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Olivé-Cirera G, Bruijstens AL, Fonseca EG, Chen LW, Caballero E, Martinez-Hernandez E, Guasp M, Sepúlveda M, Naranjo L, Ruiz-García R, Blanco Y, Saiz A, Dalmau JO, Armangue T. MOG Antibodies Restricted to CSF in Children With Inflammatory CNS Disorders. Neurology 2024; 102:e209199. [PMID: 38447115 DOI: 10.1212/wnl.0000000000209199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/13/2023] [Indexed: 03/08/2024] Open
Abstract
OBJECTIVES To assess the clinical significance of myelin oligodendrocyte glycoprotein antibodies (MOG-abs) restricted to CSF in children with inflammatory CNS disorders. METHODS Patients included 760 children (younger than 18 years) from 3 multicenter prospective cohort studies: (A) acquired demyelinating syndromes, including acute disseminated encephalomyelitis (ADEM); (B) non-ADEM encephalitis; and (C) noninflammatory neurologic disorders. For all cases, paired serum/CSF samples were systematically examined using brain immunohistochemistry and live cell-based assays. RESULTS A total of 109 patients (14%) had MOG-abs in serum or CSF: 79 from cohort A, 30 from B, and none from C. Of these, 63 (58%) had antibodies in both samples, 37 (34%) only in serum, and 9 (8%) only in CSF. Children with MOG-abs only in CSF were older than those with MOG-abs only in serum or in both samples (median 12 vs 6 vs 5 years, p = 0.0002) and were more likely to have CSF oligoclonal bands (86% vs 12% vs 7%, p = 0.0001) and be diagnosed with multiple sclerosis (6/9 [67%] vs 0/37 [0%] vs 1/63 [2%], p < 0.0001). DISCUSSION Detection of MOG-abs in serum or CSF is associated with CNS inflammatory disorders. Children with MOG-abs restricted to CSF are more likely to have CSF oligoclonal bands and multiple sclerosis than those with MOG-abs detectable in serum.
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Affiliation(s)
- Gemma Olivé-Cirera
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Arlette L Bruijstens
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Elianet G Fonseca
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Li-Wen Chen
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Eva Caballero
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Eugenia Martinez-Hernandez
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Mar Guasp
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Maria Sepúlveda
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Laura Naranjo
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Raquel Ruiz-García
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Yolanda Blanco
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Albert Saiz
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Josep O Dalmau
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
| | - Thaís Armangue
- From the Neuroimmunology Program (G.O.-C., A.L.B., E.G.F., L.-W.C., E.C., E.M.-H., M.G., M.P., R.R.G., Y.B., A.S., J.O.D., T.A.), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona; Pediatric Neurology Department (G.O.-C.), Hospital Parc Taulí de Sabadell, Spain; Department of Neurology (A.L.B.), Erasmus Medical Center, Rotterdam, the Netherlands; Department of Pediatrics (L.-W.C.), National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Neurology Department (E.M.-H., M.G., M.P., Y.B., A.S., J.O.D.), Institute of Neuroscience, Hospital Clínic, University of Barcelona; Centro de Investigación Biomédica en Red (E.M.-H., M.G., M.P., Y.B., J.O.D.), Enfermedades Raras (CIBERER); Department of Immunology (L.N., R.R.G.), Centre Diagnòstic Biomèdic, Hospital Clínic, Barcelona, Spain; Department of Neurology (J.O.D.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; Catalan Institute for Research and Advanced Studies (ICREA) (J.O.D.); and Pediatric Neuroimmunology Unit (T.A.), Neurology Department, Sant Joan de Déu Children's Hospital, ERN-RITA accredited center, University of Barcelona, Spain
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Sıvacı AÖ, Seferoğlu M, Piri Çınar B, Uzunköprü C, Beckmann Y, Güngör Doğan İ, Çetinkaya Tezer D, Tunç A, Ethemoğlu Ö, Gümüş H, Açıkgöz M, Yalaz Tekan Ü, Demir S. Clinical and demographic characteristics of late-onset multiple sclerosis: LOMS-TR study. Mult Scler Relat Disord 2024; 84:105469. [PMID: 38341979 DOI: 10.1016/j.msard.2024.105469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/06/2024] [Accepted: 01/22/2024] [Indexed: 02/13/2024]
Abstract
OBJECTIVES Multiple sclerosis (MS), which is known as a young-adult age disease, is called late-onset MS (LOMS) when it occurs at the age of 50 and older. In our study, we aimed to analyse the clinical and demographic characteristics, comorbidities, diagnostic and treatment challenges and prognosis of LOMS. METHODS In a retrospective analysis of 136 patients diagnosed with multiple sclerosis (MS) after the age of 50, based on the 2017 McDonald criteria, and who were under observation in eight distinct MS centers across Turkey; demographic information, clinical characteristics of the disease, oligoclonal band (OCB) status, initial and current Expanded Disability Status Scale (EDSS) values, administered treatments, and the existence of spinal lesions on magnetic resonance imaging (MRI) were investigated. RESULTS The mean age of the 136 patients was 60.96±6.42 years (51-79), the mean age at diagnosis was 54.94±4.30 years, and 89 (65.4 %) of the patients were female. Most of the cases, 61.1 % (83) had at least one comorbidity. In 97 patients who underwent lumbar puncture (LP), OCB positivity was observed in 63.6 %. In 114 patients (83.8 %), spinal lesions were detected on MRI. Eighty-seven patients had relapsing-remitting MS (RRMS) (64 %), 27 patients had secondary progressive MS (SPMS) (19.9 %), and 22 patients had primary progressive MS (PPMS) (16.2 %). The mean EDSS at the time of diagnosis was 2.44±1.46, and the mean current EDSS was 3.15±2.14. CONCLUSIONS In LOMS patients, the rates of delay in the diagnostic process, treatment disruption and progressive disease are higher than in the general MS population. The high rates of LP applying and OCB positivity of this study may indicate the habit of looking for clear evidences in advanged age in our country. This situation and comorbidities may cause a delay in diagnosis and eliminates the window of opportunity for early diagnosis. Although the high number of spinal lesions is a known marker for progressive disease, it is an issue that needs to be discussed whether the increased frequency of progressive course at older ages is due to the nature of the disease or immune aging itself.
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Affiliation(s)
- Ali Özhan Sıvacı
- Department of Neurology, University of Health Sciences, Bursa High Specialization Training and Research Hospital, Bursa, Turkey.
| | - Meral Seferoğlu
- Department of Neurology, University of Health Sciences, Bursa High Specialization Training and Research Hospital, Bursa, Turkey
| | - Bilge Piri Çınar
- Department of Neurology, School of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Cihat Uzunköprü
- Department of Neurology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - Yeşim Beckmann
- Department of Neurology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - İpek Güngör Doğan
- Department of Neurology, University of Health Sciences, Sancaktepe Prof.Dr. İlhan Varank Training And Research Hospital, İstanbul, Turkey
| | - Damla Çetinkaya Tezer
- Department of Neurology, University of Health Sciences, Sancaktepe Prof.Dr. İlhan Varank Training And Research Hospital, İstanbul, Turkey
| | - Abdulkadir Tunç
- Department of Neurology, Faculty of Medicine, Sakarya University, Sakarya, Turkey
| | - Özlem Ethemoğlu
- Department of Neurology, School of Medicine, Harran University, Şanliurfa, Turkey
| | - Haluk Gümüş
- Department of Neurology, Selçuk University School of Medicine, Konya, Turkey
| | - Mustafa Açıkgöz
- Department of Neurology, School of Medicine, Zonguldak Bülent Ecevit University, Zonguldak, Turkey
| | - Ülgen Yalaz Tekan
- Department of Neurology, Şişli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Serkan Demir
- Department of Neurology, University of Health Sciences, Sancaktepe Prof.Dr. İlhan Varank Training And Research Hospital, İstanbul, Turkey
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Direk MÇ, Besen Ş, Öncel İ, Günbey C, Özdoğan O, Orgun LT, Sahin S, Cansu A, Yıldız N, Kanmaz S, Yılmaz S, Tekgül H, Türkdoğan D, Ünver O, Thomas GÖ, Başıbüyük S, Yılmaz D, Kurt AN, Gültutan P, Özsoy Ö, Yiş U, Kurul SH, Güngör S, Özgör B, Karadağ M, Dündar NO, Gençpınar P, Bildik O, Orak SA, Kabur ÇÇ, Kara B, Karaca Ö, Canpolat M, Gümüş H, Per H, Yılmaz Ü, Karaoğlu P, Ersoy Ö, Tosun A, Öztürk SB, Yüksel D, Atasoy E, Gücüyener K, Yıldırım M, Bektaş Ö, Çavuşoğlu D, Yarar Ç, Güngör O, Mert GG, Sarıgeçili E, Edizer S, Çetin İD, Aydın S, Diler B, Özdemir AA, Erol İ, Okuyaz Ç, Anlar B. Optic neuritis in Turkish children and adolescents: A multicenter retrospective study. Mult Scler Relat Disord 2024; 81:105149. [PMID: 38096730 DOI: 10.1016/j.msard.2023.105149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND Various etiologies may underlie optic neuritis, including autoantibody-mediated disorders described in the last decade. We re-examined demographic, clinical, laboratory features and prognostic factors in pediatric patients with autoimmune optic neuritis according to current knowledge. METHODS Cases of pediatric ON from 27 centers in Türkiye diagnosed between 2009 and 2022 were included for retrospective evaluation. RESULTS The study included 279 patients, 174 females and 105 males, with a female-to-male ratio of 1.65. The average age at onset was 12.8 ± 3.4 years, and mean follow-up, 2.1 years (range: 1-12.1 years). Patients <10 years old were grouped as "prepubertal" and those ≥10 years old as "others". The diagnoses made at the end of follow-up were multiple sclerosis associated optic neuritis (n = 90, 32.3 %), single isolated optic neuritis (n = 86, 31 %), clinically isolated syndrome (n = 41, 14.7 %), myelin oligodendrocyte glycoprotein antibody associated optic neuritis (n = 22, 7.9 %), and relapsing isolated optic neuritis (n = 18, 6.5 %). Predominant diagnoses were myelin oligodendrocyte glycoprotein antibody associated optic neuritis and acute disseminated encephalomyelitis associated optic neuritis in the prepubertal group and multiple sclerosis associated optic neuritis in the older group. Recurrences were observed in 67 (24 %) patients, including 28 with multiple sclerosis associated optic neuritis, 18 with relapsing isolated optic neuritis, 11 with myelin oligodendrocyte glycoprotein antibody associated optic neuritis, 8 with aquaporin-4 antibody related optic neuritis, and 2 with chronic relapsing inflammatory optic neuropathy. Recurrences were more common among female patients. Findings supporting the diagnosis of multiple sclerosis included age of onset ≥ 10 years (OR=1.24, p = 0.027), the presence of cranial MRI lesions (OR=26.92, p<0.001), and oligoclonal bands (OR=9.7, p = 0.001). Treatment in the acute phase consisted of intravenous pulse methylprednisolone (n = 46, 16.5 %), pulse methylprednisolone with an oral taper (n = 212, 76 %), and combinations of pulse methylprednisolone, plasmapheresis, or intravenous immunoglobulin (n = 21, 7.5 %). Outcome at 12 months was satisfactory, with 247 out of 279 patients (88.5 %) demonstrating complete recovery. Thirty-two patients exhibited incomplete recovery and further combination treatments were applied. Specifically, patients with relapsing isolated optic neuritis and aquaporin-4 antibody related optic neuritis displayed a less favorable prognosis. CONCLUSION Our results suggest optic neuritis is frequently bilateral in prepubertal and unilateral in peri‑ or postpubertal patients. Age of onset 10 or older, presence of oligoclonal bands, and brain MRI findings reliably predict the development of multiple sclerosis. The risk of developing multiple sclerosis increases mostly during the second and third years of follow-up. Relapsing isolated optic neuritis remains a separate group where the pathogenesis and outcome remain unclear. Investigation of predisposing and diagnostic biomarkers and long follow-up could help to define this group.
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Affiliation(s)
- Meltem Çobanoğulları Direk
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye.
| | - Şeyda Besen
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - İbrahim Öncel
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Ceren Günbey
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Orhan Özdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
| | - Leman Tekin Orgun
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - Sevim Sahin
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Ali Cansu
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Nihal Yıldız
- Department of Pediatrics, Division of Pediatric Neurology, Karadeniz Technical University Faculty of Medicine, Trabzon, Türkiye
| | - Seda Kanmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Sanem Yılmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Hasan Tekgül
- Department of Pediatrics, Division of Pediatric Neurology, Ege University Faculty of Medicine, İzmir, Türkiye
| | - Dilşad Türkdoğan
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Olcay Ünver
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Gülten Öztürk Thomas
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Salih Başıbüyük
- Department of Pediatrics, Division of Pediatric Neurology, Marmara University Pendik Training and Research Hospital, İstanbul, Türkiye
| | - Deniz Yılmaz
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Ayşegül Neşe Kurt
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Pembe Gültutan
- Department of Pediatrics, Division of Pediatric Neurology, Ankara City Hospital, Ankara, Türkiye
| | - Özlem Özsoy
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Uluç Yiş
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Semra Hız Kurul
- Department of Pediatrics, Division of Pediatric Neurology, Dokuz Eylül University Faculty of Medicine, İzmir, Türkiye
| | - Serdal Güngör
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Bilge Özgör
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Meral Karadağ
- Department of Pediatrics, Division of Pediatric Neurology, İnönü University Faculty of Medicine, Malatya, Türkiye
| | - Nihal Olgaç Dündar
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Pınar Gençpınar
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Olgay Bildik
- Department of Pediatrics, Division of Pediatric Neurology, Katip Celebi University Faculty of Medicine, İzmir, Türkiye
| | - Sibğatullah Ali Orak
- Department of Pediatrics, Division of Pediatric Neurology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Çişil Çerçi Kabur
- Department of Pediatrics, Division of Pediatric Neurology, Celal Bayar University Faculty of Medicine, Manisa, Türkiye
| | - Bülent Kara
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Ömer Karaca
- Department of Pediatrics, Division of Pediatric Neurology, Kocaeli University Faculty of Medicine, Kocaeli, Türkiye
| | - Mehmet Canpolat
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Hakan Gümüş
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Hüseyin Per
- Department of Pediatrics, Division of Pediatric Neurology, Erciyes University Faculty of Medicine, Kayseri, Türkiye
| | - Ünsal Yılmaz
- İzmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences Türkiye, İzmir, Türkiye
| | - Pakize Karaoğlu
- İzmir Faculty of Medicine, Dr. Behçet Uz Children's Education and Research Hospital, Department of Pediatrics, Division of Pediatric Neurology, University of Health Sciences Türkiye, İzmir, Türkiye
| | - Özlem Ersoy
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye
| | - Ayşe Tosun
- Department of Pediatrics, Division of Pediatric Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Semra Büyükkorkmaz Öztürk
- Department of Pediatrics, Division of Pediatric Neurology, Adnan Menderes University Faculty of Medicine, Aydın, Türkiye
| | - Deniz Yüksel
- Dr Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Ergin Atasoy
- Dr Sami Ulus Maternity and Children's Education and Research Hospital, University of Health Sciences, Ankara, Türkiye
| | - Kıvılcım Gücüyener
- Department of Pediatrics, Division of Pediatric Neurology, Gazi University Faculty of Medicine, Ankara, Türkiye
| | - Miraç Yıldırım
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Ömer Bektaş
- Department of Pediatrics, Division of Pediatric Neurology, Ankara University Faculty of Medicine, Ankara, Türkiye
| | - Dilek Çavuşoğlu
- Department of Pediatrics, Division of Pediatric Neurology, Afyonkarahisar Health Sciences University, Afyon, Türkiye
| | - Çoşkun Yarar
- Department of Pediatrics, Division of Pediatric Neurology, Osmangazi University Faculty of Medicine, Eskişehir, Türkiye
| | - Olcay Güngör
- Department of Pediatrics, Division of Pediatric Neurology, Pamukkale University Faculty of Medicine, Denizli, Türkiye
| | - Gülen Gül Mert
- Department of Pediatrics, Division of Pediatric Neurology, Cukurova University Faculty of Medicine, Adana, Türkiye
| | - Esra Sarıgeçili
- Department of Pediatrics, Division of Pediatric Neurology, Adana City Training and Research Hospital, Adana, Türkiye
| | - Selvinaz Edizer
- Department of Pediatrics, Division of Pediatric Neurology, Istanbul Bezm-i Alem Vakıf University Hospital, İstanbul, Türkiye
| | - İpek Dokurel Çetin
- Department of Pediatrics, Division of Pediatric Neurology, Balıkesir Ataturk City Hospital, Balıkesir, Türkiye
| | - Seren Aydın
- Department of Pediatrics, Division of Pediatric Neurology, Samsun Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
| | - Betül Diler
- Giresun Maternity and Children's Education and Research Hospital, Pediatric Neurology, Giresun, Türkiye
| | - Asena Ayça Özdemir
- Department of Medical Education, Mersin University Faculty of Medicine, Mersin, Türkiye
| | - İlknur Erol
- Department of Pediatrics, Division of Pediatric Neurology, Başkent University Faculty of Medicine, Adana, Türkiye
| | - Çetin Okuyaz
- Department of Pediatrics, Division of Pediatric Neurology, Mersin University Faculty of Medicine, Faculty Of Medicine, 34, Cadde, Çiftlikköy Kampüsü, Mersin 33343, Türkiye
| | - Banu Anlar
- Department of Pediatrics, Division of Pediatric Neurology, Hacettepe University Faculty of Medicine, Ankara, Türkiye
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Zondra Revendova K, Svub K, Bunganic R, Pelisek O, Volny O, Ganesh A, Bar M, Zeman D, Kusnierova P. A comparison of measles-rubella-zoster reaction, oligoclonal IgG bands, oligoclonal kappa free light chains and kappa index in multiple sclerosis. Mult Scler Relat Disord 2024; 81:105125. [PMID: 37980789 DOI: 10.1016/j.msard.2023.105125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the diagnostic performance of the measles-rubella-zoster reaction (MRZR) in a large real-world multiple sclerosis (MS) cohort. Second, to compare MRZR with the determination of oligoclonal IgG bands (OCB), oligoclonal kappa free light chain bands (oKFLC), and the KFLC index. METHODS A single-center retrospective study was conducted at the University Hospital Ostrava (Czech Republic). Patients were eligible if aged ≥18 years with a determined clinical diagnosis. IgG antibodies against measles (M), rubella (R), and varicella zoster (Z) viruses were determined in paired CSF and serum using ELISA and MRZR indicated as positive if at least two components had an antibody index >1.4. OCB and oKFLC were detected by means of isoelectric focusing, and KFLC CSF and serum concentrations for calculation of the KFLC index were determined immunochemically. RESULTS A total of 1,751 patients were included in the analyzed data set, which comprised 379 MS patients and 1,372 non-MS controls. The frequency of positive MRZR was higher in MS than in non-MS cases (MS 32.2 % vs non-MS 2.8 %; p < 0.001). This corresponded to a specificity of 97.2 % (95 % CI 96.1-98.0) and sensitivity of 32.2 % (95 % CI 27.5-37.2) and overall accuracy of 83.1 % (95 % CI 81.3-84.8). In comparison, the highest sensitivity of 95.6% (95 % CI 93.0-97.5) was for OCB with specificity of 86.9 % (95 % CI 84.9-88.7), followed by oKFLC with sensitivity and specificity of 94.7 % (95 % CI 91.5-96.9) and 78.4% (95 % CI 75.7-80.8), respectively, and the KFLC index with sensitivity of 92.5 % (95 % CI 86.6-96.3) and specificity of 93.5 % (95 % CI 90.5-95.9). DISCUSSION MRZR remains a very specific test for the diagnosis of MS but has low sensitivity, which disallows its independent use. In contrast, OCB showed the highest sensitivity and thus remains the gold standard for the diagnosis of MS.
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Affiliation(s)
- Kamila Zondra Revendova
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic.
| | - Krystof Svub
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Radovan Bunganic
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - Ondrej Pelisek
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ondrej Volny
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic; Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Aravind Ganesh
- Departments of Clinical Neurosciences and Community Health Sciences, the Hotchkiss Brain Institute and the O'Brien Institute for Public Health, University of Calgary Cumming School of Medicine, Calgary, Canada
| | - Michal Bar
- Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic; Department of Clinical Neurosciences, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
| | - David Zeman
- Institute of Laboratory Medicine, University Hospital Brno, Brno, Czech Republic
| | - Pavlina Kusnierova
- Institute of Laboratory Medicine, University Hospital Ostrava, Ostrava, Czech Republic; Institute of Laboratory Medicine, Faculty of Medicine, University of Ostrava, Ostrava, Czech Republic
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5
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Gaetani L, Bellomo G, Di Sabatino E, Sperandei S, Mancini A, Blennow K, Zetterberg H, Parnetti L, Di Filippo M. The Immune Signature of CSF in Multiple Sclerosis with and without Oligoclonal Bands: A Machine Learning Approach to Proximity Extension Assay Analysis. Int J Mol Sci 2023; 25:139. [PMID: 38203309 PMCID: PMC10778830 DOI: 10.3390/ijms25010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/04/2023] [Accepted: 12/08/2023] [Indexed: 01/12/2024] Open
Abstract
Early diagnosis of multiple sclerosis (MS) relies on clinical evaluation, magnetic resonance imaging (MRI), and cerebrospinal fluid (CSF) analysis. Reliable biomarkers are needed to differentiate MS from other neurological conditions and to define the underlying pathogenesis. This study aimed to comprehensively profile immune activation biomarkers in the CSF of individuals with MS and explore distinct signatures between MS with and without oligoclonal bands (OCB). A total of 118 subjects, including relapsing-remitting MS with OCB (MS OCB+) (n = 58), without OCB (MS OCB-) (n = 24), and controls with other neurological diseases (OND) (n = 36), were included. CSF samples were analyzed by means of proximity extension assay (PEA) for quantifying 92 immune-related proteins. Neurofilament light chain (NfL), a marker of axonal damage, was also measured. Machine learning techniques were employed to identify biomarker panels differentiating MS with and without OCB from controls. Analyses were performed by splitting the cohort into a training and a validation set. CSF CD5 and IL-12B exhibited the highest discriminatory power in differentiating MS from controls. CSF MIP-1-alpha, CD5, CXCL10, CCL23 and CXCL9 were positively correlated with NfL. Multivariate models were developed to distinguish MS OCB+ and MS OCB- from controls. The model for MS OCB+ included IL-12B, CD5, CX3CL1, FGF-19, CST5, MCP-1 (91% sensitivity and 94% specificity in the training set, 81% sensitivity, and 94% specificity in the validation set). The model for MS OCB- included CX3CL1, CD5, NfL, CCL4 and OPG (87% sensitivity and 80% specificity in the training set, 56% sensitivity and 48% specificity in the validation set). Comprehensive immune profiling of CSF biomarkers in MS revealed distinct pathophysiological signatures associated with OCB status. The identified biomarker panels, enriched in T cell activation markers and immune mediators, hold promise for improved diagnostic accuracy and insights into MS pathogenesis.
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Affiliation(s)
- Lorenzo Gaetani
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
| | - Giovanni Bellomo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
| | - Elena Di Sabatino
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
| | - Silvia Sperandei
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
| | - Andrea Mancini
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
| | - Kaj Blennow
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, 431 41 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 41 Mölndal, Sweden
| | - Henrik Zetterberg
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, The Sahlgrenska Academy at the University of Gothenburg, 431 41 Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, 431 41 Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, Queen Square, London WC1N 3BG, UK
- UK Dementia Research Institute at UCL, London WC1E 6BT, UK
- Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong 518172, China
- Wisconsin Alzheimer’s Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI 53792, USA
| | - Lucilla Parnetti
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
| | - Massimiliano Di Filippo
- Section of Neurology, Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy; (L.G.)
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Georganta I, Chasapi D, Smith CJ, Kopsidas K, Tatham A. Systematic review exploring the clinical features of optic neuritis after SARS-CoV infection and vaccination. BMJ Open Ophthalmol 2023; 8:e001336. [PMID: 38057105 PMCID: PMC10711871 DOI: 10.1136/bmjophth-2023-001336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/02/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND This study aims to characterise the symptoms and clinical features of optic neuritis (ON) following SARS-CoV-2 infection and vaccination. METHOD A literature search was conducted in four databases (PubMed, Medline, Embase and Google Scholar) to identify relevant case reports and case series. The records were screened and articles adhering to the inclusion criteria were critically appraised. RESULTS Sixty-eight studies were found to be eligible for inclusion, including 34 reporting ON following SARS-CoV-2 infection and an equal number reporting cases postvaccination. In total 93 patients and 125 eyes were included. The infection cohort included 42 patients and 56 eyes, 51.2% were female and 33.3% experienced bilateral ON. The mean visual acuity was 1.64 log of minimum angle of resolution (LogMAR), while pain was present in 77.8%. Oligoclonal bands were present in 3 patients, myelin oligodendrocyte glycoprotein (MOG) antibodies in 18 patients and AQP-4 antibodies in 4 patients. The vaccination cohort included 51 patients and 69 eyes. 60.8% were female and 35.3% had a bilateral ON. The mean visual acuity was 0.93 LogMAR. Oligoclonal bands were present in 46.7%, MOG antibodies in nine patients and AQP-4 antibodies in three patients. CONCLUSION Patients with ON post-SARS-CoV infection were more likely to experience severe visual impairment than in cases following vaccination. Further research is required to outline the clinical features of ON after COVID-19 infection and vaccination, and establish causality.
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Affiliation(s)
| | | | | | | | - Andrew Tatham
- Department of Ophthalmology, Princess Alexandra Eye Pavilion, Edinburgh, UK
- Center for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Toscano S, Chisari CG, Lo Fermo S, Gulino G, Zappia M, Patti F. A dynamic interpretation of κFLC index for the diagnosis of multiple sclerosis: a change of perspective. J Neurol 2023; 270:6010-6020. [PMID: 37639016 PMCID: PMC10632300 DOI: 10.1007/s00415-023-11952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/16/2023] [Accepted: 08/17/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Previous studies attempted to define the best threshold for κ free light chains (κFLC) index, confirming higher sensitivity (Se) but less specificity (Sp) compared with IgG oligoclonal bands (OCB) for the diagnosis of MS. OBJECTIVE To evaluate the diagnostic accuracy of different κFLC index intervals in a miscellaneous cohort of neurological patients, proposing a procedural flowchart for MS diagnosis. METHODS We analyzed data from 607 patients diagnosed with MS (179), CIS (116), other inflammatory (94) or non-inflammatory neurological diseases (218). Measures of diagnostic accuracy were reported for different potential thresholds of κFLC index, and for IgG OCB and IgG index. Binary logistic regression was to used to calculate the odds of being diagnosed with MS based on each increase of κFLC index. RESULTS CSF IgG OCB showed 72.2% Se (CI 95% 68.4-75.7) and 95.2% Sp (CI 95% 93.1-96.7) in discriminating between MS/CIS and controls, with an AUC of 0.84 (CI 95% 0.80-0.87). The highest diagnostic accuracy was reported for κFLC index cut-off of 5.0 (Se = 85.4%, Sp = 90.4%, AUC = 0.88), while a threshold of 11.0 exhibited higher Sp (95.5%, 95% CI 93.1-97.1) than IgG OCB. AUCs for all thresholds between 4.25 and 6.6 were not significantly different from each other, but were significantly higher than the AUC of IgG OCB (p < 0.05). The odds of being diagnosed with MS/CIS increased by 17.1% for each unit increase of κFLC index (OR = 1.17; 95% CI 1.12-1.23; p < 0.001). CONCLUSION κFLC index performed better than CSF IgG OCB in supporting the diagnosis of MS/CIS, with the advantage of being a cost-effective and quantitative analysis.
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Affiliation(s)
- Simona Toscano
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia 97, 95123, Catania, Italy
- Multiple Sclerosis Unit, University-Hospital G. Rodolico-San Marco, Via Santa Sofia 78, 95123, Catania, Italy
| | - Clara Grazia Chisari
- Multiple Sclerosis Unit, University-Hospital G. Rodolico-San Marco, Via Santa Sofia 78, 95123, Catania, Italy
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 87, 95123, Catania, Italy
| | - Salvatore Lo Fermo
- Multiple Sclerosis Unit, University-Hospital G. Rodolico-San Marco, Via Santa Sofia 78, 95123, Catania, Italy
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 87, 95123, Catania, Italy
| | - Giuseppa Gulino
- Central Laboratory, A.O.U. Policlinico-San Marco, Via Santa Sofia 78, 95123, Catania, Italy
| | - Mario Zappia
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 87, 95123, Catania, Italy
| | - Francesco Patti
- Multiple Sclerosis Unit, University-Hospital G. Rodolico-San Marco, Via Santa Sofia 78, 95123, Catania, Italy.
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 87, 95123, Catania, Italy.
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Ribes García S, Castillo-Villalba J, Gasque Rubio R, Carratalà Boscà S, Cubas-Nuñez L, Alcalá C, Pérez-Miralles FC, Bonaventura CE. Is it cost-effective to request IgM oligoclonal bands against lipids in daily practice as a biomarker for poor prognosis in multiple sclerosis? Mult Scler Relat Disord 2023; 79:105033. [PMID: 37832257 DOI: 10.1016/j.msard.2023.105033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND various prognostic factors of multiple sclerosis have been identified, including demographic, clinical, radiological, and laboratory factors. The aim was to analyze whether the presence of IgM oligoclonal bands against lipids is associated with disease progression. METHODS an individual-based, prospective, observational study was conducted at the Neurology Department of Hospital Universitari i Politècnic la Fe. Clinical, radiological, and laboratory variables were collected. Data analysis was divided into a descriptive phase and a subsequent analytical phase. RESULTS a total of 116 patients were included. 81.9% of them had IgM oligoclonal bands against lipids, with phosphatidylcholine being the predominant type. A higher proportion of patients with IgM oligoclonal bands against lipids required treatment with a disease-modifying drug, started treatment at an earlier stage, showed poorer results in functional tests, and exhibited a higher increase in lesion burden, although these differences were not statistically significant. CONCLUSIONS In our study, the presence of IgM oligoclonal bands against lipids was not found to be associated with other poor prognostic variables.
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Affiliation(s)
- Sara Ribes García
- Intensive Care Medicine, Lluís Alcanyís Hospital, Xàtiva, Valencia, Spain.
| | - Jessica Castillo-Villalba
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Raquel Gasque Rubio
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Sara Carratalà Boscà
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Laura Cubas-Nuñez
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Carmen Alcalá
- Neurology, La Ribera University Hospital, Alzira, Valencia, Spain
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López-Gómez J, Sacristán Enciso B, Caro Miró MA, Querol Pascual MR. Clinically isolated syndrome: Diagnosis and risk of developing clinically definite multiple sclerosis. Neurologia 2023; 38:663-670. [PMID: 37858891 DOI: 10.1016/j.nrleng.2021.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 01/01/2021] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION In most cases, multiple sclerosis (MS) initially presents as clinically isolated syndrome (CIS). Differentiating CIS from other acute or subacute neurological diseases and estimating the risk of progression to clinically definite MS is essential since presenting a second episode in a short time is associated with poorer long-term prognosis. DEVELOPMENT We conducted a literature review to evaluate the usefulness of different variables in improving diagnostic accuracy and predicting progression from CIS to MS, including magnetic resonance imaging (MRI) and such biofluid markers as oligoclonal IgG and IgM bands, lipid-specific oligoclonal IgM bands in the CSF, CSF kappa free light-chain (KFLC) index, neurofilament light chain (NfL) in the CSF and serum, and chitinase 3-like protein 1 (CHI3L1) in the CSF and serum. CONCLUSIONS Codetection of oligoclonal IgG bands and MRI lesions reduces diagnostic delays and suggests a high risk of CIS progression to MS. A KFLC index > 10.6 and CSF NfL concentrations > 1150 ng/L indicate that CIS is more likely to progress to MS within one year (40%-50%); 90% of patients with CIS and serum CHI3L1 levels > 33 ng/mL and 100% of those with lipid-specific oligoclonal IgM bands present MS within one year of CIS onset.
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Affiliation(s)
- J López-Gómez
- Unidad de Proteínas, Servicio de Análisis Clínicos, Hospital Universitario de Badajoz, Badajoz, Spain.
| | - B Sacristán Enciso
- Sección de Proteínas y Autoinmunidad, Servicio de Análisis Clínicos, Hospital de Mérida, Badajoz, Spain
| | - M A Caro Miró
- Servicio de Análisis Clínicos, Hospital Universitario de Badajoz, Badajoz, Spain
| | - M R Querol Pascual
- Servicio de Neurología, Hospital Universitario de Badajoz, Badajoz, Spain
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10
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Ganelin-Cohen E, Shelly S, Schiller Y, Vaknin-Dembinsky A, Shachor M, Rechtman A, Osherov M, Duvdevan N, Rozenberg A. Dual positivity for anti-MOG and oligoclonal bands: Unveiling unique clinical profiles and implications. Mult Scler Relat Disord 2023; 79:105034. [PMID: 37801958 DOI: 10.1016/j.msard.2023.105034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Distinguishing between MOG-associated disease (MOGAD) and multiple sclerosis (MS) presents a considerable challenge, as there are instances of overlapping clinical presentations. This complexity is further magnified in cases where patients concurrently exhibit both anti-myelin oligodendrocyte glycoprotein (anti-MOG) positivity and detectable oligoclonal bands (OCBs) This retrospective study investigates the clinical and imaging attributes of dual-positive patients, those with both anti-MOG positivity and OCBs, The study aims to show potential areas of overlap between multiple sclerosis (MS) and MOGAD. METHODS Utilizing data gathered from three medical centers, we evaluated a cohort of 45 patients, stratifying them into two groups: those exclusively positive for anti-MOG antibodies and those displaying dual positivity. Our analysis encompassed a wide range of clinical and imaging parameters. The statistical techniques employed comprised Fisher's Exact Test along with Benjamini-Hochberg correction to ensure robustness of the findings. RESULTS The study involved 45 patients with anti-MOG antibodies; 30 exhibited isolated anti-MOG positivity without OCBs, while 15 were dual-positive. The first group's average age was 10±7 years, compared to 28±17 years in the double-positive group (p = 0.001). CSF analysis showed no significant differences in pleocytosis, protein levels, or opening pressure between the groups. In the exclusive anti-MOG positivity cohort, 9 out of 15 patients received IVIG treatment; a larger subgroup with dual positivity chose anti-CD20 treatment. Notably, papilledema incidence was higher in the single-positive group (p = 0.014). Optic nerve enhancement (p = 0.0038) and nerve thickening (p = 0.0017) were markedly elevated in the single-positive population, with a trend towards pre-chiasmatic lesions (p = 0.06). Double-positive cases exhibited more polyfocal presentation (p = 0.013) and higher attacks per case (p = 0.002, HR=10.2, 95 % CI: 2.19 to 49.23). The double-positive group had more brain lesions (p = 0.0063) but no significant distinctions in other aspects. CONCLUSION The results emphasize the challenges inherent in differentiating between MS and a more MOGAD. While the data suggest two plausible scenarios-either falling within the spectrum of MS or representing an intensified MOGAD-we recognize the need for stronger evidence to definitively classify these instances. This study underscores the imperative for thorough investigations to ascertain whether these cases align with the MS spectrum or denote an inflammatory variant of MOGAD.
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Affiliation(s)
- Esther Ganelin-Cohen
- Neuroimmunological Clinic, Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petah Tikva 4920235, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shahar Shelly
- Department of Neurology, Rambam Health Care Campus, Haifa 3525408, Israel; Neuroimmunology Laboratory, Department of Neurology, Rambam Health Care Campus and Ruth and Bruce Rapaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3525408, Israel
| | - Yael Schiller
- Department of Neurology, Rambam Health Care Campus, Haifa 3525408, Israel
| | - Adi Vaknin-Dembinsky
- Unit for Neuro-Immunology, Multiple Sclerosis & Cell Therapy, Department of Neurology, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Maayan Shachor
- Department of Pediatric, C. Schneider Children's Medical Center of Israel, Petah Tikva, 4920235, Israel
| | - Ariel Rechtman
- Unit for Neuro-Immunology, Multiple Sclerosis & Cell Therapy, Department of Neurology, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Michael Osherov
- The Neuroimmunology and Multiple Sclerosis Unit, Neurology Institute, Barzilay Ashkelon Israel
| | - Nitsan Duvdevan
- The Neuro-ophthalmology unit Rambam Health Care Campus, Haifa, 3525408, Israel
| | - Ayal Rozenberg
- Department of Neurology, Rambam Health Care Campus, Haifa 3525408, Israel; Neuroimmunology Laboratory, Department of Neurology, Rambam Health Care Campus and Ruth and Bruce Rapaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3525408, Israel.
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11
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Tortosa-Carreres J, Quiroga-Varela A, Castillo-Villalba J, Piqueras-Rodríguez M, Ramió-Torrenta L, Cubas-Núñez L, Gasqué-Rubio R, Quintanilla-Bordas C, Huertas-Pons JM, Miguela A, Casanova B, Laiz-Marro B, Pérez-Miralles FC. Improving the efficiency of free kappa light chains as diagnostic biomarker of Multiple Sclerosis by using a novel algorithm. Mult Scler Relat Disord 2023; 79:104997. [PMID: 37714099 DOI: 10.1016/j.msard.2023.104997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/21/2023] [Accepted: 09/04/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND Intrathecal immunoglobulin synthesis (ITS) plays a crucial role in the diagnosis of multiple sclerosis (MS). Traditionally, the gold standard method for detecting ITS has been through the analysis of oligoclonal bands (OCB). However, the paradigm has shifted with the introduction of the free kappa light chains (FKLC) method. In fact, a recent consensus recommends evaluating FKLC index (FKLCi) as the primary approach and reserving oligoclonal bands with borderline results. The objective of our study is to investigate the diagnostic efficiency of combining FKLC with other methods to predict ITS while minimizing the reliance on OCB. METHODS A total of 192 patients were included in the study, consisting of 145 individuals diagnosed with multiple sclerosis (pwMS) and 46 with other neurological diseases (controls). Among the MS cases, 100 patients were assigned to the Training Cohort (TC), while an external Validation Cohort (VC) comprised of 45 MS patients was established. Diagnostic efficiency was assessed for FKLCi, OCB, Link index, and the Reiber formula for IgG and FKLC. Optimal cutoff values for Link index and FKLCi were also determined. The last procedure was developed for diverse algorithms using the parameters mentioned above, which included the optimal cutoffs previously obtained. The calculations were conducted independently for both the TC and the VC, as well as for a composite cohort formed by combining data from all patients (OC) RESULTS: One algorithm, named KRO, was developed based on the determination of FKLCi and Reiber Formula as the primary diagnostic parameters. For cases where the FKLCi result was mildly increased, OCB was utilized as a supplementary test. The KRO algorithm demonstrated superior diagnostic accuracy in the OC (89%), resulting in a reduction of OCB consumption by 91%. DISCUSSION The KRO algorithm demonstrated superior sensitivity and accuracy although lower specificity and NPV compared to the use of FKLCi and OCB alone. The present research aligns with the new consensus recommendations regarding the diagnostic approach. Our findings indicate that employing a combined marker approach via KRO could prove to be a proficient screening tool for multiple sclerosis. This approach also holds the potential to address inherent limitations associated with each individual marker. However, to further validate and solidify the efficacy of our algorithm, additional studies involving larger cohorts are warranted.
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Affiliation(s)
- Jordi Tortosa-Carreres
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Medicine Department, University of Valencia, Valencia 46010, Spain.
| | - Anna Quiroga-Varela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Jessica Castillo-Villalba
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España; Medicine Department, University of Valencia, Valencia 46010, Spain
| | - Mónica Piqueras-Rodríguez
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Medicine Department, University of Valencia, Valencia 46010, Spain
| | - Lluís Ramió-Torrenta
- Girona Neuroimmumology and Multiple Sclerosis Unit, Neurology Department, Dr. Josep Trueta University Hospital and Santa Caterina Hospital, Girona, Spain; Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain; Medical Sciences Department, University of Girona, Girona, Spain
| | - Laura Cubas-Núñez
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Raquel Gasqué-Rubio
- Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España; Medicine Department, University of Valencia, Valencia 46010, Spain
| | - Carlos Quintanilla-Bordas
- Neurology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Joana María Huertas-Pons
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Albert Miguela
- Neurodegeneration and Neuroinflammation Research Group, Girona Biomedical Research Institute (IDIBGI), Girona, Spain
| | - Bonaventura Casanova
- Neurology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
| | - Begoña Laiz-Marro
- Laboratory Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain
| | - Francisco Carlos Pérez-Miralles
- Neurology Department, La Fe University and Polytechnic Hospital, Valencia 46026, Spain; Grupo de investigación en Neuroinmunología, Instituto de Investigación Sanitaria La Fe (IISLAFE), Valencia, España
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12
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Forcadela M, Birch K, Rocchi C, Campagna G, Jackson E, Chadwick C, Hamid S, Jacob A, Huda S. Do we still need OCBs in MS diagnosis and how many? Mult Scler Relat Disord 2023; 79:105035. [PMID: 37864992 DOI: 10.1016/j.msard.2023.105035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/24/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND CSF-specific oligoclonal bands (CSF-OCBs) can be used for dissemination in time (DIT) in the 2017 multiple sclerosis (MS) diagnostic criteria. A cut-off of ≥2 CSF-OCBs was recommended but studies have suggested ≥3 CSF-OCBs may be superior. OBJECTIVES To assess utility of ≥2 and ≥3 CSF-OCBs as a cut-off for MS diagnosis. METHODS Paired serum and CSF-OCBs sent to the Walton Centre, UK between July 2018 and June 2020 were included. CSF-OCBs were assessed using isoelectric focussing and reviewed by two blinded raters. Case records were reviewed. RESULTS Of 1334 paired serum and CSF-OCB requests, 945 cases had sufficient clinical information. More than 1 CSF-OCB was detected in 268/945(28%) cases. Of these, 252 had ≥2 and 230 had ≥3 CSF-OCBs. The sensitivity and specificity for MS with ≥2 and ≥3 CSF-OCBs were 91.7%, 91.2%, 90.2% and 93.8% respectively. Only 3/22 patients with 2 CSF-OCBs had MS. In 25% of patients, CSF-OCBs reduced time to MS diagnosis (median 437.5 days (28-1332)). CONCLUSION Although cut-offs of ≥2 or ≥3 CSF-OCBs performed similarly well, 2 CSF-OCBs were frequently seen with non-inflammatory pathology. Use of ≥3 CSF-OCBs for MS diagnosis should be considered. CSF analysis reduced time to MS diagnosis by approximately 14 months.
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Affiliation(s)
| | - Katherine Birch
- The Neuroscience laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | | | | | - Edward Jackson
- The Neuroscience laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Carrie Chadwick
- The Neuroscience laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Shahd Hamid
- The Walton Centre Foundation Trust, Liverpool, UK
| | - Anu Jacob
- The Walton Centre Foundation Trust, Liverpool, UK; Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Saif Huda
- The Walton Centre Foundation Trust, Liverpool, UK
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13
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Monreal E, Fernández-Velasco JI, García-Soidán A, Sainz de la Maza S, Espiño M, Villarrubia N, Rodríguez-Jorge F, Chico-García JL, Sainz-Amo R, Masjuan J, Costa-Frossard L, Villar LM. Establishing the best combination of the kappa free light chain index and oligoclonal bands for an accurate diagnosis of multiple sclerosis. Front Immunol 2023; 14:1288169. [PMID: 37954589 PMCID: PMC10634415 DOI: 10.3389/fimmu.2023.1288169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/09/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction The immunoglobulin kappa free light chain (KFLC) index has been proposed as a potentially suitable alternative to oligoclonal IgG bands (OCGB) for diagnosing multiple sclerosis (MS), offering automation and reduced processing time. However, there is no consensus on the preferred approach or how to combine both techniques. Methods This prospective cohort study aimed to determine the best utilization of OCGB and KFLC index in patients with a clinically isolated syndrome (CIS) followed for at least two years. OCGB and KFLC were assessed using isoelectric focusing and immunoblotting and turbidimetry, respectively. Sensitivity, specificity, and accuracy for diagnosing MS were calculated for each method. Results The study included 371 patients, with 260 (70.1 %) being women, and a median age of 34.9 (27.8 - 43.9) years. Using a cut-off value of 6.1, the KFLC index demonstrated a sensitivity and specificity of 86.3% and 93.9%, respectively. The sensitivity of OCGB (95.3%) was higher (p < 0.001 vs. KFLC index) and the specificity (100%) was comparable to that of the KFLC index (p = 0.5). The concordance between the methods was not uniform across all patients, with 97.8% agreement in patients with KFLC index ≥ 6.1 and 56.0 % in patients with KFLC index < 6.1. In patients with a KFLC index < 6.1, OCGB still identified 75.0 % of MS patients due to its higher sensitivity. An algorithm using the KFLC index as a screening tool and OCGB as an alternative for patients with a negative KFLC index result achieved an accuracy of 96.3 %. Discussion Combining the KFLC index and OCGB can provide an easily reproducible and accurate method for diagnosing MS, with OCGB primarily reserved for patients with a KFLC index < 6.1.
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Affiliation(s)
- Enric Monreal
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - José Ignacio Fernández-Velasco
- Department of Immunology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Ana García-Soidán
- Department of Immunology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Susana Sainz de la Maza
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Mercedes Espiño
- Department of Immunology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Noelia Villarrubia
- Department of Immunology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Fernando Rodríguez-Jorge
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Juan Luís Chico-García
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Raquel Sainz-Amo
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Jaime Masjuan
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Lucienne Costa-Frossard
- Department of Neurology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Luisa María Villar
- Department of Immunology, Hospital Universitario Ramón y Cajal, Red Española de Esclerosis Múltiple (REEM), Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
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Shaw F, Chadwick C. The diagnostic utility of IgG index and oligoclonal bands for multiple sclerosis in a neurology hospital patient population. Ann Clin Biochem 2023; 60:353-355. [PMID: 37222597 DOI: 10.1177/00045632231179618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Multiple sclerosis (MS) is a chronic demyelinating disease of the central nervous system. Diagnosis is based on the 2017 revised McDonald criteria. Unmatched oligoclonal bands (OCB) within the CSF (i.e. positive OCB) can substitute for dissemination in time by magnetic resonance imaging (MRI). Simonsen et al. (2020) claimed a raised (>0.7) immunoglobulin G (IgG) index could replace OCB status. This study aimed to establish the diagnostic utility of IgG index for MS in the population served by The Walton Centre NHS Foundation Trust (WCFT) a neurology and neurosurgery hospital, and to derive a population-based IgG index reference interval. METHODS OCB results from the laboratory information system (LIS) were collated from November 2018 to 2021. Final diagnosis and medication history was obtained from the electronic patient record. Exclusions were made based on age (<18 years) at the time of lumbar puncture (LP) disease-modifying treatment prior to LP, unknown IgG index and unclear OCB patterns. RESULTS 935 of 1101 results remained following exclusions. 226 (24.2%) had a diagnosis of MS, 212 (93.8%) were OCB positive and 165 (73.0%) had a raised IgG index. The diagnostic specificity of a raised IgG index was calculated at 90.3% compared to 86.9% for positive OCB. 386 results with negative OCB were used to establish the IgG index reference interval (0.36-0.68) at 95th percentiles. CONCLUSION This study provides evidence that IgG index should not replace OCB in the diagnosis of MS. >0.7 is an appropriate cut-off to define a raised IgG index for the patient population.
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Affiliation(s)
- Francesca Shaw
- Department of Clinical Biochemistry, Manchester University NHS Foundation Trust, Manchester, UK
| | - Carrie Chadwick
- The Neuroscience Laboratories, The Walton Centre NHS Foundation Trust, Liverpool, UK
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Öncel S, Şule Dalkılıç Ş, Sayan S, Darol E, Zafer A, Kara D, Tunç A. Clinical significance and prognostic value of serum autoantibody tests in multiple sclerosis. Neurol Neurochir Pol 2023; 58:60-65. [PMID: 37466321 DOI: 10.5603/pjnns.a2023.0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/20/2023]
Abstract
INTRODUCTION It is known that multiple sclerosis (MS) often coexists with other autoimmune diseases. Hence, autoantibody (auto-Ab) tests may prove useful in the differential diagnosis of MS. The objectives of this study were to: (a) investigate the prevalence of auto-Ab positivity at the beginning of the MS diagnostic process; (b) assess whether Auto-Ab+ and Auto-Ab- patients differ in baseline clinical, laboratory, and radiological parameters; and (c) investigate the prognostic value during a two-year follow-up period. MATERIAL AND METHODS This retrospective study consisted of 450 patients aged between 18 and 55 years. All patients underwent a wide range of auto-Ab tests, anti-nuclear antibody (ANA) tests in particular. The expanded disability status scale (EDSS) scores of the patients were recorded at the time of diagnosis and at the end of a two-year follow-up period. RESULTS The mean age of the 212 patients, 148 (69.8%) female and 64 (30.2%) male, included in the study sample was 37 ± 10.83 years. The rate of relapsing cases was 84% (178). Oligoclonal band (OCB) was positive in 142 (86.6%) of the 164 tested cases. At least one of the auto-Ab tests was positive in 51 (24.1%) of the cases. ANA test was positive in 21 (9.9%) cases. There was no significant difference between patients with at least one positive auto-Ab test and without any positive auto-Ab test and between ANA-positive and ANA-negative patients in terms of age, gender, clinical features of MS, presence of brain stem lesion, presence of spinal lesion, OCB positivity, level of clinical improvement after the first pulse steroid treatment, family history, presence of comorbidity, presence of autoimmune disease, or EDSS scores recorded at the end of the two-year follow-up period (p > 0.05). CONCLUSIONS Our study findings revealed that Auto-Ab positivity was more common in MS patients than in the general population. However, given their limited contribution to the diagnosis and differential diagnosis of MS with no effect on the prognostic process, auto-Ab tests should be requested only in the event of accompanying autoimmune disease symptoms, and in cases where the diagnosis of MS may be suspected.
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Affiliation(s)
- Samet Öncel
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Şule Şule Dalkılıç
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Saadet Sayan
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Elif Darol
- Sakarya University Training and Research Hospital, Sakarya, Turkey
| | - Ayşe Zafer
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Derya Kara
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey
| | - Abdulkadir Tunç
- Department of Neurology, Sakarya University Faculty of Medicine, Sakarya, Turkey.
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Aleksandravičiūtė E, Stankevičiūtė R, Balnytė R, Šaknys L, Ulozienė I. Oligoclonal Band Status and Features of Radiological and Clinical Findings in Patients with Multiple Sclerosis in Lithuania. Medicina (Kaunas) 2023; 59:1028. [PMID: 37374232 PMCID: PMC10301297 DOI: 10.3390/medicina59061028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 05/23/2023] [Accepted: 05/24/2023] [Indexed: 06/29/2023]
Abstract
Background and Objectives: Multiple sclerosis (MS) is a widely spread and debilitating disease with 2.8 million people worldwide currently affected. However, the exact pathogenesis of the disease and its progression remains incompletely understood. According to the revised McDonald criteria, cerebrospinal fluid oligoclonal bands (CSF OCBs) magnetic resonance imaging (MRI) results, in conjunction with clinical presentation, remain the gold standard of MS diagnostics. Therefore, this study aims to evaluate the association between CSF OCB status and features of radiological and clinical findings in patients with multiple sclerosis in Lithuania. Materials and Methods: The selection of 200 MS patients was performed in order to find associations between CSF OCB status, MRI data and various disease features. The data were acquired from outpatient records and a retrospective analysis was performed. Results: OCB positive patients were diagnosed with MS earlier and had spinal cord lesions more frequently than OCB negative patients. Patients with lesions in the corpus callosum had a greater increase in the Expanded Disability Status Scale (EDSS) score between their first and last visit. Patients with brainstem lesions had higher EDSS scores during their first and last visit. Even so, the progression of the EDSS score was not greater. The time between the first symptoms and diagnosis was shorter for patients who had juxtacortical lesions than patients who did not. Conclusions: CSF OCBs and MRI data remain irreplaceable tools when diagnosing multiple sclerosis as well as prognosing the development of the disease and disability.
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Affiliation(s)
- Emilija Aleksandravičiūtė
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Radvilė Stankevičiūtė
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Renata Balnytė
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Laurynas Šaknys
- Department of Neurology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
| | - Ingrida Ulozienė
- Department of Otorhinolaringology, Lithuanian University of Health Sciences Medical Academy, A. Mickevičiaus g.9, LT-44307 Kaunas, Lithuania
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17
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Madlener M, Strippel C, Thaler FS, Doppler K, Wandinger KP, Lewerenz J, Ringelstein M, Roessling R, Menge T, Wickel J, Kellingshaus C, Mues S, Kraft A, Linsa A, Tauber SC, Berg FT, Gerner ST, Paliantonis A, Finke A, Priller J, Schirotzek I, Süße M, Sühs KW, Urbanek C, Senel M, Sommer C, Kuempfel T, Pruess H, Fink GR, Leypoldt F, Melzer N, Malter MP. Glutamic acid decarboxylase antibody-associated neurological syndromes: Clinical and antibody characteristics and therapy response. J Neurol Sci 2023; 445:120540. [PMID: 36608627 DOI: 10.1016/j.jns.2022.120540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 11/26/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Antibodies against glutamic acid decarboxylase (GAD-abs) at high serum levels are associated with diverse autoimmune neurological syndromes (AINS), including cerebellar ataxia, epilepsy, limbic encephalitis and stiff-person syndrome. The impact of low serum GAD-ab levels in patients with suspected AINS remains controversial. Specific intrathecal GAD-ab synthesis may serve as a marker for GAD-ab-associated nervous system autoimmunity. We present characteristics of a multicentric patient cohort with suspected AINS associated with GAD antibodies (SAINS-GAD+) and explore the relevance of serum GAD-ab levels and intrathecal GAD-ab synthesis. METHODS All patients with SAINS-GAD+ included in the registry of the German Network for Research on Autoimmune Encephalitis (GENERATE) from 2011 to 2019 were analyzed. High serum GAD-ab levels were defined as RIA>2000 U/mL, ELISA>1000 U/mL, or as a positive staining pattern on cell-based assays. RESULTS One-hundred-one patients were analyzed. In descending order they presented with epilepsy/limbic encephalitis (39%), cerebellar ataxia (28%), stiff person syndrome (22%), and overlap syndrome (12%). Immunotherapy was administered in 89% of cases with improvements in 46%. 35% of SAINS-GAD+ patients had low GAD-ab serum levels. Notably, unmatched oligoclonal bands in CSF but not in serum were more frequent in patients with low GAD-ab serum levels. GAD-ab-levels (high/low) and intrathecal GAD-ab synthesis (present or not) did not impact clinical characteristics and outcome. CONCLUSIONS Overall, immunotherapy in SAINS-GAD+ was moderately effective. Serum GAD-ab levels and the absence or presence of intrathecal GAD-ab synthesis did not predict clinical characteristics or outcomes in SAINS-GAD+. The detection of unmatched oligoclonal bands might outweigh low GAD-ab serum levels.
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Affiliation(s)
- Marie Madlener
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, Cologne 50937, Germany.
| | - Christine Strippel
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany
| | - Franziska S Thaler
- Institute of Clinical Neuroimmunology, University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Marchioninistrasse 15, Munich 81377, Germany
| | - Kathrin Doppler
- Department of Neurology, University of Wuerzburg, Josef-Schneider-Straße 2, Würzburg 97080, Germany
| | - Klaus P Wandinger
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, Luebeck 23538, Germany
| | - Jan Lewerenz
- Department of Neurology, Ulm University, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Marius Ringelstein
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, Duesseldorf 40225, Germany; Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Duesseldorf, Bergische Landstraße 2, Duesseldorf 40629, Germany
| | - Rosa Roessling
- Department of Neurology and Experimental Neurology, Charité-Universitaetsmedizin Berlin, German Center for Neurodegenerative Diseases (DZNE) Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Til Menge
- Department of Neurology, Center for Neurology and Neuropsychiatry, LVR-Klinikum, Heinrich-Heine-University Duesseldorf, Bergische Landstraße 2, Duesseldorf 40629, Germany
| | - Jonathan Wickel
- Section Translational Neuroimmunology, Department of Neurology, University Hospital Jena, Am Klinikum1, Jena 07747, Germany
| | - Christoph Kellingshaus
- Department of Neurology, Klinikum Osnabrueck, Am Finkenhügel 1, Osnabrueck 49076, Germany
| | - Sigrid Mues
- Department of Neurology, University Hospital, Technische Universitaet Dresden, Fetscherstraße 74, Dresden 01307, Germany
| | - Andrea Kraft
- Department of Neurology, Martha-Maria Hospital Halle, Röntgenstraße 1, Halle (Saale) 06120, Germany
| | - Andreas Linsa
- Department of Neurology, Carl-Thiem Klinikum Cottbus, Thiemstraße 111, Cottbus 03048, Germany
| | - Simone C Tauber
- Department of Neurology, RWTH Aachen University, Templergraben 55, Aachen 52062, Germany
| | - Florian Then Berg
- Department of Neurology, University of Leipzig, Liebigstraße 20, Leipzig 04103, Germany
| | - Stefan T Gerner
- Department of Neurology, University Hospital Erlangen, Maximiliansplatz 2, Erlangen 91054, Germany
| | - Asterios Paliantonis
- Department of Neurology, Alfried Krupp Krankenhaus Essen, Alfried-Krupp-Straße 21, Essen 45131, Germany
| | - Alexander Finke
- Department of Neurology, Hospital Lueneburg, Bögelstraße 1, Lueneburg 21339, Germany
| | - Josef Priller
- Department of Neuropsychiatry and Laboratory of Molecular Psychiatry, Charité-Universitaetsmedizin Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Ingo Schirotzek
- Department of Neurology, University Hospital Giessen and Marburg, Rudolf-Buchheim-Straße 8, Giessen 35392, Germany; Department of Neurology and Neurointensive Care, Klinikum Darmstadt, Grafenstraße 9, Darmstadt 64283, Germany
| | - Marie Süße
- Department of Neurology, University Medicine Greifswald, Fleischmannstraße 8, Greifswald 17475, Germany
| | - Kurt W Sühs
- Department of Neurology, University Hospital Hannover, Carl-Neuberg-Straße 1, Hannover 30625, Germany
| | - Christian Urbanek
- Department of Neurology, Hospital Ludwigshafen, Bremserstraße 79, Ludwigshafen am Rhein 67063, Germany
| | - Makbule Senel
- Department of Neurology, Ulm University, Albert-Einstein-Allee 23, Ulm 89081, Germany
| | - Claudia Sommer
- Department of Neurology, University of Wuerzburg, Josef-Schneider-Straße 2, Würzburg 97080, Germany
| | - Tania Kuempfel
- Institute of Clinical Neuroimmunology, University Hospital and Biomedical Center, Ludwig-Maximilians University Munich, Marchioninistrasse 15, Munich 81377, Germany
| | - Harald Pruess
- Department of Neurology and Experimental Neurology, Charité-Universitaetsmedizin Berlin, German Center for Neurodegenerative Diseases (DZNE) Berlin, Charitéplatz 1, Berlin 10117, Germany
| | - Gereon R Fink
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, Cologne 50937, Germany; Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Center Juelich, Wilhelm-Johnen-Straße, Juelich 52428, Germany
| | - Frank Leypoldt
- Institute of Clinical Chemistry and Department of Neurology, University Kiel and University Hospital Schleswig-Holstein, Arnold-Heller-Straße 3, Kiel 24105, Germany
| | - Nico Melzer
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster 48149, Germany; Department of Neurology, Medical Faculty, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, Duesseldorf 40225, Germany
| | - Michael P Malter
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Kerpener Str. 62, Cologne 50937, Germany
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18
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Goldschmidt C, Galetta SL, Lisak RP, Balcer LJ, Hellman A, Racke MK, Lovett-Racke AE, Cruz R, Parsons MS, Sattarnezhad N, Steinman L, Zamvil SS, Frohman EM, Frohman TC. Multiple Sclerosis Followed by Neuromyelitis Optica Spectrum Disorder: From the National Multiple Sclerosis Society Case Conference Proceedings. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200037. [PMID: 36270950 PMCID: PMC9673749 DOI: 10.1212/nxi.0000000000200037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 08/12/2022] [Indexed: 06/16/2023]
Abstract
A woman presented at age 18 years with partial myelitis and diplopia and experienced multiple subsequent relapses. Her MRI demonstrated T2 abnormalities characteristic of multiple sclerosis (MS) (white matter ovoid lesions and Dawson fingers), and CSF demonstrated an elevated IgG index and oligoclonal bands restricted to the CSF. Diagnosed with clinically definite relapsing-remitting MS, she was treated with various MS disease-modifying therapies and eventually began experiencing secondary progression. At age 57 years, she developed an acute longitudinally extensive transverse myelitis and was found to have AQP4 antibodies by cell-based assay. Our analysis of the clinical course, radiographic findings, molecular diagnostic methods, and treatment response characteristics support the hypothesis that our patient most likely had 2 CNS inflammatory disorders: MS, which manifested as a teenager, and neuromyelitis optica spectrum disorder, which evolved in her sixth decade of life. This case emphasizes a key principle in neurology practice, which is to reconsider whether the original working diagnosis remains tenable, especially when confronted with evidence (clinical and/or paraclinical) that raises the possibility of a distinctively different disorder.
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Affiliation(s)
- Carolyn Goldschmidt
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Steven L Galetta
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Robert P Lisak
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Laura J Balcer
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Andrew Hellman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Michael K Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Amy E Lovett-Racke
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Roberto Cruz
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Matthew S Parsons
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Neda Sattarnezhad
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Lawrence Steinman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Scott S Zamvil
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
| | - Elliot M Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA.
| | - Teresa C Frohman
- From the Mellen Center for Multiple Sclerosis Treatment and Research (C.G.), Cleveland Clinic, OH; Departments of Neurology (S.L.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.L.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Quest Diagnostics (A.H., M.K.R.), Secaucus, NJ; Department of Microbial Infection and Immunity (A.E.L.-R.), Department of Neuroscience Ohio State University Wexner Medical Center, Columbus; Department of Neurology (R.C.), Doctors Hospital at Renaissance; Department of Neurology (R.C.), University of Texas Rio Grande Valley; Division of Microbiology and Immunology (M.S.P.), Yerkes National Primate Research Center, and Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA; Department of Neurology (N.S., L.S.), Stanford University School of Medicine, Palo Alto, CA; Department of Neurology and Program in Immunology (S.S.Z.), University of California San Francisco; and Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA
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Arneth B, Kraus J. The Use of Kappa Free Light Chains to Diagnose Multiple Sclerosis. Medicina (B Aires) 2022; 58:medicina58111512. [PMID: 36363469 PMCID: PMC9698214 DOI: 10.3390/medicina58111512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 10/10/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022] Open
Abstract
Background: The positive implications of using free light chains in diagnosing multiple sclerosis have increasingly gained considerable interest in medical research and the scientific community. It is often presumed that free light chains, particularly kappa and lambda free light chains, are of practical use and are associated with a higher probability of obtaining positive results compared to oligoclonal bands. The primary purpose of the current paper was to conduct a systematic review to assess the up-to-date methods for diagnosing multiple sclerosis using kappa and lambda free light chains. Method: An organized literature search was performed across four electronic sources, including Google Scholar, Web of Science, Embase, and MEDLINE. The sources analyzed in this systematic review and meta-analysis comprise randomized clinical trials, prospective cohort studies, retrospective studies, controlled clinical trials, and systematic reviews. Results: The review contains 116 reports that includes 1204 participants. The final selection includes a vast array of preexisting literature concerning the study topic: 35 randomized clinical trials, 21 prospective cohort studies, 19 retrospective studies, 22 controlled clinical trials, and 13 systematic reviews. Discussion: The incorporated literature sources provided integral insights into the benefits of free light chain diagnostics for multiple sclerosis. It was also evident that the use of free light chains in the diagnosis of clinically isolated syndrome (CIS) and multiple sclerosis is relatively fast and inexpensive in comparison to other conventional state-of-the-art diagnostic methods, e.g., using oligoclonal bands (OCBs).
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Affiliation(s)
- Borros Arneth
- Institute of Laboratory Medicine and Pathobiochemistry, Molecular Diagnostics, Justus Liebig University, Feulgenstr. 12, 35392 Giessen, Germany
- Correspondence:
| | - Jörg Kraus
- Department of Laboratory Medicine, Paracelsus Medical University and Salzburger Landeskliniken, Strubergasse 21, 5020 Salzburg, Austria
- Department of Neurology, Medical Faculty, Heinrich-Heine-University Düsseldorf, Bergische Landstraße 2, 40629 Düsseldorf, Germany
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Rival M, Thouvenot E, Du Trieu de Terdonck L, Laurent-Chabalier S, Demattei C, Uygunoglu U, Castelnovo G, Cohen M, Okuda DT, Kantarci OH, Pelletier D, Azevedo C, Marin P, Lehmann S, Siva A, Mura T, Lebrun-Frenay C. Neurofilament Light Chain Levels Are Predictive of Clinical Conversion in Radiologically Isolated Syndrome. Neurol Neuroimmunol Neuroinflamm 2022; 10:10/1/e200044. [PMID: 36280258 PMCID: PMC9621336 DOI: 10.1212/nxi.0000000000200044] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the predictive value of serum neurofilament light chain (sNfL) and CSF NfL (cNfL) in patients with radiologically isolated syndrome (RIS) for evidence of disease activity (EDA) and clinical conversion (CC). METHODS sNfL and cNfL were measured at RIS diagnosis by single-molecule array (Simoa). The risk of EDA and CC according to sNfL and cNfL was evaluated using the Kaplan-Meier analysis and multivariate Cox regression models including age, spinal cord (SC) or infratentorial lesions, oligoclonal bands, CSF chitinase 3-like protein 1, and CSF white blood cells. RESULTS Sixty-one patients with RIS were included. At diagnosis, sNfL and cNfL were correlated (Spearman r = 0.78, p < 0.001). During follow-up, 47 patients with RIS showed EDA and 36 patients showed CC (median time 12.6 months, 1-86). When compared with low levels, medium and high cNfL (>260 pg/mL) and sNfL (>5.0 pg/mL) levels were predictive of EDA (log rank, p < 0.01 and p = 0.02, respectively). Medium-high cNfL levels were predictive of CC (log rank, p < 0.01). In Cox regression models, cNfL and sNfL were independent factors of EDA, while SC lesions, cNfL, and sNfL were independent factors of CC. DISCUSSION cNfL >260 pg/mL and sNfL >5.0 pg/mL at diagnosis are independent predictive factors of EDA and CC in RIS. Although cNfL predicts disease activity better, sNfL is more accessible than cNfL and can be considered when a lumbar puncture is not performed. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that in people with radiologic isolated syndrome (RIS), initial serum and CSF NfL levels are associated with subsequent evidence of disease activity or clinical conversion.
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Affiliation(s)
- Manon Rival
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Eric Thouvenot
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France.
| | - Lucile Du Trieu de Terdonck
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Sabine Laurent-Chabalier
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Christophe Demattei
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Ugur Uygunoglu
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Giovanni Castelnovo
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Mikael Cohen
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Darin T Okuda
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Orhun H Kantarci
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Daniel Pelletier
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Christina Azevedo
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Philippe Marin
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Sylvain Lehmann
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Aksel Siva
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Thibault Mura
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
| | - Christine Lebrun-Frenay
- From the Department of Neurology (M.R., E.T., G.C.), Nîmes University Hospital Center, Univ. Montpellier; Functional Genomics Institute (M.R., E.T., L.D.T.T., P.M.), Univ. Montpellier, CNRS, INSERM; Department of Biostatistics (S.L.-C., C.D., T.M.), Clinical Epidemiology, Public Health and Innovation in Methdology (BESPIM), Nîmes University Hospital Center, Univ. Montpellier, France; Department of Neurology (U.U., A.S.), Cerrahpasa School of Medecine, University of Istanbul, Turkey; Centre de Ressources et Compétences Sclérose En Plaques (CRCSEP) (M.C., C.L.-F.), CHU de Nice, Hôpital Pasteur 2, Université Côte d'Azur, UR2CA-URRIS, France; UT Southwestern Medical Center (D.T.O.), Dallas, TX; Mayo Clinic (O.H.K.), Rochester, MN; University of South California (D.P., C.A.), Los Angeles; and LBPC-PPC (S.L.), Univ. Montpellier, CHU Montpellier, INM, INSERM, France
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Zanotelli G, Bresciani L, Anglani M, Miscioscia A, Rinaldi F, Puthenparampil M. Case Report: Para-infectious cranial nerve palsy after bacterial meningitis. Front Immunol 2022; 13:1000912. [PMID: 36275763 PMCID: PMC9582131 DOI: 10.3389/fimmu.2022.1000912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/13/2022] [Indexed: 11/13/2022] Open
Abstract
A 27-year-old woman was admitted to our hospital for fever, associated with headache, nausea, and vomiting, and she rapidly developed mild left facial nerve palsy and diplopia. Neurological examination revealed mild meningitis associated with bilateral VI cranial nerve palsy and mild left facial palsy. As central nervous system (CNS) infection was suspected, a diagnostic lumbar puncture was performed, which revealed 1,677 cells/μl, 70% of which were polymorphonuclear leukocytes. Moreover, multiplex PCR immunoassay was positive for Neisseria meningitidis, supporting the diagnosis of bacterial meningitis. Finally, IgG oligoclonal bands (IgGOB) were absent in serum and cerebrospinal fluid (CSF). Therefore, ceftriaxone antibiotic therapy was started, and in the following days, the patient’s signs and symptoms improved, with complete remission of diplopia and meningeal signs within a week. On the contrary, left facial nerve palsy progressively worsened into a severe bilateral deficit. A second lumbar puncture was therefore performed: the CSF analysis revealed a remarkable decrease of pleocytosis with a qualitative modification (only lymphocytes), and oligoclonal IgG bands were present. A new brain MRI was performed, showing a bilateral gadolinium enhancement of the intrameatal VII and VIII cranial nerves bilaterally. Due to suspicion of para-infectious etiology, the patient was treated with oral steroid (prednisolone 1 mg/kg/day), with a progressive and complete regression of the symptoms. We suggest that in this case, after a pathogen-driven immunological response (characterized by relevant CSF mixed pleocytosis and no evidence of IgGOB), a para-infectious adaptive immunity-driven reaction (with mild lymphocyte pleocytosis and pattern III IgGOB) against VII and VIII cranial nerves started. Indeed, steroid administration caused a rapid and complete restoration of cranial nerve function.
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Affiliation(s)
- Giovanni Zanotelli
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
- *Correspondence: Giovanni Zanotelli,
| | - Lorenzo Bresciani
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
| | | | | | | | - Marco Puthenparampil
- Neurology Unit, Azienda Ospedaliera di Padova, Padova, Italy
- Department of Neuroscience, Università degli Studi di Padova, Padova, Italy
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22
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Saldaña-Inda I, Aparicio-Pelaz D, Rodríguez-Montolio J, Sebastián-Torres B, Iñíguez-Martínez C, Inda-Landaluce M. [Usefulness of the kappa index in the diagnosis of multiple sclerosis and validation of reference values in the Community of Aragon]. Rev Neurol 2022; 75:181-187. [PMID: 36169324 DOI: 10.33588/rn.7507.2022266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Detection of oligoclonal bands (OCB) in CSF is essential in the diagnosis of multiple sclerosis (MS). Kappa-index is a promising biomarker, with sensitivity and sensibility values comparable to those of OCB. Our objective was to investigate kappa-index utility in the diagnosis work-up for MS and to determine the optimal cut-off point for our population. MATERIAL AND METHODS Observational study of consecutive samples received in the Immunology lab department in a third level hospital between January 2019 to June 2020. Kappa-index and IgG index were measured. ROC analysis for screening of OCB and for diagnosis of MS was conducted. Sensibility, specificity and the optimal cut-off points were determined. RESULTS 181 samples were included (59.7% females; age, 47.62 ± 17.8 years). Patients in the EM group presented significantly higher kappa-index level than patients without an EM diagnosis (66.62 versus 0.02; p < 0.001). ROC analysis reported a better area under the curve for the kappa-index than the IgG index for the detection of BOC (0.93 versus 0.83; p < 0.002) and the diagnosis of EM (0.91 versus 0.83; p < 0.021). An optimal cut-off point of 5.02 was determined for the detection of BOC (sensibility and specificity, 0.92) and of 7.58 for the diagnosis of EM (sensibility, 0.85; specificity, 0.94). CONCLUSIONS Kappa-index is an useful biomarker in the diagnosis of MS. Its specificity and sensibility are superior to the IgG index. The optimal cut-off point has yet to be determined, but for our population a cut-off of 5.02 seems reasonable.
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Affiliation(s)
| | - D Aparicio-Pelaz
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
| | | | | | | | - M Inda-Landaluce
- Hospital Clínico Universitario Lozano Blesa, 50009 Zaragoza, España
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Liu JH, Fan HS, Yan WQ, Xu JY, Li LN, Xu Y, Yi SH, Zou DH, Qiu LG, An G. [The Clinical Significance of Oligoclonal Bands in Patient with Multiple Myeloma]. Zhongguo Shi Yan Xue Ye Xue Za Zhi 2022; 30:1453-1463. [PMID: 36208249 DOI: 10.19746/j.cnki.issn.1009-2137.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To investigate the clinical value of oligoclonal bands (OB) in patients with multiple myeloma (MM). METHODS The laboratory test and clinical data of 624 newly diagnosed MM patients admitted to Blood Diseases Hospital of Chinese Academy of Medical Sciences from January 2013 to December 2019 were retrospectively analyzed, including 30 patients with OB, and the clinical characteristics, treatment effects and survival of OB and non-OB patients were analyzed and compared. RESULTS OB occurred in 11.8% (22/187) of patients who received autologous stem cell transplantation(ASCT) and only 1.8% (8/437) of patients who did not receive ASCT (P=0.000). The median time to the appearance of oligoclonal bands was 3.2(0.6-10.5) months after transplantation. The M protein types of oligoclonal bands mainly include IgG κ, IgG λ, IgM λ and λ light chains. In the presence of oligoclonal bands, 90% of patients were evaluated as complete remission (CR) and above. There were no statistically significant differences in disease stage, tumor burden, and genetic abnormalities between OB and non-OB patients. Among the all patients, the prognosis of OB patients was significantly better than that of non-OB patients, and OB patients showed deeper disease remission (significantly higher CR rate, MRD negative rate, and longer MRD negative duration). Among patients who underwent ASCT, OB patients showed earlier immune recovery, but the depth of treatment response and survival outcomes were similar between OB and non-OB patients, it was no statistically difference. Although OB patients showed earlier immune reconstitution, this did not translate into better survival, suggesting that the better prognosis of OB patients was mainly related to deeper and durable remission rather than early immune reconstitution. Further analysis in patients who received ASCT and obtained MRD negative indicated that there was no additional survival benefit in patients with OB. CONCLUSION The better prognosis of OB patients may be related to the deeper treatment response, but not to the early immune reconstitution. The appearance of OB is only a sign of deep remission and early immune reconstitution in patients, it cannot be translated into survival benefit of MM patients.
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Affiliation(s)
- Jia-Hui Liu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Hui-Shou Fan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Wen-Qiang Yan
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Jing-Yu Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Ling-Na Li
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Yan Xu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Shu-Hua Yi
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - De-Hui Zou
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Lu-Gui Qiu
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China
| | - Gang An
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Haihe Laboratory of Cell Ecosystem, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College,Tianjin 300020, China,E-mail:
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Chen Y, Li Y, Zhan T. A case report of possible concurrent vasculitis in vertebral bodies and partial transverse myelitis following COVID-19 vaccination. Medicine (Baltimore) 2022; 101:e30814. [PMID: 36181106 PMCID: PMC9524522 DOI: 10.1097/md.0000000000030814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cases with organ-specific and systemic vasculitis associated with corona virus disease 2019 (COVID-19) vaccination have been reported. However, acute partial transverse myelitis (APTM) is rare adverse events following received COVID-19 vaccines. To the best of our knowledge, there is no report on vaccine-associated APTM accompanied by possible concurrent vasculitis. Herein we present a case with possible concurrent spinal vasculitis and APTM following the second dose of inactivated COVID-19 vaccine. CASE SUMMARY A 33-year-old man presented with weakness of left lower limb and aberrant sensation of his left lower trunk and limb (from T9 level to toes) for 2 days following receipt of an inactivated COVID-19 vaccine. Remarkable demyelinating lesion at T7 spinal cord was showed by 3.0T magnetic resonance imaging (MRI) scan. Moreover, vertebral bodies of T3-T7 also presented high signal in T-2 weighted imaging (T2WI) accompanied by multiple sites of flowing void effect indicating possible vasculitis. Oligoclonal band was positive in cerebrospinal fluid (CSF) while it was negative in sera. Intravenous methylprednisolone (1 g/d) was administrated for 5 days followed by subsequent dose-tapering prednisone. His limb weakness and aberrant sensation both improved and he was able to walk unaided after treatment. The MRI recheck also showed remarkable improvement on the lesions in spinal cord and vertebral bodies. CONCLUSION this case illustrates the concurrence of possible vasculitis in vertebral bodies and acute transverse myelitis (ATM) following COVID-19 vaccination.
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Affiliation(s)
- Yanyi Chen
- Department of Integrated TCM and Western Medicine, The First Hospital of Changsha, Changsha, Hunan, China
| | - Yuxin Li
- Department of Radiology, The First Hospital of Changsha, Changsha, Hunan, China
| | - Tao Zhan
- Department of Integrated TCM and Western Medicine, The First Hospital of Changsha, Changsha, Hunan, China
- *Correspondence: Tao Zhan, Department of Integrated TCM and Western Medicine, The First Hospital of Changsha, Changsha, Hunan 410005, China (e-mail: )
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Giannoccaro MP, Matteo E, Bartiromo F, Tonon C, Santorelli FM, Liguori R, Rizzo G. Multiple sclerosis in patients with hereditary spastic paraplegia: a case report and systematic review. Neurol Sci 2022; 43:5501-5511. [PMID: 35595875 DOI: 10.1007/s10072-022-06145-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION An increasing number of cases of comorbid hereditary spastic paraplegia (HSP) and multiple sclerosis (MS) have been described. We report a patient with the SPG3A form of HSP and features of relapsing-remitting MS (RRMS). We took this opportunity to review the current literature of co-occurring MS and HSP. METHOD The patient underwent clinical, laboratory and neuroimaging evaluations. We performed a literature search for cases of HSP and MS. The 2017 McDonalds Criteria for MS were retrospectively applied to the selected cases. RESULTS A 34-year-old woman, presenting a molecular diagnosis of SPG3A, complained subacute sensory-motor symptoms. Spinal MRI disclosed T2-hyperintense lesions at C2, T6 and T4 level, the latter presenting contrast-enhancement. CSF analysis showed oligoclonal bands. She was treated with intravenous high-dose steroids, with symptom resolution. The literature review yielded 13 papers reporting 20 possible cases of MS and HSP. Nine patients (5 M, median age 34) met the 2017 McDonald criteria. Five (25%) received a diagnosis of RRMS and four (20%) of primary progressive MS. Brain MRI showed multiple WM lesions, mostly periventricular. Six of seven cases (85.7%) had spinal cord involvement. Oligoclonal bands were found in 6/8 (75%) patients. Seven patients (77.7%) improved/stabilized on immunotherapy. CONCLUSION This is the first description on the association between SPG3A type of HSP and MS. This report adds to the other reported cases of co-occurring HSPs and MS. Although it remains unclear if this association is casual or causal, clinicians should be aware that an HSP diagnosis does not always exclude a concomitant MS.
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Affiliation(s)
- Maria Pia Giannoccaro
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Eleonora Matteo
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Fiorina Bartiromo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Caterina Tonon
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | | | - Rocco Liguori
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139, Bologna, Italy
- Dipartimento di Scienze Biomediche e Neuromotorie, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Giovanni Rizzo
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bellaria Hospital, 40139, Bologna, Italy.
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Rosenstein I, Rasch S, Axelsson M, Novakova L, Blennow K, Zetterberg H, Lycke J. Increased intrathecal neurofilament light and immunoglobulin M predict severe disability in relapsing-remitting multiple sclerosis. Front Immunol 2022; 13:967953. [PMID: 36032114 PMCID: PMC9399944 DOI: 10.3389/fimmu.2022.967953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/25/2022] [Indexed: 11/15/2022] Open
Abstract
Background Emerging evidence supports that determination of intrathecal immunoglobulin M (IgM) synthesis (ITMS) and neurofilament light (NfL) concentration in cerebrospinal fluid (CSF) may be clinically useful as disease severity biomarkers in relapsing-remitting multiple sclerosis (RRMS). Methods Monocentric observational longitudinal cohort study in which prospectively collected data were retrospectively retrieved. Included were patients with RRMS (n=457) who had a diagnostic investigation including analysis of ITMS and CSF neurofilament light (cNfL). ITMS was calculated with the linear index formula, the intrathecal fraction of IgM according to Reiber (IgMIF), and by qualitative determination of oligoclonal IgM bands (OCMB). Univariable and multivariable models were performed to predict Evidence of Disease Activity-3 (EDA-3) status within 24 months from onset, and the risk of Expanded Disability Status Score (EDSS) ≥3 and ≥6. Results All investigated methods to calculate ITMS significantly predicted evidence of disease activity (EDA-3) within 24 months. IgMIF>0% showed the strongest association with EDA-3 status (adjusted hazard ratio [aHR] 3.7, 95%CI 2.7-5, p<0.001). Combining IgM-index>0.1 or OCMB with increased cNfL were strong predictors of EDSS≥3 (for cNfL+/IgM-index+: aHR 4.6, 95%CI 2.6-8.2, p<0.001) and EDSS≥6 (aHR 8.2, 95%CI 2.3-30, p<0.001). Conclusions In a real-world setting, ITMS was a useful biomarker in early RRMS to predict disabling MS and its prognostic value was even stronger in combination with cNfL. Our data suggest that determination of ITMS and cNfL should be included in the diagnostic work-up of RRMS for prognostic purposes and in decisions of disease-modifying therapy.
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Affiliation(s)
- Igal Rosenstein
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- *Correspondence: Igal Rosenstein,
| | - Sofia Rasch
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Markus Axelsson
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lenka Novakova
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Kaj Blennow
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
| | - Henrik Zetterberg
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, University of Gothenburg, Mölndal, Sweden
- UK Dementia Research Institute at University College London (UCL), London, United Kingdom
- Department of Neurodegenerative Disease, University College London (UCL) Queen Square Institute of Neurology, London, United Kingdom
- Hong Kong Centre for Neurodegenerative Diseases, Hong Kong, Hong Kong SAR, China
| | - Jan Lycke
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Haddad F, Boudet S, Peyrodie L, Vandenbroucke N, Poupart J, Hautecoeur P, Chieux V, Forzy G. Oligoclonal Band Straightening Based on Optimized Hierarchical Warping for Multiple Sclerosis Diagnosis. Sensors (Basel) 2022; 22:s22030724. [PMID: 35161470 PMCID: PMC8839259 DOI: 10.3390/s22030724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/12/2022] [Indexed: 02/04/2023]
Abstract
The detection of immunoglobulin G (IgG) oligoclonal bands (OCB) in cerebrospinal fluid (CSF) by isoelectric focusing (IEF) is a valuable tool for the diagnosis of multiple sclerosis. Over the last decade, the results of our clinical research have suggested that tears are a non-invasive alternative to CSF. However, since tear samples have a lower IgG concentration than CSF, a sensitive OCB detection is therefore required. We are developing the first automatic tool for IEF analysis, with a view to speeding up the current visual inspection method, removing user variability, reducing misinterpretation, and facilitating OCB quantification and follow-up studies. The removal of band distortion is a key image enhancement step in increasing the reliability of automatic OCB detection. Here, we describe a novel, fully automatic band-straightening algorithm. The algorithm is based on a correlation directional warping function, estimated using an energy minimization procedure. The approach was optimized via an innovative coupling of a hierarchy of image resolutions to a hierarchy of transformation, in which band misalignment is corrected at successively finer scales. The algorithm’s performance was assessed in terms of the bands’ standard deviation before and after straightening, using a synthetic dataset and a set of 200 lanes of CSF, tear, serum and control samples on which experts had manually delineated the bands. The number of distorted bands was divided by almost 16 for the synthetic lanes and by 7 for the test dataset of real lanes. This method can be applied effectively to different sample types. It can realign minimal contrast bands and is robust for non-uniform deformations.
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Affiliation(s)
- Farah Haddad
- Biomedical Signal Processing Unit (UTSB), Lille Catholic University, F-59000 Lille, France;
- Faculty of Medicine and Midwifery (FMM), Lille Catholic Institute (ICL), F-59800 Lille, France; (P.H.); (G.F.)
- Laboratoire d’Informatique Signal et Image de la Côte d’Opale (LISIC), Université du Littoral Côte d’Opale (ULCO), F-62228 Calais, France;
- Correspondence: (F.H.); (S.B.)
| | - Samuel Boudet
- Biomedical Signal Processing Unit (UTSB), Lille Catholic University, F-59000 Lille, France;
- Faculty of Medicine and Midwifery (FMM), Lille Catholic Institute (ICL), F-59800 Lille, France; (P.H.); (G.F.)
- Correspondence: (F.H.); (S.B.)
| | - Laurent Peyrodie
- Biomedical Signal Processing Unit (UTSB), Lille Catholic University, F-59000 Lille, France;
- JUNIA-HEI (Hautes Études d’Ingénieur), F-59000 Lille, France
- Imagerie Multimodale Multiéchelle et Modélisation du Tissu Osseux et articulaire (I3MTO), Université d’Orléans, F-45067 Orléans, France
| | - Nicolas Vandenbroucke
- Laboratoire d’Informatique Signal et Image de la Côte d’Opale (LISIC), Université du Littoral Côte d’Opale (ULCO), F-62228 Calais, France;
| | - Julien Poupart
- Lille Catholic Hospital (GHICL), F-59160 Lomme, France; (J.P.); (V.C.)
| | - Patrick Hautecoeur
- Faculty of Medicine and Midwifery (FMM), Lille Catholic Institute (ICL), F-59800 Lille, France; (P.H.); (G.F.)
- Lille Catholic Hospital (GHICL), F-59160 Lomme, France; (J.P.); (V.C.)
| | - Vincent Chieux
- Lille Catholic Hospital (GHICL), F-59160 Lomme, France; (J.P.); (V.C.)
| | - Gérard Forzy
- Faculty of Medicine and Midwifery (FMM), Lille Catholic Institute (ICL), F-59800 Lille, France; (P.H.); (G.F.)
- Lille Catholic Hospital (GHICL), F-59160 Lomme, France; (J.P.); (V.C.)
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Lui A, Chong J, Flanagan E, Abrams AW, Krysko KM, Arikan B, Francisco C, Rutatangwa A, Waubant E, Ziaei A. High titers of myelin oligodendrocyte glycoprotein antibody are only observed close to clinical events in pediatrics. Mult Scler Relat Disord 2021; 56:103253. [PMID: 34517190 PMCID: PMC8678350 DOI: 10.1016/j.msard.2021.103253] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/06/2021] [Accepted: 09/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG)-IgG is increasingly detected in children with CNS demyelinating diseases. Due to the clinical overlap in children with CNS demyelination with and without MOG-IgG positivity, identifying distinct characteristics would help early diagnosis. OBJECTIVE To compare the specific features that may help differentiate MOG-IgG positive from negative children with CNS demyelinating diseases. To compare characteristics of patients with high and low MOG-IgG titers. METHODS Children with CNS demyelinating disorders with onset before 18 years of age who were tested for MOG-IgG at the University of California San Francisco were included. This retrospective study collected the following by chart review: demographic, clinical, MRI, CSF, and treatment data. Serum was tested for MOG-IgG at Mayo Clinic by live cell-based fluorescent activated cell sorting assay with titer ≥1:20 confirming positivity. RESULTS We assessed 65 Mog-IgG positive and 65 MOG-IgG negative patients. Median (IQR) age of onset was 7.6 (6.6) years for MOG-IgG positive and 13.8 (5.8) years for MOG-IgG negative (p<0.001). The female to male ratio was approximately 1:1 for the MOG-IgG positive group and 3:1 for the negative group (p=0.042). The most common initial diagnosis was demyelinating disease not otherwise specified (52.3%) in the positive group, compared to relapsing-remitting multiple sclerosis (41.5%) in the negative group (p<0.01). Optic nerve involvement (52.3%) was the most common clinical localization at onset for the MOG-IgG positive group, while brainstem/cerebellar (49.2%) localization predominated in the MOG-IgG negative group. The positive group also presented more often with a severe event at disease onset than the negative group (81.5% vs 60.3%; p< 0.002). MOG-IgG positive children had a lower frequency of oligoclonal bands (15.8% vs 57.4%; p<0.001). The frequency of baseline brain and spinal cord MRI abnormalities were similar in both groups; however, MOG-IgG positive patients more often had T2 hyperintense lesions in the optic nerves (26/43 vs 10/41; p<0.001). Disease-modifying medications were used in 64.6% of MOG-IgG positive patients versus 80% of negative children. Of the 32 positive patients with follow-up titers, seven reverted to negative while two who tested negative initially converted to positive. Positive titers greater than 1:160 were only observed within four months of a clinical event (disease onset or relapse). Patients with high and low MOG-IgG titers were comparable in demographic and clinical characteristics. CONCLUSION Despite some clinical overlap, we report notable demographic, MRI and CSF differences between MOG-IgG positive and negative children with CNS demyelinating disorders at disease onset. High MOG-IgG titers were only observed close to a clinical event.
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Affiliation(s)
- Allysa Lui
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Janet Chong
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Eoin Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Aaron W Abrams
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Kristen M Krysko
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA; Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Burak Arikan
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Carla Francisco
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Alice Rutatangwa
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Emmanuelle Waubant
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
| | - Amin Ziaei
- UCSF Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, San Francisco, CA, USA
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Ben Noon G, Vigiser I, Shiner T, Kolb H, Karni A, Regev K. Reinforcing the evidence of oligoclonal bands as a prognostic factor in patients with Multiple sclerosis. Mult Scler Relat Disord 2021; 56:103220. [PMID: 34455137 DOI: 10.1016/j.msard.2021.103220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 08/09/2021] [Accepted: 08/15/2021] [Indexed: 11/17/2022]
Abstract
The prognostic value of oligoclonal bands in the cerebrospinal fluid of Multiple Sclerosis (MS) patients is controversial. While several studies have demonstrated a worse disease course in OCB positive patients, others did not reproduce these findings. We evaluated the prognostic significance of OCB retrospectively based on clinical records of OCB status upon diagnosis and severity outcomes including the MS Severity Score, Progression Index and regional involvement in Magnetic Resonance Imaging. OCB positive patients had a higher median MSSS and PI, and a greater proportion of spinal cord involvement. These findings provide further evidence of the prognostic importance of OCB in MS patients.
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Affiliation(s)
- G Ben Noon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - I Vigiser
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - T Shiner
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Sagol School of Neuroscience Tel Aviv University, Tel Aviv, Israel
| | - H Kolb
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Karni
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience Tel Aviv University, Tel Aviv, Israel
| | - K Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Department of Neurology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Pita MC, Alonso RN, Cohen L, Garcea O, Silva BA. [Atypical clinical manifestations as a form of presentation in multiple sclerosis]. Medicina (B Aires) 2021; 81:972-977. [PMID: 34875596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
The atypical clinical features in multiple sclerosis (MS) have been rarely reported and suggest the possibility of an alternative diagnosis. The aim was to describe the clinical and demographic characteristics of MS patients who debuted with atypical symptoms and to estimate the sensitivity, specificity and positive predictive value (PPV) for MS diagnosis. A retrospective analysis of clinical records was performed. The following data were recorded: patients with MS diagnosis according to current diagnostic criteria at the time of diagnosis, type of symptom at the onset, time to second relapse, presence of oligoclonal bands (OCB) in cerebrospinal fluid (CSF) and radiological red flags on MRI. A descriptive and inferential analysis was performed using the chi square test, and sensitivity, specificity and PPV were calculated. Six hundred two patients were diagnosed with MS, of which 22 (3.65%) had an atypical clinical presentation. 54.5% were women. The mean age was 29 years (SD ± 11.7). The most common atypical symptom was peripheral facial palsy (27%). The PPV for atypical onset was 6.14%; p < 0.001. Sensitivity and specificity of these symptoms to MS diagnosis were 3.65% and 19%, respectively. In our research, the presence of atypical symptoms at the onset of MS was very low. Other diseases must be excluded, taking into account their low sensitivity, specificity and PPV.
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Affiliation(s)
- María Cecilia Pita
- Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Ricardo N Alonso
- Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Orlando Garcea
- Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Berenice A Silva
- Centro Universitario de Esclerosis Múltiple, Hospital General de Agudos Dr. J.M. Ramos Mejía, Facultad de Medicina, Universidad de Buenos Aires, Buenos Aires, Argentina. E-mail:
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Zeman D, Kušnierová P, Všianský F, Reguliová K, Škutová M, Woznicová I, Zapletalová O, Hradílek P. Cerebrospinal fluid oligoclonal IgM test in routine practice: Comparison with quantitative assessment of intrathecal IgM synthesis. Clin Chim Acta 2020; 508:137-145. [PMID: 32416174 DOI: 10.1016/j.cca.2020.05.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/11/2020] [Accepted: 05/11/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Intrathecal IgM synthesis demonstrated either as cerebrospinal fluid (CSF)-restricted oligoclonal (o-) IgM bands or calculated using various formulas has been linked to more aggressive multiple sclerosis (MS) course. However, the proportion of MS patients showing intrathecal IgM synthesis varies largely between studies. We aimed to explore the relation between different formulas and results of o-IgM, and to assess the frequency of o-IgM bands in an unselected series of samples. METHODS 432 samples were analyzed for o-IgM, o-IgG and quantitative measures of IgM and IgG synthesis. IgM index and formulas of Reiber, Auer and Öhman were compared to the result of the o-IgM test. RESULTS At the cut-off commonly used, the non-linear formulas for intrathecal synthesis were specific (>94%) but rather insensitive (<40% even at a cut-off of 4 CSF-restricted bands) compared to o-IgM. No significant difference was noted in the performance of different formulas. At a cut-off of 4 bands, 61% of MS patients, but none of the controls were positive for o-IgM. CONCLUSIONS Formulas for intrathecal IgM synthesis are insensitive compared to o-IgM. We propose to evaluate samples with 2 or 3 extra-CSF IgM bands as borderline and only samples with 4 or more as definitely positive.
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Affiliation(s)
- David Zeman
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic.
| | - Pavlína Kušnierová
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Biomedical Sciences, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - František Všianský
- Institute of Laboratory Diagnostics, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Katarína Reguliová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Monika Škutová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Ivana Woznicová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
| | - Olga Zapletalová
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic; Dept. of Neurology and Psychiatry, Faculty of Medicine, University of Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
| | - Pavel Hradílek
- Clinic of Neurology, University Hospital Ostrava, 17. listopadu 1790, 708 52 Ostrava, Czech Republic
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Di Luca DG, De Leon-Benedetti A, Williamson S, Irving LT, Margolesky J. Teaching Video NeuroImages: A patient with Holmes tremor due to demyelinating lesion of the inferior cerebellar peduncle. Neurology 2019; 92:e2179-e2180. [PMID: 31036583 DOI: 10.1212/wnl.0000000000007408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
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Casanova B, Lacruz L, Villar ML, Domínguez JA, Gadea MC, Gascón F, Mallada J, Hervás D, Simó-Castelló M, Álvarez-Cermeño JC, Calles C, Olascoaga J, Ramió-Torrentà L, Alcalá C, Cervelló A, Boscá I, Pérez-Mirallles FC, Coret F. Different clinical response to interferon beta and glatiramer acetate related to the presence of oligoclonal IgM bands in CSF in multiple sclerosis patients. Neurol Sci 2018; 39:1423-1430. [PMID: 29882169 DOI: 10.1007/s10072-018-3442-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/08/2018] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the efficacy of interferon beta (IFNβ) and glatiramer acetate (GA) related to the presence of oligoclonal M bands (OCMB) in the cerebrospinal fluid in relapsing-remitting multiple sclerosis (RRMS). METHOD This is an observational, multicenter and retrospective study with prospectively collected data of patients that started treatment with IFNβ or GA. Treatment decision was made blinded to the OCMB status. Time to first attack after starting therapy was compared by using Kaplan-Meier curves, and adjustment by Cox regression analysis was performed. RESULTS Two hundred and fifty-six patients entered in the study (141-55% received IFNβ; 115-45% received GA). After a mean follow-up of 41 and 65 months, 54.7% of patients remained free from further attacks (RF). The proportion of RF patients was higher in the GA group than in the IFNβ group (72.2 vs. 40.4%, p < 0.001). The IFNβ patients with OCMB+ presented the poorest response, 31.3% RF vs. 48.1% in IFNβ without OCMB, p = 0.03. CONCLUSION OCMB in CSF could be a biomarker of treatment response in multiple sclerosis.
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Affiliation(s)
| | - Laura Lacruz
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
| | | | | | | | - Francisco Gascón
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
| | | | - David Hervás
- Biostatistical Unit, Institut d'Investigació Sanitaria La Fe, Valencia, Spain
| | - María Simó-Castelló
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Carmen Calles
- Neurological Service, Hospital Son Espases, Mallorca, Spain
| | | | - Lluís Ramió-Torrentà
- Neuroimmunology and Multiple Sclerosis Unit, Hospital Dr. Josep Trueta, IDIBGI, Girona, Spain
| | - Carmen Alcalá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Angeles Cervelló
- Neurological Service, Hospital General de València, Valencia, Spain
| | - Isabel Boscá
- Neuroimmunology Unit, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Francisco Coret
- Neuroimmunology Unit, Hospital Clínic Universitari de València, Valencia, Spain
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Zdziarski P, Gamian A, Dworacki G. A case report of lymphoid intestitial pneumonia in common variable immunodeficiency: Oligoclonal expansion of effector lymphocytes with preferential cytomegalovirus-specific immune response and lymphoproliferative disease promotion. Medicine (Baltimore) 2017; 96:e7031. [PMID: 28591035 PMCID: PMC5466213 DOI: 10.1097/md.0000000000007031] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Lymphoid interstitial pneumonia (LIP) is a rare disease with lymphocytic infiltration of the alveolar interstitial and air spaces, sometimes classified as a clonal lymphoproliferative disease (LPD) with high prevalence in patients with immunodysregulation. Although association of mucosa-associated lymphoid tissue (MALT) lymphoma development with infectious agents has been well described, it is not so in the case of LIP. Attempts to demonstrate an infective cause by direct microbe detection have failed, but association with atypical specific immune response to opportunistic infectious agent has not been studied. PATIENT CONCERNS AND DIAGNOSES We performed clinical, biochemical, and immunologic analysis of patients LIP that arises primarily from the common variable immune deficiency (CVID) with normal immunoglobulin class M (IgM) level and mild infectious course as a result of immunodysregulation. At the age of 13 multiple nodules, areas of consolidation were observed and LIP was confirmed by histological examination. The progression of the disease with massive splenomegaly (17→27 cm), lymphadenopathy soft tissue infiltration coincides with high standardized uptake value (SUV was 3.1-5.2), regulatory T cells decrease (CD4+25FoxP3+ level -0.02%, i.e., 8 cells per 100 μL), oligoclonal gammapathy: very high IgM (3340 mg/dL) and β2-microglobulin (18.8 mg/L) level observed 10 years later.Immune response polarization was observed in humoral and cellular compartment -Th and Tc-dependent: 10.8% of lymphocytes are CD8high+CMV pp65-pentamer positive cells (Epstein-Barr virus-specific not observed). Specific immune response polarization correlates with negative immunofixation, light chains κ/λ = 2.84 and narrow, but non-monoclonal T cell receptor (TCR)/ B cell receptor (BCR) repertoire. LESSONS Taking everything into account, this case report shows that LIP is a consequence of immune-dysregulation in CVID, that is, Treg deficiency, narrow lymphocyte repertoire, and abnormal ability to respond to cytomegalovirus (CMV) antigens. It may be visualized by positron emission tomography (PET) and monitored by CMV-specific immune response, β2-microglobulin level, and IgM paraproteinaemia, but not by immunofixation and κ/λ ratio.
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Affiliation(s)
- Przemyslaw Zdziarski
- Department of Clinical Immunology, Lower Silesian Center for Cellular Transplantation
- L Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw
| | - Andrzej Gamian
- L Hirszfeld Institute of Immunology and Experimental Therapy, Polish Academy of Sciences, Wroclaw
| | - Grzegorz Dworacki
- Department of Clinical Immunology, Lower Silesian Center for Cellular Transplantation
- Department of Immunology, Poznan University of Medical Sciences, Poznań, Poland
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Pieri M, Pignalosa S, Zenobi R, Dessi M. Author's response to Letter to the Editor by N. Messaoudani, R. Djidjik and M. Ghaffor published in JNI 266 (2014) entitled "Comments on CSF κFLC assay evaluation in assessing intrathecal synthesis". J Neuroimmunol 2017; 306:19. [PMID: 28385182 DOI: 10.1016/j.jneuroim.2017.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/20/2017] [Accepted: 02/19/2017] [Indexed: 11/16/2022]
Affiliation(s)
- M Pieri
- Department of Experimental Medicine and Surgery, "Tor Vergata" University Hospital, Rome, Italy
| | - S Pignalosa
- Department of Experimental Medicine and Surgery, "Tor Vergata" University Hospital, Rome, Italy
| | - R Zenobi
- Department of Experimental Medicine and Surgery, "Tor Vergata" University Hospital, Rome, Italy
| | - M Dessi
- Department of Experimental Medicine and Surgery, "Tor Vergata" University Hospital, Rome, Italy.
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Vasilj M, Klarić M, Vrkić N, Mikulić I, Boras MM, Jelić-Knezović N, Šoljić V. Kappa Free Light Chains in Cerebrospinal Fluid of Patients with Identified Oligoclonal Immunoglobulin G. Psychiatr Danub 2017; 29:124-128. [PMID: 28492219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Production of kappa free light chains (KFLC) represents a part of humoral immune response, along with the synthesis of intrathecal immunoglobulins. Increased concentrations of immunoglobulin G light chains, kappa and lambda chains, were identified through research of numerous diseases of central nervous system. The qualitative method of isoelectric focusing (IEF) followed by immunofixation currently represents the accepted standard in identifying oligoclonal bands (OCB), but establishing a sensitive immunonephelometric method for quantification of kappa free light chains (KFLC) in cerebrospinal fluid (CSF) has paved a way for new diagnostic possibilities. Andersson classified the pattern types of OCB, ranging from type 1 to type 5, wherein types 2 and 3 indicate intrathecal synthesis. Our aim was to determine KFLC in CSF of patients with clinically isolated syndrome (CIS) who had presented with type 2 and type 3 OCB, to determine if there is a difference in concentrations between those two groups and to establish a borderline value of KFLC which would enable differential diagnostics. SUBJECTS AND METHODS 70 patients, who underwent lumbar punction for CSF analysis and had their blood sampled through the cubital vein, participated in the study. Patients were classified according to Andersson as type 2 or type 3, which besides adulthood, represented the inclusion criteria. The average age of patients classified as type 2 was 36 years, and those classified as type 3 was 39 years, where it is evident that there was not a statistically significant difference (p=0.0685). We used a qualitative electrophoretic technique of IEF with agarose gel followed by immunofixation, and a quantitative immunonephelometric method. All results were interpreted on a level of statistic significance of p<0.05. RESULTS CSF KFLC concentrations in type 3 were statistically and significantly elevated with regard to type 2 (Mann-Whitney test, p=0.0430). The median for KFLC in type 2 was 0.9 mg/L, while the median for KFLC in type 3 was 2.71 mg/L, and the detection limit for both types was 0.18 mg/L. We used a statistical ROC curve to determine that KFLC concentration can be used for differential diagnostics, meaning it can discriminate type 2 from type 3 with clinical sensitivity of 61% and clinical specificity of 71% (AUC=0.641) (p=0.037). CONCLUSION Despite the obtained statistically significant differences in concentrations of KFLC between types of OCBs and ROC analysis results, determination of KFLC by a nephelometric method, insufficiently strong clinical sensitivity and specificity does not justify abandonment of IEF method followed by immunofixation.
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Affiliation(s)
- Marina Vasilj
- Department of Laboratory Medicine, University Clinical Hospital Mostar, Bijeli Brijeg bb, 88000 Mostar, Bosnia and Herzegovina,
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Crespi I, Sulas MG, Mora R, Naldi P, Vecchio D, Comi C, Cantello R, Bellomo G. Combined use of Kappa Free Light Chain Index and Isoelectrofocusing of Cerebro-Spinal Fluid in Diagnosing Multiple Sclerosis: Performances and Costs. Clin Lab 2017; 63:551-559. [PMID: 28271695 DOI: 10.7754/clin.lab.2016.160930] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Lopez-Martin D, Martinez-Anton J. [Optic neuritis in childhood. A pediatric series, literature review and treatment approach]. Rev Neurol 2016; 63:103-108. [PMID: 27412016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
INTRODUCTION In children, the most common form of optic neuritis usually occurs after an infectious disease with papilledema, usually bilateral and has a good prognosis. Conversion to multiple sclerosis is low. AIM To present clinical and laboratory case of optic neuritis in pediatrics features. PATIENTS AND METHODS Seventeen clinical cases of optic neuritis in children and young people aged 4-14 years, referred from 2000 to 2015 were analyzed. RESULTS The median age of the series was 11 years. They predominated the female patients and infectious history was uncommon; in five of 17 patients was bilateral engagement and four cases evolved with retrobulbar optic neuritis. Magnetic resonance imaging showed hyperintensity on T2 in the optic nerves affected in five patients. The study of cerebrospinal fluid and oligoclonal bands was normal in all cases. Patients treated with intravenous methylprednisolone had good recovery. It was found subsequent evolution to multiple sclerosis only in three cases. CONCLUSIONS In our series, the cases that evolved multiple sclerosis showed no clinical differences although they had a higher number of hyperintense lesions on magnetic resonance imaging. This fact, described in previous studies, supports our diagnostic and therapeutic scheme in an attempt to approach the optimal management of this disease.
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Affiliation(s)
- D Lopez-Martin
- Hospital Regional Universitario de Malaga, Malaga, Espana
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Abstract
Combined central and peripheral demyelination (CCPD) is a rare clinical entity characterized by inflammatory demyelination in both the central and peripheral nervous system. A recently conducted nation-wide survey revealed that clinical features of CCPD are atypical for multiple sclerosis, including an absence of oligoclonal immunoglobulin G bands in most CCPD cases. We found that autoantibody responses of CCPD target the nodes and paranodes of Ranvier in the brain and peripheral nerve tissues. We identified anti-neurofascin antibody in the serum from these CCPD patients. CCPD patients showed a significantly higher positive rate of anti-neurofascin antibody than the other limited form of inflammatory demyelinating diseases. Autoantibody responses targeting neurofascins, which are common proteins to the central and peripheral nervous system may play a pivotal role in combined demyelination in CCPD.
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Nunez-Enamorado N, Camacho-Salas A, Belda-Hofheinz S, Cordero-Castro C, Simon-De Las Heras R, Saiz-Diaz R, Martinez-Sarries FJ, Martinez-Menendez B, Graus F. [Fast and spectacular clinical response to plasmapheresis in a paediatric case of anti-NMDA encephalitis]. Rev Neurol 2012; 54:420-424. [PMID: 22451129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Autoimmune encephalitis against N-methyl-D-aspartate (NMDA) receptors is being diagnosed more and more frequently in the paediatric age. It should be suspected in children with psychiatric symptoms, encephalopathy, abnormal movements or epileptic seizures. Paraneoplastic cases are less frequent than in adults. CASE REPORT We report the case of a boy, 2.5 years of age, with subacute encephalopathic signs and symptoms and epileptic seizures followed by behaviour disorders, neurological regression, dyskinesias and insomnia. Results of a cerebrospinal fluid study were normal, the magnetic resonance scan of the head revealed a focal periventricular lesion and diffuse leptomeningeal uptake; moreover, the serial electroencephalograms showed high-amplitude delta activity interspersed with generalised intercritical epileptiform activity. The patient was given empirical treatment with high doses of corticoids and intravenous immunoglobulins with no response. After showing up positive for antibodies against the NMDA receptor, plasmapheresis was begun, which led to his swift and spectacular recovery. After more than 18 months' follow-up, his sequelae are limited to mild behavioural and language alterations. He has had no relapses and has not needed any kind of maintenance treatment. CONCLUSIONS Anti-NMDA encephalitis is a treatable disorder and, sometimes, the first evidence of an underlying neoplasia, which makes its early recognition and treatment essential. Treatment of the non-paraneoplastic forms are based on immunotherapy: glucocorticoids, intravenous immunoglobulins, plasmapheresis and immunosuppressants. Plasmapheresis can bring about a fast, spectacular improvement.
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Roceanu A, Romaniţan O, Antochi F, Tiu C, Băjenaru O, Pascu R, Alexandrescu C, Nanea M, Voinea L. [Assessment of a patient with optic neuropathy]. Oftalmologia 2010; 54:3-8. [PMID: 20540361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Optic neuropathy (ON) is defined as the reduction of vision due to inflammatory lesion of the optic nerve. The patient with ON has to be evaluated clinically but also with complex techniques (magnetic resonance imaging, visual evoked potentials, cerebrospinal fluid examination) because ON could be the presenting symptom in multiple sclerosis patients. Corticosteroids should be administrated intravenous and the patient should be followed by the neurologist in order to signal the appearance of new neurological signs.
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Affiliation(s)
- Adina Roceanu
- 'Clinica de Neurologie, Spitalul Universitar de Urgenţă Bucureţi
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Tintore M, Sastre-Garriga J. Role of MRI criteria and OB for diagnosing multiple sclerosis in patients presenting with clinically isolated syndromes. Mult Scler 2009; 15:407-8. [PMID: 19324977 DOI: 10.1177/1352458509104581] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Miwa A. [How to diagnose a patient precisely as a myeloma patient?--Lots of problems during diagnostic process]. Nihon Rinsho 2007; 65:2268-2279. [PMID: 18069272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Typical multiple myeloma can be diagnosed precisely through lots of evaluations including the confirmation of the presence of increased clonal myeloma cells in bone marrow accompanied by monoclonal protein, cytopenia, bone diseases and renal disturbance. However, there still exists not a little difficulity during diagnostic process. In this article, representative problems are presented. Among them, the following issues are included; the confirmation or identification of minimal or 'masked' monoclonal proteins in several conditions (eg. myeloma following polyclonal hypergammaglobulinemic conditions), the differential diagnosis between Waldenström macroglobulinemia and IgM multiple myeloma, the differential diagnosis between MGUS with various complications and myeloma, the differential diagnosis of tumors in refractory phase of myeloma (eg. extramedullary plasmacytoma or transition to lympho -proliferative disorders from myeloma), and finally the interpretation of new M-component or oligo-clonal protein band in some periods after stem cell transplantation for myeloma.
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Affiliation(s)
- Akiyoshi Miwa
- Department of Hematology, International Medical Center of Japan
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Gregoire SM, van Pesch V, Goffette S, Peeters A, Sindic CJM. Polymerase chain reaction analysis and oligoclonal antibody in the cerebrospinal fluid from 34 patients with varicella-zoster virus infection of the nervous system. J Neurol Neurosurg Psychiatry 2006; 77:938-42. [PMID: 16844949 PMCID: PMC2077607 DOI: 10.1136/jnnp.2006.090316] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study cerebrospinal fluid (CSF) and serum samples from 34 consecutive patients suspected of having varicella-zoster virus (VZV) infection of the central nervous system (CNS). POPULATION AND METHODS The patients were divided into three groups. The first group consisted of 27 patients with a rash in one to three dermatomes and clinical suspicion of meningitis and radiculitis; among them, three subgroups were distinguished according to the affected dermatome: ophthalmicus (n = 9), oticus (n = 11) and cervico-thoraco-lumbar zoster (n = 7). Four cases of zoster sine herpete (ZSH) were included in the second group: these patients presented with either radiculitis (n = 2) or meningoencephalitis (n = 2), without cutaneous eruption. The third group consisted of three patients with a generalised rash and encephalitis. A polymerase chain reaction (PCR) for VZV DNA and antigen-driven immunoblots for oligoclonal anti-VZV antibodies were carried out on all CSF samples. RESULTS PCR of the CSF was positive in 44% of the patients from the first group, mainly within the first 7 days after eruption. In addition, intrathecal synthesis of anti-VZV antibodies was detected in 37% of patients, always after an interval of 7 days (p<0.0001). Among the four patients with ZSH, a positive VZV PCR was detected in three patients and CSF-specific oligoclonal anti-VZV antibodies in two. PCR was also positive in the CSF of two of the three patients with generalised rash and encephalitis; local production of anti-VZV antibodies was seen in a second CSF sample in one patient, and was also present in the third patient. CONCLUSION Amplification of VZV DNA by PCR in the CSF and antigen-driven immunoblots have important diagnostic value in suspected VZV infection, although their presence depends on the timing of the CSF sampling. VZV is thought to be a causative agent in unexplained cases of meningitis associated with radiculitis or focal CNS symptoms, even in the absence of skin manifestations. In such patients, rapid diagnosis by this combined approach permits early antiviral treatment.
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Affiliation(s)
- S M Gregoire
- Department of Neurology, Université catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Abstract
Abstract
Background: Intrathecal immunoglobulin synthesis is observed in several inflammatory disorders of the central nervous system, but its detection by current laboratory tests is either tedious or relatively insensitive. We assessed the diagnostic accuracy of an assay for κ free light chains (κFLC) in cerebrospinal fluid (CSF) and serum, and compared it with traditional tests for intrathecal immunoglobulin synthesis.
Methods: κFLCs were measured by nephelometry in CSF/serum pairs from 112 patients. Samples were excluded if blood contamination of CSF as a result of traumatic lumbar puncture (n = 12) or monoclonal bands in both CSF and serum (n = 5) were present. The remaining sample pairs were grouped according to the presence (n = 71) or absence (n = 24) of oligoclonal bands. Data were analyzed as κFLC concentrations in CSF, as κFLC CSF/serum ratios, and by use of the quotient diagram described previously for immunoglobulins.
Results: Both κFLC concentrations in CSF and the κFLC CSF/serum ratio identified patients with oligoclonal bands with high specificity and sensitivity. The areas under the ROC curves were 0.991 (95% confidence interval, 0.944–0.998) and 0.978 (0.924–0.996), respectively. Exclusion of patients with impaired blood–CSF barrier function further improved diagnostic accuracy. To account for patients with impaired blood–CSF barrier function, data were also analyzed in a quotient diagram. Only two patients without detectable oligoclonal bands would have been misclassified by this approach.
Conclusions: Our data indicate that the nephelometric assay for κFLCs in CSF reliably detects intrathecal immunoglobulin synthesis. This automated and quantitative method could simplify the diagnostic procedure for CSF analysis in the routine laboratory.
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Affiliation(s)
- Christian Fischer
- Institute of Clinical Chemistry and Laboratory Medicine, Department of Neurology, Johannes Gutenberg University, Mainz, Germany
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Rowley AH, Baker SC, Shulman ST, Garcia FL, Guzman-Cottrill JA, Chou P, Terai M, Kawasaki T, Kalelkar MB, Crawford SE. Detection of antigen in bronchial epithelium and macrophages in acute Kawasaki disease by use of synthetic antibody. J Infect Dis 2004; 190:856-65. [PMID: 15272416 DOI: 10.1086/422648] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2004] [Accepted: 03/01/2004] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Kawasaki disease (KD) is the most common acquired cardiac disease in children in developed nations. The etiology is unknown, but a ubiquitous infectious agent appears to be likely. Immunoglobulin A plasma cells infiltrate inflamed tissues in acute KD, producing oligoclonal, antigen-driven antibodies. METHODS To identify antigens important in the pathogenesis of KD, oligoclonal KD antibodies were prepared in vitro and tested by immunohistochemistry experiments on tissues from patients with acute KD and from control subjects and were also tested for reactivity with human inflammatory proteins. RESULTS By use of synthetic antibody A, specific binding to a cytoplasmic antigen in proximal bronchial epithelium was observed in 10 of 13 patients with acute KD but in 0 of 9 control subjects (P=.001). A subset of macrophages was positive in at least 1 inflamed tissue from all 17 patients with acute KD. Antigen was detected in 9 of 12 acute KD coronary artery aneurysms but in 0 of 10 control coronary arteries (P<.001). The antigen is not immunoglobulin or any of 40 common inflammatory proteins. CONCLUSIONS We report the first demonstration of a KD-associated antigen in the tissues targeted by the disease. Our findings are consistent with the theory that KD is caused by a previously unidentified respiratory infectious agent with tropism for vascular tissue.
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Affiliation(s)
- Anne H Rowley
- Departments of Pediatrics and Microbiology/Immunology, Feinberg School of Medicine, Children's Memorial Hospital, Northwestern University, Chicago, Illinois 60611, USA.
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47
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Fangerau T, Schimrigk S, Haupts M, Kaeder M, Ahle G, Brune N, Klinkenberg K, Kotterba S, Möhring M, Sindern E. Diagnosis of multiple sclerosis: comparison of the Poser criteria and the new McDonald criteria. Acta Neurol Scand 2004; 109:385-9. [PMID: 15147460 DOI: 10.1111/j.1600-0404.2004.00246.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES A confident and accurate diagnosis of multiple sclerosis (MS) is important, but a specific diagnostic test for the disease does not exist. The traditional diagnostic criteria of Poser et al. were published in 1983, and recently, McDonald et al. recommended new criteria for the diagnosis of MS. PATIENTS AND METHODS In this study these two diagnostic schemes were compared by prospectively applying both of them to 76 patients with clinical features suggesting a new diagnosis of MS. RESULTS Using the Poser criteria, 29 patients (38%) were classified as clinically definite and 35 patients (46%) as laboratory definite MS. According to the new McDonald criteria, MS was diagnosed in 39 (52%) patients, 37 patients (48%) had 'possible MS'. All patients with a clinically definite MS with the Poser criteria were also given the diagnosis of MS as recommended by McDonald et al. Of those 35 patients with laboratory definite MS according to Poser et al., four patients could be classified as having MS with the McDonald criteria, 89% of them had 'possible MS'. Conversely, 75% of the 39 patients, who fulfilled the new McDonald criteria for MS were assigned to the category of clinically definite MS according to the Poser criteria, and 83% of the patients with a 'possible MS' using the McDonald criteria, had a laboratory definite MS with the Poser criteria. CONCLUSION MS according to the McDonald criteria was diagnosed more often than 'clinically definite MS' according to Poser et al., but combining the categories of clinically and laboratory definite MS, the diagnosis of MS could clearly be established more frequently using the Poser criteria.
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Affiliation(s)
- T Fangerau
- BG-Kliniken Bergmannsheil Bochum, Bochum, Germany
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48
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Kojima M, Nakamura S, Itoh H, Yamane Y, Tanaka H, Sugihara S, Sakata N, Masawa N. Sclerosing variant of follicular lymphoma arising from submandibular glands and resembling "Küttner tumor": a report of 3 patients. Int J Surg Pathol 2004; 11:303-7. [PMID: 14615825 DOI: 10.1177/106689690301100407] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We present 3 patients with a sclerosing variant of follicular lymphoma that arose from the submandibular gland and resembled "Küttner tumor." All 3 patients developed a painless unilateral tumor in the submandibular region. Histologically, all 3 lesions were categorized as follicular lymphoma grade 2. The neoplastic follicles were found to be separated by thick connective tissue, and periductal chronic inflammation with periductal fibrosis and duct ectasia was found in the residual atrophic gland. Immunohistochemistry revealed that all of the lesions contained a monoclonal tumor cell population. The immunophenotyopes of the lymphoma cells were CD 10+, CD 20+, CD 79a+, BCL-6+, CD 3-, CD 5-, CD 21-, CD 23-, CD 43-, CD 45RO-, BCL-2-, and Cyclin D1-. Two of the 3 patients exhibited clonal bands for the IgH gene by polymerase chain reaction assay. "Küttner tumor," which is a common fibrosing, chronic inflammatory lesion of the submandibular gland, is sometimes diagnosed as a malignant tumor. This study indicates that this sclerosing variant of follicular lymphoma should be added to the list of different diagnoses for "Küttner tumor."
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Affiliation(s)
- Masaru Kojima
- Department of Pathology and Clinical Laboratories, Gunma Cancer Center Hospital, Ohta, Japan
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49
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Burgoon MP, Hammack BN, Owens GP, Maybach AL, Eikelenboom MJ, Gilden DH. Oligoclonal immunoglobulins in cerebrospinal fluid during varicella zoster virus (VZV) vasculopathy are directed against VZV. Ann Neurol 2003; 54:459-63. [PMID: 14520657 PMCID: PMC3293399 DOI: 10.1002/ana.10685] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Limited analyses of cerebrospinal fluid from patients with central nervous system infections have shown that the oligoclonal IgG is antibody directed against the agent that causes disease. Using a new method involving binding of IgG to beads coated with lysates prepared from candidate infectious antigens, we showed that the oligoclonal IgG in cerebrospinal fluid of a patient with chronic varicella zoster virus vasculopathy is directed against the causative virus. This approach holds promise in identifying and purifying the relevant oligoclonal IgGs in inflammatory central nervous system diseases of unknown cause.
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Affiliation(s)
- Mark P Burgoon
- Department of Neurology, University of Colorado Health Sciences Center, Denver, CO 80262, USA.
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Nash RA, Bowen JD, McSweeney PA, Pavletic SZ, Maravilla KR, Park MS, Storek J, Sullivan KM, Al-Omaishi J, Corboy JR, DiPersio J, Georges GE, Gooley TA, Holmberg LA, LeMaistre CF, Ryan K, Openshaw H, Sunderhaus J, Storb R, Zunt J, Kraft GH. High-dose immunosuppressive therapy and autologous peripheral blood stem cell transplantation for severe multiple sclerosis. Blood 2003; 102:2364-72. [PMID: 12763935 PMCID: PMC2963562 DOI: 10.1182/blood-2002-12-3908] [Citation(s) in RCA: 160] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
There were 26 patients enrolled in a pilot study of high-dose immunosuppressive therapy (HDIT) for severe multiple sclerosis (MS). Median baseline expanded disability status scale (EDSS) was 7.0 (range, 5.0-8.0). HDIT consisted of total body irradiation, cyclophosphamide, and antithymocyte globulin (ATG) and was followed by transplantation of autologous, granulocyte colony-stimulating factor (G-CSF)-mobilized CD34-selected stem cells. Regimen-related toxicities were mild. Because of bladder dysfunction, there were 8 infectious events of the lower urinary tract. One patient died from Epstein-Barr virus (EBV)-related posttransplantation lymphoproliferative disorder (PTLD) associated with a change from horse-derived to rabbit-derived ATG in the HDIT regimen. An engraftment syndrome characterized by noninfectious fever with or without rash developed in 13 of the first 18 patients and was associated in some cases with transient worsening of neurologic symptoms. There were 2 significant adverse neurologic events that occurred, including a flare of MS during mobilization and an episode of irreversible neurologic deterioration after HDIT associated with fever. With a median follow-up of 24 (range, 3-36) months, the Kaplan-Meier estimate of progression (>/= 1.0 point EDSS) at 3 years was 27%. Of 12 patients who had oligoclonal bands in the cerebrospinal fluid at baseline, 9 had persistence after HDIT. After HDIT, 4 patients developed new enhancing lesions on magnetic resonance imaging of the brain. The estimate of survival at 3 years was 91%. Important clinical issues in the use of HDIT and stem cell transplantation for MS were identified; however, modifications of the initial approaches appear to reduce treatment risks. This was a heterogeneous high-risk group, and a phase 3 study is planned to fully assess efficacy.
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Affiliation(s)
- Richard A Nash
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, D1-100, PO Box 19024, Seattle, WA 98109-1024, USA.
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