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Li L, Fang GL, Zheng Y, Zhang YX. Late-onset neuromyelitis optica spectrum disorder mimicking stroke in an elderly Chinese man: Case report. J Spinal Cord Med 2022; 45:148-150. [PMID: 32298226 PMCID: PMC8890564 DOI: 10.1080/10790268.2020.1749475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context: Few cases of neuromyelitis optica spectrum disorder (NMOSD) with an onset older than 75 years old have been reported.Finding: Herein, we report an 81-year-old Chinese male initially suspected of acute stroke but was ultimately diagnosed with NMOSD.Conclusion: Even in the elderly, a diagnosis of NMOSD should be considered for patients with myelitis, especially those with longitudinally extensive spinal cord involvement. Testing for aquaporin 4 antibody in this scenario is recommended for further confirmation. Once diagnosed, careful consideration of treatment options and close monitoring of side effects are important to improve prognosis in elderly patients.
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Affiliation(s)
- Lei Li
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, People’s Republic of China
| | - Gao-Li Fang
- Department of Neurology, Zhejiang Chinese Medicine and Western Medicine Integrated Hospital, Hangzhou, People’s Republic of China
| | - Yang Zheng
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China
| | - Yin-Xi Zhang
- Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, People’s Republic of China,Correspondence to: Yin-Xi Zhang, Department of Neurology, Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou310009, People’s Republic of China.
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Sengupta MB, Chakrabarti A, Saha S, Mukhopadhyay D. Clinical proteomics of enervated neurons. Clin Proteomics 2016; 13:10. [PMID: 27152104 PMCID: PMC4857373 DOI: 10.1186/s12014-016-9112-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 04/18/2016] [Indexed: 11/16/2022] Open
Abstract
The dynamic field of neurosciences entails ever increasing search for molecular mechanisms of disease states, especially in the domain of neurodegenerative disorders. The previous century heralded the techniques in proteomics when indexing of the human proteomes relating to various disease conditions became important. Early stage research in certain diseases or pathological conditions requires a more holistic approach of first discovering the proteins of interest for the condition. Despite its limitations, proteomics is one of the most powerful techniques available to us today to dissect the molecular scenario in a particular disease situation. In this review we will discuss about the current clinical research in neurodegenerative disorders that employ proteomics techniques. We will specifically focus on our understanding of Alzheimer’s disease, traumatic spinal cord injury and neuromyelitis optica. Discussions will include ongoing worldwide research in these areas, research in India and specifically our laboratory in these domains of neurodegenerative conditions.
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Affiliation(s)
- Mohor Biplab Sengupta
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, West Bengal 700064 India
| | - Arunabha Chakrabarti
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, West Bengal 700064 India
| | - Suparna Saha
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, West Bengal 700064 India
| | - Debashis Mukhopadhyay
- Biophysics and Structural Genomics Division, Saha Institute of Nuclear Physics, 1/AF Bidhannagar, Kolkata, West Bengal 700064 India
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Very late-onset neuromyelitis optica spectrum disorder beyond the age of 75. J Neurol 2015; 262:1379-84. [PMID: 25957640 PMCID: PMC4441737 DOI: 10.1007/s00415-015-7766-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/20/2015] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
Abstract
Aquaporin-4 antibody (AQP4-Ab)-positive neuromyelitis optica spectrum disorder (NMOSD) is a rare but often severe autoimmune disease with median onset around 40 years of age. We report characteristics of three very-late-onset NMOSD (including complete NMO) patients >75 years of age, in whom this diagnosis initially seemed unlikely because of their age and age-associated concomitant diseases, and briefly review the literature. All three patients, aged 79, 82 and 88 years, presented with a spinal cord syndrome as the first clinical manifestation of AQP4-Ab-positive NMOSD. They all had severe relapses unless immunosuppressive therapy was initiated, and one untreated patient died of a fatal NMOSD course. Two patients developed side effects of immunosuppression. We conclude that a first manifestation of NMOSD should be considered even in patients beyond the age of 75 years with a compatible syndrome, especially longitudinally extensive myelitis. Early diagnosis and treatment are feasible and highly relevant. Special attention is warranted in the elderly to recognize adverse effects of immunosuppressive therapies as early as possible.
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Souza CS, Brooks JBB, Oliveira CLS, Fragoso YD. Neuromyelitis optica with very late onset. ARQUIVOS DE NEURO-PSIQUIATRIA 2014; 71:556-7. [PMID: 23982016 DOI: 10.1590/0004-282x20130077] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 04/01/2013] [Indexed: 11/22/2022]
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Collongues N, Marignier R, Jacob A, Leite MI, Siva A, Paul F, Zephir H, Akman-Demir G, Elsone L, Jarius S, Papeix C, Mutch K, Saip S, Wildemann B, Kitley J, Karabudak R, Aktas O, Kuscu D, Altintas A, Palace J, Confavreux C, De Seze J. Characterization of neuromyelitis optica and neuromyelitis optica spectrum disorder patients with a late onset. Mult Scler 2013; 20:1086-94. [PMID: 24323817 DOI: 10.1177/1352458513515085] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Accepted: 11/05/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few data are available for patients with a late onset (≥ 50 years) of neuromyelitis optica (LONMO) or neuromyelitis optica spectrum disease (LONMOSD), defined by an optic neuritis/longitudinally extensive transverse myelitis with aquaporin-4 antibodies (AQP4-Ab). OBJECTIVE To characterize LONMO and LONMOSD, and to analyze their predictive factors of disability and death. METHODS We identified 430 patients from four cohorts of NMO/NMOSD in France, Germany, Turkey and UK. We extracted the late onset patients and analyzed them for predictive factors of disability and death, using the Cox proportional model. RESULTS We followed up on 63 patients with LONMO and 45 with LONMOSD during a mean of 4.6 years. This LONMO/LONMOSD cohort was mainly of Caucasian origin (93%), women (80%), seropositive for AQP4-Ab (85%) and from 50 to 82.5 years of age at onset. No progressive course was noted. At last follow-up, the median Expanded Disability Status Scale (EDSS) scores were 5.5 and 6 in the LONMO and LONMOSD groups, respectively. Outcome was mainly characterized by motor disability and relatively good visual function. At last follow-up, 14 patients had died, including seven (50%) due to acute myelitis and six (43%) because of opportunistic infections. The EDSS 4 score was independently predicted by an older age at onset, as a continuous variable after 50 years of age. Death was predicted by two independent factors: an older age at onset and a high annualized relapse rate. CONCLUSION LONMO/LONMOSD is particularly severe, with a high rate of motor impairment and death.
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Affiliation(s)
- N Collongues
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
| | - R Marignier
- Department of Neurology, Pierre Wertheimer Hospital, University of Lyon, France
| | - A Jacob
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - M I Leite
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - A Siva
- Department of Neurology, Istanbul University, Turkey
| | - F Paul
- Neurocure, Charité University Medicine Berlin, Germany
| | - H Zephir
- Department of Neurology, Robert Salengro Hospital, University of Lille Nord de France, France
| | - G Akman-Demir
- Department of Neurology, Istanbul University, Turkey
| | - L Elsone
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Jarius
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - C Papeix
- Department of Neurology, Groupe Hospitalier Pitié Salpétrière, Paris, France
| | - K Mutch
- The Walton Centre for Neurology and Neurosurgery, The Walton Centre Foundation Trust, Liverpool, UK
| | - S Saip
- Department of Neurology, Istanbul University, Turkey
| | - B Wildemann
- Division of Molecular Neuroimmunology, University of Heidelberg, Germany
| | - J Kitley
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | - R Karabudak
- Department of Neurology, Hacettepe University, Ankara, Turkey
| | - O Aktas
- Department of Neurology, Heinrich-Heine-University of Düsseldorf, Germany
| | - D Kuscu
- Department of Neurology, Bakýrkoy Hospital for Psychiatric and Neurological Diseases, Istanbul, Turkey
| | - A Altintas
- Department of Neurology, Istanbul University, Turkey
| | - J Palace
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, UK
| | | | - J De Seze
- Department of Neurology, Hautepierre Hospital, University of Strasbourg, France
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Lefaucheur R, Bourre B, Ahtoy P, Ozkul O, Tollard E, Hannequin D, Maltête D. NEUROMYELITIS OPTICA WITH VERY LATE ONSET. J Am Geriatr Soc 2011; 59:1138-40. [DOI: 10.1111/j.1532-5415.2011.03435.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Adoni T, Lino AMM, da Gama PD, Apostolos-Pereira SL, Marchiori PE, Kok F, Callegaro D. Recurrent neuromyelitis optica in Brazilian patients: clinical, immunological, and neuroimaging characteristics. Mult Scler 2009; 16:81-6. [DOI: 10.1177/1352458509353651] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neuromyelitis optica has not been thoroughly studied in Brazilian patients following the discovery of NMO-IgG and its specific antigen aquaporin-4. In this study we aimed to describe the clinical NMO-IgG immunological status and neuroimaging characteristics of recurrent neuromyelitis optica in a series Brazilian patients. We undertook a retrospective study of 28 patients with recurrent neuromyelitis optica, according to 1999 Wingerchuk’s diagnostic criteria. Data on NMO-IgG status, clinical features, and MRI findings were analyzed. Three men and 25 women were evaluated. Median age at onset of disease was 26 years (range 7—55); median time of follow-up was 7 years (range 2—14). The mean time elapsed between the first and the second attack was 17 months (median 8.5; range 2—88). NMO-IgG was detected in 18 patients (64.3%). Four patients died due to respiratory failure. Most patients presented with cervical (36%) and cervical-thoracic myelitis (46.4%). Holocord lesion was the most common pattern of involvement (50%) on the axial plane. We did not find a statistical association between myelitis extension and NMO-IgG result. Our series of Brazilian patients showed a younger age of onset than previously reported. In our series, in contrast to previous reports, there was no correlation between the extension of myelitis and NMO-IgG positivity.
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Affiliation(s)
- T. Adoni
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil,
| | - AMM Lino
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - PD da Gama
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - SL Apostolos-Pereira
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - PE Marchiori
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - F. Kok
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - D. Callegaro
- Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
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Lana-Peixoto MA. Devic’s neuromyelitis optica: a critical review. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:120-38. [DOI: 10.1590/s0004-282x2008000100034] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 02/04/2008] [Indexed: 11/21/2022]
Abstract
Devic's neuromyelitis optica (NMO) is an idiopathic inflammatory demyelinating and necrotizing disease characterized by predominant involvement of the optic nerves and spinal cord. In Asian countries relapsing NMO has been known as opticospinal multiple sclerosis. It has long been debated if NMO is a variant of multiple sclerosis (MS) or a distinct disease. Recent studies have shown that NMO has more frequently a relapsing course, and results from attack to aquaporin-4 which is the dominant water channel in the central nervous system, located in foot processes of the astrocytes. Distinctive pathological features of NMO include perivascular deposition of IgG and complement in the perivascular space, granulocyte and eosinophil infiltrates and hyalinization of the vascular walls. These features distinguish NMO from other demyelinating diseases such as MS and acute demyelinating encephalomyelopathy. An IgG-antibody that binds to aquaporin-4, named NMO-IgG has high sensitivity and specificity. Magnetic resonance imaging (MRI) studies have revealed that more frequently there is a long spinal cord lesion that extends through three or more vertebral segments in length. Brain MRI lesions atypical for MS are found in the majority of cases. Treatment in the acute phase includes intravenous steroids and plasma exchange therapy. Immunosupressive agents are recommended for prophylaxis of relapses.
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Yamakawa K, Kuroda H, Fujihara K, Sato S, Nakashima I, Takeda A, Suzuki K, Itoyama Y. Familial neuromyelitis optica (Devic's syndrome) with late onset in Japan. Neurology 2000; 55:318-20. [PMID: 10908921 DOI: 10.1212/wnl.55.2.318] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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