1
|
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.
Collapse
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
| |
Collapse
|
2
|
Bruijstens AL, Molenaar S, Wong YYM, Kraaij R, Neuteboom RF. Gut microbiota analysis in pediatric-onset multiple sclerosis compared to pediatric monophasic demyelinating syndromes and pediatric controls. Eur J Neurol 2023; 30:3507-3515. [PMID: 36209482 DOI: 10.1111/ene.15594] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/23/2022] [Accepted: 09/15/2022] [Indexed: 10/15/2023]
Abstract
BACKGROUND AND PURPOSE Gut microbiota dysbiosis may lead to proinflammatory conditions contributing to multiple sclerosis (MS) etiology. Pediatric-onset MS patients are close to biological disease onset and less exposed to confounders. Therefore, this study investigated gut microbiota composition and functional pathways in pediatric-onset MS, compared to monophasic acquired demyelinating syndromes (mADS) and healthy controls (HCs). METHODS Pediatric participants were selected from the Dutch national prospective cohort study including ADS patients and HCs <18 years old. Amplicon sequence variants (ASVs) were generated from sequencing the V3/4 regions of the 16S rRNA gene. Functional MetaCyc microbial pathways were predicted based on Enzyme Commission numbers. Gut microbiota composition (alpha/beta diversity and individual microbe abundance at ASV to phylum level) and predicted functional pathways were tested using nonparametric tests, permutational multivariate analysis of variance, and linear regression. RESULTS Twenty-six pediatric-onset MS (24 with disease-modifying therapy [DMT]), 25 mADS, and 24 HC subjects were included. Alpha/beta diversity, abundance of individual resident microbes, and microbial functional features were not different between these participant groups. Body mass index (BMI) showed significant differences, with obese children having a lower alpha diversity (Chao1 Index p = 0.015, Shannon/Simpson Diversity Index p = 0.014/p = 0.023), divergent beta diversity (R2 = 3.7%, p = 0.013), and higher abundance of numerous individual resident microbes and functional microbial pathways. CONCLUSIONS Previous results of gut microbiota composition and predicted functional features could not be validated in this Dutch pediatric-onset MS cohort using a more sensitive 16S pipeline, although it was limited by sample size and DMT use. Notably, several other host-related factors were found to associate with gut microbiota variation, especially BMI.
Collapse
Affiliation(s)
- Arlette L Bruijstens
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Sandy Molenaar
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Yu Yi M Wong
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Robert Kraaij
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
3
|
Van Steenhoven RW, de Vries JM, Bruijstens AL, Paunovic M, Nagtzaam MM, Franken SC, Bastiaansen AE, De Bruijn MA, Van Sonderen A, Schreurs MWJ, Gardeniers M, Verdijk RM, Balvers RK, Sillevis Smitt PA, Neuteboom RF, Titulaer MJ. Mimics of Autoimmune Encephalitis: Validation of the 2016 Clinical Autoimmune Encephalitis Criteria. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200148. [PMID: 37582614 PMCID: PMC10427145 DOI: 10.1212/nxi.0000000000200148] [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: 05/08/2023] [Accepted: 06/27/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND OBJECTIVES The clinical criteria for autoimmune encephalitis (AE) were proposed by Graus et al. in 2016. In this study, the AE criteria were validated in the real world, and common AE mimics were described. In addition, criteria for probable anti-LGI1 encephalitis were proposed and validated. METHODS In this retrospective cohort study, patients referred to our national referral center with suspicion of AE and specific neuroinflammatory disorders with similar clinical presentations were included from July 2016 to December 2019. Exclusion criteria were pure cerebellar or peripheral nerve system disorders. All patients were evaluated according to the AE criteria. RESULTS In total, 239 patients were included (56% female; median age 42 years, range 1-85). AE was diagnosed in 104 patients (44%) and AE mimics in 109 patients (46%). The most common AE mimics and misdiagnoses were neuroinflammatory CNS disorders (26%), psychiatric disorders (19%), epilepsy with a noninflammatory cause (13%), CNS infections (7%), neurodegenerative diseases (7%), and CNS neoplasms (6%). Common confounding factors were mesiotemporal lesions on brain MRI (17%) and false-positive antibodies in serum (12%). Additional mesiotemporal features (involvement extralimbic structures, enhancement, diffusion restriction) were observed more frequently in AE mimics compared with AE (61% vs 24%; p = 0.005). AE criteria showed the following sensitivity and specificity: possible AE, 83% (95% CI 74-89) and 27% (95% CI 20-36); definite autoimmune limbic encephalitis (LE), 10% (95% CI 5-17) and 98% (95% CI 94-100); and probable anti-NMDAR encephalitis, 50% (95% CI 26-74) and 96% (95% CI 92-98), respectively. Specificity of the criteria for probable seronegative AE was 99% (95% CI 96-100). The newly proposed criteria for probable anti-LGI1 encephalitis showed a sensitivity of 66% (95% CI 47-81) and specificity of 96% (95% CI 93-98). DISCUSSION AE mimics occur frequently. Common pitfalls in AE misdiagnosis are mesiotemporal lesions (predominantly with atypical features) and false-positive serum antibodies. As expected, the specificity of the criteria for possible AE is low because these criteria represent the minimal requirements for entry in the diagnostic algorithm for AE. Criteria for probable AE (-LGI1, -NMDAR, seronegative) and definite autoimmune LE are applicable for decisions on immunotherapy in early disease stage, as specificity is high.
Collapse
Affiliation(s)
- Robin W Van Steenhoven
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Juna M de Vries
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Arlette L Bruijstens
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Manuela Paunovic
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mariska M Nagtzaam
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Suzanne C Franken
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anna E Bastiaansen
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marienke A De Bruijn
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Agnes Van Sonderen
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marco W J Schreurs
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Mayke Gardeniers
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Robert M Verdijk
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rutger K Balvers
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Peter A Sillevis Smitt
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Rinze F Neuteboom
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Maarten J Titulaer
- From the Department of Neurology (R.W.V.S., J.M.V., A.L.B., M.P., M.M.N., S.C.F., A.E.B., M.A.D.B., P.A.S.S., M.J.T.), Erasmus MC University Medical Center, Rotterdam; Department of Neurology (A.V.S.), Haaglanden Medical Center, The Hague; Departments of Immunology (M.W.J.S.), Radiology (M.G.), Neuropathology (R.M.V.), and Neurosurgery (R.K.B.), Erasmus MC University Medical Center; and Department of Pediatric Neurology (R.F.N.), Sophia Childrens Hospital, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
| |
Collapse
|
4
|
Helfferich J, Bruijstens AL, Knoester M, Brouwer OF, Neuteboom RF. Comparison of acute flaccid myelitis and transverse myelitis in children and evaluation of diagnostic criteria. Eur J Neurol 2023. [PMID: 37170790 DOI: 10.1111/ene.15861] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 04/21/2023] [Accepted: 05/09/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) and transverse myelitis (TM) are serious conditions that may be difficult to differentiate, especially at onset of disease. In this study we compared clinical features of pediatric AFM and TM and evaluated current diagnostic criteria, aiming to improve early and accurate diagnosis. METHODS Two cohorts of children with enterovirus D68-associated AFM and clinically diagnosed TM were compared regarding presenting clinical features, additional investigations and outcome. Current diagnostic criteria for AFM and TM were applied to evaluate their specificity. RESULTS Children with AFM (n=21) compared to those with TM (n=36) were younger (median 3 vs. 10 years), more often had a prodromal illness (100% vs. 39%), predominant proximal weakness (69% vs. 17%) and hyporeflexia (100% vs. 44%), and less often had sensory deficits (0% vs. 81%), bowel and/or bladder dysfunction (12% vs. 69%) and hyperreflexia (0% vs. 44%). On MRI, brainstem involvement was more common in AFM (74% vs. 21%), while supratentorial abnormalities were only seen in TM (0% vs. 40%). When omitting the criterion of a sensory level, 11/15 (73%) children with AFM fulfilled the diagnostic criteria for TM. Of children with TM, 4/33 (12%) fulfilled the diagnostic criteria for probable/definite AFM. CONCLUSION While there is considerable overlap between AFM and TM in children, we found important early differentiating clinical and diagnostic features. Meeting diagnostic criteria for AFM in children with TM and vice versa, underlines the importance of thorough clinical examination and early and accurate diagnostic studies.
Collapse
Affiliation(s)
- Jelte Helfferich
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Arlette L Bruijstens
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Knoester
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Oebele F Brouwer
- Department of Neurology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
5
|
Bruijstens AL, Stingl C, Güzel C, Stoop MP, Wong YYM, van Pelt ED, Banwell BL, Bar-Or A, Luider TM, Neuteboom RF. Neurodegeneration and humoral response proteins in cerebrospinal fluid associate with pediatric-onset multiple sclerosis and not monophasic demyelinating syndromes in childhood. Mult Scler 2023; 29:52-62. [PMID: 36154753 PMCID: PMC9896265 DOI: 10.1177/13524585221125369] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pediatric-onset multiple sclerosis (POMS) represents the earliest stage of disease pathogenesis. Investigating the cerebrospinal fluid (CSF) proteome in POMS may provide novel insights into early MS processes. OBJECTIVE To analyze CSF obtained from children at time of initial central nervous system (CNS) acquired demyelinating syndrome (ADS), to compare CSF proteome of those subsequently ascertained as having POMS versus monophasic acquired demyelinating syndrome (mADS). METHODS Patients were selected from two prospective pediatric ADS studies. Liquid chromatography-mass spectrometry (LC-MS) was performed in a Dutch discovery cohort (POMS n = 28; mADS n = 39). Parallel reaction monitoring-mass spectrometry (PRM-MS) was performed on selected proteins more abundant in POMS in a combined Dutch and Canadian validation cohort (POMS n = 48; mADS n = 106). RESULTS Discovery identified 5580 peptides belonging to 576 proteins; 58 proteins were differentially abundant with ⩾2 peptides between POMS and mADS, of which 28 more abundant in POMS. Fourteen had increased abundance in POMS with ⩾8 unique peptides. Five selected proteins were all confirmed within validation. Adjusted for age, 2 out of 5 proteins remained more abundant in POMS, that is, Carboxypeptidase E (CPE) and Semaphorin-7A (SEMA7A). CONCLUSION This exploratory study identified several CSF proteins associated with POMS and not mADS, potentially reflecting neurodegeneration, compensatory neuroprotection, and humoral response in POMS. The proteins associated with POMS highly correlated with age at CSF sampling.
Collapse
Affiliation(s)
- Arlette L Bruijstens
- AL Bruijstens Department of Neurology, Erasmus University Medical Center, Room Ee-2230, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Christoph Stingl
- Laboratory of Neuro-Oncology, Clinical and Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Coşkun Güzel
- Laboratory of Neuro-Oncology, Clinical and Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marcel P Stoop
- Laboratory of Neuro-Oncology, Clinical and Cancer Proteomics, Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Yu Yi M Wong
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - E Daniëlle van Pelt
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | | |
Collapse
|
6
|
de Mol CL, Bruijstens AL, Jansen PR, Dremmen MHG, Wong YYM, van der Lugt A, White TJH, Neuteboom RF. Prevalence of radiologically isolated syndrome in a pediatric population-based cohort: A longitudinal description of a rare diagnosis. Mult Scler 2021; 27:1790-1793. [PMID: 33480814 PMCID: PMC8474308 DOI: 10.1177/1352458521989220] [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] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 12/17/2020] [Accepted: 12/28/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Radiologically isolated syndrome (RIS) is typified by multiple sclerosis (MS)-like lesions on imaging, without clinical MS symptoms. The prevalence of pediatric RIS is largely unknown. OBJECTIVE The objective of the study is to provide an estimated RIS prevalence in a population-based cohort of children. METHODS We used data from the Generation R study to identify the childhood RIS prevalence. RESULTS In 5238 participants, only one RIS case was identified (prevalence: 0.02%; 95% confidence interval (CI): 0.00-0.11). During a 62-month follow-up, imaging examinations showed accrual of new focal demyelinating lesions; however, no clinical MS symptoms occurred. CONCLUSIONS This study shows that the occurrence of RIS in children from the general population is rare.
Collapse
Affiliation(s)
- CL de Mol
- Department of Neurology, MS Center ErasMS,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
The Generation R Study Group, Erasmus MC University Medical Center
Rotterdam, Rotterdam, The Netherlands
| | - AL Bruijstens
- Department of Neurology, MS Center ErasMS,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The
Netherlands
| | - PR Jansen
- Department of Complex Trait Genetics, Center for
Neurogenomics and Cognitive Research, Amsterdam Neuroscience, Amsterdam UMC,
Amsterdam, The Netherlands Department of Clinical Genetics, Amsterdam UMC,
Amsterdam, The Netherlands
| | - MHG Dremmen
- The Generation R Study Group, Erasmus MC
University Medical Center Rotterdam, Rotterdam, The Netherlands Department
of Radiology and Nuclear Medicine, Erasmus MC University Medical Center
Rotterdam, Rotterdam, The Netherlands
| | - YYM Wong
- Department of Neurology, MS Center ErasMS,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The
Netherlands
| | - A van der Lugt
- Department of Radiology and Nuclear Medicine,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The
Netherlands
| | - TJH White
- Department of Child and Adolescent Psychiatry,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
Department of Radiology and Nuclear Medicine, Erasmus MC University Medical
Center Rotterdam, Rotterdam, The Netherlands
| | - RF Neuteboom
- Department of Neurology, MS Center ErasMS,
Erasmus MC University Medical Center Rotterdam, Rotterdam, The
Netherlands
| |
Collapse
|
7
|
Helfferich J, Bruijstens AL, Wong YYM, Danielle van Pelt E, Boon M, Neuteboom RF. Prognostic factors for relapse and outcome in pediatric acute transverse myelitis. Brain Dev 2021; 43:626-636. [PMID: 33509615 DOI: 10.1016/j.braindev.2020.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/04/2020] [Accepted: 12/24/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE It may be difficult for clinicians to estimate the prognosis of pediatric acute transverse myelitis (ATM). The aim of this study was to define prognostic factors for relapsing disease and poor outcome in pediatric ATM. METHODS This prospective cohort study included 49 children, 18 boys and 31 girls (median age 13.1 years, IQR 6.5-16.2) with a first episode of ATM. Factors associated with relapsing disease and poor outcome (Expanded Disability Status Scale (EDSS) ≥ 4) were assessed during a median follow-up of 37 months (IQR 18-75). RESULTS In total, 14 patients (29%) experienced ≥ 1 relapse(s) and nine patients (18%) had a poor outcome. Factors at onset associated with relapsing disease included higher age (16.1 vs. 11.6 years, p = 0.002), longer time to maximum severity of symptoms (5.5 vs. 3 days, p = 0.01), lower maximum EDSS score (4.0 vs. 6.5, p = 0.003), short lesion on spinal MRI (64 vs. 21%, p = 0.006), abnormalities on brain MRI (93 vs. 44%, p = 0.002) and presence of oligoclonal bands in cerebrospinal fluid (67 vs. 14%, p = 0.004). The only factor associated with poor outcome was presence of a spinal cord lesion on MRI without cervical involvement (56 vs. 14%, p = 0.02). CONCLUSION Pediatric ATM patients presenting with clinical, radiological and laboratory features associated with multiple sclerosis (MS) are at risk for relapsing disease. In absence of these known MS risk factors at onset of disease these patients are at low risk for relapses. Only a minority of pediatric ATM patients in this cohort have a poor outcome.
Collapse
Affiliation(s)
- Jelte Helfferich
- Department of Neurology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands; Department of Neurology, Erasmus Medical Center, Room Ee-2230, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Arlette L Bruijstens
- Department of Neurology, Erasmus Medical Center, Room Ee-2230, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Yu Yi M Wong
- Department of Neurology, Erasmus Medical Center, Room Ee-2230, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - E Danielle van Pelt
- Department of Neurology, Erasmus Medical Center, Room Ee-2230, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | - Maartje Boon
- Department of Neurology, University Medical Center Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands.
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus Medical Center, Room Ee-2230, PO Box 2040, 3000 CA Rotterdam, the Netherlands.
| | | |
Collapse
|
8
|
Janssen M, Bruijstens AL, van Langelaar J, Wong Y, Wierenga-Wolf AF, Melief MJ, Rijvers L, van Pelt ED, Smolders J, Wokke BH, van Luijn MM. Naive B cells in neuromyelitis optica spectrum disorders: impact of steroid use and relapses. Brain Commun 2020; 2:fcaa197. [PMID: 33305266 PMCID: PMC7714275 DOI: 10.1093/braincomms/fcaa197] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 10/14/2020] [Accepted: 10/16/2020] [Indexed: 12/19/2022] Open
Abstract
Neuromyelitis optica spectrum disorders are a group of rare, but severe autoimmune diseases characterized by inflammation of the optic nerve(s) and/or spinal cord. Although naive B cells are considered key players by escaping central tolerance checkpoints, it remains unclear how their composition and outgrowth differ in patients with neuromyelitis optica spectrum disorders. Under complete treatment-naive circumstances, we found that naive mature/transitional B-cell ratios were reduced in the blood of 10 patients with aquaporin-4 immunoglobulin G-positive disease (neuromyelitis optica spectrum disorders) as compared to 11 both age- and gender-matched healthy controls, eight patients with myelin oligodendrocyte glycoprotein-immunoglobulin G-associated disorders and 10 patients with multiple sclerosis. This was the result of increased proportions of transitional B cells, which were the highest in patients with neuromyelitis optica spectrum disorders with relapses and strongly diminished in a separate group of nine patients with neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein-immunoglobulin G-associated disorders who received corticosteroid treatment. These findings need to be confirmed in longitudinal studies. For purified naive mature B cells of seven patients with neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein-immunoglobulin G-associated disorders with relapses, Toll-like receptor 9 ligand synergized with interferon-γ to enhance plasmablast formation during germinal centre-like cultures. This was not seen for 11 patients without relapses and nine healthy controls. In the neuromyelitis optica spectrum disorders group, in vitro plasmablast formation corresponded to total and anti-aquaporin-4 immunoglobulin G secretion, of which the latter was found only for relapsing cases. These data indicate that naive B-cell homoeostasis is different and selectively targeted by corticosteroids in patients with neuromyelitis optica spectrum disorders. This also supports further exploration of naive B cells for their use in Toll-like receptor 9-dependent in vitro platforms in order to predict the activity of neuromyelitis optica spectrum disorders.
Collapse
Affiliation(s)
- Malou Janssen
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands.,Department of Neurology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
| | - Arlette L Bruijstens
- Department of Neurology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
| | - Jamie van Langelaar
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands
| | - YuYi Wong
- Department of Neurology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
| | - Annet F Wierenga-Wolf
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands
| | - Marie-José Melief
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands
| | - Liza Rijvers
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands
| | - E Daniëlle van Pelt
- Department of Neurology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
| | - Joost Smolders
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands.,Department of Neurology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
| | - Beatrijs H Wokke
- Department of Neurology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GD, The Netherlands
| | - Marvin M van Luijn
- Department of Immunology, MS Center ErasMS, Erasmus MC, Rotterdam, 3015 GE, The Netherlands
| |
Collapse
|
9
|
Bruijstens AL, Lechner C, Flet-Berliac L, Deiva K, Neuteboom RF, Hemingway C, Wassmer E, Baumann M, Bartels F, Finke C, Adamsbaum C, Hacohen Y, Rostasy K. E.U. paediatric MOG consortium consensus: Part 1 - Classification of clinical phenotypes of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders. Eur J Paediatr Neurol 2020; 29:2-13. [PMID: 33162302 DOI: 10.1016/j.ejpn.2020.10.006] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/13/2020] [Accepted: 10/14/2020] [Indexed: 12/30/2022]
Abstract
Over the past few years, increasing interest in the role of autoantibodies against myelin oligodendrocyte glycoprotein (MOG-abs) as a new candidate biomarker in demyelinating central nervous system diseases has arisen. MOG-abs have now consistently been identified in a variety of demyelinating syndromes, with a predominance in paediatric patients. The clinical spectrum of these MOG-ab-associated disorders (MOGAD) is still expanding and differs between paediatric and adult patients. This first part of the Paediatric European Collaborative Consensus emphasises the diversity in clinical phenotypes associated with MOG-abs in paediatric patients and discusses these associated clinical phenotypes in detail. Typical MOGAD presentations consist of demyelinating syndromes, including acute disseminated encephalomyelitis (ADEM) in younger, and optic neuritis (ON) and/or transverse myelitis (TM) in older children. A proportion of patients experience a relapsing disease course, presenting as ADEM followed by one or multiple episode(s) of ON (ADEM-ON), multiphasic disseminated encephalomyelitis (MDEM), relapsing ON (RON) or relapsing neuromyelitis optica spectrum disorders (NMOSD)-like syndromes. More recently, the disease spectrum has been expanded with clinical and radiological phenotypes including encephalitis-like, leukodystrophy-like, and other non-classifiable presentations. This review concludes with recommendations following expert consensus on serologic testing for MOG-abs in paediatric patients, the presence of which has consequences for long-term monitoring, relapse risk, treatments, and for counselling of patient and families. Furthermore, we propose a clinical classification of paediatric MOGAD with clinical definitions and key features. These are operational and need to be tested, however essential for future paediatric MOGAD studies.
Collapse
Affiliation(s)
| | - Christian Lechner
- Department of Paediatrics, Division of Paediatric Neurology, Medical University of Innsbruck, Austria
| | - Lorraine Flet-Berliac
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Kumaran Deiva
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France; French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, European Reference Network-RITA, France
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Bruijstens AL, Wendel EM, Lechner C, Bartels F, Finke C, Breu M, Flet-Berliac L, de Chalus A, Adamsbaum C, Capobianco M, Laetitia G, Hacohen Y, Hemingway C, Wassmer E, Lim M, Baumann M, Wickström R, Armangue T, Rostasy K, Deiva K, Neuteboom RF. E.U. paediatric MOG consortium consensus: Part 5 - Treatment of paediatric myelin oligodendrocyte glycoprotein antibody-associated disorders. Eur J Paediatr Neurol 2020; 29:41-53. [PMID: 33176999 DOI: 10.1016/j.ejpn.2020.10.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/12/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
In recent years, the understanding about the different clinical phenotypes, diagnostic and prognostic factors of myelin oligodendrocyte glycoprotein-antibody-associated disorders (MOGAD) has significantly increased. However, there is still lack of evidence-based treatment protocols for acute attacks and children with a relapsing course of the disease. Currently used acute and maintenance treatment regimens are derived from other demyelinating central nervous system diseases and are mostly centre-specific. Therefore, this part of the Paediatric European Collaborative Consensus attempts to provide recommendations for acute and maintenance therapy based on clinical experience and evidence available from mainly retrospective studies. In the acute attack, intravenous methylprednisolone (IVMP) leads to a favourable outcome in the majority of patients and can be followed by tapering of oral steroids up to a maximum of three months to maintain the benefit of acute treatment by suppressing disease activity. Intravenous immunoglobulins (IVIG) and plasmapheresis constitute second-line therapies in case of insufficient response to IVMP. After a first relapse, maintenance treatment should be started in order to prevent further relapses and the possibility of permanent sequelae. Four first-line therapies consisting of rituximab (RTX), azathioprine, mycophenolate mofetil or monthly IVIG have been identified by the consensus group. In case of further relapses despite maintenance treatment, the consensus group recommends treatment escalation with RTX or IVIG, followed by combining those two, and ultimately adding maintenance oral steroids. Many open questions remain which need to be addressed in further international prospective evaluation of MOGAD treatment. This international collaboration is essential to expand the state of current knowledge.
Collapse
Affiliation(s)
| | - Eva-Maria Wendel
- Department of Paediatrics, Klinikum Stuttgart/Olgahospital, Stuttgart, Germany
| | - Christian Lechner
- Department of Paediatrics, Division of Paediatric Neurology, Medical University of Innsbruck, Austria
| | - Frederik Bartels
- Department of Neurology, Charité - Universitätsmedizin Berlin / Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Germany
| | - Carsten Finke
- Department of Neurology, Charité - Universitätsmedizin Berlin / Berlin School of Mind and Brain, Humboldt-Universität zu Berlin, Germany
| | - Markus Breu
- Department of Paediatrics and Adolescent Medicine, Division of Paediatric Neurology, Medical University of Vienna, Austria
| | - Lorraine Flet-Berliac
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Aliénor de Chalus
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Catherine Adamsbaum
- Paediatric Radiology Department, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Marco Capobianco
- Department of Neurology and Regional Multiple Sclerosis Centre, University Hospital San Luigi Gonzaga, Orbassano, Italy
| | - Giorgi Laetitia
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
| | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology / Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Evangeline Wassmer
- Department of Paediatric Neurology, Birmingham Children's Hospital, Birmingham, UK
| | - Ming Lim
- Children's Neurosciences, Evelina London Children's Hospital at Guy's and St Thomas' National Health Service Foundation Trust, London, Faculty of Life Sciences and Medicine, Kings College Hospital, London, UK
| | - Matthias Baumann
- Department of Paediatrics, Division of Paediatric Neurology, Medical University of Innsbruck, Austria
| | - Ronny Wickström
- Neuropaediatric Unit, Karolinska University Hospital, Sweden
| | - Thaís Armangue
- Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Paediatric Neuroimmunology Unit, Neurology Department, Sant Joan de Déu (SJD) Children's Hospital, University of Barcelona, Barcelona, Spain
| | - Kevin Rostasy
- Department of Paediatric Neurology, Children's Hospital Datteln, Witten/Herdecke University, Datteln, Germany
| | - Kumaran Deiva
- Department of Paediatric Neurology, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris-Saclay, Bicêtre Hospital and Faculty of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France; French Reference Network of Rare Inflammatory Brain and Spinal Diseases, Le Kremlin Bicêtre, France and European Reference Network-RITA
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
11
|
Bruijstens AL, Blok KM, Smolders J, Wokke BH, Neuteboom RF. Pediatric MS patients with a primary progressive-like disease may still have relevant inflammatory activity and may benefit from regular MS treatment. Mult Scler 2020; 26:1962-1964. [PMID: 32406801 PMCID: PMC7720353 DOI: 10.1177/1352458520921367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Arlette L Bruijstens
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Katelijn M Blok
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Joost Smolders
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands.,Neuroimmunology Research Group, Netherlands Institute for Neuroscience, Amsterdam, The Netherlands
| | - Beatrijs Ha Wokke
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rinze F Neuteboom
- Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| |
Collapse
|
12
|
Bruijstens AL, Wong YYM, van Pelt DE, van der Linden PJE, Haasnoot GW, Hintzen RQ, Claas FHJ, Neuteboom RF, Wokke BHA. HLA association in MOG-IgG- and AQP4-IgG-related disorders of the CNS in the Dutch population. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/3/e702. [PMID: 32198229 PMCID: PMC7136059 DOI: 10.1212/nxi.0000000000000702] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 02/07/2020] [Indexed: 01/04/2023]
Abstract
Objective To investigate the possible human leukocyte antigen (HLA) association of both myelin oligodendrocyte glycoprotein (MOG-IgG)-associated diseases (MOGAD) and aquaporin-4 antibody (AQP4-IgG)-positive neuromyelitis optica spectrum disorders (NMOSDs) in the Dutch population with European ancestry to clarify similarities or differences in the immunogenetic background of both diseases. Methods Blood samples from patients in the Dutch national MS/NMOSD expert clinic were tested for MOG-IgG and AQP4-IgG using a cell-based assay. HLA Class I and II genotyping was performed in 43 MOG-IgG–seropositive and 42 AQP4-IgG–seropositive Dutch patients with European ancestry and compared with those of 5,604 Dutch healthy blood donors. Results No significant HLA association was found in MOG-IgG–seropositive patients. The AQP4-IgG–seropositive patients had a significant higher frequency of HLA-A*01 (61.9% vs 33.7%, OR 3.16, 95% CI, 1.707–5.863, p after correction [pc] = 0.0045), HLA-B*08 (61.9% vs 25.6%, OR 4.66, 95% CI, 2.513–8.643, pc < 0.0001), and HLA-DRB1*03 (51.2% vs 27.6%, OR 2.75, 95% CI, 1.495–5.042, pc = 0.0199) compared with controls. Conclusions The present study demonstrates differences in the immunogenetic background of MOGAD and AQP4-IgG–positive NMOSD. The strong positive association with HLA-A*01, -B*08, and -DRB1*03 is suggestive of a role of this haplotype in the etiology of AQP4-IgG–positive NMOSD in patients with European ancestry, whereas in MOGAD no evidence was found for any HLA association in these disorders.
Collapse
Affiliation(s)
- Arlette L Bruijstens
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands.
| | - Yu Yi M Wong
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Daniëlle E van Pelt
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Pieter J E van der Linden
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Geert W Haasnoot
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Rogier Q Hintzen
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Frans H J Claas
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Rinze F Neuteboom
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| | - Beatrijs H A Wokke
- From the Department of Neurology (A.L.B., Y.Y.M.W., E.D.P., R.Q.H., R.F.N., B.H.A.W.), Erasmus University Medical Center, Rotterdam; and Department of Immunohaematology and Blood Transfusion (P.J.E.L., G.W.H., F.H.J.C.), Leiden University Medical Center, the Netherlands
| |
Collapse
|
13
|
de Bruijn MAAM, Bruijstens AL, Bastiaansen AEM, van Sonderen A, Schreurs MWJ, Sillevis Smitt PAE, Hintzen RQ, Neuteboom RF, Titulaer MJ. Pediatric autoimmune encephalitis: Recognition and diagnosis. Neurol Neuroimmunol Neuroinflamm 2020; 7:7/3/e682. [PMID: 32047077 PMCID: PMC7051211 DOI: 10.1212/nxi.0000000000000682] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 01/03/2020] [Indexed: 12/18/2022]
Abstract
Objective The aims of this study were (1) to describe the incidence of autoimmune encephalitis (AIE) and acute disseminated encephalomyelitis (ADEM) in children, (2) to validate the currently used clinical criteria to diagnose AIE, and (3) to describe pitfalls in the diagnosis of pediatric autoimmune (AI) and inflammatory neurologic disorders. Methods This study cohort consists of 3 patient categories: (1) children with antibody-mediated AIE (n = 21), (2) children with ADEM (n = 32), and (3) children with suspicion of an AI etiology of their neurologic symptoms (n = 60). Baseline and follow-up clinical data were used to validate the current guideline to diagnose AIE. In addition, patient files and final diagnoses were reviewed. Results One-hundred three of the 113 included patients fulfilled the criteria of possible AIE. Twenty-one children had antibody-mediated AIE, of whom 19 had anti-N-methyl-D-aspartate receptor (NMDAR), 1 had anti–α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor, and 1 had anti–leucine-rich glioma-inactivated protein 1 encephalitis. Finally, 34 children had ADEM, and 2 children had Hashimoto encephalopathy. Mean incidence rates were 1.54 children/million (95% CI 0.95–2.35) for antibody-mediated AIE and 2.49 children/million (95% CI 1.73–3.48) for ADEM. Of the other 48 children, treating physicians' diagnoses were reviewed. In 22% (n = 6) of children initially diagnosed as having an AI/inflammatory etiology (n = 27), no support for AI/inflammation was found. Conclusion Besides anti-NMDAR encephalitis and ADEM, other AIEs are rare in children. The current guideline to diagnose AIE is also useful in children. However, in children with nonspecific symptoms, it is important to review data critically, to perform complete workup, and to consult specialized neuroinflammatory centers.
Collapse
Affiliation(s)
- Marienke A A M de Bruijn
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Arlette L Bruijstens
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Anna E M Bastiaansen
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Agnes van Sonderen
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Marco W J Schreurs
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Peter A E Sillevis Smitt
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Rogier Q Hintzen
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Rinze F Neuteboom
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague
| | - Maarten J Titulaer
- From the Department of Neurology (M.A.A.M.d.B., A.L.B., A.E.M.B., A.v.S., P.A.E.S.S., M.J.T.), Department of Immunology (M.W.J.S.), and Department of Pediatric Neurology (R.F.N.), Erasmus MC University Medical Center, Rotterdam; Haga Hospital (A.v.S.), The Hague; and Sophia Children's Hospital (R.F.N.), Rotterdam, the Netherlands. A.v.S. is currently working at Medisch Centrum Haaglanden, The Hague.
| | | |
Collapse
|
14
|
Wong YYM, Bruijstens AL, Barro C, Michalak Z, Melief MJ, Wierenga AF, van Pelt ED, Neuteboom RF, Kuhle J, Hintzen RQ. Serum neurofilament light chain in pediatric MS and other acquired demyelinating syndromes. Neurology 2019; 93:e968-e974. [DOI: 10.1212/wnl.0000000000008057] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/09/2019] [Indexed: 11/15/2022] Open
Abstract
ObjectiveTo explore the correlation between serum and CSF neurofilament light chain (NfL) and the association of NfL levels and future disease activity in pediatric patients with a first attack of acquired demyelinating syndromes (ADS).MethodsIn total, 102 children <18 years with a first attack of CNS demyelination and 23 age-matched controls were included. Clinically definite multiple sclerosis (CDMS) was set as an endpoint for analysis. CSF NfL was tested by the commercially available ELISA (UmanDiagnostics); serum NfL (sNfL) was tested with a Simoa assay. Hazard ratios (HR) were calculated with Cox regression analysis.ResultsOf the 102 patients, 47 (46%) were tested for CSF NfL. CSF and serum NfL correlated significantly in the total group (ρ 0.532, p < 0.001) and even more significantly in the subgroup of patients with future CDMS diagnosis (ρ 0.773, p < 0.001). sNfL was higher in patients than in controls (geometric mean 6.1 pg/mL, p < 0.001), and was highest in ADS presenting with encephalopathy (acute disseminated encephalomyelitis, n = 28, 100.4 pg/mL), followed by patients without encephalopathy (ADS−) with future CDMS diagnosis (n = 40, 32.5 pg/mL), and ADS− who remained monophasic (n = 34, 17.6 pg/mL). sNfL levels higher than a median of 26.7 pg/mL at baseline are associated with a shorter time to CDMS diagnosis in ADS− (p = 0.045). HR for CDMS diagnosis was 1.09 for each 10 pg/mL increase of sNfL, after correction for age, oligoclonal bands, and MRI measures (p = 0.012).ConclusionThe significant correlation between CSF and serum NfL strengthens its reliability as a peripheral marker of neuroaxonal damage. Higher sNfL levels at baseline were associated with higher probability of future CDMS diagnosis in ADS−.
Collapse
|