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Jeyakumar N, Lerch M, Dale RC, Ramanathan S. MOG antibody-associated optic neuritis. Eye (Lond) 2024:10.1038/s41433-024-03108-y. [PMID: 38783085 DOI: 10.1038/s41433-024-03108-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/04/2024] [Accepted: 04/19/2024] [Indexed: 05/25/2024] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is a demyelinating disorder, distinct from multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD). MOGAD most frequently presents with optic neuritis (MOG-ON), often with characteristic clinical and radiological features. Bilateral involvement, disc swelling clinically and radiologically, and longitudinally extensive optic nerve hyperintensity with associated optic perineuritis on MRI are key characteristics that can help distinguish MOG-ON from optic neuritis due to other aetiologies. The detection of serum MOG immunoglobulin G utilising a live cell-based assay in a patient with a compatible clinical phenotype is highly specific for the diagnosis of MOGAD. This review will highlight the key clinical and radiological features which expedite diagnosis, as well as ancillary investigations such as visual fields, visual evoked potentials and cerebrospinal fluid analysis, which may be less discriminatory. Optical coherence tomography can identify optic nerve swelling acutely, and atrophy chronically, and may transpire to have utility as a diagnostic and prognostic biomarker. MOG-ON appears to be largely responsive to corticosteroids, which are often the mainstay of acute management. However, relapses are common in patients in whom follow-up is prolonged, often in the context of early or rapid corticosteroid tapering. Establishing optimal acute therapy, the role of maintenance steroid-sparing immunotherapy for long-term relapse prevention, and identifying predictors of relapsing disease remain key research priorities in MOG-ON.
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Affiliation(s)
- Niroshan Jeyakumar
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Magdalena Lerch
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Russell C Dale
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- Clinical Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
- TY Nelson Department of Neurology, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
- Department of Neurology, Concord Hospital, Sydney, NSW, Australia.
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Trewin BP, Dale RC, Qiu J, Chu M, Jeyakumar N, Dela Cruz F, Andersen J, Siriratnam P, Ma KKM, Hardy TA, van der Walt A, Lechner-Scott J, Butzkueven H, Broadley SA, Barnett MH, Reddel SW, Brilot F, Kalincik T, Ramanathan S. Oral corticosteroid dosage and taper duration at onset in myelin oligodendrocyte glycoprotein antibody-associated disease influences time to first relapse. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-333463. [PMID: 38744459 DOI: 10.1136/jnnp-2024-333463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/03/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND We sought to identify an optimal oral corticosteroid regimen at the onset of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), which would delay time to first relapse while minimising cumulative corticosteroid exposure. METHODS In a retrospective multicentre cohort study, Cox proportional hazards models examined the relationship between corticosteroid course as a time-varying covariate and time to first relapse. Simon-Makuch and Kaplan-Meier plots identified an optimal dosing strategy. RESULTS We evaluated 109 patients (62 female, 57%; 41 paediatric, 38%; median age at onset 26 years, (IQR 8-38); median follow-up 6.2 years (IQR 2.6-9.6)). 76/109 (70%) experienced a relapse (median time to first relapse 13.7 months; 95% CI 8.2 to 37.9). In a multivariable model, higher doses of oral prednisone delayed time to first relapse with an effect estimate of 3.7% (95% CI 0.8% to 6.6%; p=0.014) reduced hazard of relapse for every 1 mg/day dose increment. There was evidence of reduced hazard of relapse for patients dosed ≥12.5 mg/day (HR 0.21, 95% CI 0.07 to 0.6; p=0.0036), corresponding to a 79% reduction in relapse risk. There was evidence of reduced hazard of relapse for those dosed ≥12.5 mg/day for at least 3 months (HR 0.12, 95% CI 0.03 to 0.44; p=0.0012), corresponding to an 88% reduction in relapse risk compared with those never treated in this range. No patient with this recommended dosing at onset experienced a Common Terminology Criteria for Adverse Events grade >3 adverse effect. CONCLUSIONS The optimal dose of 12.5 mg of prednisone daily in adults (0.16 mg/kg/day for children) for a minimum of 3 months at the onset of MOGAD delays time to first relapse.
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Affiliation(s)
- Benjamin P Trewin
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Russell C Dale
- Clinical Neuroimmunology Group, Institute for Neuroscience and Muscle Research, Kids Research Institute at the Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Jessica Qiu
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Melissa Chu
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Niroshan Jeyakumar
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Fionna Dela Cruz
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Jane Andersen
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Brain Autoimmunity, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Pakeeran Siriratnam
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Kit Kwan M Ma
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Todd A Hardy
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Concord, New South Wales, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | | | - Helmut Butzkueven
- Department of Neuroscience, Monash University Central Clinical School, Melbourne, Victoria, Australia
- Alfred Hospital, Melbourne, Victoria, Australia
| | - Simon A Broadley
- School of Medicine, Griffith University, Nathan, Queensland, Australia
- Department of Neurology, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Michael H Barnett
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Brain and Mind Centre, The University Of Sydney, Camperdown, New South Wales, Australia
| | - Stephen W Reddel
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Concord, New South Wales, Australia
| | - Fabienne Brilot
- Brain Autoimmunity, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, New South Wales, Australia
- School of Medical Science, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Tomas Kalincik
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurology, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Sudarshini Ramanathan
- Translational Neuroimmunology Group, Kids Neuroscience Centre and Brain and Mind Centre, Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Concord Hospital, Concord, New South Wales, Australia
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Küchlin S, Ihorst G, Heinrich SP, Márquez Neila P, Albrecht P, Hug MJ, Diem R, Lagrèze WA. Disease Course of Clinically Isolated Optic Neuritis. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200223. [PMID: 38588480 PMCID: PMC11010245 DOI: 10.1212/nxi.0000000000200223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/06/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND AND OBJECTIVES Optic neuritis is the most common optic neuropathy in young adults and a frequent manifestation of multiple sclerosis. Its clinical course is pertinent to the design of visual pathway neuroprotection trials. METHODS This is a secondary analysis of longitudinal data from the TONE trial, which included 103 patients from 12 German academic tertiary centers with acute unilateral optic neuritis as a clinically isolated syndrome and baseline high-contrast visual acuity <0.5 decimal. Patients were randomized to 1,000 mg methylprednisolone i.v./d plus either erythropoietin (33,000 IU/d) or placebo (saline solution) for 3 days. They were followed up at standardized intervals with a battery of tests including high-contrast visual acuity, low-contrast letter acuity, contrast sensitivity, visual fields, visual evoked potentials, and retinal optical coherence tomography. At 6 months, participants answered a standardized questionnaire on vision-related quality of life (NEI-VFQ 25). We describe the disease course with mixed-effects piecewise linear models and calculate structure-function correlations using Pearson r. Because erythropoietin had no effect on the visual system, we use pooled (treatment-agnostic) data. RESULTS Patients experienced initial rapid and then decelerating improvements of visual function with thinning of inner and thickening of outer retinal layers. At 6 months, visual parameters were positively correlated with inner and negatively correlated with outer retinal thickness changes. Peripapillary retinal nerve fiber layer thinning predominantly occurred in sectors without previous swelling. At 6 months, macular ganglion cell and inner plexiform layer thinning was weakly correlated with the P100 peak time (r = -0.11) and moderately correlated with the amplitude of visual evoked potentials (r = 0.35). Only functional outcomes were at least moderately correlated with vision-related quality of life. DISCUSSION The longitudinal data from this large study cohort may serve as a reference for the clinical course of acute optic neuritis. The pattern of correlation between visual evoked potentials and inner retinal thinning may argue that the latter is mostly due to ganglion cell loss, rather than dysfunction. Visual pathway neuroprotection trials with functional outcomes are needed to confirm that candidate drugs will benefit patients' vision-related quality of life. TRIAL REGISTRATION INFORMATION ClinicalTrials.gov, NCT01962571.
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Affiliation(s)
- Sebastian Küchlin
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Gabriele Ihorst
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Sven P Heinrich
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Pablo Márquez Neila
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Philipp Albrecht
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Martin J Hug
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Ricarda Diem
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
| | - Wolf A Lagrèze
- From the Eye Center (S.K., S.P.H., W.A.L.); Clinical Trials Unit (G.I.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; ARTOG (P.M.N.), University of Bern, Switzerland; Department of Neurology (P.A.), Maria Hilf Clinics Mönchengladbach; Department of Neurology (P.A.), Medical Faculty, Heinrich Heine-Universität Düsseldorf; Pharmacy (M.J.H.), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg; and Department of Neurology and National Center for Tumor Diseases (R.D.), Faculty of Medicine, University Hospital Heidelberg, Germany
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Tisavipat N, Stiebel-Kalish H, Palevski D, Bialer OY, Moss HE, Chaitanuwong P, Padungkiatsagul T, Henderson AD, Sotirchos ES, Singh S, Salman AR, Tajfirouz DA, Chodnicki KD, Pittock SJ, Flanagan EP, Chen JJ. Acute Optic Neuropathy in Older Adults: Differentiating Between MOGAD Optic Neuritis and Nonarteritic Anterior Ischemic Optic Neuropathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200214. [PMID: 38547435 DOI: 10.1212/nxi.0000000000200214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disease optic neuritis (MOGAD-ON) and nonarteritic anterior ischemic optic neuropathy (NAION) can cause acute optic neuropathy in older adults but have different managements. We aimed to determine differentiating factors between MOGAD-ON and NAION and the frequency of serum MOG-IgG false positivity among patients with NAION. METHODS In this international, multicenter, case-control study at tertiary neuro-ophthalmology centers, patients with MOGAD presenting with unilateral optic neuritis as their first attack at age 45 years or older and age-matched and sex-matched patients with NAION were included. Comorbidities, clinical presentations, acute optic disc findings, optical coherence tomography (OCT) findings, and outcomes were compared between MOGAD-ON and NAION. Multivariate analysis was performed to find statistically significant predictors of MOGAD-ON. A separate review of consecutive NAION patients seen at Mayo Clinic, Rochester, from 2018 to 2022, was conducted to estimate the frequency of false-positive MOG-IgG in this population. RESULTS Sixty-four patients with unilateral MOGAD-ON were compared with 64 patients with NAION. Among patients with MOGAD-ON, the median age at onset was 56 (interquartile range [IQR] 50-61) years, 70% were female, and 78% were White. Multivariate analysis showed that eye pain was strongly associated with MOGAD-ON (OR 32.905; 95% CI 2.299-473.181), while crowded optic disc (OR 0.033; 95% CI 0.002-0.492) and altitudinal visual field defect (OR 0.028; 95% CI 0.002-0.521) were strongly associated with NAION. On OCT, peripapillary retinal nerve fiber layer (pRNFL) thickness in unilateral MOGAD-ON was lower than in NAION (median 114 vs 201 μm, p < 0.001; median pRNFL thickening 25 vs 102 μm, p < 0.001). MOGAD-ON had more severe vision loss at nadir (median logMAR 1.0 vs 0.3, p < 0.001), but better recovery (median logMAR 0.1 vs 0.3, p = 0.002). In the cohort of consecutive NAION patients, 66/212 (31%) patients with NAION were tested for MOG-IgG and 8% (95% CI 1%-14%) of those had false-positive serum MOG-IgG at low titers. DISCUSSION Acute unilateral optic neuropathy with optic disc edema in older adults can be caused by either MOGAD-ON or NAION. Detailed history, the degree of pRNFL swelling on OCT, and visual outcomes can help differentiate the entities and prevent indiscriminate serum MOG-IgG testing in all patients with acute optic neuropathy.
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Affiliation(s)
- Nanthaya Tisavipat
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Hadas Stiebel-Kalish
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Dahlia Palevski
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Omer Y Bialer
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Heather E Moss
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pareena Chaitanuwong
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Tanyatuth Padungkiatsagul
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Amanda D Henderson
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elias S Sotirchos
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Shonar Singh
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Abdul-Rahman Salman
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Deena A Tajfirouz
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Kevin D Chodnicki
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
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5
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Iancu R, Pirvulescu R, Anton N, Iancu G, Istrate S, Romanitan MO, Geamanu A, Popa Cherecheanu M. Visual Function Improvement after Plasma Exchange Therapy for Acute Optic Neuritis in Neuromyelitis Optica Spectrum Disorders: Case Series and Review. Diagnostics (Basel) 2024; 14:863. [PMID: 38732279 PMCID: PMC11083380 DOI: 10.3390/diagnostics14090863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/17/2024] [Accepted: 04/19/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE Neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorder (NMOSD) are autoimmune-mediated central nervous system disorders distinguished by the presence of serum aquaporine-4 IgG antibody (AQP4-Ab). The clinical panel comprises severe optic neuritis (ON) and transverse myelitis, which can result in incomplete recovery and a high risk of recurrence. METHODS This study aimed to evaluate the visual outcomes of three patients with severe acute ON in NMOSD that was non-responsive to intravenous methylprednisolone (IVMP), who received plasma exchange therapy (PLEX). We included three patients (P1, P2 and P3) with severe acute ON who had no improvement after IVMP treatment and were admitted to the ophthalmology department at the Emergency University Hospital Bucharest from January 2022 to September 2023. All three patients with ON were diagnosed in accordance with the criteria described by the Optic Neuritis Treatment Trial. All the subjects were experiencing their first attack. RESULTS The mean recruitment age was 35.3 ± 7.71. All patients were seropositive for the AQP4 antibody. All patients were tested for serum myelin oligodendrocyte glycoprotein (MOG) antibody but only one showed a positive test (P3). Lesions visible in orbital MRI indicated the involvement of retrobulbar, canalicular and/or intracranial segments. All three subjects had no response or incomplete remission after an IVMP protocol (5 days of 1000 mg intravenous methylprednisolone in sodium chloride 0.9%). The mean time from onset of optic neuritis to PLEX was 37.6 days. The PLEX treatment protocol comprised five cycles of plasma exchange treatment over 10 days, with a plasma exchange session every other day. An amount of 1 to 1.5 volumes of circulating plasma were dialyzed for 2-4 h. At 1 month after the completion of PLEX therapy, BCVA and VF parameters were improved in all three patients. CONCLUSION The treatment of ON remains subject to debate and is somewhat controversial. Plasma exchange must be considered as a rescue therapy when IVMP is insufficient for AQP4-ON patients. This study revealed that PLEX treatment effectively improves the visual outcomes of patients experiencing their first attack of severe acute isolated ON after high-dose IVMP treatment. This study suggests that PLEX may be associated with improved visual outcomes in NMOSD acute optic neuritis.
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Affiliation(s)
- Raluca Iancu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Ruxandra Pirvulescu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Nicoleta Anton
- Department of Ophthalmology, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - George Iancu
- Department of Obstetrics-Gynecology, “Carol Davila” University of Medicine and Pharmacy, 020956 Bucharest, Romania;
| | - Sinziana Istrate
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Mihaela Oana Romanitan
- Department of Internal Medicine, Section of Neurology, Södersjukhuset, 11883 Stockholm, Sweden;
| | - Aida Geamanu
- Department of Ophthalmology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (R.I.); (S.I.); (A.G.)
| | - Matei Popa Cherecheanu
- Department of Cardiovascular Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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Hoshina Y, Seay M, Vegunta S, Stulberg EL, Wright MA, Wong KH, Smith TL, Shimura D, Clardy SL. Isolated Optic Neuritis: Etiology, Characteristics, and Outcomes in a US Mountain West Cohort. J Neuroophthalmol 2024:00041327-990000000-00625. [PMID: 38644536 DOI: 10.1097/wno.0000000000002157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
BACKGROUND The diagnosis and treatment of autoimmune optic neuritis (ON) has improved with the accessibility and reliability of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibody testing, yet autoantibody-negative ON remains common. This study describes the demographic, clinical, and outcome data in patients with isolated ON across the pediatric and adult cohort. METHODS A retrospective chart review of University of Utah Health patients with the International Classification of Diseases (ICD) code of ICD-9 377.30 (ON unspecified), ICD-9 377.39 (other ON), or ICD-10 H46 (ON) and at least 2 ophthalmologic evaluations were conducted between February 2011 and July 2023. Only isolated cases of ON without other brain or spinal demyelinating lesions were evaluated. Differences in demographic and clinical characteristics between AQP4, MOG, and Other-ON were determined. RESULTS Of the 98 patients (15 children and 83 adults), 9 (9.2%) were positive for AQP4-IgG and 35 (35.7%) tested positive for MOG-IgG. Fifty-four were classified into Other-ON, of which 7 (13.0%) had recurrence or new demyelinating lesions during a median follow-up of 12.5 months-2 were ultimately diagnosed with recurrent isolated ON (RION), 1 with chronic relapsing inflammatory ON (CRION), 2 with multiple sclerosis, 1 with collapsin response-mediator protein (CRMP)-5-ON, and 1 with seronegative neuromyelitis optica spectrum disorder. Four patients were treated with long-term immunosuppressive therapy. No patients with RION or CRION had preceding infections; they had first recurrences of ON within 2 months. At presentation, AQP4-ON (75%) and MOG-ON (48.8%) had more severe vision loss (visual acuity <20/200) than Other-ON (23.2%, P = 0.01). At the 1-month follow-up, 93.0% of patients with MOG-ON and 89.3% of patients with Other-ON demonstrated a visual acuity ≥20/40, compared with only 50% of patients with AQP4-ON (P < 0.01). By the last follow-up, 37.5% of the AQP4-ON still exhibited visual acuity <20/40, including 25% who experienced severe vision loss (visual acuity <20/200). By contrast, over 95% of patients with MOG-ON and Other-ON maintained a visual acuity of ≥20/40. In our cohort, over a quarter of pediatric cases presented with simultaneous bilateral ON, 40% had a preceding infection, and 44.4% initially presented with a visual acuity <20/200. Two pediatric cases had recurrence, and both were MOG-ON. By their last follow-up, all pediatric cases had achieved a visual acuity of 20/40 or better. In addition, pediatric cases were more likely to exhibit disc edema compared with adult cases (100% vs 64%, P < 0.01). CONCLUSIONS Despite recent advances in identification and availability of testing for AQP4-IgG and MOG-IgG, over half of patients who presented with isolated ON remained with an "idiopathic" diagnostic label. As more than 1 in 10 patients with AQP4-IgG and MOG-IgG negative ON experienced recurrence or develop new demyelinating lesions, clinicians should provide anticipatory guidance and closely monitor for potential long-term outcomes. In addition, it is crucial to re-evaluate the diagnosis in cases of poor recovery, ON recurrence, and the emergence of new neurological symptoms, as ON can often be the initial presentation of other conditions.
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Affiliation(s)
- Yoji Hoshina
- Departments of Neurology (YH, MS, ELS, MAW, K-HW, TLS, SLC) and Pathology (TLS), University of Utah, Salt Lake City, Utah; Department of Ophthalmology and Visual Sciences (MS, SV), University of Utah Moran Eye Center, Salt Lake City, Utah; Department of Pediatric Neurology (MAW), Primary Children's Hospital, Salt Lake City, Utah; George E. Wahlen Department of Veterans Affairs Medical Center (TLS, SLC), Salt Lake City, Utah; and Nora Eccles Harrison Cardiovascular Research and Training Institute (DS), University of Utah, Salt Lake City, Utah
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Akosman S, Li R, Asahi M, Kwon B, Dossantos J, Tavakoli M, Chen JJ. Trends in Plasma Exchange Use in Optic Neuritis Hospitalizations in the United States. Ophthalmology 2024:S0161-6420(24)00201-X. [PMID: 38552677 DOI: 10.1016/j.ophtha.2024.03.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 03/15/2024] [Accepted: 03/18/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To report use trends of plasma exchange (PLEX) as well as sociodemographic and medical comorbidities associated with PLEX in the United States. DESIGN Retrospective cross-sectional study. PARTICIPANTS Adult patients (≥ 18 years) admitted for inpatient hospitalization with a primary diagnosis of optic neuritis (ON). METHODS Data from the National Inpatient Sample database was compiled to assess PLEX use rates between 2000 and 2020. The cohorts of patients receiving PLEX versus not receiving PLEX were analyzed between quarter 4 of 2015 through 2020 (International Classification of Diseases, Tenth Revision [ICD-10], only) for patient sociodemographic variables, medical diagnoses, insurance types, hospital characteristics, cause of disease, time to therapy, length of stay (LOS), and total charges incurred. MAIN OUTCOME MEASURES Incidence of ON, incidence of PLEX, demographics, diagnoses associated with PLEX therapy, total charges, and LOS. RESULTS From 2000 through 2020, 11 209 patients hospitalized with a primary diagnosis of ON were identified, with a significant majority managed at urban teaching hospitals. Use of PLEX increased steadily over 2 decades from 0.63% to 5.46%. Use was greatest in the western United States and least in the eastern United States. In the subset of ICD-10 cases, 3215 patients were identified. The median time to therapy of PLEX was 1 day after admission, and PLEX use was highest in patients with neuromyelitis optica spectrum disorder (NMOSD) (21.21%) and lowest in multiple sclerosis-associated ON (3.80%). Use of PLEX was associated with significantly longer LOS and higher total charges incurred. Medical comorbidities associated with PLEX included adverse reaction to glucocorticoids (adjusted odds ratio [aOR], 31.50), hemiplegia (aOR, 28.48), neuralgia (aOR, 4.81), optic atrophy (aOR, 3.74), paralytic strabismus (aOR, 2.36), and psoriasis (aOR, 1.76). CONCLUSIONS Over the last 2 decades in the United States, PLEX therapy for ON has increased, with the highest use in the western United States and for patients with the diagnosis NMOSD ON. FINANCIAL DISCLOSURE(S) The author(s) have no proprietary or commercial interest in any materials discussed in this article.
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Affiliation(s)
- Sinan Akosman
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Renxi Li
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Masumi Asahi
- Gavin Herbert Eye Institute, University of California Irvine, Irvine, California
| | - Bryan Kwon
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Jason Dossantos
- Department of Ophthalmology, George Washington University, Washington, DC
| | - Mehdi Tavakoli
- Department of Ophthalmology, George Washington University, Washington, DC
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, Minnesota.
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Nair A, Sankhyan N, Sukhija J, Saini AG, Vyas S, Suthar R, Sahu JK, Rawat A. Clinical outcomes and Anti-MOG antibodies in pediatric optic neuritis: A prospective observational study. Eur J Paediatr Neurol 2024; 49:1-5. [PMID: 38271780 DOI: 10.1016/j.ejpn.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 11/04/2023] [Accepted: 01/09/2024] [Indexed: 01/27/2024]
Abstract
OBJECTIVES The objective of this study was to look at the clinical outcomes, and to determine the proportion of children with visual recovery after the first demyelinating event of optic neuritis (ON). METHODOLOGY In this observational study, children with the first clinical event of optic neuritis at an age less than 18 years were evaluated. High-contrast visual acuity, colour vision, Expanded Disability Status Scale (EDSS), Anti-MOG and AQP-4 antibodies were assessed. RESULTS Of the 55 screened, 45 children (77 eyes), median age-98 months, 30 (67%) bilateral were enrolled. Fifty of 77 eyes (67%) had Snellen visual acuity less than 6/60. Twelve children (27%) were MOG seropositive and 3 had AQP-4 positivity. At median follow up of 35 months, 10 (22%) children had one or more relapses. At follow up, the median (IQR) visual acuity improved from nadir of 2.1 (1-2.7) logMAR to 0 (0-0.18) logMAR and 64/77 eyes (83%) had visual recovery. The diagnosis at last follow up was isolated ON in 39/45 (86.6%), relapsing ON (5, 11%), AQP-4 positive NMOSD (3, 7%), MOG antibody associated demyelination (12, 27%), dual seronegative ON (30,67%) and Multiple sclerosis (1, 2%). CONCLUSIONS Most children with first demyelinating event as ON have a monophasic illness. Despite severe acute-phase visual loss, most eyes with ON will recover good visual functions. The risk of AQP-4 disease and multiple sclerosis is low in this group.
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Affiliation(s)
- Abhirami Nair
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Naveen Sankhyan
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jaspreet Sukhija
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Arushi Gahlot Saini
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Sameer Vyas
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Renu Suthar
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Jitendra Kumar Sahu
- Pediatric Neurology Unit, Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Amit Rawat
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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Wei S, Du Y, Luo M, Song R. Development of a predictive model for predicting disability after optic neuritis: a secondary analysis of the Optic Neuritis Treatment Trial. Front Neurol 2024; 14:1326261. [PMID: 38268999 PMCID: PMC10807422 DOI: 10.3389/fneur.2023.1326261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 12/12/2023] [Indexed: 01/26/2024] Open
Abstract
Objective The present study aimed to develop a prediction model for predicting developing debilities after optic neuritis. Methods The data for this research was obtained from the Optic Neuritis Treatment Trial (ONTT). The predictive model was built based on a Cox proportional hazards regression model. Model performance was assessed using Harrell's C-index for discrimination, calibration plots for calibration, and stratification of patients into low-risk and high-risk groups for utility evaluation. Results A total of 416 patients participated. Among them, 101 patients (24.3%) experienced disability, which was defined as achieving or surpassing a score of 3 on the expanded disability status scale. The median follow-up duration was 15.5 years (interquartile range, 7.0 to 16.8). Two predictors in the final predictive model included the classification of multiple sclerosis at baseline and the condition of the optic disk in the affected eye at baseline. Upon incorporating these two factors into the model, the model's C-index stood at 0.71 (95% CI, 0.66-0.76, with an optimism of 0.005) with a favorable alignment with the calibration curve. By utilizing this model, the ONTT cohort can be categorized into two risk categories, each having distinct rates of disability development within a 15-year timeframe (high-risk group, 41% [95% CI, 31-49%] and low-risk group, 13% [95% CI, 8.4-17%]; log-rank p-value of <0.001). Conclusion This predictive model has the potential to assist physicians in identifying individuals at a heightened risk of experiencing disability following optic neuritis, enabling timely intervention and treatment.
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Vosoughi AR, Muccilli A, Schneider R, Rotstein D, Micieli JA. Recovery of Vision in Myelin Oligodendrocyte Glycoprotein-IgG Optic Neuritis Without Treatment: A Case Series. J Neuroophthalmol 2023; 43:e126-e128. [PMID: 36166801 DOI: 10.1097/wno.0000000000001583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Amir R Vosoughi
- Max Rady College of Medicine (ARV), Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Division of Neurology, Department of Medicine (AM, RS, DR), St. Michael's Hospital, Unity Health, University of Toronto, Toronto, Ontario, Canada; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Ontario, Canada; and Kensington Vision and Research Centre (JAM), Toronto, Ontario, Canada
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11
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Greco G, Colombo E, Gastaldi M, Ahmad L, Tavazzi E, Bergamaschi R, Rigoni E. Beyond Myelin Oligodendrocyte Glycoprotein and Aquaporin-4 Antibodies: Alternative Causes of Optic Neuritis. Int J Mol Sci 2023; 24:15986. [PMID: 37958968 PMCID: PMC10649355 DOI: 10.3390/ijms242115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Optic neuritis (ON) is the most common cause of vision loss in young adults. It manifests as acute or subacute vision loss, often accompanied by retrobulbar discomfort or pain during eye movements. Typical ON is associated with Multiple Sclerosis (MS) and is generally mild and steroid-responsive. Atypical forms are characterized by unusual features, such as prominent optic disc edema, poor treatment response, and bilateral involvement, and they are often associated with autoantibodies against aquaporin-4 (AQP4) or Myelin Oligodendrocyte Glycoprotein (MOG). However, in some cases, AQP4 and MOG antibodies will return as negative, plunging the clinician into a diagnostic conundrum. AQP4- and MOG-seronegative ON warrants a broad differential diagnosis, including autoantibody-associated, granulomatous, and systemic disorders. These rare forms need to be identified promptly, as their management and prognosis are greatly different. The aim of this review is to describe the possible rarer etiologies of non-MS-related and AQP4- and MOG-IgG-seronegative inflammatory ON and discuss their diagnoses and treatments.
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Affiliation(s)
- Giacomo Greco
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Matteo Gastaldi
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Lara Ahmad
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Eleonora Tavazzi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Eleonora Rigoni
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
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12
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Kraker JA, Chen JJ. An update on optic neuritis. J Neurol 2023; 270:5113-5126. [PMID: 37542657 DOI: 10.1007/s00415-023-11920-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/27/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
Optic neuritis (ON) is the most common cause of subacute optic neuropathy in young adults. Although most cases of optic neuritis (ON) are classified as typical, meaning idiopathic or associated with multiple sclerosis, there is a growing understanding of atypical forms of optic neuritis such as antibody mediated aquaporin-4 (AQP4)-IgG neuromyelitis optica spectrum disorder (NMOSD) and the recently described entity, myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD). Differentiating typical ON from atypical ON is important because they have different prognoses and treatments. Findings of atypical ON, including severe vision loss with poor recovery with steroids or steroid dependence, prominent optic disc edema, bilateral vision loss, and childhood or late adult onset, should prompt serologic testing for AQP4-IgG and MOG-IgG. Although the traditional division of typical and atypical ON can be helpful, it should be noted that there can be severe presentations of otherwise typical ON and mild presentations of atypical ON that blur these traditional lines. Rare causes of autoimmune optic neuropathies, such as glial fibrillary acidic protein (GFAP) and collapsin response-mediator protein 5 (CRMP5) autoimmunity also should be considered in patients with bilateral painless optic neuropathy associated with optic disc edema, especially if there are other accompanying suggestive neurologic symptoms/signs. Typical ON usually recovers well without treatment, though recovery may be expedited by steroids. Atypical ON is usually treated with intravenous steroids, and some forms, such as NMOSD, often require plasma exchange for acute attacks and long-term immunosuppressive therapy to prevent relapses. Since treatment is tailored to the cause of the ON, elucidating the etiology of the ON is of the utmost importance.
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Affiliation(s)
- Jessica A Kraker
- Department of Ophthalmology, Mayo Clinic Hospital, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology, Mayo Clinic Hospital, Rochester, MN, USA.
- Department of Neurology, Mayo Clinic Hospital, Rochester, MN, USA.
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13
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Tardo L, Salter A, Truong-Le M, Horton L, Blackburn KM, Sguigna PV. A narrative review of neuro-ophthalmologic disease in African Americans and Hispanics with multiple sclerosis. Ther Adv Chronic Dis 2023; 14:20406223231202645. [PMID: 37790945 PMCID: PMC10542320 DOI: 10.1177/20406223231202645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/05/2023] [Indexed: 10/05/2023] Open
Abstract
Multiple sclerosis (MS) is the most common non-traumatic cause of disability in young people, with vision loss in the disease representing the second largest contributor to disability. In particular, African-American patients with MS are noted to have lower vision than their Caucasian counterparts. In this review, we examine the disparities in eye diseases in the MS population with our gaps in knowledge and discuss the underlying nature of pathological disparities.
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Affiliation(s)
- Lauren Tardo
- Department of Neurology, The University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8806, USA
| | - Amber Salter
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Melanie Truong-Le
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
- Department of Ophthalmology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Lindsay Horton
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kyle M. Blackburn
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Peter V. Sguigna
- Department of Neurology, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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14
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Song R, Huang W, Yang J, Tang X, Huang Y, Chen Y, Zhao M, Hu Q, Du Y. Association of aquaporin-4 antibody-seropositive optic neuritis with vision-related quality of life and depression. Front Neurol 2023; 14:1265170. [PMID: 37840923 PMCID: PMC10575616 DOI: 10.3389/fneur.2023.1265170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 09/14/2023] [Indexed: 10/17/2023] Open
Abstract
Objective Aquaporin-4 (AQP4) antibody-seropositive optic neuritis (AQP4-ON) is one of the most common types of optic neuritis in China. However, the association between AQP4-ON and vision-related quality of life (QoL) and depression remains poorly understood. Methods In this cross-sectional study, 57 patients with optic neuritis were evaluated for their vision-related QoL using a Chinese version of the 25-item National Eye Institute Visual Function Questionnaire (VFQ-25) and assessed for depressive symptoms using a Chinese version of the Beck Depression Inventory-II (BDI-II). Data regarding participants' age, sex, visual acuity, and the number of recurrence events were gathered. Linear regression analysis was employed to investigate the relationships between AQP4-ON and vision-related QoL, as well as depression. Results Of the 57 included patients, 28 were AQP4-ON, and 29 were idiopathic optic neuritis (ION). AQP4-ON demonstrated a significant correlation with a decreased VFQ-25 composite score (Mean difference, -11.65 [95% CI, -21.61 to -1.69]; p = 0.023) and an increased BDI-II score (Mean difference, 6.48 [95% CI, 0.25 to 12.71]; p = 0.042) when compared to ION. The BDI-II score was correlated with the VFQ-25 composite score (Spearman ρ = -0.469; p < 0.001) but not with the visual acuity in the worse-seeing eye (Spearman ρ = 0.024; p = 0.860) or in the better-seeing eye (Spearman ρ = -0.039; p = 0.775), bilateral severe visual impairment (Spearman ρ = 0.039; p = 0.772) or the number of recurrence events (Spearman ρ = 0.184; p = 0.171). Conclusion AQP4-positive optic neuritis is associated with a decline in vision-related quality of life as well as an increased likelihood of experiencing depression. It is crucial for clinicians to assess both vision-related QoL and depression in patients with AQP4-positive optic neuritis to provide patient-centered care.
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Affiliation(s)
- Ruitong Song
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Wenqiao Huang
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Jun Yang
- Department of Ophthalmology, Wuzhou Gongren Hospital, Wuzhou, China
| | - Xueshan Tang
- Department of Ophthalmology, Wuzhou Gongren Hospital, Wuzhou, China
| | - Yihua Huang
- Department of Ophthalmology, Wuming Hospital of Guangxi Medical University, Nanning, China
| | - Yingying Chen
- Department of Ophthalmology, The Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mukun Zhao
- Jingliang Eye Hospital, Guangxi Medical University, Nanning, China
| | - Qiuming Hu
- Jingliang Eye Hospital, Guangxi Medical University, Nanning, China
| | - Yi Du
- Department of Ophthalmology, The First Affiliated Hospital of Guangxi Medical University, Nanning, China
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15
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Villacieros-Álvarez J, Espejo C, Arrambide G, Castillo M, Carbonell-Mirabent P, Rodriguez M, Bollo L, Castilló J, Comabella M, Galán I, Midaglia L, Mongay-Ochoa N, Nos C, Rio J, Rodríguez-Acevedo B, Sastre-Garriga J, Tur C, Vidal-Jordana A, Vilaseca A, Zabalza A, Auger C, Rovira A, Montalban X, Tintoré M, Cobo-Calvo Á. Myelin Oligodendrocyte Glycoprotein Antibodies in Adults with a First Demyelinating Event Suggestive of Multiple Sclerosis. Ann Neurol 2023. [PMID: 37705507 DOI: 10.1002/ana.26793] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/21/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibodies (MOG-Ab) distinguish multiple sclerosis (MS) from MOG-associated disease in most cases. However, studies analyzing MOG-Ab at the time of a first demyelinating event suggestive of MS in adults are lacking. We aimed to (1) evaluate the prevalence of MOG-Ab in a first demyelinating event suggestive of MS and (2) compare clinical and paraclinical features between seropositive (MOG-Ab+) and seronegative (MOG-Ab-) patients. METHODS Six hundred thirty adult patients with available serum samples obtained within 6 months from the first event were included. MOG-Ab were analyzed using a live cell-based assay. Statistical analyses included parametric and nonparametric tests, logistic regression, and survival models. RESULTS MOG-Ab were positive in 17 of 630 (2.7%). Fourteen out of 17 (82.4%) MOG-Ab+ patients presented with optic neuritis (ON) compared to 227of 613 (37.0%) MOG-Ab- patients (p = 0.009). Cerebrospinal fluid-restricted oligoclonal bands (CSF-OBs) were found in 2 of 16 (12.5%) MOG-Ab+ versus 371 of 601 (61.7%) MOG-Ab- subjects (p < 0.001). Baseline brain magnetic resonance imaging (MRI) was normal in 9 of 17 (52.9%) MOG-Ab+ versus 153 of 585 (26.2%) MOG-Ab- patients (p = 0.029). Absence of CSF-OBs and ON at onset were independently associated with MOG-Ab positivity (odds ratio [OR] = 9.03, 95% confidence interval [CI] = 2.04-53.6, p = 0.009; and OR = 4.17, 95% CI = 1.15-19.8, p = 0.042, respectively). Of MOG-Ab+ patients, 22.9% (95% CI = 0.0-42.7) compared to 67.6% (95% CI = 63.3-71.3) of MOG-Ab- patients fulfilled McDonald 2017 criteria at 5 years (log-rank p = 0.003). INTERPRETATION MOG-Ab are infrequent in adults with a first demyelinating event suggestive of MS. However, based on our results, we suggest to determine these antibodies in those patients with ON and absence of CSF-OBs, as long as the brain MRI is not suggestive of MS. ANN NEUROL 2023.
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Affiliation(s)
- Javier Villacieros-Álvarez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Espejo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Georgina Arrambide
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Castillo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Pere Carbonell-Mirabent
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Marta Rodriguez
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luca Bollo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Joaquín Castilló
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Manuel Comabella
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ingrid Galán
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Luciana Midaglia
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Neus Mongay-Ochoa
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carlos Nos
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Rio
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Breogan Rodríguez-Acevedo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Jaume Sastre-Garriga
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Tur
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Angela Vidal-Jordana
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Andreu Vilaseca
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Ana Zabalza
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Cristina Auger
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Alex Rovira
- Autonomous University of Barcelona, Barcelona, Spain
- Section of Neuroradiology, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Xavier Montalban
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Mar Tintoré
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
| | - Álvaro Cobo-Calvo
- Neurology-Neuroimmunology Department, Multiple Sclerosis Center of Catalonia, Vall d'Hebron Barcelona Hospital Campus, Vall d'Hebron Research Institute, Barcelona, Spain
- Autonomous University of Barcelona, Barcelona, Spain
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16
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Ochi H, Kurimoto T, Yamagami A, Goto K, Miki A, Kawai M, Ishikawa H, Matsuzaki M, Kondo M, Mochizuki Y, Kimura A, Maekubo T, Chuman H, Ueki S, Nakamura M. Structure-function relationship between magnetic resonance imaging lesion areas and visual field defects in initial optic neuritis with altitudinal hemianopsia. Jpn J Ophthalmol 2023; 67:618-627. [PMID: 37402942 DOI: 10.1007/s10384-023-01008-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/26/2023] [Indexed: 07/06/2023]
Abstract
PURPOSE To study the spatial association of magnetic resonance imaging (MRI) contrast enhancement (CE) areas with visual field defect (VFD) asymmetry in initial cases of optic neuritis (ON) with altitudinal hemianopsia (AH) with reference to nonarteritic anterior ischemic optic neuropathy (NAION) with AH. STUDY DESIGN Multicenter, cross-sectional study. METHODS The present study comprised 19 ON patients and 20 NAION patients with AH who underwent orbital contrast fat-suppressed MRI. The signal-to-intensity ratio (SIR) was calculated by dividing the maximum CE of the optic nerve by the mean CE of the cerebral white matter in 11 coronal sections at 3-mm intervals from immediately posterior to the eyeball to the optic chiasm. Sections in ON patients with an SIR exceeding the mean plus 2 standard deviations of the SIR at the corresponding section in the NAION group were considered abnormal. The correlation between upper-to-lower CE asymmetry in the maximum SIR section and VFD counterpart was determined. RESULTS The ON group had significantly higher maximum SIR than that of the NAION group (1.77 ± 0.88 vs. 1.25 ± 0.32; P < .01). Seven of the 19 patients had sections with abnormally high CE extending posteriorly beyond the orbital apex. Significant spatial correspondence was observed between CE and VFD asymmetry (rs = 0.563; P = .015) in the ON group but not in the NAION group (rs = - 0. 048; P = .850). CONCLUSIONS ON patients with AH frequently show CE even in the intracerebral optic nerve, maintaining a moderate structure-function correspondence.
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Affiliation(s)
- Hirotaka Ochi
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
- Kobe City Eye Hospital, Kobe, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takuji Kurimoto
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan
| | | | - Katsutoshi Goto
- Kawasaki Medical School, Department of Ophthalmology, Kurashiki, Japan
| | - Atsushi Miki
- Kawasaki Medical School, Department of Ophthalmology, Kurashiki, Japan
| | - Manami Kawai
- Department of Ophthalmology, School of Medicine, Kitasato University, Sagamihara,, Japan
| | - Hitoshi Ishikawa
- Department of Orthoptics and Visual Science, Kitasato University School of Allied Health Sciences, Sagamihara, Japan
| | - Mitsuhiro Matsuzaki
- Kobe City Eye Hospital, Kobe, Japan
- Department of Ophthalmology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Miho Kondo
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | | | - Akiko Kimura
- Department of Ophthalmology, Hyogo Medical University, Nishinomiya, Japan
| | | | - Hideki Chuman
- Faculty of Medicine, Department of Ophthalmology, University of Miyazaki, Miyazaki, Japan
| | - Satoshi Ueki
- Graduate School of Medical and Dental Sciences, Division of Ophthalmology and Visual Science, Niigata University, Niigata, Japan
| | - Makoto Nakamura
- Department of Surgery, Division of Ophthalmology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan.
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17
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Moheb N, Chen JJ. The neuro-ophthalmological manifestations of NMOSD and MOGAD-a comprehensive review. Eye (Lond) 2023; 37:2391-2398. [PMID: 36928226 PMCID: PMC10397275 DOI: 10.1038/s41433-023-02477-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/07/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023] Open
Abstract
Optic neuritis (ON) is one of the most frequently seen neuro-ophthalmic causes of vision loss worldwide. Typical ON is often idiopathic or seen in patients with multiple sclerosis, which is well described in the landmark clinical trial, the Optic Neuritis Treatment Trial (ONTT). However, since the completion of the ONTT, there has been the discovery of aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies, which are biomarkers for neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody-associated disease (MOGAD), respectively. These disorders are associated with atypical ON that was not well characterised in the ONTT. The severity, rate of recurrence and overall outcome differs in these two entities requiring prompt and accurate diagnosis and management. This review will summarise the characteristic neuro-ophthalmological signs in NMOSD and MOGAD, serological markers and radiographic findings, as well as acute and long-term therapies used for these disorders.
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Affiliation(s)
- Negar Moheb
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA.
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18
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Deschamps R, Shor N, Vignal C, Guillaume J, Bensa C, Lecler A, Marignier R, Vasseur V, Papeix C, Boudot de la Motte M, Lamirel C. Acute optic neuritis: What are the clues to the aetiological diagnosis in real life? Mult Scler Relat Disord 2023; 76:104764. [PMID: 37270881 DOI: 10.1016/j.msard.2023.104764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 05/03/2023] [Accepted: 05/14/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Previous cross-sectional studies have reported distinct clinical and radiological features among the different acute optic neuritis (ON) aetiologies. Nevertheless, these reports often included the same number of patients in each group, not taking into account the disparity in frequencies of ON aetiologies in a real-life setting and thus, it remains unclear what are the truly useful features for distinguishing the different ON causes. To determine whether clinical evaluation, ophthalmological assessment including the optical coherence tomography (OCT), CSF analysis, and MRI imaging may help to discriminate the different causes of acute ON in a real-life cohort. METHODS In this prospective monocentric study, adult patients with recent acute ON (<1 month) underwent evaluation at baseline and 1 and 12 months, including, high- and low-contrast visual acuity, visual field assessment and OCT measurements, baseline CSF analysis and MRI. RESULTS Among 108 patients, 71 (65.7%) had multiple sclerosis (MS), 19 (17.6%) had idiopathic ON, 13 (12.0%) and 5 (4.6%) had myelin oligodendrocyte glycoprotein and aquaporin-4 antibodies, at last follow up respectively.At baseline, the distribution of bilateral ON, CSF-restricted oligoclonal bands, optic perineuritis, optic nerve length lesions and positive dissemination in space and dissemination in time criteria on MRI were significantly different between the four groups (p <0.001). No significant difference in visual acuity nor inner retinal layer thickness was found between the different ON aetiologies. CONCLUSIONS In this large prospective study, bilateral visual involvement, CSF and MRI results are the most useful clues in distinguishing the different aetiologies of acute ON, whereas ophthalmological assessments including OCT measurements revealed no significant difference between the aetiologies.
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Affiliation(s)
- Romain Deschamps
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France.
| | - Natalia Shor
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France; Department of Neuro-Radiology, Assistance Publique Hôpitaux de Paris, Hôpitaux Universitaires La Pitié Salpêtrière - Sorbonne Université, Paris, France
| | - Catherine Vignal
- Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Jessica Guillaume
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Caroline Bensa
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Augustin Lecler
- Department of Radiology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Romain Marignier
- Department of Neurology and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hospices civils de Lyon, Hôpital neurologique Pierre Wertheimer, Lyon/Bron, France
| | - Vivien Vasseur
- Clinical Research Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Caroline Papeix
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Cedric Lamirel
- Department of Neuro-Ophthalmology, Hôpital Fondation Adolphe de Rothschild, Paris, France
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19
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Leite MI, Panahloo Z, Harrison N, Palace J. A systematic literature review to examine the considerations around pregnancy in women of child-bearing age with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) or aquaporin 4 neuromyelitis optica spectrum disorder (AQP4+ NMOSD). Mult Scler Relat Disord 2023; 75:104760. [PMID: 37224631 DOI: 10.1016/j.msard.2023.104760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Aquaporin-4 antibody positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare autoimmune diseases with overlapping phenotypes. Understanding their clinical manifestation prior to, during and after pregnancy may influence the management of women of child-bearing age (WOCBA) with these diseases. METHODS This systematic review identified relevant MEDLINE-indexed publications dated between 01 January 2011 and 01 November 2021, and congress materials from key conferences between 01 January 2019 and 01 November 2021. These were manually assessed for relevance to AQP4+ NMOSD and/or MOGAD in WOCBA, with selected data extracted and considered. RESULTS In total, 107 articles were retrieved and reviewed for relevancy, including 65 clinical studies. Limited evidence was found regarding a conclusive impact of either disease on female fertility, sexual function or menarche, and impact on maternal outcomes requires further investigation in both conditions to establish risk for pre-eclampsia, gestational diabetes and other complications relative to the general population. Collated data for pregnancy outcomes show clear risks in AQP4+ NMOSD to healthy delivery and a rise in annualised relapse rate postpartum that may require adaptation of treatment regimens. Disease activity appears to be attenuated during pregnancy in MOGAD patients with an increased risk of relapse during the postpartum months, but strong conclusions cannot be made due to a paucity of available data. CONCLUSIONS This review brings together the literature on AQP4+ NMOSD and MOGAD in WOCBA. The potential impact of pregnancy and the postpartum period on disease activity suggest a proactive management strategy early on may improve maternal and infant outcomes, but more clinical data are needed, particularly for MOGAD.
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Affiliation(s)
- M Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
| | | | | | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
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20
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Keyhanian K, Chwalisz BK. The Treatment of Acute Optic Neuritis. Semin Ophthalmol 2023:1-4. [PMID: 37162276 DOI: 10.1080/08820538.2023.2211662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Despite the high incidence of optic neuritis (ON), and the growing number of therapeutic options for the long-term treatment of diseases associated with ON including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD) and MOG antibody associated disease (MOGAD), there are still only limited therapeutic options for treating an acute event of optic neuritis. These include steroids, plasma exchange (PLEX) and intravenous immunoglobulin (IVIG). High-dose steroids remain the mainstay of acute treatment. However, evidence is emerging that when optic neuritis is accompanied with certain atypical features that suggest a more unfavorable outcome this mandates special consideration such as early addition of other therapeutic agents or tapering the steroid very slowly. This review will distinguish between typical and atypical neuritis and discuss acute treatment options.
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Affiliation(s)
- Kiandokht Keyhanian
- Neuro-ophthalmology Division, Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, MA, USA
| | - Bart K Chwalisz
- Neuro-ophthalmology Division, Department of Ophthalmology, Massachusetts Eye and Ear/Harvard Medical School, Boston, MA, USA
- Neuro-immunology Division, Department of Neurology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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21
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Al-Ani A, Chen JJ, Costello F. Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): current understanding and challenges. J Neurol 2023:10.1007/s00415-023-11737-8. [PMID: 37154894 PMCID: PMC10165591 DOI: 10.1007/s00415-023-11737-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/15/2023] [Accepted: 04/17/2023] [Indexed: 05/10/2023]
Abstract
New diagnostic criteria for myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) have recently been proposed, distinguishing this syndrome from other inflammatory diseases of the central nervous system. Seropositivity status for MOG-IgG autoantibodies is important for diagnosing MOGAD, but only in the context of robust clinical characterization and cautious interpretation of neuroimaging. Over the last several years, access to cell-based assay (CBA) techniques has improved diagnostic accuracy, yet the positive predictive value of serum MOG-IgG values varies with the prevalence of MOGAD in any given patient population. For this reason, possible alternative diagnoses need to be considered, and low MOG-IgG titers need to be carefully weighted. In this review, cardinal clinical features of MOGAD are discussed. Key challenges to the current understanding of MOGAD are also highlighted, including uncertainty regarding the specificity and pathogenicity of MOG autoantibodies, the need to identify immunopathologic targets for future therapies, the quest to validate biomarkers that facilitate diagnosis and detect disease activity, and the importance of deciphering which patients with MOGAD require long-term immunotherapy.
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Affiliation(s)
- Abdullah Al-Ani
- Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
| | - Fiona Costello
- Section of Ophthalmology, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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22
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A 10-Year Single-Center Study of the Clinical Characteristics of Optic Neuritis-Related NMOSD, MS, and Double Seronegative Optic Neuritis, Together with Factors Predicting Visual Outcomes. Vision (Basel) 2023; 7:vision7010016. [PMID: 36977296 PMCID: PMC10056788 DOI: 10.3390/vision7010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/14/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023] Open
Abstract
The clinical characteristics of three types of optic neuritis (double seronegative optic neuritis; DN-ON, Neuromyelitis optica spectrum disorder-related optic neuritis; NMOSD-ON, and multiple sclerosis-related optic neuritis; MS-ON) were examined in order to identify factors that may affect good visual recovery in Thai patients. The study included patients diagnosed with three types of optic neuritis at Rajavithi Hospital between 2011 and 2020. Visual acuity at the end of 12 months was used as the treatment outcome. Multiple logistic regression analysis was used to evaluate potential predictors of good visual recovery. Of the 76 patients, 61 had optic neuritis, with DN-ON as the most common subtype (52.6%). MS-ON patients were significantly younger (28.3 ± 6.6 years, p = 0.002) and there was a female predominance in all subgroups (p = 0.076). NMOSD-ON patients had a significantly higher proportion of poor baseline VA (p < 0.001). None of the NMOSD-ON patients achieved 0.3 logMAR visual recovery in the 12-month period (p = 0.022). A delay in treatment with intravenous methylprednisolone (IVMP) for more than 7 days increased the risk of failure to gain 0.3 logMAR visual recovery by five times (OR 5.29, 95% CI 1.359–20.616, p = 0.016), with NMOSD-ON as the strongest predictor (OR 10.47, 95% CI; 1.095–99.993, p = 0.041). Early treatment with intravenous methylprednisolone may be important for achieving at least 0.3 logMAR visual recovery in Thai patients with optic neuritis.
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23
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Bennett JL, Costello F, Chen JJ, Petzold A, Biousse V, Newman NJ, Galetta SL. Optic neuritis and autoimmune optic neuropathies: advances in diagnosis and treatment. Lancet Neurol 2023; 22:89-100. [PMID: 36155661 DOI: 10.1016/s1474-4422(22)00187-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 04/14/2022] [Accepted: 04/22/2022] [Indexed: 01/04/2023]
Abstract
Optic neuritis is an inflammatory optic neuropathy that is commonly indicative of autoimmune neurological disorders including multiple sclerosis, myelin-oligodendrocyte glycoprotein antibody-associated disease, and neuromyelitis optica spectrum disorder. Early clinical recognition of optic neuritis is important in determining the potential aetiology, which has bearing on prognosis and treatment. Regaining high-contrast visual acuity is common in people with idiopathic optic neuritis and multiple sclerosis-associated optic neuritis; however, residual deficits in contrast sensitivity, binocular vision, and motion perception might impair vision-specific quality-of-life metrics. In contrast, recovery of visual acuity can be poorer and optic nerve atrophy more severe in individuals who are seropositive for antibodies to myelin oligodendrocyte glycoprotein, AQP4, and CRMP5 than in individuals with typical optic neuritis from idiopathic or multiple-sclerosis associated optic neuritis. Key clinical, imaging, and laboratory findings differentiate these disorders, allowing clinicians to focus their diagnostic studies and optimise acute and preventive treatments. Guided by early and accurate diagnosis of optic neuritis subtypes, the timely use of high-dose corticosteroids and, in some instances, plasmapheresis could prevent loss of high-contrast vision, improve contrast sensitivity, and preserve colour vision and visual fields. Advancements in our knowledge, diagnosis, and treatment of optic neuritis will ultimately improve our understanding of autoimmune neurological disorders, improve clinical trial design, and spearhead therapeutic innovation.
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Affiliation(s)
- Jeffrey L Bennett
- Department of Neurology and Department of Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery, University of Calgary, Calgary, AB, Canada
| | - John J Chen
- Department of Ophthalmology and Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Axel Petzold
- National Hospital for Neurology and Neurosurgery, University College London Hospital, London, UK; Moorfields Eye Hospital, London, UK; Neuro-ophthalmology Expert Centre, Amsterdam, Netherlands
| | - Valérie Biousse
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA
| | - Nancy J Newman
- Department of Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA; Department of Neurological Surgery, Emory University School of Medicine, Atlanta, GA, USA
| | - Steven L Galetta
- Department of Neurology and Department of Opthalmology, NYU Langone Medical Center, New York, NY, USA
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24
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Details and outcomes of a large cohort of MOG-IgG associated optic neuritis. Mult Scler Relat Disord 2022; 68:104237. [PMID: 36252317 DOI: 10.1016/j.msard.2022.104237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/16/2022] [Accepted: 10/09/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The goal of this study was to examine the temporal relationship of eye pain to visual loss and investigate whether timing of steroid treatment affects the rate and extent of visual recovery in optic neuritis (ON) from MOG-IgG associated disease (MOGAD) in a large cohort of MOGAD patients with ON. METHODS This is a multicenter, retrospective cohort study of consecutive MOGAD patients with ON attacks seen from 2017 to 2021 fulfilling the following criteria: (1) clinical history of ON; (2) MOG-IgG seropositivity. ON attacks were evaluated for presence/duration of eye pain, nadir of vision loss, time to intravenous methylprednisolone (IVMP) treatment, time to recovery, and final visual outcomes. RESULTS There were 107 patients with 140 attacks treated with IVMP and details on timing of treatment and outcomes. Eye pain was present in 125/140 (89%) attacks with pain onset a median of 3 days (range, 0 to 20) prior to vision loss. Among 46 ON attacks treated with IVMP within 2 days of onset of vision loss, median time to recovery was 4 days (range, 0 to 103) compared to 15 days (range, 0 to 365) in 94 ON attacks treated after 2 days (p = 0.004). Those treated within 2 days had less severe VA loss at time of treatment (median LogMAR VA 0.48, range, 0.1 to 3) compared to those treated after 2 days (median LogMAR VA 1.7, range, 0 to 3; p < 0.001), and were more likely to have a VA outcome of 20/40 or better (98% vs 83%, p = 0.01). After adjustment for the initial VA at time of treatment, the differences in final VA were no longer significantly different (p = 0.14). In addition, some patients were documented to recover without steroid treatment. CONCLUSION This study suggests that pain precedes vision loss in the majority of ON attacks and early steroids may lead to better outcomes in MOG-IgG ON, but some patients can recover without steroid treatment. Prospective randomized clinical trials are required to confirm these findings.
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25
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Song H, Yang M, Zhou H, Li Z, Wei S. MOG antibody prevalence in adult optic neuritis and clinical predictive factors for diagnosis: A Chinese cohort study. Mult Scler Relat Disord 2022; 68:104248. [PMID: 36544312 DOI: 10.1016/j.msard.2022.104248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 10/13/2022] [Accepted: 10/15/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Because AQP4/MOG antibody testing is not available in some parts of the world and there are often delays in obtaining results, it is particularly important to use clinical factors to predict the subtypes of adult optic neuritis (ON). METHODS This was a single-center retrospective cohort study. RESULTS The final analysis included 249 adult patients presenting with the first ON attack during January 2016 to January 2020. These included 109 (43.8%) AQP4-ON cases, 49 (19.7%) MOG-ON cases, and 91 (36.5%) Seronegative-ON cases. The proportion of optic disk swelling (ODS) and bilateral involvement in MOG-ON group was significantly higher than in the other two subgroups (P = 0.029, 0.001). The MOG-ON group had the best follow-up BCVA (P = 0.003). To predict adult AQP4-ON, unilateral involvement (sensitivity 0.88, NPV 0.77) was the most sensitivity predictors, while neurological history (specificity 0.96, PPV 0.65) and concomitant other autoimmune antibodies (specificity 0.76, PPV 0.65) were the most specific predictors. Using the parallel test 'unilateral or other autoimmune antibodies' increased sensitivity to 0.95, with an optimal NPV of 0.88. To predict adult MOG-ON, the most sensitive clinical characteristics were ODS (sensitivity 0.79, NPV 0.88), and follow-up VA ≤0.1logMAR (sensitivity 0.78, NPV 0.92), whereas the most specific values were prior neurological history or bilateral involvement, with specificities of 0.92 and 0.82, respectively. The sensitivity increased to 0.94, 0.97, and 0.97 when using the parallel clinical factors of 'bilateral or ODS or relapse', 'bilateral or ODS or follow-up VA ≤0.1logMAR', and 'ODS or follow-up VA ≤0.1logMAR', and the corresponding NPV (0.94, 0.97 vs 0.98). CONCLUSION The proportion of MOG-ON (19.7%) was less than that of AQP4-ON and Seronegative-ON. Moreover, MOG-ON had a better prognosis and was more likely to be associated with ODS or bilateral involvement. The use of parallel clinical parameters improved the sensitivity for the diagnosis of adult MOG-ON and AQP4-ON.
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Affiliation(s)
- Honglu Song
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China; Department of Ophthalmology, the 980th Hospital of the Chinese PLA Joint Logistics Support Force, Shijiazhuang, Hebei, China
| | - Mo Yang
- Department of Neuro-ophthalmology, Eye Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huanfen Zhou
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China
| | - Zhaohui Li
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China.
| | - Shihui Wei
- Senior Department of Ophthalmology, The Chinese People's Liberation Army General Hospital, Beijing, China.
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26
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Branco J, Elze T, Wang JK, Pasquale LR, Garvin MK, Kardon R, Kupersmith MJ. Longitudinal visual field archetypal analysis of optic neuritis treated in a clinical setting. BMJ Open Ophthalmol 2022. [PMCID: PMC9670935 DOI: 10.1136/bmjophth-2022-001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background/aims We previously used archetypal analysis (AA) to create a model that quantified patterns (archetypes (ATs)) of visual field (VF) loss that can predict recovery and reveal residual VF deficits from eyes in the Optic Neuritis Treatment Trial (ONTT). We hypothesised that AA could produce similar results for ON VFs collected in clinical practice. Methods We applied AA to a retrospective data set of 486 VFs collected in 1 neuro-ophthalmology service from 141 eyes with acute ON and typical VF defects, to create a clinic-derived AT model. We also used the ONTT-derived AT model to analyse this new dataset. We compared the findings of both models by decomposing VFs into component ATs of varying per cent weight (PW), correlating presentation AT PW with mean deviation (MD) at final visits for each eye and identifying residual deficits in VFs considered normal. Results Both models, each with 16 ATs, decomposed each presentation VF into 0–6 abnormal ATs representative of known patterns of ON-related VF loss. AT1, the normal pattern in both models, correlated strongly with MD for VFs collected at presentation (r=0.82; p<0.001) and the final visit (r=0.81, p<0.001). The presentation AT1 PW was associated with improvement in MD over time. 67% of VFs considered ‘normal’ at final visit had 1.2±0.4 abnormal ATs, and both models revealed similar patterns of regional VF loss. Conclusions AA is a quantitative method to measure change and outcome of ON VFs. Presentation AT features are associated with MD at final visit. AA identifies residual VF deficits not otherwise indicated by MD.
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Affiliation(s)
| | - Tobias Elze
- Retina Service, Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts, USA
| | - Jui-Kai Wang
- Ophthalmology, University of Iowa Hospitals and Clinics Pathology, Iowa City, Iowa, USA
| | - Louis R Pasquale
- Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mona K Garvin
- Bioengineering, University of Iowa Hospitals and Clinics Pathology, Iowa City, Iowa, USA
| | - Randy Kardon
- Ophthalmology, University of Iowa Hospitals and Clinics Pathology, Iowa City, Iowa, USA
| | - Mark J Kupersmith
- Neurology/Ophthalmology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Benard-Seguin E, Costello F. A Practical Approach to the Diagnosis and Management of Optic Neuritis. Ann Indian Acad Neurol 2022; 25:S48-S53. [PMID: 36589032 PMCID: PMC9795707 DOI: 10.4103/aian.aian_170_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/19/2022] [Indexed: 01/04/2023] Open
Abstract
Optic neuritis (ON), as an umbrella term, refers to a spectrum of inflammatory optic neuropathies arising from a myriad of potential causes. In its most common form, "typical" ON presents as a unilateral, painful subacute vision loss event in young Caucasian women. The Optic Neuritis Treatment Trial (ONTT) has historically guided our treatment of ON, and taught us important lessons about the clinical presentation, visual prognosis, and future risk of multiple sclerosis (MS) diagnosis associated with this condition. However, in the decades since the ONTT, several immune-mediated conditions such as neuromyelitis optica spectrum disorder (NMOSD), and myelin-oligodendrocyte glycoprotein IgG associated disease (MOGAD) have been discovered, complicating the clinical approach to ON. Unlike MS, other central nervous system (CNS) inflammatory conditions are associated with ON subtypes that are potentially blinding, and prone to recurrence. Owing to differences in the clinical presentation, serological biomarkers, radiological findings, and prognostic implications associated with MS ON, NMOSD ON, and MOGAD ON subtypes, it is imperative that clinicians be aware of the diagnostic approach and management options for these conditions.
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Affiliation(s)
| | - Fiona Costello
- Department of Surgery in Ophthalmology, University of Calgary, Calgary, AB, Canada,Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada,Address for correspondence: Dr. Fiona Costello, 7007 14 St SW, Calgary, AB T2V 1P9, Calgary, Alberta, Canada. E-mail:
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28
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Petzold A, Fraser CL, Abegg M, Alroughani R, Alshowaeir D, Alvarenga R, Andris C, Asgari N, Barnett Y, Battistella R, Behbehani R, Berger T, Bikbov MM, Biotti D, Biousse V, Boschi A, Brazdil M, Brezhnev A, Calabresi PA, Cordonnier M, Costello F, Cruz FM, Cunha LP, Daoudi S, Deschamps R, de Seze J, Diem R, Etemadifar M, Flores-Rivera J, Fonseca P, Frederiksen J, Frohman E, Frohman T, Tilikete CF, Fujihara K, Gálvez A, Gouider R, Gracia F, Grigoriadis N, Guajardo JM, Habek M, Hawlina M, Martínez-Lapiscina EH, Hooker J, Hor JY, Howlett W, Huang-Link Y, Idrissova Z, Illes Z, Jancic J, Jindahra P, Karussis D, Kerty E, Kim HJ, Lagrèze W, Leocani L, Levin N, Liskova P, Liu Y, Maiga Y, Marignier R, McGuigan C, Meira D, Merle H, Monteiro MLR, Moodley A, Moura F, Muñoz S, Mustafa S, Nakashima I, Noval S, Oehninger C, Ogun O, Omoti A, Pandit L, Paul F, Rebolleda G, Reddel S, Rejdak K, Rejdak R, Rodriguez-Morales AJ, Rougier MB, Sa MJ, Sanchez-Dalmau B, Saylor D, Shatriah I, Siva A, Stiebel-Kalish H, Szatmary G, Ta L, Tenembaum S, Tran H, Trufanov Y, van Pesch V, Wang AG, Wattjes MP, Willoughby E, Zakaria M, Zvornicanin J, Balcer L, Plant GT. Diagnosis and classification of optic neuritis. Lancet Neurol 2022; 21:1120-1134. [PMID: 36179757 DOI: 10.1016/s1474-4422(22)00200-9] [Citation(s) in RCA: 67] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 03/16/2022] [Accepted: 04/20/2022] [Indexed: 11/28/2022]
Abstract
There is no consensus regarding the classification of optic neuritis, and precise diagnostic criteria are not available. This reality means that the diagnosis of disorders that have optic neuritis as the first manifestation can be challenging. Accurate diagnosis of optic neuritis at presentation can facilitate the timely treatment of individuals with multiple sclerosis, neuromyelitis optica spectrum disorder, or myelin oligodendrocyte glycoprotein antibody-associated disease. Epidemiological data show that, cumulatively, optic neuritis is most frequently caused by many conditions other than multiple sclerosis. Worldwide, the cause and management of optic neuritis varies with geographical location, treatment availability, and ethnic background. We have developed diagnostic criteria for optic neuritis and a classification of optic neuritis subgroups. Our diagnostic criteria are based on clinical features that permit a diagnosis of possible optic neuritis; further paraclinical tests, utilising brain, orbital, and retinal imaging, together with antibody and other protein biomarker data, can lead to a diagnosis of definite optic neuritis. Paraclinical tests can also be applied retrospectively on stored samples and historical brain or retinal scans, which will be useful for future validation studies. Our criteria have the potential to reduce the risk of misdiagnosis, provide information on optic neuritis disease course that can guide future treatment trial design, and enable physicians to judge the likelihood of a need for long-term pharmacological management, which might differ according to optic neuritis subgroups.
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29
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Treatment and Relapse Prevention of Typical and Atypical Optic Neuritis. Int J Mol Sci 2022; 23:ijms23179769. [PMID: 36077167 PMCID: PMC9456305 DOI: 10.3390/ijms23179769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 12/02/2022] Open
Abstract
Optic neuritis (ON) is an inflammatory condition involving the optic nerve. Several important typical and atypical ON variants are now recognized. Typical ON has a more favorable prognosis; it can be idiopathic or represent an early manifestation of demyelinating diseases, mostly multiple sclerosis (MS). The atypical spectrum includes entities such as antibody-driven ON associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody disease (MOGAD), chronic/relapsing inflammatory optic neuropathy (CRION), and sarcoidosis-associated ON. Appropriate and timely diagnosis is essential to rapidly decide on the appropriate treatment, maximize visual recovery, and minimize recurrences. This review paper aims at presenting the currently available state-of-the-art treatment strategies for typical and atypical ON, both in the acute phase and in the long-term. Moreover, emerging therapeutic approaches and novel steps in the direction of achieving remyelination are discussed.
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30
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The Treatment of Myelin Oligodendrocyte Glycoprotein Antibody Disease: A State-of-the-Art Review. J Neuroophthalmol 2022; 42:292-296. [PMID: 35944137 DOI: 10.1097/wno.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is an important etiology of neurologic morbidity and specifically, atypical, and relapsing optic neuritis. This review summarizes acute treatment and long-term prevention approaches in MOGAD. EVIDENCE ACQUISITION PubMed and Google Scholar databases were manually searched and reviewed. RESULTS We review the evidence base for acute treatment of MOGAD with corticosteroids and adjunct therapies, such as intravenous immunoglobulin (IVIg) and plasma exchange. We discuss the utility of prolonged corticosteroid tapering after the acute attack. We then summarize the commonly used disease-modifying treatments for relapsing MOGAD, including chronic low-dose corticosteroids, classic antirheumatic immune suppressants, biologic agents, and IVIg. CONCLUSIONS While acute MOGAD attacks are usually treated with high-dose IV corticosteroids, longer oral corticosteroid tapers may prevent rapid relapse. Multiple long-term treatment strategies are being employed in recurrent MOGAD, with IVIg is emerging as probably the most effective therapy.
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31
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Longbrake E. Myelin Oligodendrocyte Glycoprotein-Associated Disorders. Continuum (Minneap Minn) 2022; 28:1171-1193. [PMID: 35938661 PMCID: PMC9523511 DOI: 10.1212/con.0000000000001127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW Anti-myelin oligodendrocyte glycoprotein (MOG) autoantibodies have become a recognized cause of a pathophysiologically distinct group of central nervous system (CNS) autoimmune diseases. MOG-associated disorders can easily be confused with other CNS diseases such as multiple sclerosis or neuromyelitis optica, but they have a distinct clinical phenotype and prognosis. RECENT FINDINGS Most patients with MOG-associated disorders exhibit optic neuritis, myelitis, or acute disseminated encephalomyelitis (ADEM) alone, sequentially, or in combination; the disease may be either monophasic or relapsing. Recent case reports have continued to expand the clinical spectrum of disease, and increasingly larger cohort studies have helped clarify its pathophysiology and natural history. SUMMARY Anti-MOG-associated disorders comprise a substantial subset of patients previously thought to have other seronegative CNS diseases. Accurate diagnosis is important because the relapse patterns and prognosis for MOG-associated disorders are unique. Immunotherapy appears to successfully mitigate the disease, although not all agents are equally effective. The emerging large-scale data describing the clinical spectrum and natural history of MOG-associated disorders will be foundational for future therapeutic trials.
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Update on glial antibody-mediated optic neuritis. Jpn J Ophthalmol 2022; 66:405-412. [PMID: 35895155 DOI: 10.1007/s10384-022-00932-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/16/2022] [Indexed: 10/16/2022]
Abstract
Optic neuritis (ON) refers to inflammatory demyelinating lesions of the optic nerve, which can cause acute or subacute vision loss and is a major cause of vision loss in young adults. Much of our understanding of typical ON is from the Optic Neuritis Treatment Trial. Glial autoantibodies to aquaporin-4 immunoglobulin (AQP4-IgG) and myelin oligodendrocyte glycoprotein immunoglobulin (MOG-IgG) are recently established biomarkers of ON that have revolutionized our understanding of atypical ON. The detection of glial antibodies is helpful in the diagnosis, treatment, and follow-up of patients with different types of ON. AQP4-IgG and MOG-IgG screening is strongly recommended for patients with atypical ON. Research on the pathogenesis of NMOSD and MOGAD will promote the development and marketing of targeted immunotherapies. The application of new and efficient drugs, such as the selective complement C5 inhibitor, IL-6 receptor inhibitor, B cell-depleting agents, and drugs against other monoclonal antibodies, provides additional medical evidence. This review provides information on the diagnosis and management of glial antibody-mediated ON.
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Vision Prognosis and Associated Factors of Optic Neuritis in Dependence of Glial Autoimmune Antibodies. Am J Ophthalmol 2022; 239:11-25. [PMID: 35081416 DOI: 10.1016/j.ajo.2022.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/08/2022] [Accepted: 01/14/2022] [Indexed: 02/05/2023]
Abstract
PURPOSE To assess the visual prognosis of optic neuritis (ON) in dependence of the glial autoimmune antibody status and associated factors. DESIGN Longitudinal observational cohort study. METHODS Patients with ON and measurements of serum concentrations of glial autoantibodies were consecutively and longitudinally examined with a minimal follow-up of 3 months. Patients with multiple sclerosis and double seronegative results were excluded. RESULTS The study included 529 patients (aquaporin-4 immunoglobulin [AQP4-IgG] seropositive, n = 291; myelin oligodendrocyte glycoprotein immunoglobulin [MOG-IgG] seropositive, n = 112; double-seronegative, n = 126) with 1022 ON episodes (AQP4-IgG seropositive, n = 550; MOG-IgG seropositive, n=254; double-seronegative, n = 218). Prevalence of severe vision loss (best-corrected visual acuity [BCVA] ≤20/200 at the end of follow-up) was higher (P < .001) in the AQP4-IgG group (236/550; 42.9%) than in the seronegative group (68/218; 31.2%) and in the MOG-IgG group (15/254; 5.9%). Prevalence of good vision recovery (BCVA≥20/40) was higher (P < .001) in the MOG-IgG group (229/254; 90.2%) than in the seronegative group (111/218; 50.9%) and in the AQP4-IgG group (236/550; 42.9%). In multivariable logistic analysis, higher prevalence of severe vision loss was associated with AQP4-IgG seropositivity (odds ratio [OR] 1.66; 95% CI 1.14, 2.43; P = .008), male sex (OR 1.97, 95% CI 1.33, 2.93; P < .001), age at ON onset >45 years (OR 1.93, 95% CI 1.35, 2.77; P < .001), nadir vision ≤20/200 (OR 14.11, 95% CI 6.54, 36.93; P < .001), and higher number of recurrences (OR 1.35, 95% CI 1.14, 1.61; P = .001). Higher prevalence of good vision outcome was associated with MOG-IgG seropositivity (OR 8.13, 95% CI 4.82, 14.2; P < .001), age at ON onset <18 years (OR 1.78, 95% CI 1.18, 2.71; P = .006), nadir visual acuity ≥20/40 (OR 4.03; 95% CI 1.45, 14.37; P = .015), and lower number of recurrences (OR 0.60; 95% CI 0.50, 0.72; P < .001). CONCLUSION Severe vision loss (prevalence in the AQP4-IgG group, MOG-IgG group, and seronegative group: 42.9%, 5.9%, and 31.2%, respectively) was associated with AQP4-IgG seropositivity, male gender, older age at onset, worse nadir vision, and higher number of recurrences.
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Kim KH, Kim SH, Hyun JW, Kim HJ. Clinical and Radiological Features of Myelin Oligodendrocyte Glycoprotein-Associated Myelitis in Adults. J Clin Neurol 2022; 18:280-289. [PMID: 35589317 PMCID: PMC9163942 DOI: 10.3988/jcn.2022.18.3.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/14/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Antibodies against myelin oligodendrocyte glycoprotein (MOG-IgG) have recently been established as a biomarker for MOG-antibody-associated disease (MOGAD), which is a distinct demyelinating disease of the central nervous system. Among the diverse clinical phenotypes of MOGAD, myelitis is the second-most-common presentation in adults, followed by optic neuritis. While some features overlap, there are multiple reports of distinctive clinical and radiological features of MOG-IgG-associated myelitis, which are useful for differentiating MOGAD from both multiple sclerosis and neuromyelitis optica spectrum disorder. In this review we summarize the clinical and radiographic characteristics of MOG-IgG-associated myelitis with a particular focus on adult patients.
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Affiliation(s)
- Ki Hoon Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Su-Hyun Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Jae-Won Hyun
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea.
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Tanimura Y, Hiroaki Y, Mori M, Fujiyoshi Y. Cell-based flow cytometry assay for simultaneous detection of multiple autoantibodies in a single serum sample. Anal Biochem 2022; 650:114721. [DOI: 10.1016/j.ab.2022.114721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 04/06/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022]
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A Longitudinal Comparison of the Recovery Patterns of Optic Neuritis with MOG Antibody-Seropositive and AQP4 Antibody-Seropositive or -Seronegative for Both Antibodies. J Ophthalmol 2022; 2022:4951491. [PMID: 35360549 PMCID: PMC8964224 DOI: 10.1155/2022/4951491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 02/01/2022] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
In this study, the aim is to compare the recovery pattern among patients with acute myelin oligodendrocyte glycoprotein antibody-seropositive optic neuritis (MOG-Ab + ON) attacks and aquaporin-4 antibody-seropositive ON (AQP4-Ab + ON) or -seronegative ON. At the onset of the first-ever ON attack, the thickness of RNFL (RNFLt) in the MOG-Ab + ON group was significantly thicker than others (
), while visual function damage was not significantly different to other groups. One month to six months after onset, the MOG-Ab + ON group showed significantly better visual function (
) than the other two groups, while the RNFLt showed no significant difference among the three groups (
). MOG-Ab + ON and AQP4-Ab + ON groups showed rapid recovery in the first month and then plateaued. The annual relapse rate was significantly higher in MOG-Ab + ON and AQP4-Ab + ON groups than seronegative ON. The relapse interval of the MOG-Ab + ON group (9.00 ± 7.86 months) was significantly shorter than that of the AQP4-Ab + ON group (45.76 ± 37.82 months) (
) but showed no significant difference from that of the seronegative ON group (
). To sum up, the recovery patterns were different among these three types of ON. RNFLt was not parallel to the recovery of visual function among these types of ON. MOG-Ab + ON had the mildest visual function damage but the most substantial RNFL changes, while AQP4-Ab + ON suffered the worst function damage. MOG-Ab + ON had a similar relapse rate as AQP4-Ab + ON but a shorter interval, indicating that relapse prevention was necessary and should be initiated as early as possible.
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Miller NR, Johnson LN, Bakaeva T, Van Stavern GP, Lee AG. Is Neuroretinitis Associated With Multiple Sclerosis? J Neuroophthalmol 2022; 42:126-130. [PMID: 34873139 DOI: 10.1097/wno.0000000000001374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Neil R Miller
- Wilmer Eye Institute (NRM), Johns Hopkins University School of Medicine, Baltimore, Maryland; Neuro-Ophthalmology Unit (LNJ, TB), Warren Alpert Medical School of Brown University, Lifespan, Rhode Island Hospital, Providence, Rhode Island; Department of Ophthalmology and Visual Sciences (GPVS), Washington University in St. Louis School of Medicine, St. Louis, Missouri; and Chair, Blanton Eye Institute (AGL), Houston Methodist Hospital, Houston, Texas
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Luo W, Deng X, Xu X, Song R, Luo M, Moss HE, Du Y. Development of a Prognostic Model for Predicting Multiple Sclerosis After Optic Neuritis: A Secondary Analysis of Data From the Optic Neuritis Treatment Trial. J Neuroophthalmol 2022; 42:88-96. [PMID: 34860745 PMCID: PMC9159903 DOI: 10.1097/wno.0000000000001424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optic neuritis can be the initial manifestation of multiple sclerosis (MS). The purpose of this study was to develop a prognostic model for predicting the risk of MS development among patients with optic neuritis. METHODS The data from 388 patients with optic neuritis were retrieved from the Optic Neuritis Treatment Trial (ONTT). Cox proportional hazards regression analysis was used to develop a prognostic model. The performance of the model was assessed by using Harrell's C-index and calibration curves. The rates of MS development were estimated using the Kaplan-Meier method. RESULTS Among the enrolled subjects, a total of 154 (39.7%) patients developed clinically definite MS during a median follow-up period of 15.8 years (interquartile range, 7.2-16.9 years). The factors associated with the development of MS were the presence of brain lesions as on baseline MRI, previous nonspecific neurologic symptoms, commencing low-dose corticosteroids treatment, ocular pain, and absence of optic disc/peripapillary hemorrhage. After incorporating these 5 factors into the prognostic model, a C-index of 0.72 (95% confidence interval [CI], 0.69-0.76) and good calibration curves were obtained. The C-index of the model was significantly higher than the C-indexes of any single factor (P < 0.001 in all cases). The model was able to stratify the ONTT patient cohort into 3 risk groups with significantly different intergroup rates of developing MS (rates for developing MS within a 15-year period: high-risk group, 75.7% [95% CI, 65.6%-82.9%], intermediate-risk group, 44.7% [95% CI, 31.4%-55.4%]; and low-risk group, 20.8% [95% CI, 14.2%-26.8%]; log-rank P < 0.001). CONCLUSIONS This prognostic model had a better prediction ability when compared with the standard practice that relies solely on using brain lesions on MRI. It can, therefore, help guide decision-making to initiate earlier disease-modifying therapy for patients with optic neuritis at risk of developing MS.
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Affiliation(s)
- Wenjing Luo
- Department of Neurology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
- Geriatrics Neurology Ward, the People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning, China
| | - Xinlei Deng
- Department of Environmental Health Sciences, University at Albany, State University of New York, Rensselaer, NY, USA
| | - Xiaoyu Xu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Ruitong Song
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Meifeng Luo
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Heather E. Moss
- Byers Eye Institute, Stanford University, Palo Alto, CA, USA
- Department of Neurology & Neurological Sciences, Stanford University, Stanford, CA, USA
| | - Yi Du
- Department of Ophthalmology, the First Affiliated Hospital of Guangxi Medical University, Nanning, China
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Foo R, Yau C, Singhal S, Tow S, Loo JL, Tan K, Milea D. Optic Neuritis in the Era of NMOSD and MOGAD: A Survey of Practice Patterns in Singapore. Asia Pac J Ophthalmol (Phila) 2022; 11:184-195. [PMID: 35533337 DOI: 10.1097/apo.0000000000000513] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
PURPOSE The Optic Neuritis Treatment Trial was a landmark study with implications worldwide. In the advent of antibody testing for neuromyelitis optica spectrum disease (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), emerging concepts, such as routine antibody testing and management, remain controversial, resulting mostly from studies in White populations. We evaluate the practice patterns of optic neuritis investigation and management by neuro-ophthalmologists and neurologists in Singapore. DESIGN 21-question online survey consisting of 4 clinical vignettes. METHODS The survey was sent to all Singapore Medical Council- registered ophthalmologists and neurologists who regularly manage patients with optic neuritis. RESULTS Forty-two recipients (17 formally trained neuro-ophthalmol-ogists [100% response rate] and 25 neurologists) responded. Participants opted for routine testing of anti-aquaporin-4 antibodies (88.1% in mild optic neuritis and 97.6% in severe optic neuritis). Anti-MOG antibodies were frequently obtained (76.2% in mild and 88.1% in severe optic neuritis). Plasmapheresis was rapidly initiated (85.7%) in cases of nonresponse to intravenous steroids, even before obtaining anti-aquaporin-4 or anti-MOG serology results. In both NMOSD and MOGAD, oral mycophenolate mofetil was the preferred option if chronic immunosuppression was necessary. Steroids were given for a longer duration and tapered more gradually than in idiopathic optic neuritis cases. CONCLUSIONS Serological testing for NMOSD and MOGAD is considered as a routine procedure in cases of optic neuritis in Singapore, possibly due to local epidemiological features of these conditions. Chronic oral immunosuppression is preferred for the long term, but further research is necessary to establish the efficacy and cost-effectiveness of these practices.
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Affiliation(s)
- Reuben Foo
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
| | - Christine Yau
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
| | - Shweta Singhal
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| | - Sharon Tow
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
| | - Jing-Liang Loo
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- National University Hospital, Singapore City, Singapore
| | - Kevin Tan
- Duke-NUS Medical School, Singapore City, Singapore
- Department of Neurology, National Neuroscience Institute, Singapore City, Singapore
| | - Dan Milea
- Department of Neuro-Ophthalmology, Singapore National Eye Centre, Singapore City, Singapore
- Singapore Eye Research Institute, Singapore City, Singapore
- Duke-NUS Medical School, Singapore City, Singapore
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Chen JJ, Sotirchos ES, Henderson AD, Vasileiou ES, Flanagan EP, Bhatti MT, Jamali S, Eggenberger ER, Dinome M, Frohman LP, Arnold AC, Bonelli L, Seleme N, Mejia-Vergara AJ, Moss HE, Padungkiatsagul T, Stiebel-Kalish H, Lotan I, Hellmann MA, Hodge D, Oertel FC, Paul F, Saidha S, Calabresi PA, Pittock SJ. OCT retinal nerve fiber layer thickness differentiates acute optic neuritis from MOG antibody-associated disease and Multiple Sclerosis: RNFL thickening in acute optic neuritis from MOGAD vs MS. Mult Scler Relat Disord 2022; 58:103525. [PMID: 35038647 PMCID: PMC8882134 DOI: 10.1016/j.msard.2022.103525] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/31/2021] [Accepted: 01/09/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Optic neuritis (ON) is the most common manifestation of myelin oligodendrocyte glycoprotein antibody associated disorder (MOGAD) and multiple sclerosis (MS). Acute ON in MOGAD is thought to be associated with more severe optic disk edema than in other demyelinating diseases, but this has not been quantitatively confirmed. The goal of this study was to determine whether optical coherence tomography (OCT) can distinguish acute ON in MOGAD from MS, and establish the sensitivity of OCT as a confirmatory biomarker of ON in these entities. METHODS This was a multicenter cross-sectional study of MOGAD and MS patients with peripapillary retinal nerve fiber layer (pRNFL) thickness measured with OCT within two weeks of acute ON symptom. Cirrus HD-OCT (Carl Zeiss Meditec, Inc. Dublin, CA, USA) was used to measure the pRNFL during acute ON. Eyes with prior ON or disk pallor were excluded. A receiver operating characteristic (ROC) curve analysis was performed to assess the ability of pRNFL thickness to distinguish MOGAD from MS. RESULTS Sixty-four MOGAD and 50 MS patients met study inclusion criteria. Median age was 46.5 years (interquartile range [IQR]: 34.3-57.0) for the MOGAD group and 30.4 years (IQR: 25.7-38.4) for the MS group (p<0.001). Thirty-nine (61%) of MOGAD patients were female compared to 42 (84%) for MS (p = 0.007). The median pRNFL thickness was 164 µm (IQR: 116-212) in 96 acute MOGAD ON eyes compared to 103 µm (IQR: 93-113) in 51 acute MS ON eyes (p<0.001). The ROC area under the curve for pRNFL thickness was 0.81 (95% confidence interval 0.74-0.88) to discriminate MOGAD from MS. The pRNFL cutoff that maximized Youden's index was 118 µm, which provided a sensitivity of 74% and specificity of 82% for MOGAD. Among 31 MOGAD and 48 MS eyes with an unaffected contralateral eye or a prior baseline, the symptomatic eye had a median estimated pRNFL thickening of 45 µm (IQR: 17-105) and 7.5 µm (IQR: 1-18), respectively (p<0.001). All MOGAD affected eyes had a ≥ 5 µm pRNFL thickening, whereas 26 (54%) MS affected eyes had a ≥ 5 µm thickening. CONCLUSION OCT-derived pRNFL thickness in acute ON can help differentiate MOGAD from MS. This can aid with early diagnosis and guide disease-specific therapy in the acute setting before antibody testing returns, and help differentiate borderline cases. In addition, pRNFL thickening is a sensitive biomarker for confirming acute ON in MOGAD, which is clinically helpful and could be used for adjudication of attacks in future MOGAD clinical trials.
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Affiliation(s)
- John J. Chen
- Departments of Ophthalmology,Departments of Neurology, Mayo Clinic, Rochester, MN,Corresponding Author: John J. Chen, MD, PhD, Mayo Clinic, Department of Ophthalmology, 200 First Street, SW, Rochester, MN, USA 55905,
| | | | - Amanda D. Henderson
- Departments of Neurology,Departments of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Eoin P. Flanagan
- Departments of Neurology, Mayo Clinic, Rochester, MN,Departments of Laboratory Medicine and Pathology,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - M. Tariq Bhatti
- Departments of Ophthalmology,Departments of Neurology, Mayo Clinic, Rochester, MN
| | | | - Eric R. Eggenberger
- Departments of Neurology, Neurosurgery, and Neuro-Ophthalmology Mayo Clinic, Jacksonville, FL
| | - Marie Dinome
- Departments of Ophthalmology, Neurology, Mayo Clinic, Scottsdale, AZ
| | - Larry P. Frohman
- Departments of Ophthalmology & Visual Sciences and Neurology & Neurosciences, Rutgers-New Jersey Medical School, Newark, New Jersey
| | - Anthony C. Arnold
- Department of Ophthalmology, University of California Los Angeles, CA
| | - Laura Bonelli
- Department of Ophthalmology, University of California Los Angeles, CA
| | - Nicolas Seleme
- Department of Ophthalmology, University of California Los Angeles, CA
| | - Alvaro J. Mejia-Vergara
- Department of Ophthalmology, University of California Los Angeles, CA,Hospital Universitario San Ignacio, Pontificia Universidad Javeriana. Bogotá, Colombia Department of Ophthalmology, Sanitas Eye Institute. Fundación Universitaria Sanita, Bogotá. Colombia
| | - Heather E. Moss
- Department of Neurology & Neurological Sciences, Stanford University, Palo Alto, CA,Department of Ophthalmology, Stanford University, Palo Alto, CA
| | - Tanyatuth Padungkiatsagul
- Department of Ophthalmology, Stanford University, Palo Alto, CA,Department of Ophthalmology, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Hadas Stiebel-Kalish
- Felsenstein Research Center, Sackler School of Medicine, Tel Aviv University, Israel,Department of Ophthalmology and Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Itay Lotan
- Department of Ophthalmology and Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Mark A. Hellmann
- Department of Ophthalmology and Neurology, Rabin Medical Center, Sackler School of Medicine, Tel Aviv University, Israel
| | - Dave Hodge
- Department of Quantitative Health Sciences (D.O.H.), Mayo Clinic, Jacksonville, Florida, USA
| | - Frederike Cosima Oertel
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrück Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany,Department of Neurology, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | | | - Peter A. Calabresi
- Departments of Neurology,Departments of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sean J. Pittock
- Departments of Neurology, Mayo Clinic, Rochester, MN,Departments of Laboratory Medicine and Pathology,Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
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Yang X, Li X, Lai M, Wang J, Tan S, Chan HHL. Pain Symptoms in Optic Neuritis. FRONTIERS IN PAIN RESEARCH 2022; 3:865032. [PMID: 35498555 PMCID: PMC9046587 DOI: 10.3389/fpain.2022.865032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 03/21/2022] [Indexed: 02/05/2023] Open
Abstract
Signs and symptoms of optic neuritis (ON), an autoimmune disorder of the central nervous system (CNS), differ between patients. Pain, which is commonly reported by ON patients, may be the major reason for some patients to visit the clinic. This article reviews the presence of pain related to ON with respect to underlying disorders, including multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), and myelin oligodendrocyte glycoprotein associated disease (MOGAD). The aim of this review is to provide an overview of pain symptoms in accordance with the context of various pathophysiological explanations, assist in differential diagnosis of ON patients, especially at the onset of disease, and make recommendations to aid physicians make decisions for follow up diagnostic examinations.
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Affiliation(s)
- Xiayin Yang
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Department of Ophthalmology, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China
| | - Xuefen Li
- Department of Vascular Neurosurgery, The First Affiliated Hospital of the Medical College of Shantou University, Shantou, China
- Shantou University Medical College, Guangdong, China
| | - Mengying Lai
- Shantou University Medical College, Guangdong, China
- Department of Ophthalmology, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Jincui Wang
- Shantou University Medical College, Guangdong, China
| | - Shaoying Tan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Center for Eye and Vision Research (CEVR), Hong Kong, Hong Kong SAR, China
- *Correspondence: Shaoying Tan
| | - Henry Ho-lung Chan
- School of Optometry, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Research Centre for SHARP Vision (RCSV), The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- Center for Eye and Vision Research (CEVR), Hong Kong, Hong Kong SAR, China
- University Research Facilities in Behavioral and Systems Neuroscience (UBSN), The Hong Kong Polytechnic University, Hong Kong, Hong Kong SAR, China
- Henry Ho-lung Chan
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De Lott LB, Bennett JL, Costello F. The changing landscape of optic neuritis: a narrative review. J Neurol 2022; 269:111-124. [PMID: 33389032 PMCID: PMC8253868 DOI: 10.1007/s00415-020-10352-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 12/02/2020] [Accepted: 12/04/2020] [Indexed: 01/03/2023]
Abstract
Optic neuritis (ON) is an inflammatory optic neuropathy that is often a harbinger of central nervous system (CNS) demyelinating disorders. ON is frequently misdiagnosed in the clinical arena, leading to either inappropriate management or diagnostic delays. As a result, patients may fail to achieve optimal recovery. The treatment response to corticosteroids and long term risk of multiple sclerosis was established in the first clinical trials conducted roughly 30 years ago. Spontaneous resolution was observed in the vast majority of patients and intravenous high-dose corticosteroids hastened recovery; half of the patients eventually developed multiple sclerosis. Over the ensuing decades, the number of inflammatory conditions associated with ON has significantly expanded exposing substantial variability in the prognosis, treatment, and management of ON patients. ON subtypes can frequently be distinguished by distinct clinical, serological, and radiological profiles allowing expedited and specialized treatment. Guided by an increased understanding of the immunopathology underlying optic nerve and associated CNS injuries, novel disease management strategies are emerging to minimize vision loss, improve long-term surveillance strategies, and minimize CNS injury and disability. Knowledge regarding the clinical signs and symptoms of different ON subtypes is essential to guide acute therapy, prognosticate recovery, accurately identify underlying CNS inflammatory disorders, and facilitate study design for the next generation of clinical and translational trials.
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Affiliation(s)
- Lindsey B. De Lott
- Departments of Neurology, and Ophthalmology and Visual
Sciences, University of Michigan, Ann Arbor, Michigan, USA
| | - Jeffrey L. Bennett
- Departments of Neurology and Ophthalmology, Programs in
Neuroscience and Immunology, University of Colorado, Denver, Colorado, USA
| | - Fiona Costello
- Departments of Clinical Neurosciences and Surgery
(Ophthalmology), University of Calgary, Calgary, Alberta, Canada
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Kaushik M, Burdon MA. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis-A Review. J Neuroophthalmol 2021; 41:e786-e795. [PMID: 33870945 DOI: 10.1097/wno.0000000000001234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Our understanding of demyelinating optic neuritis has substantially evolved over the past 2 decades. With advancements in serological testing, antibodies against myelin oligodendrocyte glycoprotein (MOG) have been recently discovered in a distinct subset of demyelinating neuroinflammatory disease. Although MOG-immunoglobulin G (IgG)-associated disorder (MOGAD) has previously been seen as a component of neuromyelitis optica spectrum disorder (NMOSD), evidence increasingly suggests that it should be distinguished as a separate condition. The distinction of MOGAD from aquaporin-4 IgG NMOSD is imperative as treatment plans need to be tailored to its unique disease course and prognosis. The purpose of this review is to explore the nature and outcomes of MOGAD optic neuritis to help guide acute and long-term immunosuppressive treatment decisions.
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Affiliation(s)
- Megha Kaushik
- Neuro-Ophthalmology, Department of Ophthalmology, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
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Hickman SJ, Petzold A. Update on Optic Neuritis: An International View. Neuroophthalmology 2021; 46:1-18. [PMID: 35095131 PMCID: PMC8794242 DOI: 10.1080/01658107.2021.1964541] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/26/2021] [Accepted: 07/31/2021] [Indexed: 10/20/2022] Open
Abstract
Previously, optic neuritis was thought to be typical, i.e. idiopathic or multiple sclerosis (MS) related, associated with a good visual prognosis, or atypical, i.e. not associated with MS and requiring corticosteroids or plasma exchange for vision to recover. More recently, the importance of optic neuritis in neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein (MOG) antibody disease has become more appreciated. The results of the Optic Neuritis Treatment Trial (ONTT) has influenced how optic neuritis is treated around the world. For this review we surveyed the international literature on optic neuritis in adults. Our aims were first to find the reported incidence of optic neuritis in different countries and to ascertain what percentage of cases were seropositive for anti-aquaporin 4 and anti-MOG antibodies, and second, to document the presenting features, treatment, and outcomes from a first episode of the different types of optic neuritis from these countries, and to compare the results with the outcomes of the ONTT cohort. From these data we have sought to highlight where ambiguities currently lie in how to manage optic neuritis and have made recommendations as to how future treatment trials in optic neuritis should be carried out in the current antibody testing era.
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Affiliation(s)
- Simon J. Hickman
- Department of Neurology, Royal Hallamshire Hospital, Sheffield, UK
| | - Axel Petzold
- Expertise Centrum Neuro-ophthalmology, Departments of Neurology & Ophthalmology, Amsterdam Umc, Amsterdam, The Netherlands
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, UK
- Department of Neuro-Ophthalmology, The National Hospital For Neurology And Neurosurgery, London, UK
- Department of Molecular Neurosciences, Ucl Institute of Neurology, London, UK
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Marignier R, Hacohen Y, Cobo-Calvo A, Pröbstel AK, Aktas O, Alexopoulos H, Amato MP, Asgari N, Banwell B, Bennett J, Brilot F, Capobianco M, Chitnis T, Ciccarelli O, Deiva K, De Sèze J, Fujihara K, Jacob A, Kim HJ, Kleiter I, Lassmann H, Leite MI, Linington C, Meinl E, Palace J, Paul F, Petzold A, Pittock S, Reindl M, Sato DK, Selmaj K, Siva A, Stankoff B, Tintore M, Traboulsee A, Waters P, Waubant E, Weinshenker B, Derfuss T, Vukusic S, Hemmer B. Myelin-oligodendrocyte glycoprotein antibody-associated disease. Lancet Neurol 2021; 20:762-772. [PMID: 34418402 DOI: 10.1016/s1474-4422(21)00218-0] [Citation(s) in RCA: 235] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 06/07/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently identified autoimmune disorder that presents in both adults and children as CNS demyelination. Although there are clinical phenotypic overlaps between MOGAD, multiple sclerosis, and aquaporin-4 antibody-associated neuromyelitis optica spectrum disorder (NMOSD) cumulative biological, clinical, and pathological evidence discriminates between these conditions. Patients should not be diagnosed with multiple sclerosis or NMOSD if they have anti-MOG antibodies in their serum. However, many questions related to the clinical characterisation of MOGAD and pathogenetic role of MOG antibodies are still unanswered. Furthermore, therapy is mainly based on standard protocols for aquaporin-4 antibody-associated NMOSD and multiple sclerosis, and more evidence is needed regarding how and when to treat patients with MOGAD.
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Affiliation(s)
- Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Bron, France; Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France.
| | - Yael Hacohen
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Alvaro Cobo-Calvo
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anne-Katrin Pröbstel
- Neurologic Clinic and Policlinic and Research Center for Clinical Neuroimmunology and Neuroscience, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Orhan Aktas
- Medical Faculty, Department of Neurology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Harry Alexopoulos
- Neuroimmunology Unit, Department of Pathophysiology, Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria-Pia Amato
- IRCCS Fondazione Don Carlo Gnocchi, University of Florence, Florence, Italy
| | - Nasrin Asgari
- Institute of Regional Health Research and Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Neurology and Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jeffrey Bennett
- Department of Neurology and Department of Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Brain and Mind Centre and School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Marco Capobianco
- Regional Multiple Sclerosis Centre, Department of Neurology, University Hospital San Luigi, Orbassano, Italy
| | - Tanuja Chitnis
- Department of Pediatric Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Olga Ciccarelli
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
| | - Kumaran Deiva
- Assistance Publique-Hôpitaux de Paris, Hôpitaux Universitaires Paris-Sud, Hôpital Bicêtre, Pediatric Neurology Department, National Referral Center for Rare Inflammatory Brain and Spinal Diseases, Université Paris-Sud, and UMR 1184-CEA-IDMIT, Center for Immunology of Viral Infections and Autoimmune Diseases, Le Kremlin Bicêtre, France
| | - Jérôme De Sèze
- Department of Neurology, Strasbourg University Hospital and Clinical Investigation Center, INSERM 1434, Strasbourg, France
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine Koriyama, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Anu Jacob
- Division of Multiple Sclerosis and Autoimmune Neurology, Neurological Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates; Walton Centre National Health Service Trust, Liverpool, UK
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Korea
| | - Ingo Kleiter
- Marianne-Strauß-Klinik, Behandlungszentrum Kempfenhausen für Multiple Sklerose Kranke, Berg, Germany; Department of Neurology, Ruhr-University Bochum, Bochum, Germany
| | - Hans Lassmann
- Department of Neuroimmunology, Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Maria-Isabel Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Christopher Linington
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Edgar Meinl
- Institute of Clinical Neuroimmunology, Biomedical Center and University Hospitals, Ludwig Maximilian University Munich, Germany
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, and Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Axel Petzold
- Moorfields Eye Hospital and National Hospital for Neurology and Neurosurgery, London, UK; University College London Queen Square Institute of Neurology, London, UK; National Institute for Health Research Biomedical Research Centre at Moorfields Eye Hospital and University College London Institute of Ophthalmology, London, UK
| | - Sean Pittock
- Department of Neurology and Laboratory Medicine and Pathology, and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Douglas Kazutoshi Sato
- Brain Institute of Rio Grande do Sul and School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Krzysztof Selmaj
- University of Warmia and Mazury, Olsztyn, Poland; Center of Neurology, Łódź, Poland
| | - Aksel Siva
- Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Department of Neurology, Istanbul, Turkey
| | - Bruno Stankoff
- Sorbonne Université, Paris Brain Institute, ICM, CNRS, Inserm, and Saint Antoine Hospital, APHP, Paris, France
| | - Mar Tintore
- Centre d'Esclerosi Múltiple de Catalunya, Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anthony Traboulsee
- Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Emmanuelle Waubant
- Department of Neurology, University of California San Francisco, San Francisco, CA, USA
| | - Brian Weinshenker
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Tobias Derfuss
- Neurologic Clinic and Policlinic and Research Center for Clinical Neuroimmunology and Neuroscience, Departments of Medicine, Biomedicine, and Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Bron, France; Centre des Neurosciences de Lyon, INSERM 1028 et CNRS UMR5292, Lyon, France; Université Claude Bernard Lyon 1, Lyon, France
| | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany
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Abstract
Multiple sclerosis (MS) is a neurological inflammatory disorder known to attack the heavily myelinated regions of the nervous system including the optic nerves, cerebellum, brainstem and spinal cord. This review will discuss the clinical manifestations and investigations for MS and other similar neurological inflammatory disorders affecting vision, as well as the effects of MS treatments on vision. Assessment of visual pathways is critical, considering MS can involve multiple components of the visual pathway, including optic nerves, uvea, retina and occipital cortex. Optical coherence tomography is increasingly being recognised as a highly sensitive tool in detecting subclinical optic nerve changes. Magnetic resonance imaging (MRI) is critical in MS diagnosis and in predicting long-term disability. Optic neuritis in MS involves unilateral vision loss, with characteristic pain on eye movement. The visual loss in neuromyelitis optica spectrum disorder tends to be more severe with preferential altitudinal field loss, chiasmal and tract lesions are also more common. Other differential diagnoses include chronic relapsing inflammatory optic neuropathy and giant cell arteritis. Leber's hereditary optic neuropathy affects young males and visual loss tends to be painless and subacute, typically involving both optic nerves. MS lesions in the vestibulocerebellum, brainstem, thalamus and basal ganglia may lead to abnormalities of gaze, saccades, pursuit and nystagmus which can be identified on eye examination. Medial longitudinal fasciculus lesions can cause another frequent presentation of MS, internuclear ophthalmoplegia, with failure of ipsilateral eye adduction and contralateral eye abduction nystagmus. Treatments for MS include high-dose corticosteroids for acute relapses and disease-modifying medications for relapse prevention. These therapies may also have adverse effects on vision, including central serous retinopathy with corticosteroid therapy and macular oedema with fingolimod.
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Affiliation(s)
- Roshan Dhanapalaratnam
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
| | - Maria Markoulli
- School of Optometry and Vision Science, University of New South Wales Sydney, Sydney, Australia
| | - Arun V Krishnan
- Prince of Wales Clinical School, University of New South Wales Sydney, Sydney, Australia
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Ducloyer JB, Marignier R, Wiertlewski S, Lebranchu P. Optic neuritis classification in 2021. Eur J Ophthalmol 2021; 32:11206721211028050. [PMID: 34218696 DOI: 10.1177/11206721211028050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.
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Affiliation(s)
| | - Romain Marignier
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM), Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Lyon, Auvergne-Rhône-Alpes, France
| | | | - Pierre Lebranchu
- Department of Ophthalmology, University Hospital of Nantes, Nantes, France
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48
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Nakazawa M, Ishikawa H, Sakamoto T. Current understanding of the epidemiologic and clinical characteristics of optic neuritis. Jpn J Ophthalmol 2021; 65:439-447. [PMID: 34021411 DOI: 10.1007/s10384-021-00840-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/12/2021] [Indexed: 02/07/2023]
Abstract
Optic neuritis is an ocular disorder whose pathogenesis has not been fully determined, although autoimmune mechanisms have been suggested to be involved in its development. In recent years, anti-aquaporin-4 antibody (AQP4-Ab) and anti-myelin oligodendrocyte glycoprotein antibody (MOG-Ab) have been shown to play major roles in the development of optic neuritis. Because these two antibodies target different tissues, optic neuritis can be classified by the type of antibody. AQP4-Ab-positive optic neuritis responds poorly to steroid therapy and has a poor prognosis in terms of visual acuity. On the other hand, MOG-Ab-positive optic neuritis responds favorably to steroid therapy but is likely to recur when the dosage of steroids is reduced or discontinued. We first present the high incidence of idiopathic optic neuritis and discuss these relatively newer disease concepts of AQP4-Ab-positive optic neuritis and MOG-Ab-positive optic neuritis.
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Affiliation(s)
- Masanori Nakazawa
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Hitoshi Ishikawa
- Department of Orthoptics and Visual Science, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Taiji Sakamoto
- Department of Ophthalmology, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan.
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Cherayil NR, Tamhankar MA. Neuro-Ophthalmology for Internists. Med Clin North Am 2021; 105:511-529. [PMID: 33926644 DOI: 10.1016/j.mcna.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Neuro-ophthalmology is the study of the neurologic underpinnings of vision and includes a fascinating variety of disorders that span the broad spectrum of ophthalmic and neurologic disease. This subspecialty relies heavily on accurate neuroanatomic localization and examination. This article discusses neuro-ophthalmic complaints that frequently present to the internist, including acute vision loss, double vision, and unequal pupils. It focuses on pertinent clinical features of the most common causes of these chief complaints and additionally highlights salient points of history, diagnosis, examination, and management with special emphasis on the signs and symptoms that should prompt expedited evaluation.
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Affiliation(s)
- Neena R Cherayil
- Department of Neurology, Northwestern University, 259 E. Erie St, Ste 1520, Chicago, IL 60611, USA; Department of Ophthalmology, Northwestern University, Chicago, IL, USA.
| | - Madhura A Tamhankar
- Department of Ophthalmology, University of Pennsylvania, 51 N 39th St, Philadelphia, PA 19104, USA
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50
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[Aquaporin 4 antibody-positive neuromyelitis optica spectrum disorders and myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis. A brief review]. DER NERVENARZT 2021; 92:317-333. [PMID: 33787942 DOI: 10.1007/s00115-021-01106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/25/2021] [Indexed: 10/21/2022]
Abstract
Aquaporin 4 (AQP4) immunoglobulin (Ig)G-associated neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein immunoglobulin (Ig)G-associated encephalomyelitis (MOG-EM, also termed MOG antibody-associated disease, MOGAD) are important autoimmune differential diagnoses of multiple sclerosis (MS), which differ from MS with respect to optimum treatment and prognosis. AQP4 IgG-positive NMOSD take a relapsing course in virtually all cases and MOG-EM in at least 80% of adult cases. Both diseases can quickly lead to permanent disability if left untreated, although MOG-EM is associated with a better overall long-term prognosis. Antibody testing must be carried out by means of so-called cell-based assays. A number of red flags have been defined that must be checked prior to making a diagnosis of NMOSD or MOG-EM. Acute attacks are treated using high-dose glucocorticoids and plasma exchange or immunoadsorption. Rituximab and other immunosuppressants are used off-label for attack prevention. Recently, eculizumab, a C5 complement inhibitor, has been approved in the European Union (EU) for the treatment of patients with AQP4 IgG-positive NMOSD. This article gives a brief overview of the clinical and paraclinical features, pathology, treatment and prognosis of these rare disorders.
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