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Hurtubise B, Frohman EM, Galetta S, Balcer LJ, Frohman TC, Lisak RP, Newsome SD, Graves JS, Zamvil SS, Amezcua L. MOG Antibody-Associated Disease and Thymic Hyperplasia: From the National Multiple Sclerosis Society Case Conference Proceedings. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200077. [PMID: 36517233 PMCID: PMC9753285 DOI: 10.1212/nxi.0000000000200077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 10/26/2022] [Indexed: 12/15/2022]
Abstract
Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently described CNS inflammatory disorder that may manifest with optic neuritis, myelitis, seizures, and/or acute disseminated encephalomyelitis. While MOG-specific antibodies in patients with MOGAD are IgG1, a T-cell-dependent antibody isotype, immunologic mechanisms of this disease are not fully understood. Thymic hyperplasia can be associated with certain autoimmune diseases. In this report we describe a case of MOGAD associated with thymic hyperplasia in a young adult.
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Affiliation(s)
- Brigitte Hurtubise
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Elliot M Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Steven Galetta
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Laura J Balcer
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Teresa C Frohman
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Robert P Lisak
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott D Newsome
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Jennifer S Graves
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
| | - Scott S Zamvil
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco.
| | - Lilyana Amezcua
- From the Department of Neurology (B.H., L.A.), University of Southern California (USC), Keck School of Medicine; Distinguished Senior Fellows (Sabbatical) Neuroimmunology Laboratory of Professor Lawrence Steinman (E.M.F., T.C.F.), Stanford University School of Medicine, Palo Alto, CA; Departments of Neurology (S.G., L.J.B.), Population Health (L.J.B.) and Ophthalmology (L.J.B., S.G.), New York University Grossman School of Medicine; Department of Neurology (R.P.L.), Wayne State University, Detroit MI; Department of Neurology (S.D.N.), Johns Hopkins University School of Medicine, Baltimore, MD; Department of Neurosciences (J.S.G.), University of California, San Diego; and Department of Neurology and Program in Immunology (S.S.Z.), University of California, San Francisco
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Vallinayagam MK, Deepikadevi S, Sainath D, Balla SC. Clinical spectrum of first episode of optic neuritis in a tertiary care hospital in Southern India - A retrospective analysis. Saudi J Ophthalmol 2023; 37:20-24. [PMID: 36968764 PMCID: PMC10032289 DOI: 10.4103/sjopt.sjopt_166_21] [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: 07/11/2021] [Revised: 03/29/2022] [Accepted: 03/31/2022] [Indexed: 03/29/2023] Open
Abstract
PURPOSE The purpose of this study was to determine the demographic and clinical patterns of optic neuritis (ON) in patients presenting to a tertiary health-care institute and to study the incidence of multiple sclerosis (MS), magnetic resonance imaging features in varied ON, treatment outcome, and prognosis. METHODS A retrospective analysis of patients with first episode of ON presenting to a tertiary care center during the period from March 2013 to March 2021 was done. Details of ocular examination were retrieved from medical records and statistically analyzed. RESULTS Three hundred and fifty-four participants with ON were included in this study. The mean age was 40.25 ± 12.2 years. The male: female ratio was 1:1.35. 48.1% had visual acuity of <3/60. Based on clinical presentation, papillitis was seen in 31.5% of subjects, neuroretinitis in 24.1%, and retrobulbar neuritis in 44.4%. Based on etiology, 79.6% were idiopathic, 1.8% presented with infectious ON, and 9.26% were associated with demyelinating disease (MS). CONCLUSION Females were predominantly affected. Idiopathic ON formed the major subset etiologically. Sixty-six percent had visual recovery of 6/18 or better following corticosteroid therapy. 9.2% revealed multiple intracranial lesions on neuroimaging, suggesting high association with MS. Therefore, early diagnosis, vigilant monitoring of steroid therapy, and regular follow-up screening for MS remain the mainstay of management in ON.
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Affiliation(s)
- Muthu K. Vallinayagam
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
- Address for correspondence: Dr. Muthu K. Vallinayagam, Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India. E-mail:
| | - S.N. Deepikadevi
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Dipika Sainath
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
| | - Shravya C. Balla
- Department of Ophthalmology, Mahatma Gandhi Medical College and Research Institute, Puducherry, India
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Behera G, Gera P, Stephen M, Jose A, Thabah MM, Wadwekar V. Bilateral Optic Neuritis and Facial Palsy Following COVID-19 Infection. Cureus 2022; 14:e28735. [PMID: 36072783 PMCID: PMC9440666 DOI: 10.7759/cureus.28735] [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] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Abstract
Cases of optic neuritis have been reported following the novel coronavirus disease 2019 (COVID-19), with most being unilateral and associated with demyelinating illness. We report a case of a 22-year-old woman who presented with sudden onset painless diminution of vision in both eyes six weeks following COVID-19 infection. She also had a history of left lower motor neuron (LMN) facial palsy immediately following COVID-19 disease that recovered fully on steroids. Ocular examination and ancillary and laboratory investigations pointed to bilateral atypical optic neuritis. The patient responded well to the standard optic neuritis treatment protocol. We diagnosed her as a case of left LMN facial palsy and parainfectious bilateral optic neuritis following COVID-19. Parainfectious bilateral optic neuritis and facial nerve palsy associated with COVID-19 can occur following COVID-19 disease. Ours is the first case to report the occurrence of both in a patient.
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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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Distinguishing CNS neurosarcoidosis from multiple sclerosis and an approach to “overlap” cases. J Neuroimmunol 2022; 369:577904. [DOI: 10.1016/j.jneuroim.2022.577904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/30/2022] [Accepted: 05/30/2022] [Indexed: 12/17/2022]
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Nagaratnam SA, Ferdi AC, Leaney J, Lee RLK, Hwang YT, Heard R. Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination. BMC Neurol 2022; 22:54. [PMID: 35151258 PMCID: PMC8840677 DOI: 10.1186/s12883-022-02575-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 01/28/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated inflammatory demyelinating disease of the central nervous system. We report a case of ADEM presenting with bilateral optic neuritis temporally associated with the ChAdOx1 vaccine against SARS-COVID19 virus.
Case presentation
A 36-year-old female presented with bilateral optic neuritis following her first dose of the ChAdOx1 vaccine. Initial MRI Brain showed evidence of demyelination within the subcortical white matter, with no radiological involvement of the optic nerves. Visual evoked potentials were consistent with bilateral optic neuritis which was confirmed radiologically on follow up MRI. She was treated with intravenous steroids with improvement both in symptoms and radiological appearance. A pseudo-relapse occurred which was treated with a further course of intravenous steroids followed by an oral taper. The clinical, radiological and serological results were most consistent with diagnosis of ADEM.
Conclusions
ADEM is an exceedingly rare complication of ChAdOx1 vaccine despite millions of doses. While it is imperative clinicians remain aware of neurological complications of vaccines, the importance of vaccination to control a pandemic should not be undermined.
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Candadai AA, Liu F, Verma A, Adil MS, Alfarhan M, Fagan SC, Somanath PR, Narayanan SP. Neuroprotective Effects of Fingolimod in a Cellular Model of Optic Neuritis. Cells 2021; 10:cells10112938. [PMID: 34831161 PMCID: PMC8616192 DOI: 10.3390/cells10112938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/19/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
Visual dysfunction resulting from optic neuritis (ON) is one of the most common clinical manifestations of multiple sclerosis (MS), characterized by loss of retinal ganglion cells, thinning of the nerve fiber layer, and inflammation to the optic nerve. Current treatments available for ON or MS are only partially effective, specifically target the inflammatory phase, and have limited effects on long-term disability. Fingolimod (FTY) is an FDA-approved immunomodulatory agent for MS therapy. The objective of the current study was to evaluate the neuroprotective properties of FTY in the cellular model of ON-associated neuronal damage. R28 retinal neuronal cell damage was induced through treatment with tumor necrosis factor-α (TNFα). In our cell viability analysis, FTY treatment showed significantly reduced TNFα-induced neuronal death. Treatment with FTY attenuated the TNFα-induced changes in cell survival and cell stress signaling molecules. Furthermore, immunofluorescence studies performed using various markers indicated that FTY treatment protects the R28 cells against the TNFα-induced neurodegenerative changes by suppressing reactive oxygen species generation and promoting the expression of neuronal markers. In conclusion, our study suggests neuroprotective effects of FTY in an in vitro model of optic neuritis.
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Affiliation(s)
- Amritha A. Candadai
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
- Culver Vision Discovery Institute, Augusta University, Augusta, GA 30912, USA
| | - Fang Liu
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
- Culver Vision Discovery Institute, Augusta University, Augusta, GA 30912, USA
| | - Arti Verma
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
| | - Mir S. Adil
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
| | - Moaddey Alfarhan
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
- Culver Vision Discovery Institute, Augusta University, Augusta, GA 30912, USA
| | - Susan C. Fagan
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
| | - Payaningal R. Somanath
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
| | - S. Priya Narayanan
- Clinical and Experimental Therapeutics Program, College of Pharmacy, University of Georgia, Augusta, GA 30912, USA; (A.A.C.); (F.L.); (A.V.); (M.S.A.); (M.A.); (S.C.F.); (P.R.S.)
- Charlie Norwood VA Medical Center, Augusta, GA 30912, USA
- Culver Vision Discovery Institute, Augusta University, Augusta, GA 30912, USA
- Correspondence:
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Meneguette NS, Almeida KMFR, Figueiredo MTJDO, de Araújo E Araújo ACR, Alvarenga MP, Vasconcelos CCF, Nascimento ACB, Colombini GNUI, Petzold A, Alvarenga RMP. Optic neuritis in Asian type opticospinal multiple sclerosis (OSMS-ON) in a non-Asian population: A functional-structural paradox. Mult Scler Relat Disord 2021; 56:103260. [PMID: 34562767 DOI: 10.1016/j.msard.2021.103260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/23/2021] [Accepted: 09/06/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Biomarkers have improved the classification of autoimmune inflammatory disorders, including optic neuritis (ON) as a frequent presentation of multiple sclerosis, neuromyelitis spectrum disorders, MOG antibody-related disease (MOGAD), and opticospinal multiple sclerosis (OSMS). The phenotype of OSMS in non-Asian populations is less well known. OBJECTIVE We investigated the clinical features and prognosis of OSMS-ON in a Brazilian cohort. METHODS This was a single-center cohort study of patients from Rio de Janeiro (Brazil) with OSMS. All individuals were MOG- and AQP4-seronegative, clinically diagnosed with ON, and had magnetic resonance imaging-confirmed transverse myelitis (TM). Subjects and healthy controls (HCs) were assessed for visual acuity (logMAR VA), automated perimetry mean deviation (MD), intraocular pressure, and spectral-domain optical coherence tomography (OCT), followed by automated retinal layer segmentation of the peripapillary retinal nerve fiber layer (pRNFL) and macular ganglion cell and inner plexiform layer (mGCIPL). Receiver operator characteristic curves were plotted and the area under the curve (AUC) was calculated for group comparisons of retinal asymmetry of the pRNFL and mGCIPL. RESULTS The 30 patients with OSMS were predominantly female and white. The mean age was 48 years (range 20-70 years). Unilateral ON was the index event in 83.3% of patients. Over the average 18-year follow-up period, there were 89 relapses of ON. In individuals with OSMS, the average VA was 0.07±0.14 in the right eye (RE) and 0.13±0.30 in the left eye (LE). The MD was -5.37±5.88 dB and -5.23±3.34 dB for the RE and LE, respectively. There was a significant cumulative loss of VA (p = 0.0003) and MD (p = 0.0001) with a higher number of recurrent episodes. Atrophy of the pRNFL thickness was significant in OSMS (RE, 78.62 ± 16.01 µm; LE, 79.86 ± 13.79 µm) relative to the HC group (RE, 98.87 ± 10.68 µm; LE, 97.87 ± 10.85 µm, p = 0.0001). Likewise, there was significant mGCIPL atrophy in patients with OSMS (RE, 74.96 ± 14.46 µm; LE, 73.88 ± 13.79 µm) relative to the HC group (RE, 90.50 ± 6.74 µm; LE, 90.41± 6.89 µm; p = 0.0001). Retinal asymmetry, inter-eye percentage, and absolute differences accurately separated patients with unilateral ON from HCs (AUC=0.89 and AUC=0.85, respectively). CONCLUSION A structural-functional paradox was found in OSMS with a high diagnostic value for a novel metric based on retinal asymmetry. The functional visual outcome are excellent despite significant structural damage to the inner retinal layers in patients with a high ON relapse rate and long-term bilateral sequential involvement.
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Affiliation(s)
- Nathalie Stéphanie Meneguette
- Department of Neurology and Ophthalmology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Ana Carolina Ribeiro de Araújo E Araújo
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazi; Multiple Sclerosis Center, Federal Hospital of Lagoa, Rio de Janeiro, Brazil
| | - Marcos Papais Alvarenga
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazi; Multiple Sclerosis Center, Federal Hospital of Lagoa, Rio de Janeiro, Brazil
| | | | | | | | - Axel Petzold
- Department of Neuro-ophthalmology, Moorfields Eye Hospital, The National Hospital for Neurology and Neurosurgery, Queen Square UCL Institute of Neurology, London, United Kingdom; Expert Centre Neuro-ophthalmology, Amsterdam UMC, the Netherlands.
| | - Regina Maria Papais Alvarenga
- Department of Neurology, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazi; Multiple Sclerosis Center, Federal Hospital of Lagoa, Rio de Janeiro, Brazil.
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Gontkovsky ST. Understanding visual-spatial perceptual deficits in individuals with multiple sclerosis: an analysis of patient performance on the Hooper Visual Organization Test and Visual Form Discrimination. Int J Neurosci 2021; 133:636-641. [PMID: 34253124 DOI: 10.1080/00207454.2021.1954642] [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: 10/20/2022]
Abstract
Purpose: Although the cognitive sequelae of multiple sclerosis have been recognized for more than four decades, the focus of research has been on studying the more common deficits of the disease, including those involving memory and information processing speed. Less understood and investigated are the visual-spatial perceptual disturbances of multiple sclerosis, which can be difficult to assess and interpret given the potential confounds associated with the physical problems and other cognitive disturbances of the disorder.Materials and methods: This study examined the visual-spatial perceptual deficits of multiple sclerosis in 40 participants diagnosed with this condition using two measures generally unaffected by the aforementioned confounds, the Hooper Visual Organization Test and Visual Form Discrimination.Results: Results revealed both measures to be sensitive to the impairments of multiple sclerosis but suggested that they are assessing somewhat different aspects of visual-spatial perception in this population, given their relationship with one another and with disease-related variables.Conclusions: In this light, findings indicate that a complete and accurate understanding of the visual-spatial perceptual sequelae of multiple sclerosis requires the administration of more than a single measure.
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Candadai AA, Liu F, Fouda AY, Alfarhan M, Palani CD, Xu Z, Caldwell RB, Narayanan SP. Deletion of arginase 2 attenuates neuroinflammation in an experimental model of optic neuritis. PLoS One 2021; 16:e0247901. [PMID: 33735314 PMCID: PMC7971528 DOI: 10.1371/journal.pone.0247901] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 02/16/2021] [Indexed: 12/11/2022] Open
Abstract
Vision impairment due to optic neuritis (ON) is one of the major clinical presentations in Multiple Sclerosis (MS) and is characterized by inflammation and degeneration of the optic nerve and retina. Currently available treatments are only partially effective and have a limited impact on the neuroinflammatory pathology of the disease. A recent study from our laboratory highlighted the beneficial effect of arginase 2 (A2) deletion in suppressing retinal neurodegeneration and inflammation in an experimental model of MS. Utilizing the same model, the present study investigated the impact of A2 deficiency on MS-induced optic neuritis. Experimental autoimmune encephalomyelitis (EAE) was induced in wild-type (WT) and A2 knockout (A2-/-) mice. EAE-induced cellular infiltration, as well as activation of microglia and macrophages, were reduced in A2-/- optic nerves. Axonal degeneration and demyelination seen in EAE optic nerves were observed to be reduced with A2 deletion. Further, the lack of A2 significantly ameliorated astrogliosis induced by EAE. In conclusion, our findings demonstrate a critical involvement of arginase 2 in mediating neuroinflammation in optic neuritis and suggest the potential of A2 blockade as a targeted therapy for MS-induced optic neuritis.
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Affiliation(s)
- Amritha A. Candadai
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, United States of America
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Charlie Norwood VA Medical Center, Augusta, GA, United States of America
| | - Fang Liu
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, United States of America
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Charlie Norwood VA Medical Center, Augusta, GA, United States of America
- Vascular Biology Center, Augusta University, Augusta, GA, United States of America
| | - Abdelrahman Y. Fouda
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Charlie Norwood VA Medical Center, Augusta, GA, United States of America
- Vascular Biology Center, Augusta University, Augusta, GA, United States of America
| | - Moaddey Alfarhan
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, United States of America
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Charlie Norwood VA Medical Center, Augusta, GA, United States of America
| | - Chithra D. Palani
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, United States of America
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Vascular Biology Center, Augusta University, Augusta, GA, United States of America
| | - Zhimin Xu
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Vascular Biology Center, Augusta University, Augusta, GA, United States of America
| | - Ruth B. Caldwell
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Vascular Biology Center, Augusta University, Augusta, GA, United States of America
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, United States of America
| | - S. Priya Narayanan
- Clinical and Experimental Therapeutics, College of Pharmacy, University of Georgia, Augusta, GA, United States of America
- Culver Vision Discovery Institute, Augusta University, Augusta, GA, United States of America
- Charlie Norwood VA Medical Center, Augusta, GA, United States of America
- Vascular Biology Center, Augusta University, Augusta, GA, United States of America
- Department of Cellular Biology and Anatomy, Augusta University, Augusta, GA, United States of America
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Pfeuffer S, Kerschke L, Ruck T, Rolfes L, Pawlitzki M, Albrecht P, Wiendl H, Meuth SG. Teriflunomide treatment is associated with optic nerve recovery in early multiple sclerosis. Ther Adv Neurol Disord 2021; 14:1756286421997372. [PMID: 33747129 PMCID: PMC7940774 DOI: 10.1177/1756286421997372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 01/22/2021] [Indexed: 01/09/2023] Open
Abstract
Background and aims: Various attempts have been made to support recovery following optic neuritis (ON), but the respective trials have mostly been negative. The aim of this study was to determine whether disease-modifying treatment (DMT) following ON as first manifestation of relapsing-remitting multiple sclerosis influences long-term outcomes. Methods: A total of 79 patients with ON were identified and evaluated at relapse, DMT induction, and 12 months following treatment induction with either glatiramer acetate (GLAT), interferon-beta (IFN), or teriflunomide (TRF). Low-contrast letter acuity (LCLA) and full-field visual-evoked potentials (FF-VEP) were compared between treatment groups using multivariable regression models. The impact of TRF treatment induction compared with IFN or GLAT following relapses outside the optic nerves was evaluated in an independent cohort of 122 patients. Magnetic resonance imaging (MRI) outcomes and rates of confirmed improvement of relapse-related disability were evaluated. Results: TRF-treated patients exhibited higher LCLA and lower relative P100 latencies normalized to the fellow-eye. Findings were significant following covariate-adjustment by multivariable analyses. Cranial MRI lesion load as well as disability progression rates were not significantly different between groups. The cohort of patients following relapses other than ON showed no differences in confirmed improvement of disability. Conclusion: TRF treatment is associated with favorable outcomes regarding functional optic nerve recovery following ON in early multiple sclerosis.
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Affiliation(s)
- Steffen Pfeuffer
- Department of Neurology and Institute of Translational Neurology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Muenster, 48149, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany
| | - Tobias Ruck
- Department of Neurology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Leoni Rolfes
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Marc Pawlitzki
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Philipp Albrecht
- Department of Neurology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Heinz Wiendl
- Department of Neurology with Institute of Translational Neurology, University Hospital Muenster, Muenster, Germany
| | - Sven G Meuth
- Department of Neurology, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
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12
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Gospe SM, Chen JJ, Bhatti MT. Neuromyelitis optica spectrum disorder and myelin oligodendrocyte glycoprotein associated disorder-optic neuritis: a comprehensive review of diagnosis and treatment. Eye (Lond) 2021; 35:753-768. [PMID: 33323985 PMCID: PMC8026985 DOI: 10.1038/s41433-020-01334-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 11/10/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022] Open
Abstract
Optic neuritis (ON) is the most common cause of acute optic neuropathy in patients younger than 50 years of age and is most frequently idiopathic or associated with multiple sclerosis. However, the discovery of aquaporin-4 immunoglobulin G (IgG) and myelin oligodendrocyte glycoprotein (MOG)-IgG as biomarkers for two separate central nervous system inflammatory demyelinating diseases has revealed that neuromyelitis optica spectrum disorder (NMSOD) and MOG-IgG-associated disease (MOGAD) are responsible for clinically distinct subsets of ON. NMOSD-ON and MOGAD-ON both demonstrate tendencies for bilateral optic nerve involvement and often exhibit a relapsing course with the potential for devastating long-term visual outcomes. Early and accurate diagnosis is therefore essential. This review will summarize the current understanding of the clinical spectra of NMOSD and MOGAD, the radiographic and serological findings which support their diagnoses, and the current evidence behind various acute and long-term therapeutic strategies for ON related to these conditions. A particular emphasis is placed on a number of recent multi-centre randomized placebo-controlled trials, which provide the first level I evidence for long-term treatment of NMOSD.
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Affiliation(s)
- Sidney M Gospe
- Department of Ophthalmology, Duke University School of Medicine, Durham, NC, USA
| | - John J Chen
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - M Tariq Bhatti
- Departments of Ophthalmology and Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA.
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13
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Narula N, Iannuzzi M. Sarcoidosis: Pitfalls and Challenging Mimickers. Front Med (Lausanne) 2021; 7:594275. [PMID: 33505980 PMCID: PMC7829200 DOI: 10.3389/fmed.2020.594275] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
Sarcoidosis, a systemic granulomatous disease of unknown etiology, may mimic other conditions at presentation often resulting in delayed diagnosis. These conditions include infections, neoplasms, autoimmune, cardiovascular, and drug-induced diseases. This review highlights the most common sarcoidosis mimics that often lead to pitfalls in diagnosis and delay in appropriate treatment. Prior to invasive testing and initiating immunosuppressants (commonly corticosteroids), it is important to exclude sarcoid mimickers.
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Affiliation(s)
- Naureen Narula
- Staten Island University Hospital, New York, NY, United States
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14
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Abstract
Acute isolated optic neuritis can be the initial presentation of demyelinating inflammatory central nervous system disease related to multiple sclerosis (MS), neuromyelitis optica (NMO) or myelin oligodendrocyte glycoprotein antibody disease (MOG-AD). In addition to the well-characterized brain and spinal cord imaging features, important and characteristic differences in the radiologic appearance of the optic nerves in these disorders are being described, and magnetic resonance imaging (MRI) of the optic nerves is becoming an essential tool in the differential diagnosis of optic neuritis. Whereas typical demyelinating optic neuritis is a relatively mild and self-limited disease, atypical optic neuritis in NMO and MOG-AD is potentially much more vision-threatening and merits a different treatment approach. Thus, differentiation based on MRI features may be particularly important during the first attack of optic neuritis, when antibody status is not yet known. This review discusses the optic nerve imaging in the major demyelinating disorders with an emphasis on clinically relevant differences that can help clinicians assess and manage these important neuro-ophthalmic disorders. It also reviews the utility of optic nerve MRI as a prognostic indicator in acute optic neuritis.
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Affiliation(s)
- Aaron Winter
- Department of Neuro-Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Bart Chwalisz
- Department of Neuro-Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA.,Neuroimmunology Division, Department of Neurology, Massachusetts General Hospital/Harvard Medical School , Boston, MA, USA
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15
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Visual Outcomes and Clinical Manifestations of Pediatric Optic Neuritis in Indian Population: An Institutional Study. J Neuroophthalmol 2020; 38:462-465. [PMID: 29554001 DOI: 10.1097/wno.0000000000000646] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Optic neuritis in children is an uncommon disorder which usually occurs after a viral illness or vaccination and, less frequently, occurs as a manifestation of a demyelinating disorder. Pediatric optic neuritis usually is bilateral and presents with optic disc edema, recovers rapidly with steroid therapy, and generally has low conversion rate to multiple sclerosis or neuromyelitis optica spectrum disorder. We report the clinical features and treatment outcomes of pediatric optic neuritis in Indian population, for which little data are available. METHODS We reviewed the medical case records of patients with optic neuritis who were younger than 18 years, from 1999 to 2016. All patients were assessed and managed in the Neuro-Ophthalmology Department of Sankara Nethralaya, a unit of Medical Research Foundation and Pediatric Neurology Department of Kanchi Kamakoti-Childs Trust Hospital, Chennai, India. RESULTS One hundred seventeen eyes of 78 children with mean age of 11.84 (±4.58) years were identified. Forty-two (53.8%) were females and 36 (46.2%) were males. Thirty-nine patients (50%) had bilateral involvement and a similar number had unilateral involvement. Fifty-nine eyes (50.4%) had optic disc edema, 20 eyes (17.1%) had disc pallor, and 38 eyes (32.4%) had normal discs. Of 63 patients who had neuroimaging, 36 had MRI, and 27 underwent computed tomography. Eighty-four eyes (of 59 patients) received steroid therapy according to the protocol of the Optic Neuritis Treatment Trial (ONTT). Thirty-three eyes that were treated with other steroid protocols were excluded from the final visual outcome analyses. Sixty of the 84 eyes (72.3%) recovered visual acuity of 20/40 or better. Visual acuity improvement was statistically significant between initial and final visual acuity (logMAR) in our patients treated with the ONTT protocol (P ≤ 0.001). CONCLUSIONS Our Indian pediatric population had good visual recovery after steroid treatment for optic neuritis. Profound loss of visual acuity on presentation and bilateral involvement were significantly associated with poor visual outcome.
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Change in visual acuity and retinal structures following Repository Corticotropin Injection (RCI) therapy in patients with acute demyelinating optic neuritis: Improvement in low contrast visual acuity in both affected and contralateral eyes in a single-armed open-label study. J Neurol Sci 2019; 407:116505. [PMID: 31706456 DOI: 10.1016/j.jns.2019.116505] [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: 03/29/2019] [Revised: 08/22/2019] [Accepted: 09/19/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Current treatments after an episode of optic neuritis have limited success protecting the retinal nerves and restoring visual function. OBJECTIVE To assess the effectiveness of Repository Corticotropin Injection (RCI) after the onset of optic neuritis. METHODS Twenty-four adults were treated with RCI within 2 weeks of symptom onset. Seven exams over 400 days measured low- and high-contrast visual acuity (LCVA and HCVA) and spectral domain optical coherence tomography of the retinal structures. Differences between and among affected and contralateral eyes were assessed using linear mixed models. RESULTS HCVA improved in the affected eye over the study (36.2 letters to 52.5), and LCVA improved in both the affected eye (1.8 letters to 6.8) and the contralateral eye (8.3 letters to 11.7). These functional improvements occurred concurrent to a thinning in the papillomacular bundle and the ganglion cell, inner plexiform, and retinal nerve fiber layers, while the inner nuclear, outer plexiform, outer nuclear, and photoreceptor layers thickened. CONCLUSION The eyes affected by the ON and treated with RCI improved in both LCVA and HCVA, and unexpectedly LCVA improved in the contralateral eye as well. This functional improvement was mirrored by structural changes in the retina. This study lays the groundwork for future studies to explore potential neuro-protective and neuro-restorative effects of RCI.
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Tyshkov C, Pawate S, Bradshaw MJ, Kimbrough DJ, Chitnis T, Gelfand JM, Ryerson LZ, Kister I. Multiple sclerosis and sarcoidosis: A case for coexistence. Neurol Clin Pract 2019; 9:218-227. [PMID: 31341709 DOI: 10.1212/cpj.0000000000000629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
Abstract
Background Patients with biopsy-proven systemic sarcoidosis who develop a chronic CNS disorder are often presumed to have neurosarcoidosis (NS), however, the possibility of comorbid neurologic disease, such as MS, must be considered if presentation and course are not typical for NS. Methods Retrospective chart review across 4 academic MS centers was undertaken to identify patients with diagnosis of MS (2017 McDonald criteria) and biopsy-confirmed extraneural sarcoidosis. Data were abstracted from each chart using a case report form that systematically queried for demographic, clinical, and paraclinical characteristics relevant to NS and MS. Results Ten patients met our inclusion criteria (mean age 47.7 [±5.9] years; 80% female). Noncaseating granulomas consistent with sarcoidosis were found on biopsy in all cases (lung 7/10, mediastinum 2/10, liver 1/10, spleen 1/10, and skin 1/10). Diagnosis of MS was based on clinical history of MS-like relapses and MRI findings characteristic of demyelination and typical disease evolution during follow-up (average of 7 years). No patient developed features of NS that could be considered a "red flag" against the diagnosis of MS (such as meningeal enhancement, hydrocephalus, and pituitary involvement). All patients were treated with disease-modifying therapy for MS. Conclusions We propose a rational diagnostic approach to patients with sarcoidosis who may have comorbid MS. When the clinical picture is equivocal, the presence of multiple "MS-typical lesions" and the absence of any "NS-typical lesions" on MRI favor diagnosis of MS. Close follow-up is required to ascertain whether clinical and radiologic disease evolution and response to MS therapies conform to the proposed diagnosis of MS.
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Affiliation(s)
- Charles Tyshkov
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Siddharama Pawate
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Michael J Bradshaw
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Dorlan J Kimbrough
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Tanuja Chitnis
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Jeffrey M Gelfand
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Lana Zhovtis Ryerson
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
| | - Ilya Kister
- New York University Langone Medical Center (CT, LZR, IK), Multiple Sclerosis Comprehensive Care Center, New York, NY; the Vanderbilt University Medical Center (SP), Neuroimmunology Division, Nashville, TN; the Brigham and Women's Hospital (MJB, DJK, TC), Massachusetts General Hospital, Harvard Medical School, Boston, MA; and the Division of Neuroinflammation and Glial Biology (JMG), UCSF Department of Neurology, Weill Institute for Neurosciences, University of California, San Francisco, CA
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Recurrent optic neuritis – Different patterns in multiple sclerosis, neuromyelitis optica spectrum disorders and MOG-antibody disease. J Neuroimmunol 2018; 324:115-118. [DOI: 10.1016/j.jneuroim.2018.09.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 09/19/2018] [Accepted: 09/19/2018] [Indexed: 11/24/2022]
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Srikajon J, Siritho S, Ngamsombat C, Prayoonwiwat N, Chirapapaisan N. Differences in clinical features between optic neuritis in neuromyelitis optica spectrum disorders and in multiple sclerosis. Mult Scler J Exp Transl Clin 2018; 4:2055217318791196. [PMID: 30116549 PMCID: PMC6088491 DOI: 10.1177/2055217318791196] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/01/2018] [Accepted: 07/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background Optic neuritis (ON) is one of the common manifestations both in neuromyelitis-optica spectrum disorders (NMOSD) and in multiple sclerosis (MS). Objectives The objective of this paper is to compare clinical presentations, laboratories and imaging findings in ON associated with MS and NMOSD. Methods A retrospective chart review was performed in patients presenting with ON in 59 NMOSD patients with 72 eyes’ involvement and 163 ON attacks, and 20 MS patients with 23 eyes’ involvement and 36 ON attacks. Results ON-NMOSD patients had recurrent ON more often and tended to have simultaneous bilateral ON involvement at their first ON attack. Individuals with ON-NMOSD revealed worse visual acuity at first ON attacks and also had poorer long-term visual outcome than those with ON-MS, with nearly half of ON-NMOSD patients still having LogMAR visual acuity ≥1 at their last follow-up (p = 0.035). Significant thinner average retinal nerve fiber layer thickness was found in the ON-NMOSD group. We found no significant differences in segmentation location of the optic nerve lesions and the length of involvement between the two groups. Conclusions It was difficult to completely differentiate ON-NMOSD from ON-MS. ON-NMOSD patients, however, tended to have simultaneous bilateral ON involvement and poorer long-term visual outcome than individuals with ON-MS.
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Affiliation(s)
- Jindapa Srikajon
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Thailand
| | - Sasitorn Siritho
- Division of Neurology, Department of Medicine, Siriraj Hospital, Mahidol University, Thailand.,Bumrungrad International Hospital, Thailand
| | - Chanon Ngamsombat
- Radiology Department, Siriraj Hospital, Mahidol University, Thailand
| | - Naraporn Prayoonwiwat
- Department of Neurology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Niphon Chirapapaisan
- Department of Ophthalmology, Faculty of Medicine SirirajHospital, Mahidol University, Bangkok, Thailand
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20
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Time is vision in recurrent optic neuritis. Brain Res 2017; 1673:95-101. [PMID: 28823952 DOI: 10.1016/j.brainres.2017.08.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 11/22/2022]
Abstract
In optic neuritis (ON) inflammation precedes onset of demyelination and axonal loss. The anti-inflammatory properties of corticosteroids may be most effective in the early inflammatory phase, but rapid patient recruitment remains a logistic challenge. The aim of the study was to review the effect of time to initiation of treatment on visual outcome in recurrent ON. A retrospective case note review of patients known to our centre with recurrent ON. The primary clinical outcome was change of best corrected high contrast visual acuity (BCVA). The secondary outcome was the change of optical coherence tomography (OCT) thickness of the peripapillary retinal nerve fibre layer (pRNFL) and macular ganglion cell layer (mGCL) from baseline and after a minimum of 3months following the episode of recurrent ON. Of 269 patients with a previous episode of ON, 54 experienced recurrent ON. In total 40 OCT documented episodes of relapsing ON were captured in 19 patients. Treatment within <2days led to better recovery of the BCVA (+0.02) and mGCL (-2.4µm) if compared to delayed treatment (BCVA -0.2, p=0.036, mGCL -25.6µm, p=0.019) or no corticosteroids treatment (BCVA -0.2, p=0.045, GCL -5.0µm, p=0.836). These data suggest a beneficial effect of hyperacute corticosteroid treatment. A pragmatic approach for a prospective treatment trial should consider patients with recurrent ON for logistic reasons.
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21
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Peng C, Wang W, Xu Q, Zhao S, Li H, Yang M, Cao S, Zhou H, Wei S. Structural Alterations of Segmented Macular Inner Layers in Aquaporin4-Antibody-Positive Optic Neuritis Patients in a Chinese Population. PLoS One 2016; 11:e0157645. [PMID: 27336477 PMCID: PMC4919051 DOI: 10.1371/journal.pone.0157645] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 06/02/2016] [Indexed: 12/28/2022] Open
Abstract
Objectives This study aimed to analyse the structural injury of the peripapillary retinal nerve fibre layer (pRNFL) and segmented macular layers in optic neuritis (ON) in aquaporin4-antibody (AQP4-Ab) seropositivity(AQP4-Ab-positiveON) patients and in AQP4-Ab seronegativity (AQP4-Ab-negative ON) patients in order to evaluate their correlations with the best-corrected visual acuity (BCVA) and the value of the early diagnosis of neuromyelitis optica (NMO). Design This is a retrospective, cross-sectional and control observational study. Methods In total, 213 ON patients (291 eyes) and 50 healthy controls (HC) (100 eyes) were recruited in this study. According to a serum AQP4-Ab assay, 98 ON patients (132 eyes) were grouped as AQP4-Ab-positive ON and 115 ON patients (159 eyes) were grouped as AQP4-Ab-negative ON cohorts. All subjects underwent scanning with spectralis optical coherence tomography (OCT) and BCVA tests. pRNFL and segmented macular layer measurements were analysed. Results The pRNFL thickness in AQP4-Ab-positive ON eyes showed a more serious loss during 0–2 months (-27.61μm versus -14.47 μm) and ≥6 months (-57.91μm versus -47.19μm) when compared with AQP4-Ab-negative ON eyes. AQP4-Ab-positive ON preferentially damaged the nasal lateral pRNFL. The alterations in the macular ganglion cell layer plus the inner plexiform layer (GCIP) in AQP4-Ab-positive ON eyes were similar to those in AQP4-Ab-negative ON eyes. AQP4-Ab-positive ON eyes had entirely different injury patterns in the inner nuclear layer (INL) compared with AQP4-Ab-negative ON eyes during the first 6 months after the initial ON attack. These differences were as follows: the INL volume of AQP4-Ab-positive ON eyes had a gradual growing trend compared with AQP4-Ab-negative ON eyes, and it increased rapidly during 0–2 months, reached its peak during 2–4 months, and then decreased gradually. The pRNFL and GCIP in AQP4-Ab-positive ON eyes had positive correlations with BCVA. When the pRNFL thickness decreased to 95%CI (50.77μmto 60.85μm) or when the GCIP volume decreased to 95%CI (1.288 mm3to 1.399 mm3), BCVA began to be irreversibly damaged. Conclusion The structural alterations of pRNFL and GCIP could indicate the resulting visual damage. In addition, the injury pattern of INL could be a potential structural marker to predict the conversion of ON to NMO.
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Affiliation(s)
- Chunxia Peng
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Wei Wang
- Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Shuo Zhao
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Hongyang Li
- Department of Ophthalmology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Mo Yang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Shanshan Cao
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Huanfen Zhou
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
- * E-mail:
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Wu GF, Parker Harp CR, Shindler KS. Optic Neuritis: A Model for the Immuno-pathogenesis of Central Nervous System Inflammatory Demyelinating Diseases. ACTA ACUST UNITED AC 2015; 11:85-92. [PMID: 29399010 DOI: 10.2174/1573395511666150707181644] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Evidence for the tenuous regulation between the immune system and central nervous system (CNS) can be found with examples of interaction between these organ systems gone awry. Multiple sclerosis (MS) is the prototypical inflammatory disease of the CNS and is characterized by widely distributed inflammatory demyelinating plaques that can involve the brain, spinal cord and/or optic nerves. Optic neuritis (ON), inflammatory injury of the optic nerve that frequently occurs in patients with MS, has been the focus of intense study in part given the readily accessible nature of clinical outcome measures. Exploring the clinical and pathological features of ON in relation to other inflammatory demyelinating conditions of the CNS, namely MS and neuromyelitis optica, provides an opportunity to glean common and distinct mechanisms of disease. Emerging data from clinical studies along with various animal models involving ON implicate innate and adaptive immune responses directed at glial targets, including myelin oligodendrocyte glycoprotein and aquaporin 4. Resolution of inflammation in ON is commonly observed both clinically and experimentally, but persistent nerve injury is also one emerging hallmark of ON. One hypothesis seeking evaluation is that, in comparison to other sites targeted in MS, the optic nerve is a highly specialized target within the CNS predisposing to unique immunologic processes that generate ON. Overall, ON serves as a highly relevant entity for understanding the pathogenesis of other CNS demyelinating conditions, most notably MS.
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Affiliation(s)
- Gregory F Wu
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA.,Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Chelsea R Parker Harp
- Department of Pathology & Immunology, Washington University in St. Louis School of Medicine, St. Louis, MO 63110, USA
| | - Kenneth S Shindler
- Department of Ophthalmology, University of Pennsylvania School of Medicine, Philadelphia, PA 19004, USA
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Features of anti-aquaporin 4 antibody-seropositive Chinese patients with neuromyelitis optica spectrum optic neuritis. J Neurol 2015; 262:2293-304. [DOI: 10.1007/s00415-015-7844-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 07/01/2015] [Accepted: 07/01/2015] [Indexed: 01/04/2023]
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Juryńczyk M, Craner M, Palace J. Overlapping CNS inflammatory diseases: differentiating features of NMO and MS. J Neurol Neurosurg Psychiatry 2015; 86:20-5. [PMID: 25248365 DOI: 10.1136/jnnp-2014-308984] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Neuromyelitis optica (NMO) has long been considered as a variant of multiple sclerosis (MS) rather than a distinct disease. This concept changed with the discovery of serum antibodies (Ab) against aquaporin-4 (AQP4), which unequivocally differentiate NMO from MS. Patients who test positive for AQP4-Abs and present with optic neuritis (ON) and transverse myelitis (TM) are diagnosed with NMO and those who show an incomplete phenotype with isolated ON or longitudinally extensive TM (LETM) or less commonly brain/brainstem disease are referred to as NMO spectrum disorders (NMOSD). However, many patients, who have overlapping features of both NMO and MS, test negative for AQP4-Abs and may be difficult to definitively diagnose. This raises important practical issues, since NMO and MS respond differently to immunomodulatory treatment and have different prognoses. Here we review distinct features of AQP4-positive NMO and MS, which might then be useful in the diagnosis of antibody-negative overlap syndromes. We identify discriminators, which are related to demographic data (non-white origin, very late onset), clinical features (limited recovery from ON, bilateral ON, intractable nausea, progressive course of disability), laboratory results (cerebrospinal fluid (CSF) pleocytosis with eosinophils and/or neutrophils, oligoclonal bands, glial fibrillary acidic protein in the CSF) and imaging (LETM, LETM with T1 hypointensity, periependymal brainstem lesions, perivenous white matter lesions, Dawson's fingers, curved or S-shaped U-fibre juxtacortical lesions). We review the value of these discriminators and discuss the compelling need for new diagnostic markers in these two autoimmune demyelinating diseases of the central nervous system.
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Affiliation(s)
- Maciej Juryńczyk
- Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK
| | - Matthew Craner
- Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK
| | - Jacqueline Palace
- Department of Neurology, Oxford University Hospitals National Health Service Trust, Oxford, UK
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Pérez-Cambrodí RJ, Gómez-Hurtado Cubillana A, Merino-Suárez ML, Piñero-Llorens DP, Laria-Ochaita C. Optic neuritis in pediatric population: a review in current tendencies of diagnosis and management. JOURNAL OF OPTOMETRY 2014; 7:125-130. [PMID: 25000867 PMCID: PMC4087179 DOI: 10.1016/j.optom.2013.12.008] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Revised: 09/23/2013] [Accepted: 09/23/2013] [Indexed: 06/03/2023]
Abstract
Optic neuritis is an inflammation of the optic nerve and may be related to different systemic conditions. The clinical presentation of this pathology usually includes sudden loss of visual acuity (VA) which may be unilateral or bilateral, visual field restriction, pain with eye movements, dyschromatopsia, a relative afferent pupillary defect and optic disk swelling. Optic neuritis in children has specific clinical features and a better prognosis than in adulthood. Although usually appears an underlying viral disease, the main concern for practitioners is the relationship of optic neuritis with multiple sclerosis. In addition to the classical techniques as magnetic resonance imaging (MRI), current tendencies of diagnosis for eye practitioners include new imaging devices as optical coherence tomography (OCT), useful to show a thinning of the retinal fibers layer (RFL) after the inflammatory episode. Regarding the management of these patients, short-term intravenous steroid dosages seem to be the best option to treat acute attacks characterized by a very poor bilateral VA.
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Affiliation(s)
| | | | - María L Merino-Suárez
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain; Department of Optics, Anatomy and Pharmacology, University of Alicante, Spain
| | - David P Piñero-Llorens
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain; Department of Optics, Anatomy and Pharmacology, University of Alicante, Spain
| | - Carlos Laria-Ochaita
- Oftalmar, Ophthalmology Department, Hospital Internacional Medimar, Alicante, Spain
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Burton JM, Costello F. Does this optic neuritis patient have neuromyelitis optica? An approach to optic neuritis in the context of neuromyelitis optica. EXPERT REVIEW OF OPHTHALMOLOGY 2014. [DOI: 10.1586/17469899.2014.922874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Malik MT, Healy BC, Benson LA, Kivisakk P, Musallam A, Weiner HL, Chitnis T. Factors associated with recovery from acute optic neuritis in patients with multiple sclerosis. Neurology 2014; 82:2173-9. [PMID: 24850491 DOI: 10.1212/wnl.0000000000000524] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical and demographic features associated with the severity and recovery from acute optic neuritis (AON) episodes in patients with multiple sclerosis (MS). METHODS Adult (n = 253) and pediatric (n = 38) patients whose first symptom was AON were identified from our MS database. Severity measured by loss of visual acuity (mild attack ≤20/40, moderate attack 20/50-20/190, and severe attack ≥20/200) and recovery in visual acuity at 1 year after the attack (complete recovery ≤20/20, fair recovery 20/40, and poor recovery ≥20/50) were recorded. Demographic and clinical features associated with attack severity and recovery were identified using proportional odds logistic regression. For another group of patients, blood samples were available within 6 months of an AON attack. In this group, the impact of vitamin D level on the severity/recovery was also assessed. RESULTS Men (adjusted odds ratio [OR] = 2.28, p = 0.03) and subjects with severe attacks (adjusted OR = 5.24, p < 0.001) had worse recovery. AON severity was similar between the pediatric and adult subjects, but recovery was significantly better in pediatric subjects in the unadjusted analysis (p = 0.041) and the analysis adjusted for sex (p = 0.029). Season-adjusted vitamin D level was significantly associated with attack severity (OR for 10-U increase in vitamin D level = 0.47; 95% confidence interval: 0.32, 0.68; p < 0.001). Vitamin D level was not associated with recovery from the attack (p = 0.98) in univariate analysis or after accounting for attack severity (p = 0.10). CONCLUSION Vitamin D levels affect AON severity, whereas younger age, attack severity, and male sex affect AON recovery. Underlying mechanisms and potential therapeutic targets may identify new measures to mitigate disability accrual in MS.
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Affiliation(s)
- Muhammad Taimur Malik
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Brian C Healy
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Leslie A Benson
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Pia Kivisakk
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Alexander Musallam
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Howard L Weiner
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston
| | - Tanuja Chitnis
- From the Partners Multiple Sclerosis Center (M.T.M., B.C.H., L.A.B., A.M., H.L.W., T.C.) and Center for Neurological Diseases (P.K., H.L.W., T.C.), Brigham and Women's Hospital, Harvard Medical School, Boston; Department of Neurology (L.A.B.), Boston Children's Hospital; and Partners Pediatric Multiple Sclerosis Center (L.A.B., T.C.), Massachusetts General Hospital, Boston.
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Grech R, Cornish KS, Galvin PL, Grech S, Looby S, O'Hare A, Mizzi A, Thornton J, Brennan P. Imaging of adult ocular and orbital pathology--a pictorial review. J Radiol Case Rep 2014; 8:1-29. [PMID: 24967016 DOI: 10.3941/jrcr.v8i2.1525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Orbital pathology often presents a diagnostic challenge to the reporting radiologist. The aetiology is protean, and clinical input is therefore often necessary to narrow the differential diagnosis. With this manuscript, we provide a pictorial review of adult ocular and orbital pathology.
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Affiliation(s)
- Reuben Grech
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Kurt Spiteri Cornish
- Department of Ophthalmology, Aberdeen Royal Infirmary, Foresterhill, United Kingdom
| | - Patrick Leo Galvin
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | | | - Seamus Looby
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Alan O'Hare
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Adrian Mizzi
- Department of Radiology, Mater Dei Hospital, Malta
| | - John Thornton
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
| | - Paul Brennan
- Department of Neuroradiology, Beaumont Hospital, Dublin, Republic of Ireland
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Hickman SJ, Raoof N, McLean RJ, Gottlob I. Vision and multiple sclerosis. Mult Scler Relat Disord 2014; 3:3-16. [DOI: 10.1016/j.msard.2013.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Accepted: 04/29/2013] [Indexed: 10/26/2022]
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Waschbisch A, Atiya M, Schaub C, Derfuss T, Schwab S, Lee DH, Müller M, Linker RA. Aquaporin-4 antibody negative recurrent isolated optic neuritis: clinical evidence for disease heterogeneity. J Neurol Sci 2013; 331:72-5. [PMID: 23735776 DOI: 10.1016/j.jns.2013.05.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 04/22/2013] [Accepted: 05/10/2013] [Indexed: 11/28/2022]
Abstract
Recurrent optic neuritis is frequently observed in multiple sclerosis (MS) and is a typical finding in neuromyelitis optica (NMO). Patients that lack further evidence of demyelinating disease are diagnosed with RION (recurrent isolated optic neuritis) or CRION (chronic relapsing inflammatory neuropathy) if they require immunosuppressive therapy to prevent further relapses. The etiology and disease course of this rare condition are not well defined. We studied a series of 10 patients who presented with recurrent episodes of isolated optic neuritis (ON, n=57) and were followed over a median of 3.5 years. Visual acuity was severely reduced at the nadir of the disease (20/200 to 20/800). All patients had MRI non-diagnostic for MS/NMO and were aquaporin-4 antibody negative. Six patients fulfilled the CRION criteria. In two of these a single ON followed by a long disease-free interval preceded development of CRION for years, suggesting the conversion of an initially "benign" isolated ON into the chronic relapsing course. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis in 5 patients, identical oligoclonal bands in serum and CSF were observed in 2 patients, while the others remained negative. In conclusion, recurrent ON is a disease entity that requires aggressive glucocorticoid and eventually long-term immunosuppressive therapy to prevent substantial visual impairment.
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Affiliation(s)
- A Waschbisch
- Dept. of Neurology, Friedrich-Alexander University of Erlangen, Erlangen, Germany.
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31
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Abstract
Neuromyelitis optica (NMO) is a disabling inflammatory condition that targets astrocytes in the optic nerves and spinal cord. Neuro-ophthalmologists must be particularly aware of this disorder because about half of patients present as isolated unilateral optic neuritis months or years before a disease-defining and often crippling bout of myelitis. NMO is easily confused with multiple sclerosis because it is characterized by relapses that lead to stepwise accrual of deficits. The best predictor of conversion from optic neuritis to clinical definite NMO is the presence of a serum antibody to aquaporin-4 called NMO-IgG. However, this test is currently only about 75% sensitive. Suspicion of NMO should be high in patients who present with vision of light perception or worse or who are left with acuity of 20/50 or worse after optic neuritis and in those with simultaneous bilateral optic neuritis or recurrent attacks. Acute NMO relapses are generally treated with high-dose intravenous steroids, with plasma exchange often used as a rescue therapy for those who do not respond. Preventative strategies against relapses currently use broad-spectrum or selective B-lymphocyte immune suppression, but their use is based on small, generally uncontrolled studies. Hopefully, the future will bring more sensitive tools for defining risk and predicting outcome, as well as more targeted and effective forms of therapy.
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Reitz LY, Inglese M, Fiehler J, Finsterbusch J, Holst B, Heesen C, Martin R, Schippling S. Quantitative T2' imaging in patients with clinically isolated syndrome. Acta Neurol Scand 2012; 126:357-63. [PMID: 22211987 DOI: 10.1111/j.1600-0404.2011.01635.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2011] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The T2' imaging has been shown to be sensitive to oxygen saturation changes in normal appearing white and grey matter (NAWM, NAGM) in patients with relapsing-remitting multiple sclerosis (RRMS). We aimed to explore the presence and extent of T2' changes in patients with a clinically isolated syndrome (CIS) and a possible association of T2' with conventional magnetic resonance imaging and clinical outcomes. MATERIAL AND METHODS Quantitative T2- and T2*-weighted images were acquired in 32 treatment-naive patients with a CIS within 3 months of presentation and 15 age-matched healthy controls (HC). Quantitative T2' values were determined in six regions of interest (ROIs). RESULTS The T2' values in CIS did not differ significantly from those in HC. Among patients, T2' values correlated positively with the T2 lesion volume (T2LV, r = 0.34, P < 0.05). T2' values of the frontal NAWM correlated with the T2LV (r = 0.35, P < 0.05) and T2 lesion count (r = 0.4, P = 0.02). CONCLUSION As opposed to RRMS, patients with CIS did not show T2' alterations compared to HC. However, the association between the T2LV and higher T2' values suggests that T2' reflects disease evolution. In CIS metabolic changes might be masked by compensatory mechanisms and become overt when disease progresses as has been shown for RRMS patients.
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Affiliation(s)
- L. Y. Reitz
- Department of Neurology; Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims); University Medical Center; Hamburg; DE; Germany
| | - M. Inglese
- Department of Neurology; Mount Sinai School of Medicine; New York; NY; Germany
| | - J. Fiehler
- Department of Neuroradiology; University Medical Center; Hamburg; DE; Germany
| | - J. Finsterbusch
- Department of Systems Neuroscience; University Medical Center; Hamburg; DE; Germany
| | - B. Holst
- Department of Neuroradiology; University Medical Center; Hamburg; DE; Germany
| | - C. Heesen
- Department of Neurology; Institute for Neuroimmunology and Clinical Multiple Sclerosis Research (inims); University Medical Center; Hamburg; DE; Germany
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Magnetic Resonance Imaging of Optic Neuritis in Patients With Neuromyelitis Optica Versus Multiple Sclerosis. J Neuroophthalmol 2012; 32:216-20. [DOI: 10.1097/wno.0b013e318254c62d] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Roesner S, Appel R, Gbadamosi J, Martin R, Heesen C. Treatment of steroid-unresponsive optic neuritis with plasma exchange. Acta Neurol Scand 2012; 126:103-8. [PMID: 22050360 DOI: 10.1111/j.1600-0404.2011.01612.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Until now, the significance of plasma exchange (PE) as a treatment for steroid-unresponsive optic neuritis (ON) is still unclear because placebo-controlled and larger studies are missing. We report our experience with 23 patients treated by PE due to steroid-unresponsive ON. MATERIALS AND METHODS Patients were admitted to the University Medical Center Hamburg-Eppendorf between 2006 and 2010 with a visual acuity of <50% on the affected eye following steroid treatment. Ten patients suffered from RR-MS, one from neuromyelitis optica, and 12 patients developed ON as a clinically isolated syndrome. Routinely, they were treated with five cycles of PE. Visual acuity was measured before and directly after PE and during follow-up (first follow-up after 50 days, second follow-up after 174 days). RESULTS Altogether, 70% of our patients improved after PE, 69% of them showed a good or very good response to therapy. Patients who improved well after PE (n = 11) showed a mean visual acuity of 16% before PE compared to 45% immediately after PE and 60% at the first follow-up. No serious adverse events occurred. CONCLUSIONS To our knowledge, our study is the largest case series of patients with steroid-unresponsive ON treated with PE. Based on our experience, we conclude that PE is an important treatment option for patients with steroid-unresponsive ON although placebo-controlled studies are missing until now.
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Affiliation(s)
- S Roesner
- Departmant of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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The use of serum glial fibrillary acidic protein measurements in the diagnosis of neuromyelitis optica spectrum optic neuritis. PLoS One 2011; 6:e23489. [PMID: 21876753 PMCID: PMC3158082 DOI: 10.1371/journal.pone.0023489] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 07/18/2011] [Indexed: 11/19/2022] Open
Abstract
Background Glial fibrillary acidic protein (GFAP) is a specific intermediate filament of the cytoskeleton of the astrocyte and may be used as a specific marker for astrocytic damage. It is detectable in the cerebrospinal fluid following a relapse caused by Multiple Sclerosis (MS) and Neuromyelitis Optica (NMO) spectrum disease. Higher levels are found following an NMO-related relapse. It is not known if GFAP is also detectable in the serum following such relapses. In particular, it is not known if lesions limited to the optic nerve release GFAP in sufficient quantities to be detectable within the serum. The aim of this study was to ascertain the extent to which serum GFAP levels can distinguish between an episode of optic neuritis (ON) related to NMO spectrum disease and ON from other causes. Methodology/Principal Findings Out of 150 patients consecutively presenting to our eye hospital over the period March 2009 until July 2010, we were able to collect a serum sample from 12 patients who had presented with MS-related ON and from 10 patients who had presented with NMO spectrum disease-related ON. We also identified 8 patients with recurrent isolated ON and 8 patients with a corticosteroid-dependent optic neuropathy in the absence of any identified aetiology. GFAP was detectable in the serum of all but three patients (two patients with MS-related ON and one with recurrent optic neuritis). The median serum GFAP level in the patient group with NMO spectrum disease was 4.63 pg/mL whereas in all other cases combined together, this was 2.14 pg/mL. The difference was statistically significant (P = 0.01). A similar statistically significant difference was found when cases with pathology limited to the optic nerve were compared (P = 0.03). Conclusions Glial pathology in NMO related optic neuritis is reflected in elevated serum GFAP levels independently of whether or not there is extra-optic nerve disease.
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