Einstein Center for Neurosciences, Berlin, Germany
- Department of Neurology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Humboldt—Universität zu Berlin, Berlin, Germany
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Pedapati R, Bhatia R, Singh N, Bali P, Gupta P, Saxena R, Dash D, Singh MB, Goyal V, Srivastava MVP. Anti-myelin oligodendrocyte glycoprotein antibody associated disease spectrum - A north Indian tertiary care centre experience and review of literature. J Neuroimmunol 2020; 340:577143. [PMID: 31931436 DOI: 10.1016/j.jneuroim.2019.577143] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION MOG antibody associated disease is a relatively new disorder for which the full clinical spectrum is being described and the literature is evolving. The current study outlines the observations on a cohort of patients diagnosed with this clinical entity. METHODS This is a retrospective review of prospectively followed up patients with MOG antibody positive neurological illness. Case records of patients following up in neuroimmunology clinic of All India Institute of Medical Sciences(AIIMS), New Delhi from January 2007 to July 2019 were reviewed for MOG antibody positivity and those patients with positive antibody result were included in this study. FINDINGS A total of 20 patients were tested positive for MOG-IgG antibody. 75% were females. Median (Range) age was 30.5 years (8-58). Median disease duration was 22 months (1-139). Most common symptom at presentation was decrease in vision (unilateral or bilateral) (80%). Most common syndrome at onset was unilateral optic neuritis (ON) (40%) followed by bilateral ON (35%), transverse myelitis (TM)(15%), ON plus TM (5%) and cerebral syndrome (5%). Median number of demyelinating episodes per person was 2.5. Out of 29 affected eyes, 26 had good outcome. Out of 7 patients with motor disability, 5 patients had good outcome. CONCLUSION MOG antibody associated disease presents predominantly as recurrent ON, but may also present as an opticospinal, cerebral or brainstem syndrome and recurrent myelitis. Many of the patients had relapses, but had good outcomes with treatment.
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Affiliation(s)
- Radhakrishna Pedapati
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Bhatia
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India.
| | - Nishita Singh
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Prerna Bali
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Pranjal Gupta
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Rohit Saxena
- Neuro-Opthalmology services, Dr Rajendra Prasad Centre for Opthalmic Sciences, All India Institute of Medical Sciences, New Delhi, India
| | - Deepa Dash
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Mamta Bhushan Singh
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
| | - M V Padma Srivastava
- Department of Neurology, Cardiothoracic and Neurosciences centre, All India Institute of Medical Sciences, New Delhi, India
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Overlapping demyelinating syndrome and anti- N-methyl-d-aspartate receptor encephalitis with seizures. Epilepsy Behav Rep 2019; 12:100338. [PMID: 31737864 PMCID: PMC6849071 DOI: 10.1016/j.ebr.2019.100338] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 12/31/2022] Open
Abstract
Anti-N-methyl-d-aspartate receptor (anti-NMDAR) encephalitis, the most recognized type of autoimmune encephalitis, manifests with rapid cognitive decline, psychosis, and seizures that develop in 78–86% of patients. Recently, anti-NMDAR encephalitis was reported in association with demyelinating diseases which are accompanied by a characteristic clinical phenotype, imaging abnormalities, and the presence of antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) in bodily fluids. The patient presented herein suffered from bilateral optic neuritis followed by recurrent encephalitis with focal seizures and demonstrated anti-NMDAR and MOG-IgGs in the cerebrospinal fluid and serum, respectively. Her symptoms responded to immunotherapy and antiseizure medication. The recognition of the novel syndrome of MOG antibody-associated demyelination (MOGAD), encompassing the overlapping anti-NMDAR encephalitis and other MOG-IgG associated disorders, is important for the successful management of these patients. Recurrent anti-N-methyl-d-aspirate (NMDA) receptor encephalitis with seizures may follow an acute demyelinating disease In overlap syndrome, anti-NMDA receptor antibodies and antibodies against myelin oligodendrocyte glycoprotein may be detected in the bodily fluids Recognition of the overlap syndrome is important to determine the optimal treatment and ensure the prevention of relapse
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13
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Sarbu N, Lolli V, Smirniotopoulos JG. Magnetic resonance imaging in myelopathy: a pictorial review. Clin Imaging 2019; 57:56-68. [DOI: 10.1016/j.clinimag.2019.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 04/30/2019] [Accepted: 05/13/2019] [Indexed: 11/26/2022]
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Wuerfel J, Rovira A, Paul F, Barkhof F. Neuromyelitis Optica Spectrum Disorders (NMOSD). Clin Neuroradiol 2019. [DOI: 10.1007/978-3-319-61423-6_71-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Viswanathan S, Rose N, Arip M, Chai CH, Law WC, Sim R, Ong MC. Multiple sclerosis and neuromyelitis optica spectrum disorders in Malaysia: A comparison in different ethnic groups. Mult Scler Relat Disord 2018; 25:300-308. [PMID: 30172173 DOI: 10.1016/j.msard.2018.07.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 05/30/2018] [Accepted: 07/01/2018] [Indexed: 02/08/2023]
Abstract
We performed a retrospective observational analytical study looking at the frequencies and characteristics of multiple sclerosis(MS) and neuromyelitis optica spectrum disorders(NMOSD) in consecutive patients with idiopathic inflammatory demyelinating disease (IIDDs) attending three centers (2009-2017). Of 523 patients with IIDDs, there were 173 patients with NMOSD and 230 patients with MS. The percentage of NMOSD: IIDDs was 33%. The percentage of NMOSD:Total MS and NMOSD cohort was 43%. Of 141 seropositive NMOSD patients, 134(95%) were from the three main ethnic groups. The percentage of seropositive NMOSD to IIDDs and to combined MS and NMOSD was 26.9% and 35% respectively. Ratios of MS to NMOSD were nearly equal at 1.3 to 1.0, reinforcing the high ratio of NMOSD to MS in Asia. Nearly half of the Chinese cohort were seropositive ie; 71/141 (50%) with the remainder being Malays; 56/141 (39.7%) and Indians; 7/141 (5%). Amongst the other indigenous groups seropositivity was seen in 2 each of Iban, Bajau, Kadazan descent as well as one of Bidayuh origin. Comparatively, seropositivity in NMOSD is commoner amongst the Chinese compared to the Malays (p ≤ 0.005) and Indians, p ≤ 0.05 with ratios as high as 10:1. In the MS group of 230 subjects, 123(53.5%) were Malays (ratio of MS:NMOSD of 2:1), 41(17.8%) were Chinese, (ratio of MS:NMOSD of 0.5:1.0) and 54 (23.5%)were Indians (ratios of MS:NMOSD of 5:1 amongst the Indians). The remainder from East Malaysia were made up of 2 each of Kadazans, Ibans and Bajaus including 3 each of Bidayuh and Eurasian descent. Comparatively, in the NMOSD and MS cohorts a female preponderance was noted more so amongst Chinese NMOSD patients, with rare familial occurrence in both but more in Malay MS/NMOSD patients. This study also highlighted some of the inter-ethnic differences in presentation of MS and NMOSD amongst the 3 main ethnic races in Malaysia and confirms indigenous races having MS/NMOSD which needs further research. It also reviewed current literature on similar inter-ethnic differences world wide. To conclude, MS and NMOSD are the commonest demyelinating diseases seen in Malaysia with interesting inter-ethnic differences and similarities.
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Affiliation(s)
- S Viswanathan
- Department of Neurology, Kuala Lumpur Hospital, Kuala Lumpur, Ministry of Health of Malaysia.
| | - N Rose
- Department of Radiology, Kuala Lumpur Hospital, Kuala Lumpur, Ministry of Health of Malaysia
| | - M Arip
- Department of Immunology, Medical Research Institute, Kuala Lumpur, Ministry of Health of Malaysia
| | - C H Chai
- Department of Neurology, Sarawak General Hospital, Kuching, Sarawak, Ministry of Health of Malaysia
| | - W C Law
- Department of Neurology, Sarawak General Hospital, Kuching, Sarawak, Ministry of Health of Malaysia
| | - R Sim
- Department of Neurology, Sarawak General Hospital, Kuching, Sarawak, Ministry of Health of Malaysia
| | - M C Ong
- Department of Medicine, Queen Elizabeth Hospital, Kota Kinabalu, Sabah, Ministry of Health of Malaysia
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Kallweit U, Bassetti CLA, Oberholzer M, Fronczek R, Béguin M, Strub M, Lammers GJ. Coexisting narcolepsy (with and without cataplexy) and multiple sclerosis : Six new cases and a literature review. J Neurol 2018; 265:2071-2078. [PMID: 29974206 DOI: 10.1007/s00415-018-8949-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There are increasing data suggesting the involvement of the immune system in narcolepsy. The co-occurrence of narcolepsy with other autoimmune disorders (including multiple sclerosis, MS) is rare. PATIENTS AND METHODS International multicenter sleep center survey and literature review on narcolepsy with (NC) and without (NwC) cataplexy. RESULTS A total of 26 patients (pts), 6 in the survey and 20 in the literature were found. Two different types of association were identified: (1) Symptomatic type (5 pts): MS preceding the onset of narcolepsy, which was always without cataplexy (NwC); sleep onset REM episodes (SOREM) and hypocretin deficiency were observed in some, and lesions in the hypothalamus in all patients. (2) Coexisting type (18 pts): MS preceding or following the appearance of NC with SOREM, hypocretin deficiency but no lesions in the hypothalamus. A positive effect of steroids, immunoglobulins or natalizumab on narcolepsy symptoms was observed in four patients. DISCUSSION Narcolepsy and MS are rarely associated. In addition to NwC secondary to hypothalamic demyelination, some patients present a coexistence of MS with NC without detectable hypothalamic lesions. The rarity of reports on this association probably reflects underrecognition. The elucidation of underlying genetic and immune mechanisms needs further studies.
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Affiliation(s)
- Ulf Kallweit
- Department of Neurology, University Hospital of Bern (Inselspital), Freiburgstrasse 18, 3010, Bern, Switzerland.,Institute for Immunology, University Witten/Herdecke, Witten, Germany
| | - Claudio L A Bassetti
- Department of Neurology, University Hospital of Bern (Inselspital), Freiburgstrasse 18, 3010, Bern, Switzerland.
| | - Michael Oberholzer
- Department of Neurology, University Hospital of Bern (Inselspital), Freiburgstrasse 18, 3010, Bern, Switzerland
| | - Rolf Fronczek
- Leiden Medical University Center and University of Leiden, Leiden, The Netherlands
| | - Mathieu Béguin
- Department of Neurology, University Hospital of Bern (Inselspital), Freiburgstrasse 18, 3010, Bern, Switzerland
| | | | - Gert Jan Lammers
- Leiden Medical University Center and University of Leiden, Leiden, The Netherlands.,Sleep-Wake Center SEIN, Heemstede, The Netherlands
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18
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