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Jarius S, Ringelstein M, Schanda K, Ruprecht K, Korporal-Kuhnke M, Viehöver A, Hümmert MW, Schindler P, Endmayr V, Gastaldi M, Trebst C, Franciotta D, Aktas O, Höftberger R, Haas J, Komorowski L, Paul F, Reindl M, Wildemann B. Improving the sensitivity of myelin oligodendrocyte glycoprotein-antibody testing: exclusive or predominant MOG-IgG3 seropositivity-a potential diagnostic pitfall in patients with MOG-EM/MOGAD. J Neurol 2024:10.1007/s00415-024-12285-5. [PMID: 38609667 DOI: 10.1007/s00415-024-12285-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM; also termed MOG antibody-associated disease, MOGAD) is the most important differential diagnosis of both multiple sclerosis and neuromyelitis optica spectrum disorders. A recent proposal for new diagnostic criteria for MOG-EM/MOGAD explicitly recommends the use of immunoglobulin G subclass 1 (IgG1)- or IgG crystallizable fragment (Fc) region-specific assays and allows the use of heavy-and-light-chain-(H+L) specific assays for detecting MOG-IgG. By contrast, the utility of MOG-IgG3-specific testing has not been systematically evaluated. OBJECTIVE To assess whether the use of MOG-IgG3-specific testing can improve the sensitivity of MOG-IgG testing. METHODS Re-testing of 22 patients with a definite diagnosis of MOG-EM/MOGAD and clearly positive MOG-IgG status initially but negative or equivocal results in H+L- or Fc-specific routine assays later in the disease course (i.e. patients with spontaneous or treatment-driven seroreversion). RESULTS In accordance with previous studies that had used MOG-IgG1-specific assays, IgG subclass-specific testing yielded a higher sensitivity than testing by non-subclass-specific assays. Using subclass-specific secondary antibodies, 26/27 supposedly seroreverted samples were still clearly positive for MOG-IgG, with MOG-IgG1 being the most frequently detected subclass (25/27 [93%] samples). However, also MOG-IgG3 was detected in 14/27 (52%) samples (from 12/22 [55%] patients). Most strikingly, MOG-IgG3 was the predominant subclass in 8/27 (30%) samples (from 7/22 [32%] patients), with no unequivocal MOG-IgG1 signal in 2 and only a very weak concomitant MOG-IgG1 signal in the other six samples. By contrast, no significant MOG-IgG3 reactivity was seen in 60 control samples (from 42 healthy individuals and 18 patients with MS). Of note, MOG-IgG3 was also detected in the only patient in our cohort previously diagnosed with MOG-IgA+/IgG- MOG-EM/MOGAD, a recently described new disease subvariant. MOG-IgA and MOG-IgM were negative in all other patients tested. CONCLUSIONS In some patients with MOG-EM/MOGAD, MOG-IgG is either exclusively or predominantly MOG-IgG3. Thus, the use of IgG1-specific assays might only partly overcome the current limitations of MOG-IgG testing and-just like H+L- and Fcγ-specific testing-might overlook some genuinely seropositive patients. This would have potentially significant consequences for the management of patients with MOG-EM/MOGAD. Given that IgG3 chiefly detects proteins and is a strong activator of complement and other effector mechanisms, MOG-IgG3 may be involved in the immunopathogenesis of MOG-EM/MOGAD. Studies on the frequency and dynamics as well as the clinical and therapeutic significance of MOG-IgG3 seropositivity are warranted.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - M Ringelstein
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - K Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - K Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - M Korporal-Kuhnke
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - A Viehöver
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - M W Hümmert
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - P Schindler
- Department of Neurology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - V Endmayr
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - M Gastaldi
- Neuroimmunology Laboratory and Neuroimmunology Research Unit, IRCCS Mondino Foundation National Neurological Institute, Pavia, Italy
| | - C Trebst
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - D Franciotta
- Neuroimmunology Laboratory and Neuroimmunology Research Unit, IRCCS Mondino Foundation National Neurological Institute, Pavia, Italy
| | - O Aktas
- Department of Neurology, Heinrich Heine University, Düsseldorf, Germany
| | - R Höftberger
- Division of Neuropathology and Neurochemistry, Department of Neurology, Medical University of Vienna, Vienna, Austria
- Comprehensive Center for Clinical Neurosciences and Mental Health, Medical University of Vienna, Vienna, Austria
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - L Komorowski
- Institute of Experimental Neuroimmunology, affiliated to Euroimmun AG, Lübeck, Germany
| | - F Paul
- Experimental and Clinical Research Center, a cooperation between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité - Universitätsmedizin Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - M Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
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2
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Paul F, Pittock S, Kim H, Smith M, Rees W, Patterson K, Cree B, Bennett J. P-59 Association of B cell subsets and aquaporin-4 antibody titers with disease activity in participants in the N-MOmentum trial receiving inebilizumab treatment. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Pittock S, Barnett M, Bennett J, Berthele A, de Sèze J, Levy M, Nakashima I, Oreja-Guevara C, Palace J, Paul F, Pozzilli C, Allen K, Mashhoon Y, Yountz M, Kim H. P-53 Efficacy and safety of ravulizumab in adults with anti-aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder: Outcomes from the phase 3 CHAMPION-NMOSD trial. Clin Neurophysiol 2023. [DOI: 10.1016/j.clinph.2023.02.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Arnal ME, Denis S, Uriot O, Lambert C, Holowacz S, Paul F, Kuylle S, Pereira B, Alric M, Blanquet-Diot S. Impact of oral galenic formulations of Lactobacillus salivarius on probiotic survival and interactions with microbiota in human in vitro gut models. Benef Microbes 2021; 12:75-90. [PMID: 34109893 DOI: 10.3920/bm2020.0187] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Health benefits of probiotics in humans essentially depend on their ability to survive during gastrointestinal (GI) transit and to modulate gut microbiota. To date, there is few data on the impact of galenic formulations of probiotics on these parameters. Even if clinical studies remain the gold standard to evaluate the efficacy of galenic forms, they stay hampered by technical, ethical and cost reasons. As an alternative approach, we used two complementary in vitro models of the human gut, the TNO gastrointestinal (TIM-1) model and the Artificial Colon (ARCOL), to study the effect of three oral formulations of a Lactobacillus salivarius strain (powder, capsule and sustained-release tablet) on its viability and interactions with gut microbiota. In the TIM-1 stomach, no or low numbers of bacteria were respectively released from the capsule and tablet, confirming their gastro-resistance. The capsule was disintegrated in the jejunum on average 76 min after administration while the core of sustained-release tablet was still intact at the end of digestion. Viability in TIM-1 was significantly influenced by the galenic form with survival percentages of 0.003±0.004%, 2.8±0.6% and 17.0±1.8% (n=3) for powder, capsule and tablet, respectively. In the ARCOL, the survival of the strain tended to be higher in the post-treatment phase with the tablet compared to capsule, but gut microbiota composition and activity were not differently modulated by the two formulations. In conclusion, the sustained-release tablet emerged as the formulation that most effectively preserved viability of the tested strain during GI passage. This study highlights the usefulness of in vitro gut models for the pre-screening of probiotic pharmaceutical forms. Their use could also easily be extended to the evaluation of the effects of food matrices and age on probiotic survival and activity during GI transit.
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Affiliation(s)
- M E Arnal
- Université Clermont Auvergne, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, 28 place Henri Dunant, 63000 Clermont-Ferrand, France
| | - S Denis
- Université Clermont Auvergne, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, 28 place Henri Dunant, 63000 Clermont-Ferrand, France
| | - O Uriot
- Université Clermont Auvergne, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, 28 place Henri Dunant, 63000 Clermont-Ferrand, France
| | - C Lambert
- University Hospital Clermont-Ferrand, Biostatistics Units, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - S Holowacz
- PiLeJe Industrie, Parc Naturopôle, Les Tiolans 03800 Saint-Bonnet de Rochefort, France
| | - F Paul
- Genibio, Le Pradas, ZI du Couserans, 09190 Lorp-Sentaraille, France
| | - S Kuylle
- Genibio, Le Pradas, ZI du Couserans, 09190 Lorp-Sentaraille, France
| | - B Pereira
- University Hospital Clermont-Ferrand, Biostatistics Units, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - M Alric
- Université Clermont Auvergne, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, 28 place Henri Dunant, 63000 Clermont-Ferrand, France
| | - S Blanquet-Diot
- Université Clermont Auvergne, UMR 454 MEDIS, Microbiologie Environnement Digestif et Santé, 28 place Henri Dunant, 63000 Clermont-Ferrand, France
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Shugar DH, Jacquemart M, Shean D, Bhushan S, Upadhyay K, Sattar A, Schwanghart W, McBride S, de Vries MVW, Mergili M, Emmer A, Deschamps-Berger C, McDonnell M, Bhambri R, Allen S, Berthier E, Carrivick JL, Clague JJ, Dokukin M, Dunning SA, Frey H, Gascoin S, Haritashya UK, Huggel C, Kääb A, Kargel JS, Kavanaugh JL, Lacroix P, Petley D, Rupper S, Azam MF, Cook SJ, Dimri AP, Eriksson M, Farinotti D, Fiddes J, Gnyawali KR, Harrison S, Jha M, Koppes M, Kumar A, Leinss S, Majeed U, Mal S, Muhuri A, Noetzli J, Paul F, Rashid I, Sain K, Steiner J, Ugalde F, Watson CS, Westoby MJ. A massive rock and ice avalanche caused the 2021 disaster at Chamoli, Indian Himalaya. Science 2021; 373:300-306. [PMID: 34112725 DOI: 10.1126/science.abh4455] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/27/2021] [Indexed: 11/02/2022]
Abstract
On 7 February 2021, a catastrophic mass flow descended the Ronti Gad, Rishiganga, and Dhauliganga valleys in Chamoli, Uttarakhand, India, causing widespread devastation and severely damaging two hydropower projects. More than 200 people were killed or are missing. Our analysis of satellite imagery, seismic records, numerical model results, and eyewitness videos reveals that ~27 × 106 cubic meters of rock and glacier ice collapsed from the steep north face of Ronti Peak. The rock and ice avalanche rapidly transformed into an extraordinarily large and mobile debris flow that transported boulders greater than 20 meters in diameter and scoured the valley walls up to 220 meters above the valley floor. The intersection of the hazard cascade with downvalley infrastructure resulted in a disaster, which highlights key questions about adequate monitoring and sustainable development in the Himalaya as well as other remote, high-mountain environments.
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Affiliation(s)
- D H Shugar
- Water, Sediment, Hazards, and Earth-surface Dynamics (waterSHED) Lab, Department of Geoscience, University of Calgary, AB, Canada.
| | - M Jacquemart
- Cooperative Institute for Research in Environmental Sciences, University of Colorado, Boulder, CO, USA.,Laboratory of Hydraulics, Hydrology, and Glaciology (VAW), ETH Zurich, Zurich, Switzerland.,Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland
| | - D Shean
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - S Bhushan
- Department of Civil and Environmental Engineering, University of Washington, Seattle, WA, USA
| | - K Upadhyay
- Independent journalist/water policy researcher, Nainital, Uttarakhand, India
| | - A Sattar
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - W Schwanghart
- Institute of Environmental Science and Geography, University of Potsdam, Potsdam, Germany
| | - S McBride
- U.S. Geological Survey, Earthquake Science Center, Moffett Field, CA, USA
| | - M Van Wyk de Vries
- Department of Earth and Environmental Sciences, University of Minnesota, Minneapolis, MN, USA.,St. Anthony Falls Laboratory, University of Minnesota, Minneapolis, MN, USA
| | - M Mergili
- Institute of Geography and Regional Science, University of Graz, Graz, Austria.,Institute of Applied Geology, University of Natural Resources and Life Sciences (BOKU), Vienna, Austria
| | - A Emmer
- Institute of Geography and Regional Science, University of Graz, Graz, Austria
| | - C Deschamps-Berger
- Centre d'Etudes Spatiales de la Biosphère (CESBIO), Université de Toulouse, CNES/CNRS/INRAE/IRD/UP, Toulouse, France
| | - M McDonnell
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - R Bhambri
- Department of Geography, South Asia Institute, Heidelberg University, Heidelberg, Germany
| | - S Allen
- Department of Geography, University of Zurich, Zurich, Switzerland.,Institute for Environmental Sciences, University of Geneva, Switzerland
| | - E Berthier
- Laboratoire d'Etudes en Géophysique et Océanographie Spatiales (LEGOS), Université de Toulouse, CNES/CNRS/IRD/UPS, Toulouse, France
| | - J L Carrivick
- School of Geography, University of Leeds, Leeds, West Yorkshire, UK.,water@leeds, University of Leeds, Leeds, West Yorkshire, UK
| | - J J Clague
- Department of Earth Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - M Dokukin
- Department of Natural Disasters, High-Mountain Geophysical Institute, Nalchik, Russia
| | - S A Dunning
- School of Geography, Politics, and Sociology, Newcastle University, Newcastle, UK
| | - H Frey
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - S Gascoin
- Centre d'Etudes Spatiales de la Biosphère (CESBIO), Université de Toulouse, CNES/CNRS/INRAE/IRD/UP, Toulouse, France
| | - U K Haritashya
- Department of Geology and Environmental Geosciences, University of Dayton, Dayton, OH, USA
| | - C Huggel
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - A Kääb
- Department of Geosciences, University of Oslo, Oslo, Norway
| | - J S Kargel
- Planetary Science Institute, Tucson, AZ, USA
| | - J L Kavanaugh
- Department of Earth and Atmospheric Sciences, University of Alberta, Edmonton, AB, Canada
| | - P Lacroix
- ISTerre, Université Grenoble Alpes, IRD, CNRS, Grenoble, France
| | - D Petley
- Department of Geography, The University of Sheffield, Sheffield, UK
| | - S Rupper
- Department of Geography, University of Utah, Salt Lake City, Utah, USA
| | - M F Azam
- Indian Institute of Technology Indore, Madhya Pradesh, Indore, India
| | - S J Cook
- Department of Geography and Environmental Science, University of Dundee, Dundee, UK.,United Nations Educational, Scientific and Cultural Organization (UNESCO) Centre for Water Law, Policy, and Science, University of Dundee, Dundee, UK
| | - A P Dimri
- School of Environmental Sciences, Jawaharlal Nehru University, New Delhi, India
| | - M Eriksson
- Stockholm International Water Institute, Stockholm, Sweden
| | - D Farinotti
- Laboratory of Hydraulics, Hydrology, and Glaciology (VAW), ETH Zurich, Zurich, Switzerland.,Swiss Federal Institute for Forest, Snow and Landscape Research WSL, Birmensdorf, Switzerland
| | - J Fiddes
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland
| | - K R Gnyawali
- School of Engineering, University of British Columbia, Kelowna, BC, Canada
| | - S Harrison
- College of Life and Environmental Sciences, University of Exeter, Penryn, UK
| | - M Jha
- Department of Mines and Geology, National Earthquake Monitoring and Research Center, Kathmandu, Nepal
| | - M Koppes
- Department of Geography, University of British Columbia, Vancouver, BC, Canada
| | - A Kumar
- Wadia Institute of Himalayan Geology, Dehradun, Uttarakhand, India
| | - S Leinss
- Institute of Environmental Engineering (IfU), ETH Zurich, 8093 Zürich, Switzerland
| | - U Majeed
- Department of Geoinformatics, University of Kashmir, Hazratbal Srinagar, Jammu and Kashmir, India
| | - S Mal
- Department of Geography, Shaheed Bhagat Singh College, University of Delhi, Delhi, India
| | - A Muhuri
- Centre d'Etudes Spatiales de la Biosphère (CESBIO), Université de Toulouse, CNES/CNRS/INRAE/IRD/UP, Toulouse, France.,Institute of Geography, Heidelberg University, Germany
| | - J Noetzli
- WSL Institute for Snow and Avalanche Research SLF, Davos, Switzerland
| | - F Paul
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - I Rashid
- Department of Geoinformatics, University of Kashmir, Hazratbal Srinagar, Jammu and Kashmir, India
| | - K Sain
- Wadia Institute of Himalayan Geology, Dehradun, Uttarakhand, India
| | - J Steiner
- International Centre for Integrated Mountain Development, Kathmandu, Nepal.,Department of Physical Geography, Utrecht University, Netherlands
| | - F Ugalde
- Geoestudios, San José de Maipo, Chile.,Department of Geology, University of Chile, Santiago, Chile
| | - C S Watson
- Centre for Observation and Modelling of Earthquakes, Volcanoes and Tectonics (COMET), School of Earth and Environment, University of Leeds, Leeds, UK
| | - M J Westoby
- Department of Geography and Environmental Sciences, Northumbria University, Newcastle upon Tyne, UK
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Siebert N, Duchow A, Paul F, Infante-Duarte C, Bellmann-Strobl J. Inebilizumab in AQP4-Ab-positive neuromyelitis optica spectrum disorder. Drugs Today (Barc) 2021; 57:321-336. [PMID: 34061127 DOI: 10.1358/dot.2021.57.5.3265453] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Until recently, the use of preventative immunotherapy in neuromyelitis optica spectrum disorders (NMOSD) was based on observational studies and clinical experiences. Meanwhile, the first drugs, among others the monoclonal antibody inebilizumab, were approved for the treatment of aquaporin-4 (AQP4) antibody-positive NMOSD. Inebilizumab binds to the CD19 antigen on B cells and leads to B-cell depletion. The first two dosages of 300 mg inebilizumab are administered intravenously at an interval of 2 weeks followed by further infusions every 6 months. In the placebo-controlled pivotal phase II/III study N-MOmentum, inebilizumab significantly prolonged the time to a first adjudicated relapse in AQP4 antibody-positive patients compared with placebo. The most frequent side effects were infusion reactions, urinary and respiratory tract infections, and arthralgia. This review presents data on clinical and preclinical pharmacology, administration, safety aspects and clinical trials of inebilizumab.
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Affiliation(s)
- N Siebert
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany. .,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Duchow
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Paul
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Infante-Duarte
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - J Bellmann-Strobl
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, NeuroCure Clinical Research Center, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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7
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Abstract
Dysphagia is a common symptom in neurodegenerative disorders and is generally associated with increased mortality. In the clinical care setting of ataxia patients, no systematical and standardized assessment of dysphagia is employed. Its impact on patients’ health-related quality of life is not well understood. To assess the impact of dysphagia in ataxia patients on diet, body weight, and health-related quality of life. We conducted a large survey using self-reported questionnaires for swallowing-related quality of life (Swal-QOL) and a food frequency list in combination with retrospective clinical data of 119 patients with cerebellar ataxia treated in the neurological outpatient clinic of a large German university hospital. Seventeen percent of ataxia patients suffered from dysphagia based on the Swal-QOL score. Less than 1% of all patients reported dysphagia as one of their most disabling symptoms. Dysphagia was associated with unintentional weight loss (p = 0.02) and reduced health-related quality of life (p = 0.01) but did not affect individual nutritional habits (p > 0.05; Chi-squared test). Dysphagia is a relevant symptom in cerebellar ataxia. A systematic screening for dysphagia in patients with cerebellar ataxia would be desirable to enable early diagnosis and treatment.
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Affiliation(s)
- M Rönnefarth
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - N Hanisch
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany
| | - A U Brandt
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - A Mähler
- Experimental & Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - M Endres
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - F Paul
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany.,NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Experimental & Clinical Research Center, Charité-Universitätsmedizin Berlin and Max Delbrück Center for Molecular Medicine, Lindenberger Weg 80, 13125, Berlin, Germany
| | - Sarah Doss
- Department of Neurology, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Germany. .,Movement Disorders Section, Department of Neurological Sciences, University of Nebraska Medical Center, 4242 Farnam Street, 68131, Omaha, NE, USA.
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8
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Hsieh KL, Mirelman A, Shema-Shiratzky S, Galperin I, Regev K, Shen S, Schmitz-Hübsch T, Karni A, Paul F, Devos H, Sosnoff JJ, Hausdorff JM. A multi-modal virtual reality treadmill intervention for enhancing mobility and cognitive function in people with multiple sclerosis: Protocol for a randomized controlled trial. Contemp Clin Trials 2020; 97:106122. [PMID: 32858229 DOI: 10.1016/j.cct.2020.106122] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [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: 04/30/2020] [Revised: 06/25/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Gait and cognitive impairments are common in individuals with Multiple Sclerosis (MS) and can interfere with everyday function. Those with MS have difficulties executing cognitive tasks and walking simultaneously, a reflection of dual-task interference. Therefore, dual-task training may improve functional ambulation. Additionally, using technology such as virtual reality can provide personalized rehabilitation while mimicking real-world environments. The purpose of this randomized controlled trial is to establish the benefits of a combined cognitive-motor virtual reality training on MS symptoms compared to conventional treadmill training. METHODS This study will be a single-blinded, two arm RCT with a six-week intervention period. 144 people with MS will be randomized into a treadmill training alone group or treadmill training with virtual reality group. Both groups will receive 18 sessions of training while walking on a treadmill, with the virtual reality group receiving feedback from the virtual system. Primary outcome measures include dual-task gait speed and information processing speed, which will be measured prior to training, one-week post-training, and three months following training. DISCUSSION This study will provide insight into the ability of a multi-modal cognitive-motor intervention to reduce dual-task cost and to enhance information processing speed in those with MS. This is one of the first studies that is powered to understand whether targeted dual-task training can improve MS symptoms and increase functional ambulation. We anticipate that those in the virtual reality group will have a significantly greater increase in dual-task gait speed and information processing speed than those achieved via treadmill training alone.
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Affiliation(s)
- K L Hsieh
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - A Mirelman
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Shema-Shiratzky
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I Galperin
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - K Regev
- Neuroimmunology and Multiple Sclerosis Unit of the Neurology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Shen
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - T Schmitz-Hübsch
- NeuroCure, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - A Karni
- Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Neurology, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Neuroimmunology and Multiple Sclerosis Unit of the Neurology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - F Paul
- NeuroCure, Charité - Universitaetsmedizin Berlin, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin, Berlin, Germany; Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - H Devos
- Laboratory for Advanced Rehabilitation Research in Simulation, Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States of America
| | - J J Sosnoff
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA; Illinois Multiple Sclerosis Research Collaborative, Interdisciplinary Health Science Institute, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - J M Hausdorff
- Center for the Study of Movement, Cognition and Mobility, Neurological Institute, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel; Department of Physical Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery, Rush University Medical Center, Chicago, IL, USA.
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9
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Hälbig TD, Wüstenberg T, Giess RM, Kunte H, Bellmann-Strobl J, Ruprecht K, Paul F. Emotional experience in patients with clinically isolated syndrome and early multiple sclerosis. Eur J Neurol 2020; 27:1537-1545. [PMID: 32307769 DOI: 10.1111/ene.14269] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 04/02/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND AND PURPOSE Evidence suggests that there are changes in the processing of emotional information (EP) in people with multiple sclerosis (MS). It is unclear which functional domains of EP are affected, whether these changes are secondary to other MS-related neuropsychological or psychiatric symptoms and if EP changes are present in early MS. The aim of the study was to investigate EP in patients with early MS (clinically isolated syndrome and early relapsing/remitting MS) and healthy controls (HCs). METHODS A total of 29 patients without neuropsychological or psychiatric deficits and 29 matched HCs were presented with pictures from the International Affective Picture System with negative, positive or neutral content. Participants rated the induced emotion regarding valence and arousal using nine-level Likert scales. A speeded recognition test assessed memory for the emotional stimuli and for the emotional modulation of response time. A subgroup of participants was tested during a magnetic resonance imaging (MRI) session. RESULTS Patients in the MRI subgroup rated the experience induced by pictures with positive or negative emotional content significantly more weakly than HCs. Further, these patients were significantly less aroused when watching the pictures from the International Affective Picture System. There were no effects in the non-MRI subgroup or effects on emotional memory or response times. CONCLUSIONS Emotional processing changes may be present in early MS in the form of flattened emotional experience on both the valence and arousal dimensions. These changes do not appear to be secondary to neuropsychological or psychiatric deficits. The fact that emotional flattening was only found in the MRI setting suggests that EP changes may be unmasked within stressful environments and points to the potential yet underestimated impact of the MRI setting on behavioral outcomes.
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Affiliation(s)
- T D Hälbig
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - T Wüstenberg
- Department of Psychiatry and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - R M Giess
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - H Kunte
- Faculty of Natural Sciences, MSB, Medical School Berlin, Berlin, Germany
| | - J Bellmann-Strobl
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - K Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
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10
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Le Tohic S, Muziotti C, Ferrand E, Paul F, Bailli A, Gauthier G, Boulliat C. Analyse des erreurs de préparation des piluliers dans le cadre de la DJIN destinée au service de psychiatrie à l’HIA Laveran. Eur Psychiatry 2020. [DOI: 10.1016/j.eurpsy.2015.09.314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
IntroductionDans le cadre de la sécurisation du circuit du médicament, une EPP a été réalisée pour mettre en évidence le nombre d’erreurs identifiées lors de la préparation des piluliers dans le cadre de la DJIN des patients hospitalisés en psychiatrie.Matériels et méthodeMenée de janvier à décembre 2014, cette étude prospective a permis de recenser et de typer les erreurs identifiées lors de la préparation des piluliers. Quotidiennement et de manière aléatoire, 4 chariots sur 10 étaient entièrement contrôlés. Les 6 autres ne l’étaient que partiellement, à raison de 2 piluliers choisis au hasard par chariot. Les résultats obtenus correspondent au nombre d’erreurs rapporté au nombre d’ordonnances contrôlées, par service et par mois.Résultats et discussionEn 2014, le pourcentage d’erreurs identifiées pour le service de psychiatrie est de 6,04 %, soit 1 erreur toutes les 26 lignes. Ce résultat est conforme aux données de la littérature (6–7 %)*, contrairement à celui obtenu pour l’ensemble de l’hôpital (7,78 %). En effet, le service de psychiatrie témoigne d’une certaine stabilité en raison d’une chronicité des pathologies traitées et d’une protocolisation des prises en charge. Les patients sont ainsi souvent suivis depuis longtemps et leur traitement ne change que ponctuellement. Cependant, malgré cette sécurité apparente, la vigilance de l’équipe soignante est essentielle : sur les 1300 ordonnances non contrôlées, 79 erreurs n’auraient donc pas été interceptées par la pharmacie, si le même pourcentage d’erreurs est appliqué.ConclusionLe double contrôle lors de la préparation des traitements est essentiel. Il permet d’intercepter les erreurs à la pharmacie, mais aussi dans le service clinique. À l’heure où l’exercice de l’infirmier est à la médicalisation, l’infirmier reste le dernier verrou avant le patient.
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11
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Fraysse C, Gignoux-Froment F, Juzan N, Cazes N, Poinso F, Paul F. Mesure de la prévalence du trouble de stress post-traumatique chez les marins-pompiers de Marseille. Ann Fr Med Urgence 2020. [DOI: 10.3166/afmu-2020-0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objectif : En France, peu d’études ont exploré la prévalence du trouble de stress post-traumatique (TSPT) chez les pompiers. Une étude de 2007 retrouve un taux de 1 %, identique à celui de la population générale. Or, les pompiers sont surexposés aux interventions potentiellement traumatogènes et sont donc à risque de traumatismes vicariants, c’est-à-dire par procuration. L’objectif de notre étude était d’estimer la prévalence du TSPT chez les marins-pompiers du bataillon de marins-pompiers de Marseille.
Matériel et méthodes : Durant six mois, les marins-pompiers se présentant à leur visite médicale périodique au service médical d’unité ont rempli un autoquestionnaire comprenant des données sociodémographiques, professionnelles et la Posttraumatic Stress Disorder Checklist Scale (PCLS) avec un seuil à 44.
Résultats : Parmi les 356 sauveteurs inclus, soit un taux de réponse de 86 %, 4 % (IC 95 % : [2 ; 7]) avaient un TSPT. Les facteurs associés étaient une fatigue durable, des répercussions négatives sur la vie familiale, professionnelle, sociale et le ressenti d’un manque de soutien institutionnel.
Conclusion : Ces résultats confirment que les sauveteurs constituent une population à risque. Afin de comparer avec les études internationales, de nouvelles recherches avec la PCL-5 seraient souhaitables.
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12
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Chien C, Juenger V, Scheel M, Brandt AU, Paul F. Considerations for Mean Upper Cervical Cord Area Implementation in a Longitudinal MRI Setting: Methods, Interrater Reliability, and MRI Quality Control. AJNR Am J Neuroradiol 2020; 41:343-350. [PMID: 31974079 DOI: 10.3174/ajnr.a6394] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 09/09/2019] [Accepted: 12/04/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Spinal cord atrophy is commonly measured from cerebral MRIs, including the upper cervical cord. However, rescan intraparticipant measures have not been investigated in healthy cohorts. This study investigated technical and rescan variability in the mean upper cervical cord area calculated from T1-weighted cerebral MRIs. MATERIALS AND METHODS In this retrospective study, 8 healthy participants were scanned and rescanned with non-distortion- and distortion-corrected MPRAGE sequences (11-50 sessions in 6-8 months), and 50 participants were scanned once with distortion-corrected MPRAGE sequences in the Day2day daily variability study. From another real-world observational cohort, we collected non-distortion-corrected MPRAGE scans from 27 healthy participants (annually for 2-4 years) and cross-sectionally from 77 participants. Statistical analyses included coefficient of variation, smallest real difference, intraclass correlation coefficient, Bland-Altman limits of agreement, and paired t tests. RESULTS Distortion- versus non-distortion-corrected MPRAGE-derived mean upper cervical cord areas were similar; however, a paired t test showed incomparability (t = 11.0, P = <.001). Higher variability was found in the mean upper cervical cord areas calculated from an automatic segmentation method. Interrater analysis yielded incomparable measures in the same participant scans (t = 4.5, P = <.001). Non-distortion-corrected mean upper cervical cord area measures were shown to be robust in real-world data (t = -1.04, P = .31). The main sources of variability were found to be artifacts from movement, head/neck positioning, and/or metal implants. CONCLUSIONS Technical variability in cord measures decreased using non-distortion-corrected MRIs, a semiautomatic segmentation approach, and 1 rater. Rescan variability was within ±4.4% for group mean upper cervical cord area when MR imaging quality criteria were met.
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Affiliation(s)
- C Chien
- From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)
| | - V Juenger
- From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)
- Departments of Neuroradiology (V.J., M.S.)
| | - M Scheel
- Departments of Neuroradiology (V.J., M.S.)
| | - A U Brandt
- From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)
- Department of Neurology (A.U.B.), University of California, Irvine, Irvine, California
| | - F Paul
- From the Experimental and Clinical Research Center (C.C., V.J., A.U.B., F.P.), Max Delbrück Center for Molecular Medicine & Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- NeuroCure Clinical Research Center (C.C., V.J., M.S., A.U.B., F.P.)
- Neurology (F.P.), Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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13
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Zemp M, Huss M, Thibert E, Eckert N, McNabb R, Huber J, Barandun M, Machguth H, Nussbaumer SU, Gärtner-Roer I, Thomson L, Paul F, Maussion F, Kutuzov S, Cogley JG. Global glacier mass changes and their contributions to sea-level rise from 1961 to 2016. Nature 2019; 568:382-386. [PMID: 30962533 DOI: 10.1038/s41586-019-1071-0] [Citation(s) in RCA: 121] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 01/24/2019] [Indexed: 11/09/2022]
Abstract
Glaciers distinct from the Greenland and Antarctic ice sheets cover an area of approximately 706,000 square kilometres globally1, with an estimated total volume of 170,000 cubic kilometres, or 0.4 metres of potential sea-level-rise equivalent2. Retreating and thinning glaciers are icons of climate change3 and affect regional runoff4 as well as global sea level5,6. In past reports from the Intergovernmental Panel on Climate Change, estimates of changes in glacier mass were based on the multiplication of averaged or interpolated results from available observations of a few hundred glaciers by defined regional glacier areas7-10. For data-scarce regions, these results had to be complemented with estimates based on satellite altimetry and gravimetry11. These past approaches were challenged by the small number and heterogeneous spatiotemporal distribution of in situ measurement series and their often unknown ability to represent their respective mountain ranges, as well as by the spatial limitations of satellite altimetry (for which only point data are available) and gravimetry (with its coarse resolution). Here we use an extrapolation of glaciological and geodetic observations to show that glaciers contributed 27 ± 22 millimetres to global mean sea-level rise from 1961 to 2016. Regional specific-mass-change rates for 2006-2016 range from -0.1 metres to -1.2 metres of water equivalent per year, resulting in a global sea-level contribution of 335 ± 144 gigatonnes, or 0.92 ± 0.39 millimetres, per year. Although statistical uncertainty ranges overlap, our conclusions suggest that glacier mass loss may be larger than previously reported11. The present glacier mass loss is equivalent to the sea-level contribution of the Greenland Ice Sheet12, clearly exceeds the loss from the Antarctic Ice Sheet13, and accounts for 25 to 30 per cent of the total observed sea-level rise14. Present mass-loss rates indicate that glaciers could almost disappear in some mountain ranges in this century, while heavily glacierized regions will continue to contribute to sea-level rise beyond 2100.
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Affiliation(s)
- M Zemp
- Department of Geography, University of Zurich, Zurich, Switzerland.
| | - M Huss
- Laboratory of Hydraulics, Hydrology and Glaciology (VAW), ETH Zurich, Zurich, Switzerland.,Department of Geosciences, University of Fribourg, Fribourg, Switzerland
| | - E Thibert
- Université Grenoble Alpes, Irstea, UR ETGR, Grenoble, France
| | - N Eckert
- Université Grenoble Alpes, Irstea, UR ETGR, Grenoble, France
| | - R McNabb
- Department of Geosciences, University of Oslo, Oslo, Norway
| | - J Huber
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - M Barandun
- Department of Geosciences, University of Fribourg, Fribourg, Switzerland
| | - H Machguth
- Department of Geography, University of Zurich, Zurich, Switzerland.,Department of Geosciences, University of Fribourg, Fribourg, Switzerland
| | - S U Nussbaumer
- Department of Geography, University of Zurich, Zurich, Switzerland.,Department of Geosciences, University of Fribourg, Fribourg, Switzerland
| | - I Gärtner-Roer
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - L Thomson
- Department of Geography and Planning, Queen's University, Kingston, Ontario, Canada
| | - F Paul
- Department of Geography, University of Zurich, Zurich, Switzerland
| | - F Maussion
- Department of Atmospheric and Cryospheric Sciences, University of Innsbruck, Innsbruck, Austria
| | - S Kutuzov
- Department of Glaciology, Institute of Geography, Russian Academy of Sciences, Moscow, Russia
| | - J G Cogley
- Department of Geography, Trent University, Peterborough, Ontario, Canada
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14
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Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are mostly relapsing inflammatory conditions of the central nervous system (CNS). In 55% of the cases of NMOSD optic neuritis (ON) is the most frequent first manifestation and can cause severe damage to the afferent visual system and the retina with resultant severe visual impairment. In recent years, investigations of the retina as part of the CNS by optical coherence tomography (OCT) has been shown to be a valid and efficient method for diagnostics and evaluation of the disease course in NMOSD. In addition, OCT not only shows severe damage of the afferent visual system due to multiple bouts of ON but also reveals NMOSD-specific intraretinal pathologies. The latter could be just as important for future differential diagnostics as for the evaluation of potential therapeutic targets. This article briefly reviews the principles of the OCT technique and describes its relevance for the diagnostics and assessment of disease course in NMOSD.
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Affiliation(s)
- F C Oertel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland
| | - H Zimmermann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland
| | - A U Brandt
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member der Freien Universität Berlin, Humboldt-Universität zu Berlin und Berlin Institute of Health, Berlin, Deutschland. .,Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland. .,Experimental and Clinical Research Center, Max-Delbrück-Centrum für Molekulare Medizin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland.
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15
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Olesen MN, Soelberg K, Debrabant B, Nilsson AC, Lillevang ST, Grauslund J, Brandslund I, Madsen JS, Paul F, Smith TJ, Jarius S, Asgari N. Cerebrospinal fluid biomarkers for predicting development of multiple sclerosis in acute optic neuritis: a population-based prospective cohort study. J Neuroinflammation 2019; 16:59. [PMID: 30857557 PMCID: PMC6410527 DOI: 10.1186/s12974-019-1440-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [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: 09/13/2018] [Accepted: 02/22/2019] [Indexed: 12/02/2022] Open
Abstract
Background Long-term outcome in multiple sclerosis (MS) depends on early treatment. In patients with acute optic neuritis (ON), an early inflammatory event, we investigated markers in cerebrospinal fluid (CSF), which may predict a diagnosis of MS. Methods Forty patients with acute ON were recruited in a prospective population-based cohort with median 29 months (range 19–41) of follow-up. Paired CSF and serum samples were taken within 14 days (range 2–38), prior to treatment. Prospectively, 16/40 patients were by a uniform algorithm diagnosed with MS (MS-ON) and 24 patients continued to manifest isolated ON (ION) during follow-up. Levels of cytokines and neurofilament light chain (NF-L) were measured at the onset of acute ON and compared to healthy controls (HC). Significance levels were corrected for multiple comparisons (“q”). The predictive value of biomarkers was determined with multivariable prediction models using nomograms. Results CSF TNF-α, IL-10, and CXCL13 levels were increased in MS-ON compared to those in ION patients (q = 0.021, 0.004, and 0.0006, respectively). MS-ON patients had increased CSF pleocytosis, IgG indices, and oligoclonal bands (OCBs) compared to ION (q = 0.0007, q = 0.0058, and q = 0.0021, respectively). CSF levels of IL-10, TNF-a, IL-17A, and CXCL13 in MS-ON patients correlated with leukocyte counts (r > 0.69 and p < 0.002) and IgG index (r > 0.55, p < 0.037). CSF NF-L levels were increased in ON patients compared to those in HC (q = 0.0077). In MS-ON, a progressive increase in NF-L levels was observed at 7 to 14 days after disease onset (r = 0.73, p < 0.0065). Receiver-operating characteristic (ROC) curves for two multivariable prediction models were generated, with IL-10, CXCL13, and NF-L in one (“candidate”) and IgG index, OCB, and leukocytes in another (“routine”). Area under the curve was 0.89 [95% CI 0.77–1] and 0.86 [0.74–0.98], respectively. Predictions of the risk of MS diagnosis were illustrated by two nomograms. Conclusions CSF TNF-α, IL-10, CXCL13, and NF-L levels were associated with the development of MS, suggesting that the inflammatory and neurodegenerative processes occurred early. Based on subsequent diagnosis, we observed a high predictive value of routine and candidate biomarkers in CSF for the development of MS in acute ON. The nomogram predictions may be useful in the diagnostic work-up of MS. Electronic supplementary material The online version of this article (10.1186/s12974-019-1440-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M N Olesen
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark.,Department of Clinical Immunology and Biochemistry, Lillebælt Hospital, Vejle, Denmark.,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Winsloewsvej 25.2, 5000, Odense C, Denmark
| | - K Soelberg
- Department of Internal Medicine, Slagelse Hospital, Slagelse, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark.,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
| | - B Debrabant
- Epidemiology, Biostatistics and Biodemography, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - A C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - S T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - I Brandslund
- Department of Clinical Immunology and Biochemistry, Lillebælt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - J S Madsen
- Department of Clinical Immunology and Biochemistry, Lillebælt Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - F Paul
- Clinical and Experimental Multiple Sclerosis Research Center and NeuroCure Clinical Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - T J Smith
- Departments of Ophthalmology and Visual Sciences and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - N Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark. .,Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Winsloewsvej 25.2, 5000, Odense C, Denmark. .,Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark.
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16
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Jarius S, Haas J, Paul F, Wildemann B. Myelinoclastic diffuse sclerosis (Schilder's disease) is immunologically distinct from multiple sclerosis: results from retrospective analysis of 92 lumbar punctures. J Neuroinflammation 2019; 16:51. [PMID: 30819213 PMCID: PMC6396538 DOI: 10.1186/s12974-019-1425-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 10/11/2018] [Accepted: 01/31/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Myelinoclastic diffuse sclerosis (MDS; also termed Schilder's disease) is a rare inflammatory demyelinating disorder of the central nervous system characterised by demyelination of vast areas of the white matter. It is unclear whether MDS is a variant of multiple sclerosis (MS) or a disease entity in its own right. OBJECTIVE To compare the cerebrospinal fluid (CSF) features of MDS with those of MS. METHODS Retrospective analysis of the CSF profile of all patients with MDS reported in the medical literature between 1960 and 2018. RESULTS The most striking finding was a substantial lack of oligoclonal bands (OCBs) in MDS, which were absent in at least 77% (30/39) of all lumbar punctures (LP) in the total cohort and in 86% in the subgroup of patients with normal very long-chain fatty acid serum ratios (VLCFA). Almost all cases published in the past 15 years were negative for OCBs. These findings are in contrast to MS, in which OCBs are present in up to 98% of cases (p < 0.00001 when compared with reference works in MS; both in adult and in pediatric patients). CSF pleocytosis was absent in at least 79% (46/58) of all LP (p < 0.0001 vs. MS) and in 92% (24/26) of LPs in the VLCFA-tested subgroup. CSF total protein levels were elevated in 56% of all LPs (p < 0.0001 vs. MS) and in 63% of LPs in the VLCFA-tested subgroup and were often higher than in typical MS (> 100 mg/dL in 13/22; up to 220 mg/dL). EBV serum antibodies, which are present in virtually all patients with MS, and the so-called MRZ (measles/rubella/zoster) reaction, a highly specific marker of MS, were absent in all of the few patients tested. In addition, we discuss further differences between MS and MDS, taking into account also Schilder's original comprehensive case description from 1912. CONCLUSION In the majority of patients diagnosed with MDS, CSF features differ significantly from those typically found in MS and are more similar to those previously reported in patients with myelin oligodendrocyte glycoprotein-immunoglobulin G (IgG)-positive encephalomyelitis, aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders or Baló's concentric sclerosis. Our data suggest that MDS and MS are immunopathologically distinct entities in the majority of cases.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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17
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Paul F, Kühne A, Grube M, Heck V, Hänel P. Prävention und Versorgung für den Kiez: Sozialraum- und Bedarfsanalyse für ein stadtteilorientiertes Gesundheitszentrum in Berlin-Neukölln. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667703] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- F Paul
- Gesundheitskollektiv Berlin e.V., Forschung und Evaluation, Berlin, Deutschland
| | - A Kühne
- Gesundheitskollektiv Berlin e.V., Berlin, Deutschland
| | - M Grube
- Gesundheitskollektiv Berlin e.V., Berlin, Deutschland
| | - V Heck
- Gesundheitskollektiv Berlin e.V., Berlin, Deutschland
| | - P Hänel
- Gesundheitskollektiv Berlin e.V., Berlin, Deutschland
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18
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Chien C, Brandt AU, Schmidt F, Bellmann-Strobl J, Ruprecht K, Paul F, Scheel M. MRI-Based Methods for Spinal Cord Atrophy Evaluation: A Comparison of Cervical Cord Cross-Sectional Area, Cervical Cord Volume, and Full Spinal Cord Volume in Patients with Aquaporin-4 Antibody Seropositive Neuromyelitis Optica Spectrum Disorders. AJNR Am J Neuroradiol 2018; 39:1362-1368. [PMID: 29748202 DOI: 10.3174/ajnr.a5665] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 03/13/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Measures for spinal cord atrophy have become increasingly important as imaging biomarkers in the assessment of neuroinflammatory diseases, especially in neuromyelitis optica spectrum disorders. The most commonly used method, mean upper cervical cord area, is relatively easy to measure and can be performed on brain MRIs that capture cervical myelon. Measures of spinal cord volume (eg, cervical cord volume or total cord volume) require longer scanning and more complex analysis but are potentially better suited as spinal cord atrophy measures. This study investigated spinal cord atrophy measures in a cohort of healthy subjects and patients with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorders and evaluated the discriminatory performance of mean upper cervical cord cross-sectional area compared with cervical cord volume and total cord volume. MATERIALS AND METHODS Mean upper cervical cord area, cervical cord volume, and total cord volume were measured using 3T MRIs from healthy subjects (n = 19) and patients with neuromyelitis optica spectrum disorders (n = 30). Group comparison and receiver operating characteristic analyses between healthy controls and patients with neuromyelitis optica spectrum disorders were performed. RESULTS Mean upper cervical cord area, cervical cord volume, and total cord volume measures showed similar and highly significant group differences between healthy control subjects and patients with neuromyelitis optica spectrum disorders (P < .01 for all). All 3 measures showed similar receiver operating characteristic-area under the curve values (mean upper cervical cord area = 0.70, cervical cord volume = 0.75, total cord volume = 0.77) with no significant difference between them. No associations among mean upper cervical cord cross-sectional area, cervical cord volume, or total cord volume with disability measures were found. CONCLUSIONS All 3 measures showed similar discriminatory power between healthy control and neuromyelitis optica spectrum disorders groups. Mean upper cervical cord area is easier to obtain compared with cervical cord volume and total cord volume and can be regarded as an efficient representative measure of spinal cord atrophy in the neuromyelitis optica spectrum disorders context.
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Affiliation(s)
- C Chien
- From the NeuroCure Clinical Research Center (C.C., A.U.B., F.S., J.B.-S., F.P. M.S.)
| | - A U Brandt
- From the NeuroCure Clinical Research Center (C.C., A.U.B., F.S., J.B.-S., F.P. M.S.)
| | - F Schmidt
- From the NeuroCure Clinical Research Center (C.C., A.U.B., F.S., J.B.-S., F.P. M.S.).,Departments of Neurology (F.S., K.R., F.P.)
| | - J Bellmann-Strobl
- From the NeuroCure Clinical Research Center (C.C., A.U.B., F.S., J.B.-S., F.P. M.S.).,Experimental and Clinical Research Center (J.B.-S., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - K Ruprecht
- Departments of Neurology (F.S., K.R., F.P.)
| | - F Paul
- From the NeuroCure Clinical Research Center (C.C., A.U.B., F.S., J.B.-S., F.P. M.S.) .,Departments of Neurology (F.S., K.R., F.P.).,Experimental and Clinical Research Center (J.B.-S., F.P.), Max Delbrück Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M Scheel
- From the NeuroCure Clinical Research Center (C.C., A.U.B., F.S., J.B.-S., F.P. M.S.).,Neuroradiology (M.S.), Charité-Universitätsmedizin Berlin, Berlin, Germany
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19
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Jarius S, Paul F, Aktas O, Asgari N, Dale RC, de Seze J, Franciotta D, Fujihara K, Jacob A, Kim HJ, Kleiter I, Kümpfel T, Levy M, Palace J, Ruprecht K, Saiz A, Trebst C, Weinshenker BG, Wildemann B. MOG encephalomyelitis: international recommendations on diagnosis and antibody testing. J Neuroinflammation 2018; 15:134. [PMID: 29724224 PMCID: PMC5932838 DOI: 10.1186/s12974-018-1144-2] [Citation(s) in RCA: 478] [Impact Index Per Article: 79.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/02/2018] [Indexed: 02/11/2023] Open
Abstract
Over the past few years, new-generation cell-based assays have demonstrated a robust association of autoantibodies to full-length human myelin oligodendrocyte glycoprotein (MOG-IgG) with (mostly recurrent) optic neuritis, myelitis and brainstem encephalitis, as well as with acute disseminated encephalomyelitis (ADEM)-like presentations. Most experts now consider MOG-IgG-associated encephalomyelitis (MOG-EM) a disease entity in its own right, immunopathogenetically distinct from both classic multiple sclerosis (MS) and aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorders (NMOSD). Owing to a substantial overlap in clinicoradiological presentation, MOG-EM was often unwittingly misdiagnosed as MS in the past. Accordingly, increasing numbers of patients with suspected or established MS are currently being tested for MOG-IgG. However, screening of large unselected cohorts for rare biomarkers can significantly reduce the positive predictive value of a test. To lessen the hazard of overdiagnosing MOG-EM, which may lead to inappropriate treatment, more selective criteria for MOG-IgG testing are urgently needed. In this paper, we propose indications for MOG-IgG testing based on expert consensus. In addition, we give a list of conditions atypical for MOG-EM ("red flags") that should prompt physicians to challenge a positive MOG-IgG test result. Finally, we provide recommendations regarding assay methodology, specimen sampling and data interpretation.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - F Paul
- Department of Neurology and Clinical and Experimental Multiple Sclerosis Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany.,NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Berlin, Germany
| | - O Aktas
- Department of Neurology, University of Düsseldorf, Düsseldorf, Germany
| | - N Asgari
- Department of Neurology, University of Southern Denmark, Odense, Denmark
| | - R C Dale
- Children's Hospital at Westmead, University of Sydney, Sydney, Australia
| | - J de Seze
- Department of Neurology, Hôpital de Hautepierre, Strasbourg Cedex, France
| | - D Franciotta
- IRCCS, National Neurological Institute C. Mondino, Pavia, Italy
| | - K Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - A Jacob
- The Walton Centre, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - H J Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - I Kleiter
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - M Levy
- Department of Neurology, Johns Hopkins Hospital, Cleveland, USA
| | - J Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - K Ruprecht
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Saiz
- Service of Neurology, Hospital Clinic, and Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, Barcelona, Spain
| | - C Trebst
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | | | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
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20
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Jarius S, Ruprecht K, Stellmann JP, Huss A, Ayzenberg I, Willing A, Trebst C, Pawlitzki M, Abdelhak A, Grüter T, Leypoldt F, Haas J, Kleiter I, Tumani H, Fechner K, Reindl M, Paul F, Wildemann B. MOG-IgG in primary and secondary chronic progressive multiple sclerosis: a multicenter study of 200 patients and review of the literature. J Neuroinflammation 2018; 15:88. [PMID: 29554927 PMCID: PMC5859439 DOI: 10.1186/s12974-018-1108-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 02/26/2018] [Indexed: 12/30/2022] Open
Abstract
Background Antibodies to human full-length myelin oligodendrocyte glycoprotein (MOG-IgG) as detected by new-generation cell-based assays have recently been described in patients presenting with acute demyelinating disease of the central nervous system, including patients previously diagnosed with multiple sclerosis (MS). However, only limited data are available on the relevance of MOG-IgG testing in patients with chronic progressive demyelinating disease. It is unclear if patients with primary progressive MS (PPMS) or secondary progressive MS (SPMS) should routinely be tested for MOG-IgG. Objective To evaluate the frequency of MOG-IgG among patients classified as having PPMS or SPMS based on current diagnostic criteria. Methods For this purpose, we retrospectively tested serum samples of 200 patients with PPMS or SPMS for MOG-IgG using cell-based assays. In addition, we performed a review of the entire English language literature on MOG-IgG published between 2011 and 2017. Results None of 139 PPMS and 61 SPMS patients tested was positive for MOG-IgG. Based on a review of the literature, we identified 35 further MOG-IgG tests in patients with PPMS and 55 in patients with SPMS; the only reportedly positive sample was positive just at threshold level and was tested in a non-IgG-specific assay. In total, a single borderline positive result was observed among 290 tests. Conclusion Our data suggest that MOG-IgG is absent or extremely rare among patients with PPMS or SPMS. Routine screening of patients with typical PPMS/SPMS for MOG-IgG seems not to be justified.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany. .,Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
| | - K Ruprecht
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany
| | - J P Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany.,Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - A Huss
- Department of Neurology, University of Ulm, Ulm, Germany
| | - I Ayzenberg
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - A Willing
- Institut für Neuroimmunologie und Multiple Sklerose (INIMS), Zentrum für Molekulare Neurobiologie Hamburg, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - C Trebst
- Department of Neurology, Hannover Medical School, Hanover, Germany
| | - M Pawlitzki
- Department of Neurology, Otto von Guericke University Magdeburg, Magdeburg, Germany
| | - A Abdelhak
- Department of Neurology, University of Ulm, Ulm, Germany
| | - T Grüter
- Department of Neurology, Ruhr University Bochum, Bochum, Germany
| | - F Leypoldt
- Department of Neurology and Institute of Laboratory Medicine, University Hospital Schleswig-Holstein, Kiel, Germany
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - I Kleiter
- Department of Neurology, Ruhr University Bochum, Bochum, Germany.,Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany
| | - H Tumani
- Department of Neurology, University of Ulm, Ulm, Germany.,Specialty Clinic of Neurology Dietenbronn, Schwendi, Germany
| | - K Fechner
- Institute of Experimental Immunology, affiliated to Euroimmun AG, Lübeck, Germany
| | - M Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - F Paul
- Department of Neurology, Charité - University Medicine Berlin, Berlin, Germany.,NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine, Berlin, Germany
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany. .,Otto Meyerhof Center, Im Neuenheimer Feld 350, 69120, Heidelberg, Germany.
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21
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Heesen C, Haase R, Melzig S, Poettgen J, Berghoff M, Paul F, Zettl U, Marziniak M, Angstwurm K, Kern R, Ziemssen T, Stellmann JP. Perceptions on the value of bodily functions in multiple sclerosis. Acta Neurol Scand 2018; 137:356-362. [PMID: 29205262 DOI: 10.1111/ane.12881] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND In neurological diseases presenting with a plethora of symptoms, the value of bodily functions for a given patient might be a guide for clinical management. Multiple sclerosis (MS) is paradigmatic in this respect, and little is known about the value of different bodily functions of patients and their physicians' perceptions. METHODS In a multicenter study, 171 patients with relapsing-remitting multiple sclerosis (RRMS), 61% with a clinically active disease within the last 2 years were followed over up to 3 years and yearly patients and their study physician rated on the perceived value of 13 bodily functions via a priority list. Differences between patients and physicians as well as modulating disease demographic factors were analyzed. RESULTS Patients with RRMS rated visual function followed by thinking and memory and walking highest while physicians stressed mobility, followed by thinking and memory and alertness most. Ratings were independent from disease duration or disability. Strongest value judgment differences were seen in swallowing regarded more relevant by patients and hand function regarded more relevant by physicians. In general, patients' and physicians' ratings through time were quite stable. Collapsing physical items into a physical functioning scale and mental items in a mental function scale, both dimensions were regarded equally important by patients while physicians underscored physical functioning (P = .016). CONCLUSION There are differences between patients and physicians in value statements of bodily functions in MS. In particular, visual functioning is under-recognized by physicians.
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Affiliation(s)
- C. Heesen
- Institut für Neuroimmunologie und Multiple Sklerose; Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
- Klinik und Poliklinik für Neurologie; Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
| | - R. Haase
- Zentrum für klinische Neurowissenschaften; Klinik und Poliklinik für Neurologie; Universitätsklinikum Carlk Gustav Carus; Dresden Germany
| | - S. Melzig
- Zentrum für klinische Neurowissenschaften; Klinik und Poliklinik für Neurologie; Universitätsklinikum Carlk Gustav Carus; Dresden Germany
| | - J. Poettgen
- Institut für Neuroimmunologie und Multiple Sklerose; Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
- Klinik und Poliklinik für Neurologie; Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
| | - M. Berghoff
- Department of Neurology; Justus-Liebig University Giessen; Giessen Germany
| | - F. Paul
- NeuroCure Clinical Research Center and Experimental and Clinical Research Center; Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitätsmedizin Berlin; Berlin Germany
| | - U. Zettl
- Zentrum für Nervenheilkunde; Klinik und Poliklinik für Neurologie; Universitätsmedizin Rostock; Rostock Germany
| | - M. Marziniak
- Neurologie; kbo-Isar-Amper-Klinikum; Haar Germany
| | - K. Angstwurm
- Klinik und Poliklinik für Neurologie der Universität Regensburg am Bezirksklinikum Regensburg; Regensburg Germany
| | - R. Kern
- Zentrum für klinische Neurowissenschaften; Klinik und Poliklinik für Neurologie; Universitätsklinikum Carlk Gustav Carus; Dresden Germany
| | - T. Ziemssen
- Zentrum für klinische Neurowissenschaften; Klinik und Poliklinik für Neurologie; Universitätsklinikum Carlk Gustav Carus; Dresden Germany
| | - J. P. Stellmann
- Institut für Neuroimmunologie und Multiple Sklerose; Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
- Klinik und Poliklinik für Neurologie; Universitätsklinikum Hamburg-Eppendorf; Hamburg Germany
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22
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Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that mainly affect women. In some of these patients NMOSD occurs during fertile age. For this reason, treating physicians may be confronted with questions concerning family planning, pregnancy and birth. OBJECTIVE This study provides an overview on the influence of NMOSD on fertility, pregnancy complications and pregnancy outcome. The effect of pregnancy on NMOSD course and therapy options during pregnancy are discussed. MATERIAL AND METHODS A search of the current literature was carried out using the PubMed database. RESULTS AND CONCLUSION Animal studies have shown lower fertility rates in NMOSD; however, studies investigating fertility in NMOSD patients are lacking. Pregnancy in NMOSD patients are associated with an increase in postpartum disease activity and a higher grade of disability after pregnancy. Some studies showed higher risks of pregnancy complications e. g. spontaneous abortions and preeclampsia. With a few limitations, acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. Stopping or continuing immunosuppressive therapy with azathioprine or rituximab during pregnancy should be critically weighed considering previous and current disease activity. Therefore, a joint supervision by a specialized center is recommended, particularly in specific situations such as pregnancy.
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Affiliation(s)
- N Borisow
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - K Hellwig
- Klinik für Neurologie, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Jarius S, Würthwein C, Behrens JR, Wanner J, Haas J, Paul F, Wildemann B. Baló's concentric sclerosis is immunologically distinct from multiple sclerosis: results from retrospective analysis of almost 150 lumbar punctures. J Neuroinflammation 2018; 15:22. [PMID: 29347989 PMCID: PMC5774135 DOI: 10.1186/s12974-017-1043-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Accepted: 12/14/2017] [Indexed: 01/01/2023] Open
Abstract
Background Baló’s concentric sclerosis (BCS) is a rare inflammatory demyelinating disorder of the central nervous system characterised by concentric layers of demyelination. It is unclear whether BCS is a variant of multiple sclerosis (MS) or a disease entity in its own right. Objective To compare the cerebrospinal fluid (CSF) features of BCS to those of MS. Methods Retrospective analysis of the CSF profile of all patients with BCS reported in the medical literature between 1980 and 2017. Results In total, the results of 146 lumbar punctures (LP) in 132 patients were analysed. The most striking finding was a lack of CSF-restricted oligoclonal bands (OCB) in 66% (56/85) of all LP in the total BCS group, in 74% (14/19) in the subgroup of patients with both MRI and histological evidence for BCS, and in 82% (18/22) in the subgroup of patients with highest radiological confidence (high MRI quality, ≥ 3 layers of demyelination). OCB disappeared in 1/2 initially OCB-positive patients. These findings are in stark contrast to MS, in which OCB are present in ≥ 95% of patients and are thought to remain stably detectable over the entire course of disease (p < 0.000001). OCB frequency was low both in ‘historic’ patients (1980–2009; 37%) and in more recent patients (2010–2017; 31%). OCB-positive and OCB-negative patients did not differ significantly with regard to age, sex, disease duration, number of Baló-like lesions on MRI, number of relapses, treatment or final outcome. In accordance with the high rate of OCB negativity, Link’s IgG index was negative in 63% of all tested samples (p < 0.000001 vs. MS). CSF pleocytosis was present in 28% (27/96; p < 0.000001 vs. MS) and elevated CSF total protein levels in 41% (31/76) of samples. Conclusion OCB and IgG index frequencies in BCS are much more similar to those reported in neuromyelitis optica or myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis than to those in MS. Our findings suggest that in most cases, BCS-like lesions denote the presence of a disease entity immunologically distinct from MS. In addition, we provide data on the demographics, clinical course and radiological features of BCS based on the largest cohort analysed to date.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - C Würthwein
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - J R Behrens
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Wanner
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - J Haas
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - F Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitätsmedizin Berlin, Berlin, Germany
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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24
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Soelberg K, Skejoe HPB, Grauslund J, Smith TJ, Lillevang ST, Jarius S, Wildemann B, Paul F, Asgari N. Magnetic resonance imaging findings at the first episode of acute optic neuritis. Mult Scler Relat Disord 2017; 20:30-36. [PMID: 29291481 DOI: 10.1016/j.msard.2017.12.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/30/2017] [Accepted: 12/22/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Optic neuritis (ON) is a focal demyelinating event, which may evolve into multiple sclerosis (MS). OBJECTIVE To study MRI characteristics in the acute phase of the first ON episode. METHODS A prospective population-based study was performed on 31 patients with a first episode of acute ON with a one year follow-up. MRI, clinical evaluation, and detection of aquaporin-4 (AQP4)-IgG and myelin oligodendrocyte glycoprotein (MOG)-IgG was undertaken. For lesion characterization on MRI the optic nerves were divided into three segments: intra-orbital (IO), canalicular (CAN) and chiasmal (CHI). RESULTS Lesions of the optic nerve were observed in 80.6%(25/31), with IO location in 48%(12/25), CAN in 8% (2/25) and both IO and CAN in 44%(11/25). Patients who converted to MS had lesions located at IO in 77%(10/13), whereas the group with isolated ON had IO and CAN in 73% (8/11), p = 0.003. Brain lesions were observed in 84% (21/25) at onset of ON; 62%(13/25) progressed to MS with more frequent location in brainstem (p = 0.030) and lesions in periventricular areas (p = 0.015). Spinal cord lesions were detected only in patients who progressed to MS (p = 0.002). MOG-IgG was detected in one patient with an optic nerve lesion located at IO and CAN. Serum AQP4-IgG was detected in none. Follow-up MRI showed progression in optic nerve lesions in 55% (11/20) patients. CONCLUSIONS Specific location of optic nerve and brain lesions and the presence of spinal cord lesions in the acute phase of the first ON episode facilitated an MS diagnosis. The extension of optic nerve lesions following ON suggests a long-term progressive degeneration as an important element of ON pathology.
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Affiliation(s)
- K Soelberg
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark; Departments of Neurology, Slagelse Hospital & Lillebaelt Hospital, Denmark; Department of Ophthalmology, Odense University Hospital, Denmark.
| | - H P B Skejoe
- Department of Radiology, Aleris-Hamlet Hospital, Copenhagen, Denmark.
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
| | - T J Smith
- Departments of Ophthalmology and Visual Sciences and Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA.
| | - S T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Denmark.
| | - S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Germany.
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Germany.
| | - F Paul
- Clinical and Experimental Multiple Sclerosis Research Center and NeuroCure Clinical Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - N Asgari
- Department of Neurology Slagelse Hospital, Institute of Regional Health Research, Denmark; Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
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25
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Soelberg K, Jarius S, Skejoe H, Engberg H, Mehlsen JJ, Nilsson AC, Madsen JS, Reindl M, Wildemann B, Grauslund J, Kyvik KO, Smith TJ, Lillevang ST, Paul F, Weinshenker BG, Asgari N. A population-based prospective study of optic neuritis. Mult Scler 2017; 23:1893-1901. [PMID: 28980518 DOI: 10.1177/1352458517734070] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Optic neuritis (ON) is often associated with multiple sclerosis (MS). Early diagnosis is critical to optimal patient management. OBJECTIVE To estimate the incidence of acute ON and the rates of conversion to MS and antibody-mediated ON. METHOD Population-based prospective study was performed in patients with ON from three ophthalmological departments and 44 practicing ophthalmologists from 2014 to 2016. Ophthalmological and neurological examination, magnetic resonance imaging (MRI), determination of aquaporin-4(AQP4)-IgG and myelin-oligodendrocyte glycoprotein (MOG)-IgG were investigated blindly. RESULTS In all, 63 patients were evaluated and 51 fulfilled the criteria for ON. All were Caucasian, with female:male ratio of 2.2:1 and a median age of 38 years (16-66); 44 (86%) had a single episode of ON (four bilateral), while 7/51 (14%) had recurrent ON. The overall age-specific incidence was 3.28 (2.44-4.31) per 100,000 person years, 2.02 for men and 4.57 for women. At follow-up, 20 patients met the diagnostic criteria for MS, MRI lesions disseminated in space and time in 17/20 patients. AQP4-IgG was detected in none, MOG-IgG was detected in two patients. CONCLUSION The prospective incidence of ON was estimated. MRI enabled a diagnosis of MS in a subgroup of patients. Antibody-mediated ON with specificity for MOG was detected in 4% of cases.
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Affiliation(s)
- K Soelberg
- Departments of Regional Health Research and Molecular Medicine, University of Southern Denmark, Odense, Denmark/Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark/Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Department of Neurology, Lillebaelt Hospital, Vejle, Denmark/Department of Ophthalmology, Odense University Hospital, Odense, Denmark
| | - S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - Hpb Skejoe
- Department of Radiology, Aleris-Hamlet Hospital, Copenhagen, Denmark
| | - H Engberg
- Center for Clinical Epidemiology, Odense University Hospital, Odense, Denmark/Research Unit of Clinical Epidemiology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - J J Mehlsen
- Department of Ophthalmology, Lillebaelt Hospital, Vejle, Denmark
| | - A C Nilsson
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - J S Madsen
- Department of Clinical Immunology and Biochemistry, Lillebaelt Hospital, Vejle, Denmark
| | - M Reindl
- Clinical Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, Heidelberg, Germany
| | - J Grauslund
- Department of Ophthalmology, Odense University Hospital, Odense, Denmark/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - K O Kyvik
- Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - T J Smith
- Departments of Ophthalmology & Visual Sciences and Internal Medicine, Medical School, University of Michigan, Ann Arbor, MI, USA
| | - S T Lillevang
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - F Paul
- Clinical and Experimental Multiple Sclerosis Research Center and NeuroCure Clinical Research Center, Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center (ECRC), Max Delbrück Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - N Asgari
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Departments of Regional Health Research, Neurobiology and Molecular Medicine, University of Southern Denmark, Odense, Denmark/Odense Patient data Explorative Network (OPEN), Odense University Hospital, Odense, Denmark
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26
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Heesen C, Pöttgen J, Rahn AC, Liethmann K, Kasper J, Vahter L, Drulovic J, Van Nunen A, Wilkie D, Beckmann Y, Paul F, Köpke S, Giordano A, Solari A. What should a person with relapsing-remitting multiple sclerosis know? - Focus group and survey data of a risk knowledge questionnaire (RIKNO 2.0). Mult Scler Relat Disord 2017; 18:186-195. [PMID: 29141808 DOI: 10.1016/j.msard.2017.09.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Risk knowledge is relevant to make informed decisions in multiple sclerosis (MS). The risk knowledge questionnaire for relapsing-remitting MS (RIKNO 1.0) was developed and piloted in Germany. OBJECTIVE To produce a revised RIKNO 2.0 questionnaire using mixed methodology in a European setting. METHODS The questionnaire was translated in seven languages. MS patient and health professional (HP) expert feedback was obtained from Germany, Italy, Estonia, Serbia, and the UK. A German web-based survey of RIKNO 2.0 compared the tool with the MS Knowledge Questionnaire (MSKQ), each one used with two versions (with/without a "don't know" DN option). RESULTS While RIKNO 2.0 was considered difficult, it was rated as highly educational. One item was reframed, and two new items were added. The web-based German survey (n = 708 completers) showed that the DN version did not increase participation rate and did not produce significantly higher scores. Internal consistency (Cronbach alpha) without SN response was 0.73. RIKNO 2.0 scores showed normality distribution irrespective of the answering format. Item difficulty was high ranging from 0.07 to 0.79. Less than 50% of questions were answered correctly (mean 8.9) compared to 80.4% in the MSKQ (mean 20.1). Higher numeracy competency and education were significantly, albeit weakly, associated to higher scores for both RIKNO 2.0 and MSKQ. CONCLUSION Including "don't know" options in knowledge questionnaires does not increase percentage of correct replies. RIKNO 2.0 is a complex questionnaire to be used in an educational context and studies on patient information. The tool is now available in seven languages.
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Affiliation(s)
- C Heesen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - J Pöttgen
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Neurologische Klinik, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
| | - A C Rahn
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - K Liethmann
- Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany; Unit of Health Sciences and Education, University of Hamburg, Papendamm 21, 20146 Hamburg, Germany.
| | - J Kasper
- Faculty of Health Sciences, Arctic University of Norway, 9073 Tromsø, Norway.
| | - L Vahter
- Department of Neurology, West-Tallinn Central Hospital, Paldiski mnt. 68, 10617 Tallinn, Estonia.
| | - J Drulovic
- Institute of Neurology, Clinical Center of Serbia, University of Belgrade, Dr. Subotića Starijeg 6, 11000 Beograd, Serbia.
| | - A Van Nunen
- National MS-Centrum, Melsbroek, Vereeckenstraat 44, 1820 Melsbroek, Belgium.
| | - D Wilkie
- Clinical Trials Unit, Department of Neurology, Imperial College, Room 10L18 (Lab Block, Charing Cross Campus, Hammersmith, London W6 8RF, UK.
| | - Y Beckmann
- Department of Neurology, Ataturk Training and Research Hospital, Faculty of Medicine, Konak Mahallesi, İnönü Cad. 269. Sok. No:102, 35150 Karabağlar, Izmir, Turkey.
| | - F Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
| | - S Köpke
- Institute for Social Medicine and Epidemiology, University of Lübeck, Ratzeburger Allee 160, D-23562 Lübeck, Germany.
| | - A Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
| | - A Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Via Celoria 11, 20133 Milan, Italy.
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Jarius S, König FB, Metz I, Ruprecht K, Paul F, Brück W, Wildemann B. Pattern II and pattern III MS are entities distinct from pattern I MS: evidence from cerebrospinal fluid analysis. J Neuroinflammation 2017; 14:171. [PMID: 28851393 PMCID: PMC5576197 DOI: 10.1186/s12974-017-0929-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [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: 02/01/2017] [Accepted: 07/26/2017] [Indexed: 01/01/2023] Open
Abstract
Background The diagnosis of multiple sclerosis (MS) is currently based solely on clinical and magnetic resonance imaging features. However, histopathological studies have revealed four different patterns of lesion pathology in patients diagnosed with MS, suggesting that MS may be a pathologically heterogeneous syndrome rather than a single disease entity. Objective The aim of this study was to investigate whether patients with pattern I MS differ from patients with pattern II or III MS with regard to cerebrospinal fluid (CSF) findings, especially with reference to intrathecal IgG synthesis, which is found in most patients with MS but is frequently missing in MS mimics such as aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein-IgG-positive encephalomyelitis. Methods Findings from 68 lumbar punctures in patients who underwent brain biopsy as part of their diagnostic work-up and who could be unequivocally classified as having pattern I, pattern II or pattern III MS were analysed retrospectively. Results Oligoclonal bands (OCBs) were present in 88.2% of samples from pattern I MS patients but in only 27% of samples from patients with pattern II or pattern III MS (P < 0.00004); moreover, OCBs were present only transiently in some of the latter patients. A polyspecific intrathecal IgG response to measles, rubella and/or varicella zoster virus (so-called MRZ reaction) was previously reported in 60–80% of MS patients, but was absent in all pattern II or III MS patients tested (P < 0.00001 vs. previous cohorts). In contrast, the albumin CSF/serum ratio (QAlb), a marker of blood–CSF barrier function, was more frequently elevated in samples from pattern II and III MS patients (P < 0.002). Accordingly, QAlb values and albumin and total protein levels were higher in pattern II and III MS samples than in pattern I MS samples (P < 0.005, P < 0.009 and P < 0.006, respectively). Conclusions Patients with pattern II or pattern III MS differ significantly from patients with pattern I MS as well as from previous, histologically non-classified MS cohorts with regard to both intrathecal IgG synthesis and blood–CSF barrier function. Our findings strongly corroborate the notion that pattern II and pattern III MS are entities distinct from pattern I MS.
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Affiliation(s)
- S Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
| | - F B König
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - I Metz
- Department of Neuropathology, University of Göttingen, Göttingen, Germany
| | - K Ruprecht
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - F Paul
- Department of Neurology, Charité University Medicine Berlin, Berlin, Germany.,NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Berlin, Germany
| | - W Brück
- Department of Neuropathology, University of Göttingen, Göttingen, Germany.
| | - B Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
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28
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Hahn S, Trendelenburg G, Scharf M, Denno Y, Brakopp S, Teegen B, Probst C, Wandinger KP, Buttmann M, Haarmann A, Szabados F, vom Dahl M, Kümpfel T, Eichhorn P, Gold H, Paul F, Jarius S, Melzer N, Stöcker W, Komorowski L. Identification of the flotillin-1/2 heterocomplex as a target of autoantibodies in bona fide multiple sclerosis. J Neuroinflammation 2017; 14:123. [PMID: 28645295 PMCID: PMC5481867 DOI: 10.1186/s12974-017-0900-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [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: 02/16/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Autoantibodies, in particular those against aquaporin-4 and myelin-oligodendrocyte glycoprotein (MOG), aid as biomarkers in the differential diagnosis of demyelination. Here, we report on discovery of autoantibodies against flotillin in patients with multiple sclerosis (MS). METHODS The target antigen was identified by histo-immunoprecipitation using the patients' sera and cryosections of rat or pig cerebellum combined with mass spectrometrical analysis. Correct identification was ascertained by indirect immunofluorescence and neutralization tests using the target antigens recombinantly expressed in HEK293 cells. RESULTS Serum and CSF of the index patient produced a fine-granular IgG indirect immunofluorescence staining of the hippocampal and cerebellar molecular layers. Flotillin-1 and flotillin-2 were identified as target autoantigens. They also reacted with recombinant human flotillin-1/2 co-expressed in HEK293 cells, but not with the individual flotillins in fixed- and live-cell assays. Moreover, neutralization using flotillin-1/2, but not the single flotillins, abolished the tissue reactivity of patient serum. Screening of 521 patients, for whom anti-aquaporin-4 testing was requested and negative, revealed 8 additional patients with anti-flotillin-1/2 autoantibodies. All eight were negative for anti-MOG. Six patients ex post fulfilled the revised McDonald criteria for MS. Vice versa, screening of 538 MS sera revealed anti-flotillin-1/2 autoantibodies in eight patients. The autoantibodies were not found in a cohort of 67 patients with other neural autoantibody-associated syndromes and in 444 healthy blood donors. CONCLUSIONS Autoantibodies against the flotillin-1/2 heterocomplex, a peripheral membrane protein that is involved in axon outgrowth and regeneration of the optic nerve, are present in 1-2% of patients with bona fide MS.
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Affiliation(s)
- S. Hahn
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - G. Trendelenburg
- Department of Neurology, University Medical Center Göttingen, Göttingen, Germany
| | - M. Scharf
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - Y. Denno
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - S. Brakopp
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - B. Teegen
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
- Clinical Immunological Laboratory Prof. Dr. med Stöcker, Lübeck, Germany
| | - C. Probst
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
| | - K. P. Wandinger
- Department of Neurology, University Medical Center Schleswig Holstein (UKSH), Lübeck, Germany
| | - M. Buttmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
- Department of Neurology, Caritas Hospital, Bad Mergentheim, Germany
| | - A. Haarmann
- Department of Neurology, University of Würzburg, Würzburg, Germany
| | - F. Szabados
- Medical Laboratory Osnabrück, Georgsmarienhütte, Germany
| | - M. vom Dahl
- Department of Neurology, Ammerland Klinik, Westerstede, Germany
| | - T. Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig Maximilian University, Munich, Germany
| | - P. Eichhorn
- Institute of Clinical Chemistry, Ludwig Maximilian University, Munich, Germany
| | - H. Gold
- Department of Neurology, Klinikum am Gesundbrunnen, Heilbronn, Germany
| | - F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité Universitätsmedizin, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité Universitätsmedizin, Berlin, Germany
| | - S. Jarius
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - N. Melzer
- Department of Neurology, University of Münster, Münster, Germany
| | - W. Stöcker
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
- Clinical Immunological Laboratory Prof. Dr. med Stöcker, Lübeck, Germany
| | - L. Komorowski
- Institute of Experimental Immunology, Euroimmun AG, Seekamp 31, 23560 Lübeck, Germany
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29
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Kühnel D, Marquardt C, Nau K, Krug HF, Paul F, Steinbach C. Environmental benefits and concerns on safety: communicating latest results on nanotechnology safety research-the project DaNa 2.0. Environ Sci Pollut Res Int 2017; 24:11120-11125. [PMID: 26903124 PMCID: PMC5393291 DOI: 10.1007/s11356-016-6217-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 01/31/2016] [Indexed: 05/08/2023]
Abstract
The use of nanotechnology and advanced materials promises to revolutionise many areas of technology and improve our daily life. In that respect, many positive effects on the environment are expected, either directly, by developing new technologies for remediation, filtering techniques or energy generation, or indirectly, by e.g. saving resources due to lower consumption of raw materials, or lower energy and fuel consumption due to reduced weight of vehicles. However, such beneficial effects of new technologies are often confronted by concerns regarding the safety of novel substances or materials. During the past 10 years, great effort has been put into research on potential hazards of nanomaterials towards environmental organisms. As the methodology for reliable assessment of nanomaterials was immature, many studies reporting contradictory results have been published, hindering both risk assessment for nanomaterials, as well as the knowledge communication to all involved stakeholders. Thus, DaNa2.0 serves as a platform to implement trusted knowledge on nanomaterials for an objective discussion.
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Affiliation(s)
- D Kühnel
- Department of Bioanalytical Ecotoxicology, Helmholtz Centre for Environmental Research - UFZ, Leipzig, Germany.
| | - C Marquardt
- Institute for Applied Computer Sciences (IAI), Karlsruhe Institute of Technology (KIT), Eggenstein-Leopoldshafen, Germany
| | - K Nau
- Institute for Applied Computer Sciences (IAI), Karlsruhe Institute of Technology (KIT), Eggenstein-Leopoldshafen, Germany
| | - H F Krug
- International Research Cooperations, Empa - Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - F Paul
- Society for Chemical Engineering and Biotechnology (DECHEMA), Frankfurt am Main, Germany
| | - C Steinbach
- Society for Chemical Engineering and Biotechnology (DECHEMA), Frankfurt am Main, Germany
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30
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Klotz L, Berthele A, Brück W, Chan A, Flachenecker P, Gold R, Haghikia A, Hellwig K, Hemmer B, Hohlfeld R, Korn T, Kümpfel T, Lang M, Limmroth V, Linker RA, Meier U, Meuth SG, Paul F, Salmen A, Stangel M, Tackenberg B, Tumani H, Warnke C, Weber MS, Ziemssen T, Zipp F, Wiendl H. [Monitoring of blood parameters under course-modified MS therapy : Substance-specific relevance and current recommendations for action]. Nervenarzt 2017; 87:645-59. [PMID: 26927677 DOI: 10.1007/s00115-016-0077-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
With the approval of various substances for the immunotherapy of multiple sclerosis (MS), treatment possibilities have improved significantly over the last few years. Indeed, the choice of individually tailored preparations and treatment monitoring for the treating doctor is becoming increasingly more complex. This is particularly applicable for monitoring for a treatment-induced compromise of the immune system. The following article by members of the German Multiple Sclerosis Skills Network (KKNMS) and the task force "Provision Structures and Therapeutics" summarizes the practical recommendations for approved immunotherapy for mild to moderate and for (highly) active courses of MS. The focus is on elucidating the substance-specific relevance of particular laboratory parameters with regard to the mechanism of action and the side effects profile. To enable appropriate action to be taken in clinical practice, any blood work changes that can be expected, in addition to any undesirable laboratory findings and their causes and relevance, should be elucidated.
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Affiliation(s)
- L Klotz
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - A Berthele
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - W Brück
- Institut für Neuropathologie, Universitätsmedizin Göttingen der Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - A Chan
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - P Flachenecker
- Neurologisches Rehabilitationszentrum Quellenhof in Bad Wildbad GmbH, Kuranlagenallee 2, 75323, Bad Wildbad, Deutschland
| | - R Gold
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - A Haghikia
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - K Hellwig
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - B Hemmer
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - R Hohlfeld
- Institut für Klinische Neuroimmunologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - T Korn
- Neurologische Klinik und Poliklinik, Klinikum rechts der Isar der TU München, Ismaninger Straße 22, 81675, München, Deutschland
| | - T Kümpfel
- Institut für Klinische Neuroimmunologie, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - M Lang
- NeuroTransConcept GmbH, Centers of Excellence, Pfauengasse 8, 89073, Ulm, Deutschland
| | - V Limmroth
- Klinik für Neurologie und Palliativmedizin, Kliniken der Stadt Köln, Ostmerheimer Str. 200, 51109, Köln - Merheim, Deutschland
| | - R A Linker
- Neurologische Klinik, Universitätsklinikum Erlangen, Schwabachanlage 6, 91054, Erlangen, Deutschland
| | - U Meier
- Berufsverband Deutscher Neurologen BDN, Am Ziegelkamp 1f, 41515, Grevenbroich, Deutschland
| | - S G Meuth
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland
| | - F Paul
- Institut für Neuroimmunologie, Universitätsklinikum Charité, Schumannstr. 20/21, 10117, Berlin, Deutschland
| | - A Salmen
- Neurologische Klinik, St. Josef-Hospital, Universitätsklinikum der Ruhr-Universität Bochum, Gudrunstr. 56, 44791, Bochum, Deutschland
| | - M Stangel
- Klinik für Neurologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - B Tackenberg
- Klinik für Neurologie, Philipps-Universität und Universitätsklinikum Marburg, Baldingerstr. 1, 35043, Marburg, Deutschland
| | - H Tumani
- Neurologische Universitätsklinik der Universität Ulm, Oberer Eselsberg 45, 89081, Ulm, Deutschland.,Fachklinik für Neurologie Dietenbronn, Dietenbronn 7, 88477, Schwendi, Deutschland
| | - C Warnke
- Klinik für Neurologie, Universitätsklinikum Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Deutschland
| | - M S Weber
- Institut für Neuropathologie, Universitätsmedizin Göttingen der Georg-August-Universität, Robert-Koch-Str. 40, 37075, Göttingen, Deutschland
| | - T Ziemssen
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Carl Gustav Carus der TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - F Zipp
- Klinik für Neurologie, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Langenbeckstr. 1, 55131, Mainz, Deutschland
| | - H Wiendl
- Department für Neurologie, Universitätsklinikum Münster, Albert-Schweitzer-Campus 1, Gebäude A1, 48149, Münster, Deutschland.
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31
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Marzeion B, Champollion N, Haeberli W, Langley K, Leclercq P, Paul F. Observation-Based Estimates of Global Glacier Mass Change and Its Contribution to Sea-Level Change. Surv Geophys 2017; 38:105-130. [PMID: 28203035 PMCID: PMC5283499 DOI: 10.1007/s10712-016-9394-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/21/2016] [Indexed: 05/11/2023]
Abstract
Glaciers have strongly contributed to sea-level rise during the past century and will continue to be an important part of the sea-level budget during the twenty-first century. Here, we review the progress in estimating global glacier mass change from in situ measurements of mass and length changes, remote sensing methods, and mass balance modeling driven by climate observations. For the period before the onset of satellite observations, different strategies to overcome the uncertainty associated with monitoring only a small sample of the world's glaciers have been developed. These methods now yield estimates generally reconcilable with each other within their respective uncertainty margins. Whereas this is also the case for the recent decades, the greatly increased number of estimates obtained from remote sensing reveals that gravimetry-based methods typically arrive at lower mass loss estimates than the other methods. We suggest that strategies for better interconnecting the different methods are needed to ensure progress and to increase the temporal and spatial detail of reliable glacier mass change estimates.
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Affiliation(s)
- B. Marzeion
- Institute of Geography, University of Bremen, Postfach 330 440, 28334 Bremen, Germany
| | - N. Champollion
- International Space Science Institute, Hallerstrasse 6, 3012 Bern, Switzerland
| | - W. Haeberli
- Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - K. Langley
- Asiaq Greenland Survey, Qatserisut 8, 3900 Nuuk, Greenland
| | - P. Leclercq
- Department of Geosciences, University of Oslo, P.O. Box 1047, Blindern, 0316 Oslo, Norway
| | - F. Paul
- Department of Geography, University of Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
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Pockley A, Davenport P, Paul F, Greaves M, Preston F. The use of high gradient magnetic separation for the preparation of leucocyte- and platelet-free red cell suspensions. Clin Hemorheol Microcirc 2016. [DOI: 10.3233/ch-1986-6503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A.G. Pockley
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
| | - P. Davenport
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
| | - F. Paul
- Department of Physics and Haematology, Southampton University, Southampton, England
| | - M. Greaves
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
| | - F.E. Preston
- Department of Haematology, Royal Hallamshire Hospital, Sheffield, England
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Dusek P, Bahn E, Litwin T, Jabłonka-Salach K, Łuciuk A, Huelnhagen T, Madai VI, Dieringer MA, Bulska E, Knauth M, Niendorf T, Sobesky J, Paul F, Schneider SA, Czlonkowska A, Brück W, Wegner C, Wuerfel J. Brain iron accumulation in Wilson disease: apost mortem7 Tesla MRI - histopathological study. Neuropathol Appl Neurobiol 2016; 43:514-532. [DOI: 10.1111/nan.12341] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Revised: 08/18/2016] [Accepted: 08/20/2016] [Indexed: 12/12/2022]
Affiliation(s)
- P. Dusek
- Institute of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
- Department of Neurology and Center of Clinical Neuroscience; 1 Faculty of Medicine and General University Hospital in Prague; Charles University in Prague; Praha Czech Republic
| | - E. Bahn
- Institute of Neuropathology; University Medical Center Göttingen; Göttingen Germany
| | - T. Litwin
- 2 Department of Neurology; Institute Psychiatry and Neurology; Warsaw Poland
| | - K. Jabłonka-Salach
- Faculty of Chemistry; Biological and Chemical Research Centre; University of Warsaw; Warsaw Poland
| | - A. Łuciuk
- Faculty of Chemistry; Biological and Chemical Research Centre; University of Warsaw; Warsaw Poland
| | - T. Huelnhagen
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max-Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
| | - V. I. Madai
- Department of Neurology and Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
| | - M. A. Dieringer
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max-Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - E. Bulska
- Faculty of Chemistry; Biological and Chemical Research Centre; University of Warsaw; Warsaw Poland
| | - M. Knauth
- Institute of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
| | - T. Niendorf
- Berlin Ultrahigh Field Facility (B.U.F.F.); Max-Delbrück Center for Molecular Medicine in the Helmholtz Association; Berlin Germany
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - J. Sobesky
- Department of Neurology and Center for Stroke Research Berlin (CSB); Charité-Universitätsmedizin; Berlin Germany
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
| | - F. Paul
- Experimental and Clinical Research Center (ECRC); Charité-Universitätsmedizin and Max Delbrück Center for Molecular Medicine (MDC); Berlin Germany
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité-Universitätsmedizin; Berlin Germany
| | - S. A. Schneider
- Neurology Department; University of Kiel; Kiel Germany
- Department of Neurology; Ludwig-Maximilians-University; Munich Germany
| | - A. Czlonkowska
- 2 Department of Neurology; Institute Psychiatry and Neurology; Warsaw Poland
- Department of Experimental and Clinical Pharmacology; Medical University; Warsaw Poland
| | - W. Brück
- Institute of Neuropathology; University Medical Center Göttingen; Göttingen Germany
| | - C. Wegner
- Institute of Neuropathology; University Medical Center Göttingen; Göttingen Germany
| | - J. Wuerfel
- Institute of Neuroradiology; University Medical Center Göttingen; Göttingen Germany
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité-Universitätsmedizin; Berlin Germany
- Medical Imaging Analysis Center AG; Basel Switzerland
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Abstract
Cognitive impairment is a frequent symptom in people with multiple sclerosis, affecting up to 70% of patients. This article reviews the published association of cognitive dysfunction with neuroimaging findings. Cognitive impairment has been related to focal T2 hyperintense lesions, diffuse white matter damage and corical and deep gray matter atrophy. Focal lesions cannot sufficiently explain cognitive dysfunction in MS; microstructural tissue damage detectable by diffusion tensor imaging and gray matter atrophy are probably at least as relevant. Resting state functional magnetic resonance imaging is increasingly used to investigate the contribution of functional connectivity changes to cognitive function in MS. The fact that at least one third of MS patients are not overtly cognitively impaired despite significant radiographic tissue damage argues for protective factors (brain reserve, cognitive reserve) that require further clarification. It is concluded that the reported correlations between imaging findings and cognitive function do not imply causality. Well conceived and sufficiently powered longitudinal studies are lacking. Such studies would help unravel protective mechanisms against cogniitve decline and identify suitable imaging techniques to monitor cognitive function in individual patients with MS.
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Affiliation(s)
- F. Paul
- NeuroCure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center; Department of Neurology; Charité - Universitaetsmedizin Berlin; Berlin Germany
- Experimental and Clinical Research Center; Max Delbrueck Center for Molecular Medicine and Charité - Universitaetsmedizin Berlin; Berlin Germany
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Chawla S, Kister I, Wuerfel J, Brisset JC, Liu S, Sinnecker T, Dusek P, Haacke EM, Paul F, Ge Y. Iron and Non-Iron-Related Characteristics of Multiple Sclerosis and Neuromyelitis Optica Lesions at 7T MRI. AJNR Am J Neuroradiol 2016; 37:1223-30. [PMID: 27012298 DOI: 10.3174/ajnr.a4729] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Accepted: 01/01/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Characterization of iron deposition associated with demyelinating lesions of multiple sclerosis and neuromyelitis optica has not been well studied. Our aim was to investigate the potential of ultra-high-field MR imaging to distinguish MS from neuromyelitis optica and to characterize tissue injury associated with iron pathology within lesions. MATERIALS AND METHODS Twenty-one patients with MS and 21 patients with neuromyelitis optica underwent 7T high-resolution 2D-gradient-echo-T2* and 3D-susceptibility-weighted imaging. An in-house-developed algorithm was used to reconstruct quantitative susceptibility mapping from SWI. Lesions were classified as "iron-laden" if they demonstrated hypointensity on gradient-echo-T2*-weighted images and/or SWI and hyperintensity on quantitative susceptibility mapping. Lesions were considered "non-iron-laden" if they were hyperintense on gradient-echo-T2* and isointense or hyperintense on quantitative susceptibility mapping. RESULTS Of 21 patients with MS, 19 (90.5%) demonstrated at least 1 quantitative susceptibility mapping-hyperintense lesion, and 11/21 (52.4%) had iron-laden lesions. No quantitative susceptibility mapping-hyperintense or iron-laden lesions were observed in any patients with neuromyelitis optica. Iron-laden and non-iron-laden lesions could each be further characterized into 2 distinct patterns based on lesion signal and morphology on gradient-echo-T2*/SWI and quantitative susceptibility mapping. In MS, most lesions (n = 262, 75.9% of all lesions) were hyperintense on gradient-echo T2* and isointense on quantitative susceptibility mapping (pattern A), while a small minority (n = 26, 7.5% of all lesions) were hyperintense on both gradient-echo-T2* and quantitative susceptibility mapping (pattern B). Iron-laden lesions (n = 57, 16.5% of all lesions) were further classified as nodular (n = 22, 6.4%, pattern C) or ringlike (n = 35, 10.1%, pattern D). CONCLUSIONS Ultra-high-field MR imaging may be useful in distinguishing MS from neuromyelitis optica. Different patterns related to iron and noniron pathology may provide in vivo insight into the pathophysiology of lesions in MS.
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Affiliation(s)
- S Chawla
- From the Department of Radiology (S.C., J.-C.B., Y.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging Department of Radiology (S.C.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - I Kister
- Department of Neurology (I.K.), New York University School of Medicine, New York, New York
| | - J Wuerfel
- NeuroCure (J.W., T.S., F.P.), Charité University Medicine, Berlin, Germany Institute of Neuroradiology (J.W., P.D.), Universitätsmedizin Göttingen, Göttingen, Germany Medical Image Analysis Center (J.W.), Basel, Switzerland
| | - J-C Brisset
- From the Department of Radiology (S.C., J.-C.B., Y.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging
| | - S Liu
- Department of Radiology (S.L., E.M.H.), Wayne State University School of Medicine, Detroit, Michigan
| | - T Sinnecker
- NeuroCure (J.W., T.S., F.P.), Charité University Medicine, Berlin, Germany
| | - P Dusek
- Institute of Neuroradiology (J.W., P.D.), Universitätsmedizin Göttingen, Göttingen, Germany Department of Neurology and Center of Clinical Neuroscience (P.D.), Charles University in Prague, First Faculty of Medicine and General University Hospital in Prague, Prague, Czech Republic
| | - E M Haacke
- Department of Radiology (S.L., E.M.H.), Wayne State University School of Medicine, Detroit, Michigan
| | - F Paul
- NeuroCure (J.W., T.S., F.P.), Charité University Medicine, Berlin, Germany
| | - Y Ge
- From the Department of Radiology (S.C., J.-C.B., Y.G.), Center for Advanced Imaging Innovation and Research and Bernard and Irene Schwartz Center for Biomedical Imaging
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Rommer PS, Dörner T, Freivogel K, Haas J, Kieseier BC, Kümpfel T, Paul F, Proft F, Schulze-Koops H, Schmidt E, Wiendl H, Ziemann U, Zettl UK. Safety and Clinical Outcomes of Rituximab Treatment in Patients with Multiple Sclerosis and Neuromyelitis Optica: Experience from a National Online Registry (GRAID). J Neuroimmune Pharmacol 2015; 11:1-8. [PMID: 26589235 DOI: 10.1007/s11481-015-9646-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 11/13/2015] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is an immune-mediated disease. Over the last decades therapeutic options have broadened tremendously. Nevertheless, various therapeutic agents, e.g., rituximab, are currently used in the treatment of MS off label. Disease or health registries are useful methods to collect information about off-label treatments. The German registry for autoimmune disease (GRAID) is a multicenter, retrospective, non-interventional database of patients with various autoimmune diseases. AIM/METHODS The aim of this observational analysis is to present safety data of rituximab in the treatment of MS and neuromyelitis optica (NMO) in a real life clinical setting based on the available registry data. RESULTS Data were collected nationwide in patients who received rituximab. 56 patients were treated with rituximab for MS or NMO. Average observation period was 9.6 months (SD 7.6, ranging from 6 to 29.7 months). Interval between treatments cycles differed tremendously (ranging from 0 to 21 months, median 10 months). Number of infusions ranged from 1 up to more than 8. The analysis provides experience on almost 50 patient years. Infusion related reactions were most common and reported in four patients; infections were seen in three patients (two of them were hospitalized for urinary tract infection and urosepsis). All patients recovered from infection. Full treatment response was attested in a quarter of the patients; two thirds benefited partially from treatment. DISCUSSION Safety data of almost 50 patient years of treatment with rituximab show that rituximab is tolerated well in MS/NMO patients. Infections and infusion reactions are the most common adverse events. Our data may help the individual physician to balance efficacy of rituximab against the risk. • Data on rituximab in MS and NMO are provided for almost 50 patientyears • Rituximab was tolerated well • No unexpected side effects were seen • Almost 80% of the patients benefited at least partially from treatment.
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Affiliation(s)
- P S Rommer
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany. .,Department of Neurology, Medical University of Vienna, Vienna, Austria.
| | - T Dörner
- Department of Medicine/Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - J Haas
- Department of Neurology, Jewish Hospital Berlin, Berlin, Germany
| | - B C Kieseier
- Department of Neurology, Medical Faculty, Heinrich Heine-University, Düsseldorf, Germany
| | - T Kümpfel
- Institute of Clinical Neuroimmunology, Ludwig-Maximilians-University, Munich, Germany
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - F Proft
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | - H Schulze-Koops
- Division of Rheumatology and Clinical Immunology, Department of Internal Medicine IV, University of Munich, Munich, Germany
| | | | - H Wiendl
- Department of Neurology, University of Muenster, Muenster, Germany
| | - U Ziemann
- Department of Neurology & Stroke, Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany.,Department of Neurology, Goethe University Frankfurt, Frankfurt/Main, Germany
| | - U K Zettl
- Department of Neurology, Neuroimmunological Section, University of Rostock, Rostock, Germany
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Heine J, Prüss H, Bartsch T, Ploner C, Paul F, Finke C. Imaging of autoimmune encephalitis – Relevance for clinical practice and hippocampal function. Neuroscience 2015; 309:68-83. [DOI: 10.1016/j.neuroscience.2015.05.037] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 05/04/2015] [Accepted: 05/15/2015] [Indexed: 12/25/2022]
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Paul F, Goldschmidt V. XXVΙΙ.Orthoklas-Heterozwilling. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1909.46.1.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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40
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Kuchenbecker J, Blum M, Paul F. [Investigation of color vision in acute unilateral optic neuritis using a web-based color vision test]. Ophthalmologe 2015. [PMID: 26224172 DOI: 10.1007/s00347-015-0108-5] [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: 11/27/2022]
Abstract
BACKGROUND In acute unilateral optic neuritis (ON) color vision defects combined with a decrease in visual acuity and contrast sensitivity frequently occur. This study investigated whether a web-based color vision test is a reliable detector of acquired color vision defects in ON and, if so, which charts are particularly suitable. METHODS In 12 patients with acute unilateral ON, a web-based color vision test ( www.farbsehtest.de ) with 25 color plates (16 Velhagen/Broschmann and 9 Ishihara color plates) was performed. For each patient the affected eye was tested first and then the unaffected eye. RESULTS The mean best-corrected distance visual acuity (BCDVA) in the ON eye was 0.36 ± 0.20 and 1.0 ± 0.1 in the contralateral eye. The number of incorrectly read plates correlated with the visual acuity. For the ON eye a total of 134 plates were correctly identified and 166 plates were incorrectly identified, while for the disease-free fellow eye, 276 plates were correctly identified and 24 plates were incorrectly identified. Both of the blue/yellow plates were identified correctly 14 times and incorrectly 10 times using the ON eye and exclusively correctly (24 times) using the fellow eye. The Velhagen/Broschmann plates were incorrectly identified significantly more frequently in comparison with the Ishihara plates. In 4 out of 16 Velhagen/Broschmann plates and 5 out of 9 Ishihara plates, no statistically significant differences between the ON eye and the fellow eye could be detected. CONCLUSION The number of incorrectly identified plates correlated with a decrease in visual acuity. Red/green and blue/yellow plates were incorrectly identified significantly more frequently with the ON eye, while the Velhagen/Broschmann color plates were incorrectly identified significantly more frequently than the Ishihara color plates. Thus, under defined test conditions the web-based color vision test can also be used to detect acquired color vision defects, such as those caused by ON. Optimization of the test by altering the combination of plates may be a useful next step.
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Affiliation(s)
- J Kuchenbecker
- Augenklinik des Helios Klinikum Berlin Buch, Schwanebecker Chaussee 50, 13125, Berlin, Deutschland.
| | - M Blum
- Augenklinik des Helios Klinikum Erfurt, Erfurt, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center und Klinisches und Experimentelles Forschungszentrum für Multiple Sklerose, Klinik für Neurologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
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Pandit L, Asgari N, Apiwattanakul M, Palace J, Paul F, Leite MI, Kleiter I, Chitnis T. Demographic and clinical features of neuromyelitis optica: A review. Mult Scler 2015; 21:845-53. [PMID: 25921037 PMCID: PMC4463026 DOI: 10.1177/1352458515572406] [Citation(s) in RCA: 233] [Impact Index Per Article: 25.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 01/04/2015] [Indexed: 11/16/2022]
Abstract
The comparative clinical and demographic features of neuromyelitis optica (NMO) are not well known. In this review we analyzed peer-reviewed publications for incidence and prevalence, clinical phenotypes, and demographic features of NMO. Population-based studies from Europe, South East and Southern Asia, the Caribbean, and Cuba suggest that the incidence and prevalence of NMO ranges from 0.05-0.4 and 0.52-4.4 per 100,000, respectively. Mean age at onset (32.6-45.7) and median time to first relapse (8-12 months) was similar. Most studies reported an excess of disease in women and a relapsing course, particularly in anti-aquaporin 4 antibody (anti AQP4-IgG)-positive patients. Ethnicity may have a bearing on disease phenotype and clinical outcome. Despite limitations inherent to the review process, themes noted in clinical and demographic features of NMO among different populations promote a more global understanding of NMO and strategies to address it.
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Affiliation(s)
- L Pandit
- KS Hegde Medical Academy, Nitte University, Mangalore, Karnataka, India
| | - N Asgari
- Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Denmark
| | | | - J Palace
- Department of Clinical Neurology, Oxford University Hospitals, Oxford, UK
| | - F Paul
- Neuro Cure Clinical Research Center and Clinical and Experimental Multiple Sclerosis Research Center, Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| | - M I Leite
- Department of Clinical Neurology, Oxford University Hospitals, Oxford, UK
| | - I Kleiter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - T Chitnis
- Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, USA
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Herve V, Rabbe N, Guilleminault L, Paul F, Schlick L, Azzopardi N, Duruisseaux M, Fouquenet D, Montharu J, Redini F, Paintaud G, Lemarié E, Cadranel J, Wislez M, Heuzé-Vourc’h N. Aérosolthérapie anti-VEGF dans les adénocarcinomes pulmonaires primitifs mutés pour K-ras. Rev Mal Respir 2015. [DOI: 10.1016/j.rmr.2015.02.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Bennett JL, de Seze J, Lana-Peixoto M, Palace J, Waldman A, Schippling S, Tenembaum S, Banwell B, Greenberg B, Levy M, Fujihara K, Chan KH, Kim HJ, Asgari N, Sato DK, Saiz A, Wuerfel J, Zimmermann H, Green A, Villoslada P, Paul F. Neuromyelitis optica and multiple sclerosis: Seeing differences through optical coherence tomography. Mult Scler 2015; 21:678-88. [PMID: 25662342 PMCID: PMC4425816 DOI: 10.1177/1352458514567216] [Citation(s) in RCA: 175] [Impact Index Per Article: 19.4] [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: 11/02/2014] [Accepted: 11/27/2014] [Indexed: 01/12/2023]
Abstract
Neuromyelitis optica (NMO) is an inflammatory autoimmune disease of the central nervous system that preferentially targets the optic nerves and spinal cord. The clinical presentation may suggest multiple sclerosis (MS), but a highly specific serum autoantibody against the astrocytic water channel aquaporin-4 present in up to 80% of NMO patients enables distinction from MS. Optic neuritis may occur in either condition resulting in neuro-anatomical retinal changes. Optical coherence tomography (OCT) has become a useful tool for analyzing retinal damage both in MS and NMO. Numerous studies showed that optic neuritis in NMO typically results in more severe retinal nerve fiber layer (RNFL) and ganglion cell layer thinning and more frequent development of microcystic macular edema than in MS. Furthermore, while patients’ RNFL thinning also occurs in the absence of optic neuritis in MS, subclinical damage seems to be rare in NMO. Thus, OCT might be useful in differentiating NMO from MS and serve as an outcome parameter in clinical studies.
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Affiliation(s)
- J L Bennett
- Departments of Neurology and Ophthalmology, University of Colorado, Denver, Colorado, USA
| | - J de Seze
- Neurology Service, University Hospital of Strasbourg, France
| | - M Lana-Peixoto
- CIEM MS Research Center, University of Minas Gerais Medical School, Belo Horizonte Brazil
| | - J Palace
- Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK
| | - A Waldman
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA
| | - S Schippling
- Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zürich, Switzerland
| | - S Tenembaum
- Department of Neurology, National Pediatric Hospital Dr Juan P. Garrahan, Buenos Aires, Argentina
| | - B Banwell
- Division of Neurology, Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania, USA
| | - B Greenberg
- Departments of Neurology & Neurotherapeutics, University of Texas Southwestern Medical Center at Dallas, Texas, USA
| | - M Levy
- Department of Neurology, Johns Hopkins University, Baltimore, Maryland USA
| | - K Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - K H Chan
- University Department of Medicine, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - H J Kim
- Research Institute and Hospital of National Cancer Center Goyang Republic of Korea
| | - N Asgari
- Institute of Molecular Medicine, University of Southern Denmark, and Department of Neurology, Vejle Hospital, Odense, Denmark
| | - D K Sato
- Department of Neurology, Tohoku University School of Medicine, Sendai, Japan
| | - A Saiz
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain
| | - J Wuerfel
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, and Institute of Interventional and Diagnostic Neuroradiology, University Medicine Göttingen, Germany
| | - H Zimmermann
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Germany
| | - A Green
- Multiple Sclerosis Center, UCSF Department of Neurology and Neuro-ophthalmology Service, UCSF Department of Ophthalmology, San Francisco, USA
| | - P Villoslada
- Center of Neuroimmunology, Service of Neurology, Hospital Clinic and Institute of Biomedical Research August Pi Sunyer, Barcelona, Spain
| | - F Paul
- NeuroCure Clinical Research and Department of Neurology, Charité - Universitätsmedizin Berlin and Experimental and Clinical Research Center, Charité - Universitätsmedizin Berlin and Max-Delbrück-Center for Molecular Medicine, Berlin, Germany
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Kuchling J, Sinnecker T, Bozin I, Dörr J, Madai VI, Sobesky J, Niendorf T, Paul F, Wuerfel J. [Ultrahigh field MRI in context of neurological diseases]. Nervenarzt 2014; 85:445-58. [PMID: 24549692 DOI: 10.1007/s00115-013-3967-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ultrahigh field magnetic resonance imaging (UHF-MRI) has recently gained substantial scientific interest. At field strengths of 7 Tesla (T) and higher UHF-MRI provides unprecedented spatial resolution due to an increased signal-to-noise ratio (SNR). The UHF-MRI method has been successfully applied in various neurological disorders. In neuroinflammatory diseases UHF-MRI has already provided a detailed insight into individual pathological disease processes and elucidated differential diagnoses of several disease entities, e.g. multiple sclerosis (MS), neuromyelitis optica (NMO) and Susac's syndrome. The excellent depiction of normal blood vessels, vessel abnormalities and infarct morphology by UHF-MRI can be utilized in vascular diseases. Detailed imaging of the hippocampus in Alzheimer's disease and the substantia nigra in Parkinson's disease as well as sensitivity to iron depositions could be valuable in neurodegenerative diseases. Current UHF-MRI studies still suffer from small sample sizes, selection bias or propensity to image artefacts. In addition, the increasing clinical relevance of 3T-MRI has not been sufficiently appreciated in previous studies. Although UHF-MRI is only available at a small number of medical research centers it could provide a high-end diagnostic tool for healthcare optimization in the foreseeable future. The potential of UHF-MRI still has to be carefully validated by profound prospective research to define its place in future medicine.
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Affiliation(s)
- J Kuchling
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, Campus Mitte, Charitéplatz 1, 10117, Berlin, Deutschland
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Tsimpri P, Kuchenbecker J, Blum M, Paul F. Untersuchung des Farbsehens bei einseitiger Neuritis nervi optici (NNO) mittels eines web-basierten Farbsehtests. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Hoffmann O, Albert C, Doerr JM, Paul F, Liekfeld A. Fingolimod als Primärtherapie bei erstmaliger Neuritis nervi optici – Design der MOVING-Studie. Klin Monbl Augenheilkd 2014. [DOI: 10.1055/s-0034-1396467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Finke C, Schlichting J, Papazoglou S, Scheel M, Freing A, Soemmer C, Pech LM, Pajkert A, Pfüller C, Wuerfel JT, Ploner CJ, Paul F, Brandt AU. Altered basal ganglia functional connectivity in multiple sclerosis patients with fatigue. Mult Scler 2014; 21:925-34. [DOI: 10.1177/1352458514555784] [Citation(s) in RCA: 115] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Accepted: 09/21/2014] [Indexed: 12/23/2022]
Abstract
Background: Fatigue is one of the most frequent and disabling symptoms in multiple sclerosis, but its pathophysiological mechanisms are poorly understood. It is in particular unclear whether and how fatigue relates to structural and functional brain changes. Objective: We aimed to analyse the association of fatigue severity with basal ganglia functional connectivity, basal ganglia volumes, white matter integrity and grey matter density. Methods: In 44 patients with relapsing–remitting multiple sclerosis and 20 age- and gender-matched healthy controls, resting-state fMRI, diffusion tensor imaging and voxel-based morphometry was performed. Results: In comparison with healthy controls, patients showed alteration of grey matter density, white matter integrity, basal ganglia volumes and basal ganglia functional connectivity. No association of fatigue severity with grey matter density, white matter integrity and basal ganglia volumes was observed within patients. In contrast, fatigue severity was negatively correlated with functional connectivity of basal ganglia nuclei with medial prefrontal cortex, precuneus and posterior cingulate cortex in patients. Furthermore, fatigue severity was positively correlated with functional connectivity between caudate nucleus and motor cortex. Conclusion: Fatigue is associated with distinct alterations of basal ganglia functional connectivity independent of overall disability. The pattern of connectivity changes suggests that disruption of motor and non-motor basal ganglia functions, including motivation and reward processing, contributes to fatigue pathophysiology in multiple sclerosis.
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Affiliation(s)
- C Finke
- Department of Neurology, Charité – Universitätsmedizin Berlin, Germany/Equal contribution
| | - J Schlichting
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany/Equal contribution
| | - S Papazoglou
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany
| | - M Scheel
- Department of Radiology, Charité – Universitätsmedizin Berlin, Germany
| | - A Freing
- Department of Neuroradiology, Universitätsmedizin Göttingen, Germany
| | - C Soemmer
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany
| | - LM Pech
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany
| | - A Pajkert
- Department of Neurology, Charité – Universitätsmedizin Berlin, Germany
| | - C Pfüller
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany
| | - JT Wuerfel
- Department of Neuroradiology, Universitätsmedizin Göttingen, Germany
| | - CJ Ploner
- Department of Neurology, Charité – Universitätsmedizin Berlin, Germany
| | - F Paul
- Department of Neurology, Charité – Universitätsmedizin Berlin, Germany/NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany
| | - AU Brandt
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, Germany
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Moroge S, Paul F, Milan C, Gignoux-Froment F, Henry JM, Pilard M, Marimoutou C. [Suicidal ideas in psychiatric emergency departments: prospective study comparing self- and hetero-assessment]. Encephale 2014; 40:359-65. [PMID: 25194753 DOI: 10.1016/j.encep.2014.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 09/05/2012] [Accepted: 10/14/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Many suicide victims had contacts with an emergency department before their attempt. We aimed to determine whether patients coming to a psychiatric emergency department were well assessed concerning their suicidal risk, and to test an easy to fill in scale rapidly assessing suicidal risk. METHOD We conducted a descriptive epidemiological survey in Marseille. The source population was all patients admitted to the psychiatric emergency department. We used a booklet containing three questionnaires for "nurse", "psychiatrist" and "patient". We estimated the suicidal risk using both a visual analogue scale (similar for patients and caregivers), and validated scales on self-assessment (scale of suicidality SBQ-R and the Beck Hopelessness Scale). RESULTS AND DISCUSSION The questionnaire results have shown that people who visited a psychiatric emergency department presented a significant suicidal risk on several criteria: socio-demographic criteria (social isolation, low level of education, low number of people with a job), psychiatric history (rate of pre-existing psychiatric disorders significantly higher than in the general population, high proportions of family and personal history of suicide attempts, psychiatric hospitalizations, and people with a psychiatrist). Six percent of patients claimed to have come to an emergency unit for suicidal ideas but they were ten times more with a suicidal risk, according to the SBQ-R score. The suicidal risk self-assessed by patients on our visual analogue scale was well correlated with SBQ-R scale and Beck Hopelessness scale, but was not well correlated with the evaluation of caregivers. CONCLUSION Hence, the analog scale we created is easy to use and seems to be a good tool for suicidal risk estimation when it is self-assessed by patients in our study population.
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Affiliation(s)
- S Moroge
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France.
| | - F Paul
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - C Milan
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - F Gignoux-Froment
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - J-M Henry
- Service des urgences du pôle psychiatrique centre, 147, boulevard Baille, 13385 Marseille cedex 5, France
| | - M Pilard
- Service de psychiatrie de l'hôpital d'instruction des armées Laveran, boulevard Laveran, BP 60149, 13384 Marseille cedex 13, France
| | - C Marimoutou
- Centre d'épidémiologie et santé publique des armées (CESPA), GSBdD Marseille-Aubagne, BP 40026, 13568 Marseille cedex 02, France
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Huhn K, Lämmer R, Oberwahrenbrock T, Lämmer A, Waschbisch A, Gosar D, Brandt A, Paul F, Linker RA, Lee DH. Optical coherence tomography in patients with a history of juvenile multiple sclerosis reveals early retinal damage. Eur J Neurol 2014; 22:86-92. [PMID: 25104178 DOI: 10.1111/ene.12532] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Accepted: 06/09/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND PURPOSE Some 3%-10% of patients with multiple sclerosis (MS) experience disease onset before the age of 18 years ('early' onset MS, EOMS). Optical coherence tomography is a non-invasive method to measure retinal nerve fibre layer thickness (RNFLT) and total macular volume (TMV) and may be useful to differentiate axonal and neuronal damage in the retina of patients with a history of EOMS. Here RNFLT and TMV in EOMS patients after a mean disease duration of 11.6 years were compared with patients with age- or disease-duration-matched later onset MS (LOMS) and healthy controls (HCs). METHODS In this observational cross-sectional study at two German academic MS centres, RNFLT and TMV were measured by spectral-domain optical coherence tomography in 32 HCs, 36 EOMS (mean age at onset 15.5 ± 2.0 years) and 58 LOMS patients. RESULTS In comparison with HCs, EOMS patients displayed a significant reduction of RNFLT and TMV independently of a history of optic neuritis. In particular, RNFLT loss in EOMS was similar to that in LOMS and TMV loss was slightly higher compared with disease-duration-matched LOMS. In a generalized estimating model, the EOMS group also displayed a similar correlation between disease duration and RNFLT or TMV loss to LOMS patients. CONCLUSIONS These data argue for a significant amount of axonal and neuronal damage in the retina of EOMS patients and may provide a structural basis for the observation that EOMS patients reach states of irreversible disability at a younger age than patients with LOMS.
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Affiliation(s)
- K Huhn
- Department of Neurology, University of Erlangen, Erlangen, Germany
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Marimoutou C, Milan C, Gobet A, Paul F, Pilard M. Impact psychosocial du rapatriement sanitaire pour raison médicale chez les militaires français en mission en Afghanistan. Rev Epidemiol Sante Publique 2014. [DOI: 10.1016/j.respe.2014.05.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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