Pediatric Neuromyelitis Optica Spectrum Disorder

Research hotspots and emerging topics in neuromyelitis optica spectrum disorder treatment: Insights from a bibliometric analysis

OBJECT

Effective treatment of neuromyelitis optica spectrum disorder (NMOSD) can greatly reduce the rate of disability and mortality among patients. NMOSD treatment studies are gaining prominence in academic circles. This study aims to depict the evolution and integration of NMOSD treatment over the past 20 years, identify key contributors in the field, clarify current research hotspots, and explore emerging topics that may guide future research directions.

METHOD

Articles in this field from 2004 to 2023 were collected from the Web of Science Core Collection (WoSCC). After conducting a literature search, a comprehensive bibliometric and knowledge mapping analysis was carried out on the retrieved articles using tools such as VOSviewer, Bibliometrix, and CiteSpace.

RESULT

The rapid growth in annual publications in this field indicates rapid progress and innovation. USA, Mayo Clinic, and Fujihara K led in productivity and impact, while the multiple sclerosis and related disorders topped in publication volume. The research hotspots in this field mainly focus on targeted biological agents. Additionally, this study has identified 3 emerging themes and conducted an in-depth exploration of their future development trends.

CONCLUSION

In summary, this bibliometric analysis provides for the first time a comprehensive framework and frontier hot spot analysis in the field of NMOSD treatment, offering references for researchers in the field and contributing to the further development of the field.

When the Expected Scenario Did Not Occur: A Novel NDUFA12 Mutation Resembling Neuromyelitis Optica Spectrum Disorder

Mitochondrial complex I transfers electrons from NADH (nicotinamide adenine dinucleotide) to ubiquinone, facilitating ATP synthesis via a proton gradient. Complex I defects are common among the mitochondrial diseases, especially in childhood. NDUFA12, located in complex I's transmembrane domain, is not directly involved in catalytic activity, but the NDUFA mutations are associated with Leigh syndrome and complex I defects. Complex I deficiency typically manifests as bilateral brainstem lesions and presents with dystonia, hypotonia, and optic nerve damage. This article discusses a patient with an NDUFA12 mutation resembling neuromyelitis optica spectrum disorder clinically and radiologically, highlighting the importance of considering NDUFA12 mutations in dystonia and optic neuritis diagnoses, particularly in neuromyelitis optica spectrum disorder cases that do not respond to standard treatments. Further research on NDUFA12 variants is needed for a better understanding of their phenotypic spectrum and to enhance diagnostic accuracy.

Management and outcomes of pediatric optic neuritis in a tertiary hospital in Riyadh, Saudi Arabia: a retrospective study

BACKGROUND

Although pediatric optic neuritis (PON) is a rare condition, current advancements in its diagnosis, investigation, and treatment suggest that a more precise risk assessment is necessary given the history of irreversible damage and functional degeneration of the optic nerve. Additionally, after further investigations and/or new neurological events, the initial diagnosis is revised.

AIM

To report clinical profile, management and outcome of different demyelinating disease phenotypes of pediatric optic neuritis (PON) in individuals under the age of 18 years in a tertiary center in the Kingdom of Saudi Arabia (KSA).

STUDY METHOD

We analyzed the electronic medical records of pediatric patients under the age of 18 years who first experienced different phenotypes of demyelinating PON between January 2000 and December 2020 as part of this retrospective case series. We studied the clinical characteristics, serology, imaging data, treatment regimens, and follow-up of the patients. Descriptive statistics were calculated.

RESULTS

The majority of patients were less than 10 years old (63.6%), males (63.6%) and had bilateral involvement (72.7%). Among the 11 patients diagnosed with PON, 5(45.5%) had isolated pediatric optic neuritis, 1 (9.1%) had multiple sclerosis (MS), 1(9.1%) had neuromyelitis optica spectrum disorder (NMOSD), 1 (9.1%) had acute disseminated encephalomyelitis (ADEM) and 3 (27.2%) had myelin oligodendrocyte glycoprotein (MOG) antibody associated disease (MOGAD). Despite poor vision at presentation, most of the patients improved, 81.1% achieved a BCVA of ≥ 20/40, and 36.6% attained 20/20 visual acuity. Four patients experienced recurrence.

CONCLUSIONS

The overlapping features of disease phenotypes in PON make it difficult to identify the underlying cause. The findings of this retrospective case series suggest the need for a future prospective multicenter study for a better understanding of the different phenotypes.

Racial, Ethnic, and Socioeconomic Disparities in Pediatric Aquaporin-4-Positive Neuromyelitis Optica Spectrum Disorder

BACKGROUND

Only 5% of aquaporin-4-positive neuromyelitis optica spectrum disorder (AQP4+ NMOSD) cases emerge during childhood. Poorer outcomes have been suggested in black/African American (AA) adults with NMOSD; however, conflicting and limited data exist for pediatric-onset NMOSD. This study evaluates racial, ethnic, and socioeconomic disparities in pediatric AQP4+ NMOSD outcomes.

METHODS

Thirty-eight pediatric patients with AQP4+ NMOSD cared for at three pediatric tertiary care centers between 2009 and 2021 were identified. Patient addresses connected to socioeconomic measures available from the US Census. Demographic characteristics, pertinent clinical outcomes, and health care utilization in the two years following diagnosis were captured.

RESULTS

Compared with non-Hispanic White children, Black/AA children had a significantly higher Expanded Disability Status Scale (EDSS) (2.46 vs 0.33, P = 0.003), 2.37 more hospital admissions (P = 0.002), and 28.40 additional inpatient days (P = 0.002) in the two years following their NMOSD diagnosis. Additionally, children with public insurance had higher relapse rates than those with private insurance (P = 0.046). At two years and at the most recent follow-up, a significantly higher EDSS was correlated with children living in census tracts with a lower median income, higher deprivation index, and higher proportion of population on assisted income, in poverty, and with vacant housing (all P < 0.05).

CONCLUSIONS

We identified racial, ethnic, and socioeconomic disparities in clinical outcomes and health care utilization in pediatric AQP4+ NMOSD. Further prospective and household-level data are needed to dissect the interplay of genetics, structural racism, and social determinants of health so that interventions to optimize care and outcomes for this population may be developed.

Pediatric acquired demyelinating syndromes: updates in diagnosis, testing, and management

PURPOSE OF REVIEW

To highlight the clinical presentation, diagnostic approach, and management of acquired inflammatory demyelinating syndromes in children.

RECENT FINDINGS

The identification of myelin oligodendrocyte glycoprotein antibody-associated disease in 2017 and evolving evidence regarding best practices for management has had a significant impact on pediatric neuroimmunology, as has the shift in treatment of pediatric-onset multiple sclerosis, with the use of high-efficacy disease-modifying therapies early in the disease course.

SUMMARY

With expanding awareness and growing interest in pediatric onset neuroinflammatory conditions, the number of children diagnosed with acquired demyelinating syndromes is rising. It is critical to refine our understanding of the underlying pathophysiological mechanisms in these disorders to provide the most effective care. Much of our practice continues to be modeled on adult care, and further large-scale pediatric studies are necessary to explore the natural history and assess the safety and efficacy of immunotherapies in childhood-onset demyelinating diseases.