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de Almeida GMR, de Araujo RS, Castrillo BB, Silva GD, Fortini I, Gonçalves MRR, Castro LHM, Tatsui NH, Adoni T, Sato DK, Apóstolos-Pereira SL, Callegaro D. Therapeutic plasma exchange for neuromyelitis optica attacks: Evidence and challenges from a real-world cohort from Brazil. J Neuroimmunol 2024; 388:578295. [PMID: 38280268 DOI: 10.1016/j.jneuroim.2024.578295] [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: 12/04/2023] [Revised: 01/16/2024] [Accepted: 01/23/2024] [Indexed: 01/29/2024]
Abstract
Therapeutic plasma exchange (TPE) can improve disability recovery after neuromyelitis optica spectrum disease (NMOSD) attacks, but its effectiveness and safety in Latin-American patients with access barriers and diverse ethnicity is underexplored. We carried out a retrospective cohort study with NMOSD patients that underwent TPE. 84 NMOSD attacks in 68 patients were evaluated. Despite a median 25-day delay from symptom onset to TPE, 65,5% of patients showed significant improvement. Adverse events occurred in 39% of patients, usually transitory and with no fatalities.
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Affiliation(s)
- Guilherme Mello Ramos de Almeida
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Hospital Cardio Pulmonar da Bahia, Salvador, Bahia, Brazil
| | - Roger Santana de Araujo
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil.
| | - Bruno Batitucci Castrillo
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; Hospital Universitário Cassiano Antônio Moraes, Universidade Federal do Espírito Santo, Espírito Santo, Brazil
| | - Guilherme Diogo Silva
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Ida Fortini
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | | | - Luiz Henrique Martins Castro
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Nelson Hidekazu Tatsui
- Hematology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Tarso Adoni
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
| | - Douglas Kazutoshi Sato
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil; School of Medicine and Institute for Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Dagoberto Callegaro
- Neuroimmunology Group, Neurology Department, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil
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Tieppo EMDS, Silva GD, Silva TFFD, Araujo RSD, Oliveira MBD, Spricigo MGP, Pimentel GA, Campana IG, Castrillo BB, Mendes NT, Teixeira LS, Nunes DM, Rimkus CDM, Adoni T, Apóstolos Pereira SL, Callegaro D. Misdiagnosis in multiple sclerosis in a Brazilian reference center: Clinical, radiological, laboratory profile and failures in the diagnostic process-Cohort study. Mult Scler 2023; 29:1755-1764. [PMID: 37786965 DOI: 10.1177/13524585231199323] [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: 10/04/2023]
Abstract
BACKGROUND Multiple sclerosis misdiagnosis remains a problem despite the well-validated McDonald 2017. For proper evaluation of errors in the diagnostic process that lead to misdiagnosis, it is adequate to incorporate patients who are already under regular follow-up at reference centers of demyelinating diseases. OBJECTIVES To evaluate multiple sclerosis misdiagnosis in patients who are on follow-up at a reference center of demyelinating diseases in Brazil. METHODS We designed an observational study including patients in regular follow-up, who were diagnosed with multiple sclerosis at our specialized outpatient clinic in the Hospital of Clinics in the University of Sao Paulo, from 1996 to 2021, and were reassessed for misdiagnosis in 2022. We evaluated demographic information, clinical profile, and complementary exams and classified participants as "established multiple sclerosis," "non-multiple sclerosis, diagnosed," and "non-multiple sclerosis, undiagnosed." Failures in the diagnostic process were assessed by the modified Diagnostic Error Evaluation and Research tool. RESULTS A total of 201 patients were included. After analysis, 191/201 (95.02%) participants were confirmed as "established multiple sclerosis," 5/201 (2.49%) were defined as "non-multiple sclerosis, diagnosed," and 5/201 (2.49%) were defined as "non-multiple sclerosis, undiagnosed." CONCLUSIONS Multiple sclerosis misdiagnosis persists in reference centers, emphasizing the need for careful interpretation of clinical findings to prevent errors.
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Affiliation(s)
- Eduardo Macedo de Souza Tieppo
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Guilherme Diogo Silva
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tomás Fraga Ferreira da Silva
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Roger Santana de Araujo
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mateus Boaventura de Oliveira
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Mariana Gondim Peixoto Spricigo
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Gabriela Almeida Pimentel
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Igor Gusmão Campana
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Bruno Batitucci Castrillo
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Natalia Trombini Mendes
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Larissa Silva Teixeira
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Douglas Mendes Nunes
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Carolina de Medeiros Rimkus
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Tarso Adoni
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Samira Luisa Apóstolos Pereira
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - Dagoberto Callegaro
- Neuroimmunology Division, Department of Neurology, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, Brazil
- Department of Neurology, Hospital das Clínicas, University of Sao Paulo Medical School, Sao Paulo, Brazil
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Callegaro D, Silva GD. Understanding MOG antibody-associated disease in Brazil. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:941-942. [PMID: 38035577 PMCID: PMC10689110 DOI: 10.1055/s-0043-1777298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/02/2023]
Affiliation(s)
- Dagoberto Callegaro
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
| | - Guilherme Diogo Silva
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, São Paulo SP, Brazil.
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Messias K, Moreto R, Cruz CA, Ronchi NR, Santos ACD, Messias A, Marques VD. Clinical spectrum of myelin oligodendrocyte glycoprotein antibody-associated disease in Brazil: a single-center experience. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:980-988. [PMID: 38035583 PMCID: PMC10689103 DOI: 10.1055/s-0043-1777002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/22/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibody-associated disease (MOGAD) is an immune-mediated neurological disorder with a broad spectrum of clinical presentation that is often difficult to distinguish from other demyelinating diseases, such as multiple sclerosis and neuromyelitis optica spectrum disorder. OBJECTIVE To describe the clinical and paraclinical characteristics of MOGAD in a Brazilian tertiary center. METHODS We retrospectively reviewed the records of adult and pediatric patients who tested positive for anti-MOG antibodies and presented with clinical and radiological diseases compatible with MOGAD. RESULTS Forty-one patients (10 children) were included: 56% female, 58% Caucasian, mean age at onset 31 years (range 6-64), with a mean disease duration of 59.6 months (range 1-264 months). The most frequent onset presentation was optic neuritis (68%), acute disseminated encephalomyelitis (ADEM, 12%), and myelitis (10%). A monophasic disease course was observed in 49%. EDSS median was 2.1 at the last visit. Most patients (83%) were under continuous immunosuppressive treatment. Azathioprine was the first-line treatment in 59%. In all ADEM cases, conus, and root involvement was radiologically observed on MRI. CONCLUSION Brazilian MOGAD patients presented with a similar spectrum of previously reported MOGAD phenotypes. Conus and spinal root involvement seems to be frequently present in MOGAD-ADEM and could serve as radiologic characteristics of this clinical entity.
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Affiliation(s)
- Katharina Messias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo SP, Brazil.
| | - Renata Moreto
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo SP, Brazil.
| | - Camila Aquino Cruz
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Nathalia Rossoni Ronchi
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
| | - Antonio Carlos dos Santos
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Imagens Médicas, Hematologia e Oncologia Clínica, Ribeirão Preto SP, Brazil.
| | - André Messias
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Oftalmologia, Otorrinolaringologia e Cirurgia de Cabeça e Pescoço, São Paulo SP, Brazil.
| | - Vanessa Daccach Marques
- Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto, Departamento de Neurociências e Ciências do Comportamento, Ribeirão Preto SP, Brazil.
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Hor JY, Fujihara K. Epidemiology of myelin oligodendrocyte glycoprotein antibody-associated disease: a review of prevalence and incidence worldwide. Front Neurol 2023; 14:1260358. [PMID: 37789888 PMCID: PMC10542411 DOI: 10.3389/fneur.2023.1260358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/15/2023] [Indexed: 10/05/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an inflammatory demyelinating disease of the central nervous system (CNS) with the presence of conformation-sensitive antibodies against MOG. The spectrum of MOGAD includes monophasic/relapsing optic neuritis, myelitis, neuromyelitis optica spectrum disorder (NMOSD) phenotype without aquaporin 4 (AQP4) antibodies, acute/multiphasic demyelinating encephalomyelitis (ADEM/MDEM)-like presentation, and brainstem and cerebral cortical encephalitis. There is no apparent female preponderance in MOGAD, and MOGAD can onset in all age groups (age at onset is approximately 30 years on average, and approximately 30% of cases are in the pediatric age group). While prevalence and incidence data have been available for AQP4+ NMOSD globally, such data are only beginning to accumulate for MOGAD. We reviewed the currently available data from population-based MOGAD studies conducted around the world: three studies in Europe, three in Asia, and one joint study in the Americas. The prevalence of MOGAD is approximately 1.3-2.5/100,000, and the annual incidence is approximately 3.4-4.8 per million. Among White people, the prevalence of MOGAD appears to be slightly higher than that of AQP4+ NMOSD. No obvious latitude gradient was observed in the Japanese nationwide survey. The data available so far showed no obvious racial preponderance or strong HLA associations in MOGAD. However, precedent infection was reported in approximately 20-40% of MOGAD cases, and this is worthy of further investigation. Co-existing autoimmune disorders are less common in MOGAD than in AQP4+ NMOSD, but NMDAR antibodies may occasionally be positive in patients with MOGAD. More population-based studies in different populations and regions are useful to further inform the epidemiology of this disease.
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Affiliation(s)
- Jyh Yung Hor
- Department of Neurology, Penang General Hospital, Penang, Malaysia
| | - 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
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Terrim S, Silva GD, de Sá E Benevides Falcao FC, Dos Reis Pereira C, de Souza Andrade Benassi T, Fortini I, Gonçalves MRR, Castro LHM, Comerlatti LR, de Medeiros Rimkus C, Adoni T, Pereira SLA, Monteiro ML, Callegaro D. Real-world application of the 2022 diagnostic criteria for first-ever episode of optic neuritis. J Neuroimmunol 2023; 381:578140. [PMID: 37364518 DOI: 10.1016/j.jneuroim.2023.578140] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/12/2023] [Accepted: 06/19/2023] [Indexed: 06/28/2023]
Abstract
Optic neuritis (ON) admits diverse differential diagnoses. Petzold proposed diagnostic criteria for ON in 2022, although real-world application of these criteria is missing. We conducted a retrospective review of patients with ON. We classified patients into definite or possible ON, and into groups A (typical neuritis), B (painless), or C (binocular) and estimated the frequency of etiologies for each group. We included 77 patients, with 62% definite and 38% possible ON. CRION and NMOSD-AQP4 negative-ON were less commonly seen in definite ON. Application of the 2022 criteria revealed a lower-than-expected frequency of definite ON, particularly for seronegative non-MS causes.
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Affiliation(s)
- Sara Terrim
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Guilherme Diogo Silva
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | | | - Clarissa Dos Reis Pereira
- Neuro-ophtalmology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil
| | - Thais de Souza Andrade Benassi
- Neuro-ophtalmology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil
| | - Ida Fortini
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Marcia Rubia Rodrigues Gonçalves
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Luiz Henrique Martins Castro
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Luiz Roberto Comerlatti
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Carolina de Medeiros Rimkus
- Radiology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil.
| | - Tarso Adoni
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Samira Luisa Apostolos Pereira
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil.
| | - Mário Luiz Monteiro
- Neuro-ophtalmology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, 05403-000 Sao Paulo, Brazil.
| | - Dagoberto Callegaro
- Neurology Division, Hospital das Clinicas of the University of Sao Paulo, Av Dr. Enéas de Carvalho Aguiar, 255, Sao Paulo 05403-000, Brazil
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