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Han JS, Ryu SM, Lim YH, Kim AR, Jung TD. Treatment and Rehabilitation of a Patient with Neuromyelitis Optica Spectrum Disorder-Induced Complete Spinal Cord Injury Following COVID-19 Vaccination: A Case Report. J Clin Med 2024; 13:1175. [PMID: 38398485 PMCID: PMC10888719 DOI: 10.3390/jcm13041175] [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: 01/21/2024] [Revised: 02/11/2024] [Accepted: 02/16/2024] [Indexed: 02/25/2024] Open
Abstract
Neuromyelitis optica spectrum disease (NMOSD) is a rare autoimmune disorder of the central nervous system characterized by optic neuritis, myelitis, or brain lesions. Its symptoms overlap with those of multiple sclerosis (MS), making a diagnosis of NMOSD challenging. Here, we report a rare case of NMOSD-induced complete spinal cord injury following COVID-19 vaccination. A 52-year-old female patient developed NMOSD-induced complete spinal cord injury after receiving their third dose of the Pfizer-BioNTech COVID-19 vaccine (BNT162b2). Despite the initial diagnosis of complete spinal cord injury, the patient underwent intensive treatment, including rituximab therapy and rehabilitation. As a result, she made a full recovery and transitioned from the ASIA Impairment Scale(AIS)-A to AIS-E. The remarkable neurological recovery from complete spinal cord injury to functional independence highlights the efficacy of a comprehensive treatment approach. In addition, this case emphasizes the need to recognize NMOSD as a potential adverse outcome of COVID-19 vaccination and emphasizes the importance of early diagnosis, timely intervention, and thorough rehabilitation for optimizing patient results. Further case reports and studies are needed to investigate the association between COVID-19 vaccination and the occurrence of NMOSD.
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Affiliation(s)
- Jun-Sang Han
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
| | - Seong-Mun Ryu
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
| | - Young-Hwan Lim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
| | - Ae-Ryoung Kim
- Department of Rehabilitation Medicine, Kyungpook National University Hospital, Daegu 41944, Republic of Korea; (J.-S.H.); (S.-M.R.); (Y.-H.L.); (A.-R.K.)
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
| | - Tae-Du Jung
- Department of Rehabilitation Medicine, School of Medicine, Kyungpook National University, Daegu 41944, Republic of Korea
- Department of Rehabilitation Medicine, Kyungpook National University Chilgok Hospital, Daegu 41404, Republic of Korea
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Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [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] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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Chu F, Shi M, Liu C, Zhu J. Discrepancy in clinical and laboratory profiles of NMOSD patients between AQP4 antibody positive and negative: can NMOSD be diagnosed without AQP4 antibody? Clin Exp Immunol 2023; 213:363-370. [PMID: 37161978 PMCID: PMC10570998 DOI: 10.1093/cei/uxad053] [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: 12/04/2022] [Revised: 04/02/2023] [Accepted: 05/09/2023] [Indexed: 05/11/2023] Open
Abstract
AQP4-IgG has been considered as the pathogenic factor leading to NMOSD. However, about 20-30% of patients lack AQP4-IgG. So far, all therapeutic medicines are ineffective for NMOSD patients without AQP4 IgG. Thus AQP4-IgG is the pathogenic factor of NMOSD has been suspected and challenged. In addition, lack of efficacy of immunotherapy in NMOSD without AQP4 IgG has been a serious problem in the neurology. Identifying the clinical and laboratory characteristics and diversities between NMOSD patients with and without AQP4-IgG can be helpful to further explore the pathogenesis of NMOSD and guide clinical treatment. This is a single-centre retrospective study in The First Hospital of Jilin University, China including 92 patients diagnosed as NMOSD from January 2013 to January 2015. The characteristics of clinic, blood, cerebrospinal fluid (CSF), and image between AQP4-IgG negative (AQP4-IgG-) and AQP4-IgG positive (AQP4-IgG+) NMOSDs were compared. Our results showed that in the AQP4-IgG+ group, the ratio of women to men was 5.55, while in AQP4-IgG- group was 1.54 (P = 0.0092). In the AQP4-IgG+ patients, the expanded disability status scale (EDSS) was from 0 to 8.5, with an average of 5.550 ± 0.25, and the AQP4-IgG- patients had the EDSS score from 0 to 9, with an average of 4.032 ± 0.36 (P = 0.0006), which mainly affected movement system (P < 0.05) and superficial sensory impairment (P < 0.05). In the AQP4-IgG+ group, the blood brain barrier (BBB) permeability (P = 0.0210) and myelin basic protein (MBP) were increased (P = 0.0310) when compared to AQP4-IgG- group. Higher level IL-17 was seen in AQP4-IgG+ group than AQP4-IgG- group (P= 0.0066). Our results demonstrated that the NMOSD with AQP4-IgG more likely occurred in women and presented more severe clinical symptoms as well as significant BBB damage and increased MBP and IL-17 in CSF and blood, respectively compared with NMOSD without AQP4-IgG group. The differences in clinical and laboratory profiles between NMOSD with and without AQP4-IgG indicate the heterogeneity of NMOSD, in which AQP4-IgG may not be the only pathogenic molecule. It is necessary to find more pathogenic factors and to explore the new pathogenesis of NMOSD and therapeutic methods in the future.
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Affiliation(s)
- Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Canyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
- Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrics, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
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4
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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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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Bribiesca Contreras E, Gómez-Figueroa E, Flores-Rivera J, Correa-Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Piedra Andrade JS, Galleguillos L, Tkachuk V, Nadur D, Daccach Marques V, Soto de Castillo I, Casas M, Cohen L, Alonso R, Caride A, Lana-Peixoto M, Rojas JI. Clinical outcomes and prognostic factors in patients with optic neuritis related to NMOSD and MOGAD in distinct ethnic groups from Latin America. Mult Scler Relat Disord 2023; 72:104611. [PMID: 36907119 DOI: 10.1016/j.msard.2023.104611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 02/24/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Optic neuritis (ON) can be an initial manifestation of neuromyelitis optica spectrum disorder (NMOSD) associated with aquaporin 4-antibody (AQP4-Ab) or myelin oligodendrocyte glycoprotein antibody (MOG-Ab)-associated disease (MOGAD). Additionally, both diseases may have overlapping paraclinical and radiological features. These diseases may have different outcomes and prognoses. We aimed to compare clinical outcomes and prognostic features of patients with NMOSD and MOGAD presenting ON as first attack, from different ethnic groups in Latin America. METHODS We conducted a retrospective observational multicenter study in patients from Argentina (n = 61), Chile (n = 18), Ecuador (n = 27), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 49) with MOGAD or NMOSD related ON. Predictors of disability outcomes at last follow-up, namely visual disability (Visual Functional System Score ≥4), motor disability (permanent inability to walk further than 100 m unaided) and wheelchair dependence based on EDSS score were evaluated. RESULTS After a mean disease duration of 42.7 (±40.2) months in NMOSD and 19.7 (±23.6) in MOGAD, 55% and 22% (p>0.001) experienced permanent severe visual disability (visual acuity from 20/100 to 20/200), 22% and 6% (p = 0.01) permanent motor disability and 11% and 0% (p = 0.04) had become wheelchair dependent, respectively. Older age at disease onset was a predictor of severe visual disability (OR=1,03 CI95%1.01-1.05, p = 0.03); older age at disease onset (OR=1,04 CI95%1.01-1.07, p = 0.01), higher number of relapses (OR=1,32 CI95%1.02-1.71, p = 0.03) and rituximab treatment (OR=0,36 CI95%0.14-0.90, p = 0.02) were predictors of permanent motor disability, whereas ON associated with myelitis at disease onset was a predictor of wheelchair dependency (OR=4,16, CI95%1.23-14.08, p = 0,02) in NMOSD patients. No differences were found when evaluating distinct ethnic groups (Mixed vs. Caucasian vs. Afro-descendant) CONCLUSIONS: NMOSD was associated with poorer clinical outcomes than MOGAD. Ethnicity was not associated with prognostic factors. Distinct predictors of permanent visual and motor disability and wheelchair dependency in NMOSD patients were found.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Enrique Gómez-Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | | | | | | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Débora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Ibis Soto de Castillo
- Neurology Department, Hospital Universitario de Maracaibo, Maracaibo, Bolivarian Republic of Venezuela
| | - Magdalena Casas
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, Faculty of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- Department of Neurology, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Carnero Contentti E, López PA, Criniti J, Alonso R, Silva B, Luetic G, Correa-Díaz EP, Galleguillos L, Navas C, Soto de Castillo I, Hamuy FDDB, Gracia F, Tkachuk V, Weinshenker BG, Rojas JI. Frequency of NMOSD misdiagnosis in a cohort from Latin America: Impact and evaluation of different contributors. Mult Scler 2023; 29:277-286. [PMID: 36453614 DOI: 10.1177/13524585221136259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) misdiagnosis (i.e. the incorrect diagnosis of patients who truly have NMOSD) remains an issue in clinical practice. We determined the frequency and factors associated with NMOSD misdiagnosis in patients evaluated in a cohort from Latin America. METHODS We retrospectively reviewed the medical records of patients with NMOSD, according to the 2015 diagnostic criteria, from referral clinics in six Latin American countries (Argentina, Chile, Paraguay, Colombia, Ecuador, and Venezuela). Diagnoses prior to NMOSD and ultimate diagnoses, demographic, clinical and paraclinical data, and treatment schemes were evaluated. RESULTS A total of 469 patients presented with an established diagnosis of NMOSD (73.2% seropositive) and after evaluation, we determined that 56 (12%) patients had been initially misdiagnosed with a disease other than NMOSD. The most frequent alternative diagnoses were multiple sclerosis (MS; 66.1%), clinically isolated syndrome (17.9%), and cerebrovascular disease (3.6%). NMOSD misdiagnosis was determined by MS/NMOSD specialists in 33.9% of cases. An atypical MS syndrome was found in 86% of misdiagnosed patients, 50% had NMOSD red flags in brain and/or spinal magnetic resonance imaging (MRI), and 71.5% were prescribed disease-modifying drugs. CONCLUSIONS NMOSD misdiagnosis is relatively frequent in Latin America (12%). Misapplication and misinterpretation of clinical and neuroradiological findings are relevant factors associated with misdiagnosis.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Department of Internal Medicine, Hospital Alemán, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Berenice Silva
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina/Sección Enfermedades Desmielinizantes, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Lorna Galleguillos
- Clínica Alemana de Santiago, Santiago, Chile; Universidad del Desarrollo, Santiago, Chile
| | - Carlos Navas
- Clínica Enfermedad Desmielinizante, Clinica Universitaria Colombia, Bogotá, Colombia
| | | | | | - Fernando Gracia
- Hospital Santo Tomas, Universidad Interamericana de Panamá, Panama City, Panamá
| | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín," Buenos Aires, Argentina
| | | | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
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Shi M, Chu F, Jin T, Zhu J. Progress in treatment of neuromyelitis optica spectrum disorders (NMOSD): Novel insights into therapeutic possibilities in NMOSD. CNS Neurosci Ther 2022; 28:981-991. [PMID: 35426485 PMCID: PMC9160456 DOI: 10.1111/cns.13836] [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: 10/20/2021] [Revised: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/29/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare autoimmune inflammatory demyelinating disorder of the central nervous system (CNS), which is a severely disabling disorder leading to devastating sequelae or even death. Repeated acute attacks and the presence of aquaporin-4 immunoglobulin G (AQP4-IgG) antibody are the typical characteristics of NMOSD. Recently, the phase III trials of the newly developed biologicals therapies have shown their effectiveness and good tolerance to a certain extent when compared with the traditional therapy with the first- and second-line drugs. However, there is still a lack of large sample, double-blind, randomized, clinical studies to confirm their efficacy, safety, and tolerability. Especially, these drugs have no clear effect on NMOSD patients without AQP4-IgG and refractory patients. Therefore, it is of strong demand to further conduct large sample, double-blind, randomized, clinical trials, and novel therapeutic possibilities in NMOSD are discussed briefly here.
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Affiliation(s)
- Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden
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Sechi E, Cacciaguerra L, Chen JJ, Mariotto S, Fadda G, Dinoto A, Lopez-Chiriboga AS, Pittock SJ, Flanagan EP. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD): A Review of Clinical and MRI Features, Diagnosis, and Management. Front Neurol 2022; 13:885218. [PMID: 35785363 PMCID: PMC9247462 DOI: 10.3389/fneur.2022.885218] [Citation(s) in RCA: 71] [Impact Index Per Article: 35.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 05/06/2022] [Indexed: 01/02/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is the most recently defined inflammatory demyelinating disease of the central nervous system (CNS). Over the last decade, several studies have helped delineate the characteristic clinical-MRI phenotypes of the disease, allowing distinction from aquaporin-4 (AQP4)-IgG-positive neuromyelitis optica spectrum disorder (AQP4-IgG+NMOSD) and multiple sclerosis (MS). The clinical manifestations of MOGAD are heterogeneous, ranging from isolated optic neuritis or myelitis to multifocal CNS demyelination often in the form of acute disseminated encephalomyelitis (ADEM), or cortical encephalitis. A relapsing course is observed in approximately 50% of patients. Characteristic MRI features have been described that increase the diagnostic suspicion (e.g., perineural optic nerve enhancement, spinal cord H-sign, T2-lesion resolution over time) and help discriminate from MS and AQP4+NMOSD, despite some overlap. The detection of MOG-IgG in the serum (and sometimes CSF) confirms the diagnosis in patients with compatible clinical-MRI phenotypes, but false positive results are occasionally encountered, especially with indiscriminate testing of large unselected populations. The type of cell-based assay used to evaluate for MOG-IgG (fixed vs. live) and antibody end-titer (low vs. high) can influence the likelihood of MOGAD diagnosis. International consensus diagnostic criteria for MOGAD are currently being compiled and will assist in clinical diagnosis and be useful for enrolment in clinical trials. Although randomized controlled trials are lacking, MOGAD acute attacks appear to be very responsive to high dose steroids and plasma exchange may be considered in refractory cases. Attack-prevention treatments also lack class-I data and empiric maintenance treatment is generally reserved for relapsing cases or patients with severe residual disability after the presenting attack. A variety of empiric steroid-sparing immunosuppressants can be considered and may be efficacious based on retrospective or prospective observational studies but prospective randomized placebo-controlled trials are needed to better guide treatment. In summary, this article will review our rapidly evolving understanding of MOGAD diagnosis and management.
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Affiliation(s)
- Elia Sechi
- Neurology Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Laura Cacciaguerra
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
| | - John J. Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, United States
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Giulia Fadda
- Department of Neurology and Neurosurgery, McGill University, Montreal, QC, Canada
| | - Alessandro Dinoto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | | | - Sean J. Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
| | - Eoin P. Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology Mayo Clinic, Rochester, MN, United States
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
- *Correspondence: Eoin P. Flanagan
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9
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Carnero Contentti E, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Cristiano E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Fernández Liguori N, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Seasonal variation in attacks of neuromyelitis optica spectrum disorders and multiple sclerosis: Evaluation of 794 attacks from a nationwide registry in Argentina. Mult Scler Relat Disord 2021; 58:103466. [PMID: 34929456 DOI: 10.1016/j.msard.2021.103466] [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: 08/04/2021] [Revised: 11/12/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Identification of triggers that potentially instigate attacks in neuromyelitis optica spectrum disorders (NMOSD) and multiple sclerosis (MS) has remained challenging. We aimed to analyze the seasonality of NMOSD and MS attacks in an Argentinean cohort seeking differences between the two disorders. METHODS A retrospective study was conducted in a cohort of NMOSD and MS patients followed in specialized centers from Argentina and enrolled in RelevarEM, a nationwide, longitudinal, observational, non-mandatory registry of MS/NMOSD patients. Patients with complete relapse data (date, month and year) at onset and during follow-up were included. Attack counts were analyzed by month using a Poisson regression model with the median monthly attack count used as reference. RESULTS A total of 551 patients (431 MS and 120 NMOSD), experiencing 236 NMOSD-related attacks and 558 MS-related attacks were enrolled. The mean age at disease onset in NMOSD was 39.5 ± 5.8 vs. 31.2 ± 9.6 years in MS (p < 0.01). Mean follow-up time was 6.1 ± 3.0 vs. 7.4 ± 2.4 years (p < 0.01), respectively. Most of the included patients were female in both groups (79% vs. 60%, p < 0.01). We found a peak of number of attacks in June (NMOSD: 28 attacks (11.8%) vs MS: 33 attacks (5.9%), incidence rate ratio 1.82, 95%CI 1.15-2.12, p = 0.03), but no differences were found across the months in both disorders when evaluated separately. Strikingly, we observed a significant difference in the incidence rate ratio of attacks during the winter season when comparing NMOSD vs. MS (NMOSD: 75 attacks (31.7%) vs MS: 96 attacks (17.2%), incidence rate ratio 1.82, 95%CI 1.21-2.01, p = 0.02) after applying Poisson regression model. Similar results were observed when comparing the seropositive NMOSD (n = 75) subgroup vs. MS. CONCLUSIONS Lack of seasonal variation in MS and NMOSD attacks was observed when evaluated separately. Future epidemiological studies about the effect of different environmental factors on MS and NMOSD attacks should be evaluated prospectively in Latin America population.
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Affiliation(s)
- Edgar Carnero Contentti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina.
| | - Pablo A Lopez
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Pablo Pettinicchi
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Juan Criniti
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Agustín Pappolla
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Jimena Miguez
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Susana Liwacki
- Clínica Universitaria Reina Fabiola, Córdoba, Argentina; Servicio de Neurología - Hospital Córdoba, Córdoba, Argentina
| | - Verónica Tkachuk
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes - Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Argentina
| | | | | | | | | | | | | | | | | | - Gisela Zanga
- Unidad asistencial César Milstein, CABA, Argentina
| | - Marcos Burgos
- Servicio de Neurología - Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología - Hospital Carlos G. Durand, CABA, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología - Hospital de Clínicas José de San Martín, CABA, Argentina; Hospital Naval, CABA, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes - Hospital Británico, CABA, Argentina
| | | | - Alejandro Caride
- Department of Neurosciences, Neuroimmunology Unit, Hospital Alemán, Av. Pueyrredón 1640, Buenos Aires C1118AAT, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, CABA, Argentina; Servicio de Neurología, Hospital Universitario de CEMIC, CABA, Argentina
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Carnero Contentti E, López PA, Criniti J, Pettinicchi JP, Cristiano E, Patrucco L, Bribiesca Contreras E, Gómez-Figueroa E, Flores-Rivera J, Correa-Díaz EP, Toral Granda AM, Ortiz Yepez MA, Gualotuña Pachacama WA, Piedra Andrade JS, Galleguillos L, Tkachuk V, Nadur D, Daccach Marques V, Soto de Castillo I, Casas M, Cohen L, Alonso R, Caride A, Lana-Peixoto M, Rojas JI. Chiasmatic lesions on conventional magnetic resonance imaging during the first event of optic neuritis in patients with neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein-associated disease in a Latin American cohort. Eur J Neurol 2021; 29:802-809. [PMID: 34799965 DOI: 10.1111/ene.15178] [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] [Received: 10/03/2021] [Accepted: 11/04/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Optic neuritis (ON) is often the initial symptom of neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD). We aimed to compare the frequency and pattern of chiasmatic lesions in MOGAD-related ON (MOGAD-ON) and NMOSD-related ON (NMOSD-ON) using conventional brain imaging (magnetic resonance imaging [MRI]) in Latin America (LATAM). METHODS We reviewed the medical records and brain MRI (≤30 days from ON onset) of patients with a first event of MOGAD-ON and NMOSD-ON. Patients from Argentina (n = 72), Chile (n = 21), Ecuador (n = 31), Brazil (n = 30), Venezuela (n = 10) and Mexico (n = 82) were included. Antibody status was tested using a cell-based assay. Demographic, clinical, imaging and prognostic (as measured by the Visual Functional System Score [VFSS] of the Expanded Disability Status Scale) data were compared. RESULTS A total of 246 patients (208 NMOSD and 38 MOGAD) were included. No differences were found in gender and ethnicity between the groups. We observed chiasmatic lesions in 66/208 (31.7%) NMOSD-ON and in 5/38 (13.1%) MOGAD-ON patients (p = 0.01). Of these patients with chiasmatic lesions, 54/66 (81.8%) and 4/5 had associated longitudinally extensive optic nerve lesions, 45/66 (68%) and 4/5 had bilateral lesions, and 31/66 (47%) and 4/5 showed gadolinium-enhancing chiasmatic lesions, respectively. A positive correlation was observed between VFSS and presence of bilateral (r = 0,28, p < 0.0001), chiasmatic (r = 0.27, p = 0.0001) and longitudinally extensive lesions (r = 0,25, p = 0.0009) in the NMOSD-ON group, but no correlations were observed in the MOGAD-ON group. CONCLUSIONS Chiasmatic lesions were significantly more common in NMOSD than in MOGAD during an ON attack in this LATAM cohort. Further studies are needed to assess the generalizability of these results.
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Affiliation(s)
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Criniti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Juan Pablo Pettinicchi
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Edgardo Cristiano
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | - Liliana Patrucco
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina
| | | | - Enrique Gómez-Figueroa
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | - José Flores-Rivera
- Division of Neurology, National Institute of Neurology and Neurosurgery, Mexico City, Mexico
| | | | | | | | | | | | | | - Verónica Tkachuk
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Debora Nadur
- Neuroimmunology Section, Department of Neurology, Hospital de Clínicas "José de San Martín", Buenos Aires, Argentina
| | - Vanessa Daccach Marques
- Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | | | - Magdalena Casas
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Leila Cohen
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Ricardo Alonso
- Neurology Department, Hospital J.M. Ramos Mejía, University of Buenos Aires, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Buenos Aires, Argentina
| | - Marco Lana-Peixoto
- Department of Neurology, Federal University of Minas Gerais Medical School, Belo Horizonte, Brazil
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina.,Service of Neurology, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Contentti EC, Lopez PA, Pettinicchi JP, Criniti J, Pappolla A, Miguez J, Patrucco L, Carnero Contentti E, Liwacki S, Tkachuk V, Balbuena ME, Vrech C, Deri N, Correale J, Marrodan M, Ysrraelit MC, Leguizamon F, Luetic G, Menichini ML, Tavolini D, Mainella C, Zanga G, Burgos M, Hryb J, Barboza A, Lazaro L, Alonso R, Liguori NF, Nadur D, Chercoff A, Alonso Serena M, Caride A, Paul F, Rojas JI. Assessing attacks and treatment response rates among adult patients with NMOSD and MOGAD: Data from a nationwide registry in Argentina. Mult Scler J Exp Transl Clin 2021; 7:20552173211032334. [PMID: 34434560 PMCID: PMC8381444 DOI: 10.1177/20552173211032334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/24/2021] [Indexed: 11/15/2022] Open
Abstract
We aimed to examine treatment interventions implemented in patients experiencing
neuromyelitis optica spectrum disorders (NMOSD) attacks (frequency, types, and
response).
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Affiliation(s)
| | | | | | - Juan Criniti
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | | | | | - Liliana Patrucco
- Servicio de Neurología, Hospital Italiano de Buenos Aires, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | | | | | - María E Balbuena
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Carlos Vrech
- Departamento de Enfermedades desmielinizantes, Sanatorio Allende, Córdoba, Argentina
| | - Norma Deri
- Centro de Investigaciones Diabaid, CABA, Buenos Aires, Argentina
| | | | | | | | - Felisa Leguizamon
- Hospital de Agudos, Dr. Teodoro Álvarez, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Gisela Zanga
- Unidad Asistencial César Milstein, CABA, Buenos Aires, Argentina
| | - Marcos Burgos
- Servicio de Neurología, Hospital San Bernardo, Salta, Argentina
| | - Javier Hryb
- Servicio de Neurología, Hospital Carlos G. Durand, CABA, Buenos Aires, Argentina
| | | | | | | | | | - Débora Nadur
- Sección de Neuroinmunología y Enfermedades Desmielinizantes, Servicio de Neurología, Hospital de Clínicas José de San Martín, CABA, Buenos Aires, Argentina
| | - Aníbal Chercoff
- Sección de Enfermedades Desmielinizantes, Hospital Británico, CABA, Buenos Aires, Argentina
| | - Marina Alonso Serena
- Servicio de Clínica Médica, Hospital Italiano de Buenos Aires, CABA, Buenos Aires, Argentina
| | - Alejandro Caride
- Neuroimmunology Unit, Department of Neurosciences, Hospital Alemán, Buenos Aires, Argentina
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Juan I Rojas
- Centro de Esclerosis Múltiple de Buenos Aires, CABA, Buenos Aires, Argentina
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Liu C, Shi M, Zhu M, Chu F, Jin T, Zhu J. Comparisons of clinical phenotype, radiological and laboratory features, and therapy of neuromyelitis optica spectrum disorder by regions: update and challenges. Autoimmun Rev 2021; 21:102921. [PMID: 34384938 DOI: 10.1016/j.autrev.2021.102921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disease of the central nervous system (CNS) associated with autoantibody (ab) to aquaporin-4 (AQP4). There is obvious variation between regions and countries in the epidemiology, clinical features and management in NMOSD. Based on published population-based observation and cohort studies, the different clinical pattern of NMOSD has been seen in several geographical regions and some of these patients with NMOSD-like features do not fully meet the current diagnostic criteria, which is needed to consider the value of recently revised diagnostic criteria. At present, all treatments applied in NMOSD have made great progress, however, these treatments failed in AQP4 ab negative and refractory patients. Therefore, it is necessary to turn into an innovative idea and to open a new era of NMOSD treatment to develop novel and diverse targets and effective therapeutic drugs in NMOSD and to conduct the trails in large clinical samples and case-control studies to confirm their therapeutic effects on NMOSD in the future, which still remain a challenge.
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Affiliation(s)
- Caiyun Liu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Mingchao Shi
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Mingqin Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Fengna Chu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Tao Jin
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
| | - Jie Zhu
- Neuroscience Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China; Department of Neurobiology, Care Sciences & Society, Division of Neurogeriatrcs, Karolinska Institutet, Karolinska University Hospital Solna, Stockholm, Sweden.
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13
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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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Carnero Contentti E, López PA, Rojas JI. The frequency of myelin oligodendrocyte glycoprotein antibodies in aquaporin-4-IgG-negative neuromyelitis optica spectrum disorders patients in Latin America. Mult Scler Relat Disord 2021; 54:103122. [PMID: 34246022 DOI: 10.1016/j.msard.2021.103122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/25/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Edgar Carnero Contentti
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Av Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina.
| | - Pablo A López
- Neuroimmunology Unit, Department of Neuroscience, Hospital Alemán, Av Pueyrredón 1640, C1118AAT, Buenos Aires, Argentina
| | - Juan Ignacio Rojas
- Centro de Esclerosis Múltiple de Buenos Aires (CEMBA), Buenos Aires, Argentina; Neurology Service, Hospital Universitario de CEMIC, Buenos Aires, Argentina
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Carnero Contentti E, Marrodan M, Correale J. Emerging drugs for the treatment of adult MOG-IgG-associated diseases. Expert Opin Emerg Drugs 2021; 26:75-78. [PMID: 33861167 DOI: 10.1080/14728214.2021.1919082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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