1
|
Gad AH, Kishk N, Shalaby NM, Heikal ES, Fouad AM, Merghany N, Abdelghany H. Pregnancy characteristics in Egyptian female patients with NMOSD. Mult Scler J Exp Transl Clin 2024; 10:20552173241271878. [PMID: 39139781 PMCID: PMC11320409 DOI: 10.1177/20552173241271878] [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: 12/16/2023] [Accepted: 07/04/2024] [Indexed: 08/15/2024] Open
Abstract
Background Neuromyelitis optica spectrum disorder (NMOSD) primarily affects women of childbearing age. Objectives Studying the potential relationship between NMOSD and pregnancy characteristics and outcomes. Subjects and methods This is a retrospective cohort study that was conducted on 66 married female patients diagnosed with NMOSD. All patients underwent a thorough review of their demographic and clinical history through their medical records and personal interviews. Additionally, a complete neurological examination was performed, along with the expanded disability status scale (EDSS) and a pregnancy registry questionnaire. Results After comparing married patients before and after disease onset, there was a significant increase in the number of abortions and the percentage of cesarean sections, as well as a decrease in the percentage of breastfeeding after disease onset. The p values were .02, <.001, and <.001, respectively, with odds ratios of 2.03, 5.13, and 6.17. Additionally, there was a rise in the occurrence of postpartum relapses, which accounted for 66% of all relapses after the disease onset. Most of these relapses (88.7%) occurred within the first 3 months postpartum. Conclusion Presence of NMOSD increased the percentage of miscarriage, delivery by cesarean section, and decreased the chance of breastfeeding. In addition, pregnancy increases NMOSD relapse and subsequent disability.
Collapse
Affiliation(s)
- Adel Hassanein Gad
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nirmeen Kishk
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nevin M Shalaby
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Eman Salah Heikal
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Amr Mohamed Fouad
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Nahla Merghany
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Hend Abdelghany
- Neurology Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
2
|
Siriratnam P, Huda S, Butzkueven H, van der Walt A, Jokubaitis V, Monif M. Risks and outcomes of pregnancy in neuromyelitis optica spectrum disorder: A comprehensive review. Autoimmun Rev 2024; 23:103499. [PMID: 38061621 DOI: 10.1016/j.autrev.2023.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 11/30/2023] [Indexed: 04/30/2024]
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is a rare central nervous system autoimmune disease. Aquaporin-4 antibody (AQP4-IgG) is present in over 75% of cases and criteria also exist for the diagnosis of seronegative NMOSD. AQP4-IgG NMOSD has a strong female predominance (9:1 ratio), with a median onset age of 40 years. Pregnancy in those with NMOSD is therefore an important topic. Fecundity in NMOSD is likely impaired, and for females who conceive, obstetric complications including miscarriages and pre-eclampsia are significantly higher in NMOSD compared to the general population and in related conditions such as multiple sclerosis (MS). In contrast to MS, NMOSD disease activity does not subside during pregnancy. Also, relapse risk substantially rises above pre-pregnancy rates in the early postpartum period. In view of the evolving landscape of NMOSD, we provide a contemporary update of the impacts of pregnancy in NMOSD.
Collapse
Affiliation(s)
- Pakeeran Siriratnam
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Helmut Butzkueven
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Anneke van der Walt
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Vilija Jokubaitis
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia
| | - Mastura Monif
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Neurology, Alfred Health, Melbourne, Victoria, Australia; Department of Neurology, The Royal Melbourne Hospital, Parkville, VIC, Australia.
| |
Collapse
|
3
|
Yoshida T, Watanabe O, Nomura M, Yoshimoto Y, Maki Y, Takashima H. Neuromyelitis optica spectrum disorder safely and successfully treated with satralizumab during pregnancy and breastfeeding: a case report. Front Neurol 2023; 14:1322412. [PMID: 38162440 PMCID: PMC10754991 DOI: 10.3389/fneur.2023.1322412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 01/03/2024] Open
Abstract
Background Satralizumab, a monoclonal antibody that recognizes interleukin-6 receptors, is known to reduce the relapse rate in neuromyelitis optica spectrum disorder (NMOSD), but its safety during pregnancy has not been established. We present the case of an NMOSD patient who safely completed pregnancy, parturition, and breastfeeding under satralizumab treatment. Importantly, satralizumab transfer to umbilical cord blood, infant serum, or breast milk was not observed. Case presentation A 37-year-old Japanese female developed anti-aquaporin 4 antibody-positive NMOSD with left optic neuritis. Despite responding to steroid and azathioprine therapy, she experienced moon face and weight gain and desired the prompt reduction of the steroid dosage. She also wanted to conceive a child with a safe and preferably early pregnancy and parturition. Because pregnancy and parturition after the onset of NMOSD elevate the risk of relapse and miscarriage, treatment with satralizumab was initiated with the patient's consent. She experienced normal parturition and continued with satralizumab, steroid, and azathioprine treatments while breastfeeding without experiencing any relapses. Concentrations of satralizumab in the umbilical cord blood, infant serum, and breast milk were below the detection sensitivity. Conclusion These findings suggest that satralizumab may be safe and effective for the perinatal management of NMOSD, especially when there are concerns about continuing pregnancy and the risk of relapse after parturition.
Collapse
Affiliation(s)
- Takashi Yoshida
- Division of Neurology and Stroke, Kagoshima City Hospital, Kagoshima, Japan
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| | - Osamu Watanabe
- Division of Neurology and Stroke, Kagoshima City Hospital, Kagoshima, Japan
| | - Miwa Nomura
- Division of Neurology and Stroke, Kagoshima City Hospital, Kagoshima, Japan
| | - Yusuke Yoshimoto
- Division of Neurology and Stroke, Kagoshima City Hospital, Kagoshima, Japan
| | - Yoshimitsu Maki
- Division of Neurology and Stroke, Kagoshima City Hospital, Kagoshima, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Science, Kagoshima, Japan
| |
Collapse
|
4
|
Yong HYF, Burton JM. A Clinical Approach to Existing and Emerging Therapeutics in Neuromyelitis Optica Spectrum Disorder. Curr Neurol Neurosci Rep 2023; 23:489-506. [PMID: 37540387 DOI: 10.1007/s11910-023-01287-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/05/2023]
Abstract
PURPOSE OF REVIEW Neuromyelitis optica spectrum disorder (NMOSD) is a rare but highly disabling disease of the central nervous system. Unlike multiple sclerosis, disability in NMOSD occurs secondary to relapses that, not uncommonly, lead to blindness, paralysis, and death. Recently, newer, targeted immunotherapies have been trialed and are now in the treatment arsenal. We have endeavoured to evaluate the current state of NMOSD therapeutics. RECENT FINDINGS This review provides a pragmatic evaluation of recent clinical trials and post-marketing data for rituximab, inebilizumab, satralizumab, eculizumab, and ravalizumab, contrasted to older agents. We also review contemporary issues such as treatment in the context of SARS-CoV2 infection and pregnancy. There has been a dramatic shift in NMOSD morbidity and mortality with earlier and improved disease recognition, diagnostic accuracy, and the advent of more effective, targeted therapies. Choosing a maintenance therapy remains nuanced depending on patient factors and accessibility. With over 100 putative agents in trials, disease-free survival is now a realistic goal for NMOSD patients.
Collapse
Affiliation(s)
- Heather Y F Yong
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada
| | - Jodie M Burton
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cummings School of Medicine, Calgary, AB, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| |
Collapse
|
5
|
Leite MI, Panahloo Z, Harrison N, Palace J. A systematic literature review to examine the considerations around pregnancy in women of child-bearing age with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) or aquaporin 4 neuromyelitis optica spectrum disorder (AQP4+ NMOSD). Mult Scler Relat Disord 2023; 75:104760. [PMID: 37224631 DOI: 10.1016/j.msard.2023.104760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 05/04/2023] [Accepted: 05/09/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Aquaporin-4 antibody positive (AQP4+) neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are rare autoimmune diseases with overlapping phenotypes. Understanding their clinical manifestation prior to, during and after pregnancy may influence the management of women of child-bearing age (WOCBA) with these diseases. METHODS This systematic review identified relevant MEDLINE-indexed publications dated between 01 January 2011 and 01 November 2021, and congress materials from key conferences between 01 January 2019 and 01 November 2021. These were manually assessed for relevance to AQP4+ NMOSD and/or MOGAD in WOCBA, with selected data extracted and considered. RESULTS In total, 107 articles were retrieved and reviewed for relevancy, including 65 clinical studies. Limited evidence was found regarding a conclusive impact of either disease on female fertility, sexual function or menarche, and impact on maternal outcomes requires further investigation in both conditions to establish risk for pre-eclampsia, gestational diabetes and other complications relative to the general population. Collated data for pregnancy outcomes show clear risks in AQP4+ NMOSD to healthy delivery and a rise in annualised relapse rate postpartum that may require adaptation of treatment regimens. Disease activity appears to be attenuated during pregnancy in MOGAD patients with an increased risk of relapse during the postpartum months, but strong conclusions cannot be made due to a paucity of available data. CONCLUSIONS This review brings together the literature on AQP4+ NMOSD and MOGAD in WOCBA. The potential impact of pregnancy and the postpartum period on disease activity suggest a proactive management strategy early on may improve maternal and infant outcomes, but more clinical data are needed, particularly for MOGAD.
Collapse
Affiliation(s)
- M Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK.
| | | | | | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University, Oxford, UK
| |
Collapse
|
6
|
Vukusic S, Marignier R, Ciron J, Bourre B, Cohen M, Deschamps R, Guillaume M, Kremer L, Pique J, Carra-Dalliere C, Michel L, Leray E, Guennoc AM, Laplaud D, Androdias G, Bensa C, Bigaut K, Biotti D, Branger P, Casez O, Daval E, Donze C, Dubessy AL, Dulau C, Durand-Dubief F, Hebant B, Kwiatkowski A, Lannoy J, Maarouf A, Manchon E, Mathey G, Moisset X, Montcuquet A, Roux T, Maillart E, Lebrun-Frenay C. Pregnancy and neuromyelitis optica spectrum disorders: 2022 recommendations from the French Multiple Sclerosis Society. Mult Scler 2023; 29:37-51. [PMID: 36345839 DOI: 10.1177/13524585221130934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In 2020, the French Multiple Sclerosis (MS) Society (SFSEP) decided to develop a national evidence-based consensus on pregnancy in MS. As neuromyelitis optica spectrum disorders (NMOSD) shares a series of commonalities with MS, but also some significant differences, specific recommendations had to be developed. OBJECTIVES To establish recommendations on pregnancy in women with NMOSD. METHODS The French Group for Recommendations in Multiple Sclerosis (France4MS) reviewed PubMed and universities databases (January 1975 through June 2021). The RAND/UCLA appropriateness method, which was developed to synthesise the scientific literature and expert opinions on health care topics, was used to reach a formal agreement. Fifty-six MS experts worked on the full-text review and initial wording of recommendations. A sub-group of nine NMOSD experts was dedicated to analysing available data on NMOSD. A group of 62 multidisciplinary healthcare specialists validated the final proposal of summarised evidence. RESULTS A strong agreement was reached for all 66 proposed recommendations. They cover diverse topics, such as pregnancy planning, follow-up during pregnancy and postpartum, delivery routes, loco-regional analgesia or anaesthesia, prevention of postpartum relapses, breastfeeding, vaccinations, reproductive assistance, management of relapses, and disease-modifying treatments. CONCLUSION Physicians and patients should be aware of the new and specific evidence-based recommendations of the French MS Society for pregnancy in women with NMOSD. They should help harmonise counselling and treatment practise, allowing for better individualised choices.
Collapse
Affiliation(s)
- Sandra Vukusic
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France/INSERM 1028 et CNRS UMR 5292, Observatoire Français de la Sclérose en Plaques, Centre de Recherche en Neurosciences de Lyon, Lyon, France/Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France/Eugène Devic EDMUS Foundation against Multiple Sclerosis, State-Approved Foundation, Bron, France
| | - Romain Marignier
- Université de Lyon, Université Claude Bernard Lyon 1, Lyon, France/Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron, France/FORGETTING Team, INSERM 1028 et CNRS UMR5292, Centre des Neurosciences de Lyon, Lyon, France
| | - Jonathan Ciron
- Centre Ressources et Compétences Sclérose en Plaques (CRC-SEP) et Service de Neurologie B4, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, Toulouse, France/INSERM UMR1291 - CNRS UMR5051, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III, Toulouse, France
| | | | - Mikael Cohen
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, Nice, France/UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| | - Romain Deschamps
- CRC-SEP, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | | | - Laurent Kremer
- CRC-SEP, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Julie Pique
- Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (MIRCEM), Hôpital Neurologique Pierre Wertheimer, Bron, France
| | - Clarisse Carra-Dalliere
- CRC-SEP, Neurology Department, Hôpital Gui de Chauliac, CHU de Montpellier, Montpellier, France
| | - Laure Michel
- CIC_P1414 INSERM, Neurology Department, Rennes University Hospital, Rennes, France
| | - Emmanuelle Leray
- EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS (Recherche sur les Services et Management en Santé), Université de Rennes, Rennes, France
| | | | - David Laplaud
- INSERM, Center for Research in Transplantation and Translational Immunology, Nantes Université, Nantes, France/CIC INSERM 1413, CRC-SEP Pays de la Loire, CHU Nantes, Nantes, France
| | - Géraldine Androdias
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France/Ramsay Santé, Clinique de la Sauvegarde, Lyon, France
| | - Caroline Bensa
- CRC-SEP, Neurology Department, Hôpital Fondation Adolphe de Rothschild, Paris, France
| | - Kevin Bigaut
- CRC-SEP, Service de Neurologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Damien Biotti
- Centre Ressources et Compétences Sclérose en Plaques (CRC-SEP) et Service de Neurologie B4, Hôpital Pierre-Paul Riquet, CHU Toulouse Purpan, Toulouse, France/INSERM UMR1291 - CNRS UMR5051, Institut Toulousain des Maladies Infectieuses et Inflammatoires (Infinity), Université Toulouse III, Toulouse, France
| | - Pierre Branger
- Service de Neurologie, CHU de Caen Normandie, Caen, France
| | - Olivier Casez
- Neurologie, Pathologies Inflammatoires du Système Nerveux, CHU Grenoble Alpes, Grenoble, France/TIMC-IMAG, T-RAIG (Translational Research in Autoimmunity and Inflammation Group), Université de Grenoble Alpes, Grenoble, France
| | - Elodie Daval
- Service de Neurologie, CHU de Besançon, Besançon, France
| | - Cécile Donze
- Faculté de Médecine et de Maïeutique de Lille, Groupement des Hôpitaux de l'Institut Catholique de Lille, Hôpital Saint Philibert, Lille, France
| | - Anne-Laure Dubessy
- APHP-6, Department of Neurology, Saint-Antoine Hospital, Paris, France/Sorbonne University, Paris, France
| | - Cécile Dulau
- CRC-SEP, Hôpital Pellegrin, CHU de Bordeaux, Bordeaux, France
| | - Françoise Durand-Dubief
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-Inflammation, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France
| | | | - Arnaud Kwiatkowski
- Department of Neurology, Lille Catholic Hospitals, Lille Catholic University, Lille, France
| | - Julien Lannoy
- Service de Neurologie, Centre Hospitalier de Lens, Lens, France
| | - Adil Maarouf
- CNRS, CRMBM, UMR 7339, Aix-Marseille Université, Marseille, France/APHM, Hôpital de la Timone, Marseille, France
| | - Eric Manchon
- Department of Neurology, Gonesse Hospital, Gonesse, France
| | - Guillaume Mathey
- Service de Neurologie, Hôpital Central, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France
| | - Xavier Moisset
- Inserm, Neuro-Dol, Université Clermont Auvergne, Clermont-Ferrand, France/Department of Neurology et CRC-SEP, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Thomas Roux
- CRC-SEP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Elisabeth Maillart
- CRC-SEP, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Christine Lebrun-Frenay
- CRCSEP Côte d'Azur, CHU de Nice Pasteur 2, Nice, France/UR2CA-URRIS, Université Nice Côte d'Azur, Nice, France
| |
Collapse
|
7
|
Cortese R, Mariotto S, Mancinelli CR, Tortorella C. Pregnancy and antibody-mediated CNS disorders: What do we know and what should we know? Front Neurol 2022; 13:1048502. [PMID: 36601293 PMCID: PMC9806181 DOI: 10.3389/fneur.2022.1048502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
Antibody-mediated central nervous system (CNS) disorders including those associated with aquaporin-4 or myelin oligodendrocyte glycoprotein IgG and autoimmune encephalitis often affect women of childbearing age. Pathogenic antibodies of these diseases can potentially alter reproductive functions and influence fetal development. Hormonal changes occurring during pregnancy may modify the course of autoimmune diseases by influencing relapse risk, attack severity, and affect the delivery and postpartum period. Moreover, balancing treatment related safety issues with the risk of potentially disabling relapses during pregnancy and breastfeeding are major challenges. Intentional prenatal, gestational, and post-partum counseling is paramount to address these issues and mitigate these risks. Fortunately, new insights on risk factors for adverse pregnancy outcomes and possible preventive strategies are emerging. This review aims to summarize the interplay between antibody-mediated CNS disorders and pregnancy during the prenatal, gestational, and postpartum periods, highlight current treatment recommendations, and discuss future areas of research.
Collapse
Affiliation(s)
- Rosa Cortese
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy,*Correspondence: Rosa Cortese
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | | | - Carla Tortorella
- Department of Neurosciences, S. Camillo-Forlanini Hospital, Rome, Italy
| |
Collapse
|
8
|
Bai W, Sun M, Song H, Li H, Xu X, Chen X, Zhao Y, Chen B, Yao S, Xu Q, Wei S, Zhou H, Yu S. Serial analyses of clinical spectra and outcomes in Chinese women with pregnancy-induced optic neuritis. Front Med (Lausanne) 2022; 9:1067277. [PMID: 36507533 PMCID: PMC9733704 DOI: 10.3389/fmed.2022.1067277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/04/2022] [Indexed: 11/27/2022] Open
Abstract
Objective This study aimed to investigate the clinical spectra and outcomes in pregnancy-related optic neuritis (ON). Methods We analyzed the clinical subtype and prognosis of women with pregnancy-related ON in the neuro-ophthalmology department of the First Medical Center at the Chinese PLA General Hospital from January 2014 to December 2019. Results A total of 54 patients, including 21 (38.9%) with idiopathic ON (ION), 27 (50.0%) with aquaporin-4 (AQP4)-ON, and 6 (11.6%) with myelin oligodendrocyte glycoprotein (MOG)-ON, who experienced 58 informative pregnancies and 67 episodes of pregnancy-related ON were assessed. Among the ON attacks, there were 11 (16.4%) during pregnancy and 56 (83.6%) within 1 year postpartum (PP1) or after abortion, including 33 (49.3%) in the first trimester. In total, 14 (25.9%) patients with ON onset before pregnancy had a higher relapse rate during PP1 than within 1 year before pregnancy (p = 0.021), and 24 (85.7%) eyes with ION and nine (100%) with MOG-ON had significantly better visual outcomes (p ≥ 0.5) than those with AQP4-ON (14, 35%) (p < 0.001 and p < 0.001, respectively). Two AQP4-ON patients had premature birth and low baby weight, respectively. There were no birth defects or stillbirths. Conclusion The significantly increased relapse rate and numerous cases of ON after pregnancy suggest that delivery adversely affects the course of ON.
Collapse
Affiliation(s)
- Wenhao Bai
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Mingming Sun
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Honglu Song
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Hongen Li
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xintong Xu
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Xiyun Chen
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Yixuan Zhao
- Department of Ophthalmology, Changping Maternal and Child Health Care Hospital, Beijing, China
| | - Biyue Chen
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Sheng Yao
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Quangang Xu
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Shihui Wei
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China
| | - Huanfen Zhou
- Senior Department of Ophthalmology, The Third Medical Centre of Chinese PLA General Hospital, Beijing, China,Huanfen Zhou
| | - Shengyuan Yu
- Department of Neurology, The First Medical Centre of Chinese PLA General Hospital, Beijing, China,*Correspondence: Shengyuan Yu
| |
Collapse
|
9
|
Xu X, Xie L, Wei L, Li M, Wang H, Zhou H, Sun M, Yang M, Xu Q, Yang K, Wei S. Efficacy and safety of monoclonal antibodies in neuromyelitis optica spectrum disorders: A survival meta-analysis of randomized controlled trials. ADVANCES IN OPHTHALMOLOGY PRACTICE AND RESEARCH 2022; 2:100064. [PMID: 37846287 PMCID: PMC10577852 DOI: 10.1016/j.aopr.2022.100064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 05/15/2022] [Indexed: 10/18/2023]
Abstract
Background Monoclonal antibodies such as rituximab (RTX), eculizumab, inebilizumab, satralizumab, and tocilizumab have been found to be effective therapies for neuromyelitis optica spectrum disease (NMOSD) in several clinical randomized controlled trials. Objective The purpose of this meta-analysis of randomized controlled trials was to assess the efficacy and safety of monoclonal antibodies in the treatment of NMOSD. Methods We searched the following databases for relevant English language literature from the establishment of the database to June 2021: PubMed, Embase, Cohorane Library, the Central Register of Controlled Trials (CENTRAL), and Web of Science. Randomized controlled trials of monoclonal antibodies were the targets of the review. Results We included seven trials containing 775 patients (485 in the monoclonal antibody group and 290 in the control group). Patients in the monoclonal group (HR 0.24, 95% CI: 0.14 to 0.40, P < 0.00001), as well as patients with seropositive AQP4-IgG (HR 0.18, 95% CI: 0.11 to 0.29, P < 0.00001), both had a higher free recurrence rate than that in the control group. In the first year (HR 0.25, 95% CI: 0.09 to 0.71, P = 0.009) and the second year (HR 0.32, 95% CI: 0.13 to 0.81, P = 0.02), no relapses were documented. The average changes of the expanded disability status scale (EDSS) score decreased by 0.29 (95% CI: -0.09 to 0.51, P = 0.005). Upper respiratory tract infection (OR 1.52, 95% CI: 0.76 to 3.04, P = 0.24), urinary tract infection(OR 0.79, 95% CI: 0.51 to 1.21, P = 0.27), and headache (OR 1.30, 95% CI: 0.78 to 2.17, P = 0.31) were three most frequent adverse reactions. Conclusions Monoclonal antibodies are particularly effective treatments in avoiding recurrence for NMOSD patients, according to this meta-analysis. The associated adverse responses are not significantly different from those seen with traditional immunosuppressants.
Collapse
Affiliation(s)
- Xintong Xu
- Medical School of Chinese PLA, Beijing, China
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lindan Xie
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Lili Wei
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Meixuan Li
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Hao Wang
- Department of Ophthalmology, Lanzhou University Second Hospital, Lanzhou, China
| | - Huanfen Zhou
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mingming Sun
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Mo Yang
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Quangang Xu
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| | - Kehu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China
- Gansu Medical Guideline Technology Center, Lanzhou University, Lanzhou, China
| | - Shihui Wei
- Department of Ophthalmology, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
10
|
Du Q, Shi Z, Chen H, Zhang Y, Qiu Y, Lang Y, Kong L, Zhou H. Effects of pregnancy on neuromyelitis optica spectrum disorder and predictors of related attacks. Ann Clin Transl Neurol 2022; 9:1918-1925. [PMID: 36314431 PMCID: PMC9735372 DOI: 10.1002/acn3.51683] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 09/11/2022] [Accepted: 10/07/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Our study aimed to investigate the influence of pregnancy on the course of neuromyelitis optica spectrum disorders (NMOSD) and to explore the independent predictors of pregnancy-related attacks. METHODS We performed a retrospective study of patients with NMOSD based on the Wingerchuk 2006 or the revised Wingerchuk 2015 criteria. Demographic, clinical, and pregnancy data were recorded. We compared the annualized relapse rate (ARR) before, during, and after pregnancy. The Expanded Disability Status Scale (EDSS) score was used to assess the degree of disability. Multivariate Cox proportional hazards models were used to identify the independent risk factors that predict pregnancy-related attacks. RESULTS There were 202 informative pregnancies following symptom onset in 112 women with NMOSD. The ARR in the first-trimester postpartum period (1.44 ± 2.04) was higher than that before pregnancy (0.23 ± 0.48; p < 0.001) and during pregnancy. The EDSS score increased from 1.40 ± 1.38 before pregnancy to 1.99 ± 1.78 postpartum (p = 0.004). Multivariate Cox proportional hazards models indicated that increased disease activity 1 year before conception (HR = 1.79, 95% CI 1.09-2.92, p = 0.021) and lack of immunotherapy during pregnancy and the postpartum period (HR = 5.25, 95% CI 1.91-14.42, p = 0.001) were independent risk factors that predicted pregnancy-related attacks. INTERPRETATION The postpartum period is a particularly high-risk time for the onset and relapse of NMOSD. Pregnancy exerted detrimental effects on the disease courses of NMOSD. Immunotherapy during pregnancy and the postpartum period might be recommended to decrease the risk of pregnancy-related attacks. Larger-scale prospective studies are warranted to confirm our findings.
Collapse
Affiliation(s)
- Qin Du
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Ziyan Shi
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Hongxi Chen
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Ying Zhang
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Yuhan Qiu
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Yanlin Lang
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Lingyao Kong
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| | - Hongyu Zhou
- Department of Neurology, West China HospitalSichuan UniversityGuo Xuexiang #37Chengdu610041China
| |
Collapse
|
11
|
Nytrova P, Dolezal O. Sex bias in multiple sclerosis and neuromyelitis optica spectrum disorders: How it influences clinical course, MRI parameters and prognosis. Front Immunol 2022; 13:933415. [PMID: 36016923 PMCID: PMC9396644 DOI: 10.3389/fimmu.2022.933415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
This review is a condensed summary of representative articles addressing the sex/gender bias in multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). The strong effects of sex on the incidence and possibly also the activity and progression of these disorders should be implemented in the evaluation of any phase of clinical research and also in treatment choice consideration in clinical practice and evaluation of MRI parameters. Some relationships between clinical variables and gender still remain elusive but with further understanding of sex/gender-related differences, we should be able to provide appropriate patient-centered care and research.
Collapse
Affiliation(s)
- Petra Nytrova
- Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia
- *Correspondence: Petra Nytrova,
| | - Ondrej Dolezal
- Department of Neurology, Dumfries and Galloway Royal Infirmary, NHS Scotland, Dumfries, United Kingdom
| |
Collapse
|
12
|
Wang L, Su M, Zhou Z, Zhou L, ZhangBao J, Tan H, Huang W, Chang X, Lu C, Yu J, Wang M, Lu J, Zhao C, Zhang T, Quan C. Analysis of Pregnancy-Related Attacks in Neuromyelitis Optica Spectrum Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open 2022; 5:e2225438. [PMID: 35925605 PMCID: PMC9353597 DOI: 10.1001/jamanetworkopen.2022.25438] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 06/20/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Risk of relapse may be increased in the postpartum period of neuromyelitis optica spectrum disorder (NMOSD). Information regarding factors associated with pregnancy-related attacks is still lacking. Objectives To identify factors associated with pregnancy-related NMOSD attacks, investigate the integrated annualized relapse rate (ARR) and Expanded Disability Status Scale (EDSS) score in each phase of pregnancy, and summarize pregnancy outcomes and complications in patients with NMOSD. Data Sources An electronic search was performed in the MEDLINE, PubMed in-process and non-MEDLINE, EMBASE, Web of Science, and Cochrane databases using the OvidSP search platform, updated through December 30, 2021. Study Selection All published and unpublished studies in English were considered, covering all patients with NMOSD with an informative pregnancy. Data Extraction and Synthesis Two independent reviewers extracted the published data with a standardized procedure following MOOSE and PRISMA guidelines. The end points were calculated with the DerSimonian and Laird inverse variance (for random effects) method. Main Outcomes and Measures The primary outcome was the rate of pregnancies with pregnancy-related NMOSD attacks, measured by risk ratios (RRs). The mean differences (MDs) in ARR and EDSS scores between each phase of pregnancy, pregnancy outcomes, and complications were defined as the secondary outcomes. Results A total of 15 studies were analyzed, including 443 patients with NMOSD with 639 informative pregnancies. Patients receiving immunosuppressive treatment during pregnancy (RR, 0.43; 95% CI, 0.32-0.57; P < .001) and with older age at conception (RR, 0.67; 95% CI, 0.47-0.95; P = .02) had lower rates of pregnancy with pregnancy-related attacks. The increase in the ARR was highest in the first trimester after delivery compared with before pregnancy (MD, 1.28; 95% CI, 0.94-1.62; P < .001). The EDSS scores increased significantly both during pregnancy (MD, 0.44; 95% CI, 0.20-0.69; P < .001) and in the postpartum period (MD, 0.88; 95% CI, 0.51-1.26; P < .001) compared with before pregnancy. Conclusions and Relevance This systematic review and meta-analysis found that receiving immunosuppressive treatment during pregnancy and older age at conception were associated with reduced risk of pregnancy-related NMOSD attacks, which mostly occurred in the first trimester of the postpartum period, although more high-quality prospective studies are needed.
Collapse
Affiliation(s)
- Liang Wang
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Manqiqige Su
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Zhirui Zhou
- Radiation Oncology Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Hongmei Tan
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Wenjuan Huang
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Xuechun Chang
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Jian Yu
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye and ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jiahong Lu
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| | - Tiansong Zhang
- Department of Chinese Traditional Medicine, Jing’an District Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Chao Quan
- Department of Neurology and Rare Disease Center, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
- National Center for Neurological Disorders, Shanghai, China
| |
Collapse
|
13
|
The description of neuromyelitis optica spectrum disorder: Patient registry in Yangtze River Delta area of China. Mult Scler Relat Disord 2022; 66:104023. [PMID: 35843144 DOI: 10.1016/j.msard.2022.104023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/26/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe the clinical features of neuromyelitis optica spectrum disorder (NMOSD) through patient registry in Yangtze River Delta area of China. METHODS A total of 502 consecutive patients diagnosed with aquaporin-4 antibody (AQP4-ab)-positive NMOSD were registered between December 2018 to January 2021 in multiple tertiary referral centers within the framework of Yangtze River Delta of China. Their baseline data were reviewed, and follow-up clinical information were collected prospectively. RESULTS The mean age at onset was 37.3 (range 3-80 years) years and the female-to-male ratio was 8.1:1. The median disease duration was 47 months (interquartile range [IQR] 25-84 months). A total of 1372 attacks of the 502 patients were recorded till the last follow-up, with a median annualized relapse rate of 0.4 (IQR 0.3-0.6). Nearly one-fourth (24.5%, 336/1372) of the attacks had prodromic events, including upper respiratory tract infection (36.3%, 122/336), fever (20.2%, 68/336) and pregnancy-related issues (17.9%, 60/336), etc. Myelitis was the most common attack type throughout the disease course (51.4%, 705/1372), followed by optic neuritis (ON, 43.1%, 592/1372). As for onset phenotype, ON (37.3%, 187/502) prevailed over myelitis (28.3%, 142/502). The median time to first relapse was 12 months (IQR 5-25 months). Patients with brainstem encephalitis at onset were more likely to have other anatomical region involved in subsequent attacks (p < 0.001), compared to other onset type. The median serum AQP4-ab titer measured by cell-based assays was 1:100 (IQR 1:32-1:320, range 1:10-1:10,000). The baseline AQP4-ab titer in cerebrospinal fluid (r = 0.542, p <0.001), overall ARR (r = 0.232, p< 0.001) and the EDSS scores at last follow-up (r = 0.119, p = 0.022) significantly correlated with baseline serum AQP4-ab titer. Antinuclear antibodies (48.4%), thyroid peroxidase antibodies (30.7%), and anti-SSA antibodies (26.2%) represented the most frequent concomitant antibodies, while autoimmune thyroid disorders (13.1%, 66/502) and Sjogren's syndrome (10.8%, 54/502) were the most common accompanying autoimmune diseases. Till the last follow-up, 403 patients received preventive treatments. Azathioprine represented the most common initial treatment, mycophenolate mofetil and rituximab was the most common second and third-line treatment, respectively. The EDSS score at the last follow-up ranged from 0 to 8.5 with a median of 2 (IQR 1-3). CONCLUSIONS A comprehensive clinical picture of patients with AQP4-ab-positive NMOSD in Yangtze River Delta area of China was presented. More information on disease tragedy and predictive prognostic factors could be generated through long-term observations.
Collapse
|
14
|
Mader S, Brimberg L, Vo A, Strohl JJ, Crawford JM, Bonnin A, Carrión J, Campbell D, Huerta TS, La Bella A, Berlin R, Dewey SL, Hellman M, Eidelberg D, Dujmovic I, Drulovic J, Bennett JL, Volpe BT, Huerta PT, Diamond B. In utero exposure to maternal anti-aquaporin-4 antibodies alters brain vasculature and neural dynamics in male mouse offspring. Sci Transl Med 2022; 14:eabe9726. [PMID: 35442708 PMCID: PMC9973562 DOI: 10.1126/scitranslmed.abe9726] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The fetal brain is constantly exposed to maternal IgG before the formation of an effective blood-brain barrier (BBB). Here, we studied the consequences of fetal brain exposure to an antibody to the astrocytic protein aquaporin-4 (AQP4-IgG) in mice. AQP4-IgG was cloned from a patient with neuromyelitis optica spectrum disorder (NMOSD), an autoimmune disease that can affect women of childbearing age. We found that embryonic radial glia cells in neocortex express AQP4. These cells are critical for blood vessel and BBB formation through modulation of the WNT signaling pathway. Male fetuses exposed to AQP4-IgG had abnormal cortical vasculature and lower expression of WNT signaling molecules Wnt5a and Wnt7a. Positron emission tomography of adult male mice exposed in utero to AQP4-IgG revealed increased blood flow and BBB leakiness in the entorhinal cortex. Adult male mice exposed in utero to AQP4-IgG had abnormal cortical vessels, fewer dendritic spines in pyramidal and stellate neurons, and more S100β+ astrocytes in the entorhinal cortex. Behaviorally, they showed impairments in the object-place memory task. Neural recordings indicated that their grid cell system, within the medial entorhinal cortex, did not map the local environment appropriately. Collectively, these data implicate in utero binding of AQP4-IgG to radial glia cells as a mechanism for alterations of the developing male brain and adds NMOSD to the conditions in which maternal IgG may cause persistent brain dysfunction in offspring.
Collapse
Affiliation(s)
- Simone Mader
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Institute of Clinical Neuroimmunology, Biomedical Center of the Ludwig Maximilian University of Munich, Munich 82152, Germany
| | - Lior Brimberg
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - An Vo
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Joshua J. Strohl
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - James M. Crawford
- Department of Pathology and Laboratory Medicine, Northwell Health, Manhasset, NY 11030, USA
| | - Alexandre Bonnin
- Department of Physiology and Neurosciences, Zilkha Neurogenetic Institute, University of Southern California, Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Joseph Carrión
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Delcora Campbell
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Tomás S. Huerta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Andrea La Bella
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Roseann Berlin
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Stephen L. Dewey
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Matthew Hellman
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - David Eidelberg
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Irena Dujmovic
- Clinical Center of Serbia University School of Medicine, Belgrade, 11000, Serbia
- Department of Neurology, University of North Carolina, School of Medicine, Chapel Hill, NC 27517, USA
| | - Jelena Drulovic
- Clinical Center of Serbia University School of Medicine, Belgrade, 11000, Serbia
| | - Jeffrey L. Bennett
- Department of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Denver, School of Medicine, Denver, CO 80045, USA
| | - Bruce T. Volpe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| | - Patricio T. Huerta
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
- Department of Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY 11030, USA
| | - Betty Diamond
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset NY 11030, USA
| |
Collapse
|
15
|
Deng S, Lei Q, Lu W. Pregnancy-Related Attack in Neuromyelitis Optica Spectrum Disorder With AQP4-IgG: A Single-Center Study and Meta-Analysis. Front Immunol 2022; 12:800666. [PMID: 35069584 PMCID: PMC8767555 DOI: 10.3389/fimmu.2021.800666] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Objective This study aimed to investigate the demographic characteristic of pregnancy-related attacks (PRAs) in neuromyelitis optica spectrum disorder (NMOSD). In addition, we investigated the predictors of PRAs as well as the effect of immunosuppressive (IS) therapy in patients with pregnancy-related NMOSD. Method We retrospectively analyzed data on clinical and diagnostic characteristics, therapeutic management, and pregnancy outcomes for PRAs in AQP4-IgG-positive NMOSD patients admitted to the Second Xiangya Hospital of Central South University. Moreover, we searched the literature (without any temporal restriction) to identify all such similar cohorts and performed a meta-analysis to evaluate the effectiveness and safety of IS therapy on NMOSD patients with PRAs. Result We collected clinical data on 117 women with AQP4 antibody-positive NMOSD; we ultimately included 33 patients (34 pregnancies). Ten patients were relapse-free during pregnancy, and 23 (69.7%) had PRA; attacks were most common during the first trimester of the postpartum period. Maintenance of IS treatment during pregnancy was found to greatly reduce PRAs in patients with NMOSD. PRAs were associated with a higher neutrophil-to-lymphocyte ratio (NLR) at relapse during pregnancy and shorter time interval between the last relapse and conception. The meta-analysis suggested that maintenance of IS treatment during pregnancy can significantly reduce the RR of NMOSD (95%CI=0.35-0.62; z=5.18, p<0.0001) and had no adverse effect on the miscarriage rate. However, the unhealthy newborn occurrence among those receiving IS treatment was 3.73 times higher than that of those not receiving treatment during pregnancy (95%CI=1.40–9.91; z=2.64, p=0.008). Conclusion Our study results demonstrates that pregnancy can induce the onset or relapse of attacks in NMOSD patients. The increased NLR value and disease activity may be a predictor for PRAs in patients with NMOSD. Moreover, administration of IS treatment during pregnancy can reduce the relapse rate. However, the dosage of drugs and risks of adverse effects to the fetus need to be considered. Future prospective studies with larger sample sizes are needed to confirm and extend our findings.
Collapse
Affiliation(s)
- Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiang Lei
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
16
|
Bove RM, Houtchens MK. Pregnancy Management in Multiple Sclerosis and Other Demyelinating Diseases. Continuum (Minneap Minn) 2022; 28:12-33. [DOI: 10.1212/con.0000000000001108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
17
|
Seyed Ahadi M, Sahraian MA, Shaygannejad V, Anjidani N, Mohammadiani Nejad SE, Beladi Moghadam N, Ayromlou H, Yousefi Pour GA, Yazdanbakhsh S, Jafari M, Naser Moghadasi A. Pregnancy outcome in patients with neuromyelitis optica spectrum disorder treated with rituximab: A case-series study. CASPIAN JOURNAL OF INTERNAL MEDICINE 2021; 12:S491-S494. [PMID: 34760113 PMCID: PMC8559646 DOI: 10.22088/cjim.12.0.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/26/2021] [Accepted: 04/06/2021] [Indexed: 11/23/2022]
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory disorder with a tendency to affect the spinal cord and optic nerves. As NMOSDs have a predilection for women of reproductive age and adopt an aggressive course during pregnancy, appropriate treatment strategies before conception and during pregnancy should be well-considered. Case Presentation: In this report, the pregnancy outcome of eight pregnancies following rituximab treatment was assessed, which led to 50% live births with mean birth weight of 2777.50 (SD: 545.92) grams. Two patients had abortions due to doctor’s recommendation. One pregnancy led to intrauterine fetal death (IUFD) due to nuchal cord. No spontaneous abortions were encountered. Two patients received rituximab during pregnancy. No major malformations or serious neonatal infections were encountered. Conclusion: Rituximab should be administered by caution in NMOSD patients who want to be pregnant and the probable adverse effects of the drug should be discussed by patients.
Collapse
Affiliation(s)
- Maral Seyed Ahadi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | | | - Nahid Beladi Moghadam
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hormoz Ayromlou
- Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Iran
| | | | - Sepideh Yazdanbakhsh
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Jafari
- Imam Khomeini Hospital complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
18
|
Treatment of Neuromyelitis Optica Spectrum Disorders. Int J Mol Sci 2021; 22:ijms22168638. [PMID: 34445343 PMCID: PMC8395403 DOI: 10.3390/ijms22168638] [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: 07/08/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/11/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune central nervous system (CNS) inflammatory disorder that can lead to serious disability and mortality. Females are predominantly affected, including those within the reproductive age. Most patients develop relapsing attacks of optic neuritis; longitudinally extensive transverse myelitis; and encephalitis, especially brainstem encephalitis. The majority of NMOSD patients are seropositive for IgG autoantibodies against the water channel protein aquaporin-4 (AQP4-IgG), reflecting underlying aquaporin-4 autoimmunity. Histological findings of the affected CNS tissues of patients from in-vitro and in-vivo studies support that AQP4-IgG is directly pathogenic in NMOSD. It is believed that the binding of AQP4-IgG to CNS aquaporin-4 (abundantly expressed at the endfoot processes of astrocytes) triggers astrocytopathy and neuroinflammation, resulting in acute attacks. These attacks of neuroinflammation can lead to pathologies, including aquaporin-4 loss, astrocytic activation, injury and loss, glutamate excitotoxicity, microglial activation, neuroinflammation, demyelination, and neuronal injury, via both complement-dependent and complement-independent pathophysiological mechanisms. With the increased understanding of these mechanisms underlying this serious autoimmune astrocytopathy, effective treatments for both active attacks and long-term immunosuppression to prevent relapses in NMOSD are increasingly available based on the evidence from retrospective observational data and prospective clinical trials. Knowledge on the indications and potential side effects of these medications are essential for a clear evaluation of the potential benefits and risks to NMOSD patients in a personalized manner. Special issues such as pregnancy and the coexistence of other autoimmune diseases require additional concern and meticulous care. Future directions include the identification of clinically useful biomarkers for the prediction of relapse and monitoring of the therapeutic response, as well as the development of effective medications with minimal side effects, especially opportunistic infections complicated by long-term immunosuppression.
Collapse
|
19
|
Patient-reported burden of symptoms in neuromyelitis optica: A secondary analysis on pain and quality of life. J Neurol Sci 2021; 428:117546. [PMID: 34252701 DOI: 10.1016/j.jns.2021.117546] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 06/01/2021] [Accepted: 06/16/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Relapses of neuromyelitis optica spectrum disorder (NMOSD) result in cumulative neurologic disabilities, are unpredictable, and are interspersed with remissions. Pain in NMOSD is often severe and intractable, with a significant impact on patient quality of life (QoL). We performed a more detailed analysis of previously published survey data on the association of pain and QoL, comparing patients who were seropositive and seronegative for antibodies against aquaporin-4 (AQP4-IgG). METHODS We conducted a secondary analysis of questionnaire data from 193 NMOSD patients across North America. The study population was predominantly female (88.6%) and aged 19-76 years. Results were reported for three groups: AQP4-IgG-seropositive (61.1%), AQP4-IgG-seronegative and the total cohort including patients with unknown serostatus. We measured the strength of associations and interactions between pain and variables including QoL, patient satisfaction, frequency of hospital visits, and number of relapses versus other symptoms. RESULTS Pain severity was the strongest negative predictor of QoL. In the total and AQP4-IgG-seropositive groups, pain was the most common symptom that patients wanted their physician to be concerned about; in the AQP4-IgG-seronegative group, this was fatigue. For all patients, frequent hospital visits and relapses were associated with more severe pain, but not frequency of NMOSD specialist visits. Patients without recent relapse still commonly reported moderate or severe pain (>25%). CONCLUSION This study confirms the heavy burden of pain on NMOSD patients and its effect on QoL and healthcare utilization. Prevention or early treatment of relapses and more effective pain management may reduce this burden.
Collapse
|
20
|
Collongues N, Alves Do Rego C, Bourre B, Biotti D, Marignier R, da Silva AM, Santos E, Maillart E, Papeix C, Palace J, Leite MIS, De Seze J. Pregnancy in Patients With AQP4-Ab, MOG-Ab, or Double-Negative Neuromyelitis Optica Disorder. Neurology 2021; 96:e2006-e2015. [PMID: 33627499 DOI: 10.1212/wnl.0000000000011744] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/08/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyze the effects of pregnancy on neuromyelitis optica spectrum disorder (NMOSD) according to patients' serostatus and immunosuppressive therapy (IST). METHODS We performed a retrospective multicenter international study on patients with NMOSD. Patients were tested for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) antibodies (Ab). Informative pregnancies were reported when NMOSD onset occurred before or during pregnancy or up to 12 months postpartum. The mean annualized relapse rate (ARR) was calculated for the 12 months before conception, for each trimester of pregnancy, and postpartum. Events such as miscarriage, abortion, and preeclampsia were reported. IST was considered if taken in the 3 months before or during pregnancy. RESULTS We included 89 pregnancies (46 with AQP4-Ab, 30 with MOG-Ab, and 13 without either Ab) in 58 patients with NMOSD. Compared to the prepregnancy period, the ARR was lower during pregnancy in each serostatus group and higher during the postpartum period in patients with AQP4-Ab (p < 0.01). Forty-eight percent (n = 31) of pregnancies occurred during IST and these patients presented fewer relapses during pregnancy and the 12 months postpartum than untreated patients (26% vs 53%, p = 0.04). Miscarriages occurred in 10 (11%) pregnancies, and were mainly in patients with AQP4-Ab (with or without IST) and a previous history of miscarriage. Preeclampsia was reported in 2 (2%) patients who were AQP4-Ab-positive. CONCLUSION We found a rebound in the ARR during the first postpartum trimester that was higher than the prepregnancy period only in AQP4-Ab-positive patients. Taking IST just before or during pregnancy reduces the risk of relapses in these conditions.
Collapse
Affiliation(s)
- Nicolas Collongues
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK.
| | - Cecilia Alves Do Rego
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Bertrand Bourre
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Damien Biotti
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Romain Marignier
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Ana Martins da Silva
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Ernestina Santos
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Elisabeth Maillart
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Caroline Papeix
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Jacqueline Palace
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Maria Isabel S Leite
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| | - Jerome De Seze
- From the Department of Neurology (N.C., C.A.D.R., J.D.S.), CHU de Strasbourg; Department of Neurology (B.B.), Rouen University Hospital; Department of Neurology (D.B.), CRC-SEP, CHU Toulouse; Service de Neurologie Sclérose en Plaques, Pathologies de La Myéline et Neuro-inflammation (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Department of Neurology (A.M.d.S., E.S.), Centro Hospitalar Universitario do Porto, Hospital de Santo Antonio, Oporto, Portugal; Department of Neurology (E.M., C.P.), Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Pitié-Salpétrière Hospital, Paris, France; and Department of Clinical Neurology (J.P., M.I.S.L.), John Radcliffe Hospital, Oxford University Hospitals Trust, UK
| |
Collapse
|
21
|
Zhong X, Chen C, Sun X, Wang J, Li R, Chang Y, Fan P, Wang Y, Wu Y, Peng L, Lu Z, Qiu W. Whole-exome sequencing reveals the major genetic factors contributing to neuromyelitis optica spectrum disorder in Chinese patients with aquaporin 4-IgG seropositivity. Eur J Neurol 2021; 28:2294-2304. [PMID: 33559384 DOI: 10.1111/ene.14771] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/15/2020] [Accepted: 02/02/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVE Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease. Although genetic factors are involved in its pathogenesis, limited evidence is available in this area. The aim of the present study was to identify the major genetic factors contributing to NMOSD in Chinese patients with aquaporin 4 (AQP4)-IgG seropositivity. METHODS Whole-exome sequencing (WES) was performed on 228 Chinese NMOSD patients seropositive for AQP4-IgG and 1400 healthy controls in Guangzhou, South China. Human leukocyte antigen (HLA) sequencing was also utilized. Genotype model and haplotype, gene burden, and enrichment analyses were conducted. RESULTS A significant region of the HLA composition is on chromosome 6, and great variation was observed in DQB1, DQA2 and DQA1. HLA sequencing confirmed that the most significant allele was HLA-DQB1*05:02 (p < 0.01, odds ratio [OR] 3.73). The genotype model analysis revealed that HLA-DQB1*05:02 was significantly associated with NMOSD in the additive effect model and dominant effect model (p < 0.05). The proportion of haplotype "HLA-DQB1*05:02-DRB1*15:01" was significantly greater in the NMOSD patients than the controls, at 8.42% and 1.23%, respectively (p < 0.001, OR 7.39). The gene burden analysis demonstrated that loss-of-function mutations in NOP16 were more common in the NMOSD patients (11.84%) than the controls (5.71%; p < 0.001, OR 2.22). The IgG1-G390R variant was significantly more common in NMOSD, and the rate of the T allele was 0.605 in patients and 0.345 in the controls (p < 0.01, OR 2.92). The enrichment analysis indicated that most of the genetic factors were mainly correlated with nervous and immune processes. CONCLUSIONS Human leukocyte antigen is highly correlated with NMOSD. NOP16 and IgG1-G390R play important roles in disease susceptibility.
Collapse
Affiliation(s)
- Xiaonan Zhong
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chen Chen
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xiaobo Sun
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jingqi Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Rui Li
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yanyu Chang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ping Fan
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yuge Wang
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yunting Wu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Lisheng Peng
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Lu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Wei Qiu
- Department of Neurology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
22
|
Sá MJ, Soares Dos Reis R, Altintas A, Celius EG, Chien C, Comi G, Graus F, Hillert J, Hobart J, Khan G, Kissani N, Langdon D, Leite MI, Okuda DT, Palace J, Papais-Alvarenga RM, Mendes-Pinto I, Shi FD. State of the Art and Future Challenges in Multiple Sclerosis Research and Medical Management: An Insight into the 5th International Porto Congress of Multiple Sclerosis. Neurol Ther 2020; 9:281-300. [PMID: 32666470 PMCID: PMC7606370 DOI: 10.1007/s40120-020-00202-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Indexed: 02/07/2023] Open
Abstract
The 5th International Porto Congress of Multiple Sclerosis took place between the 14th and 16th of February 2019 in Porto, Portugal. Its intensive programme covered a wide-range of themes-including many of the hot topics, challenges, pitfalls and yet unmet needs in the field of multiple sclerosis (MS)-led by a number of well-acknowledged world experts. This meeting review summarizes the talks that took place during the congress, which focussed on issues in MS as diverse as the development and challenges of progressive MS, epidemiology, differential diagnosis, medical management, molecular research and imaging tools.
Collapse
Affiliation(s)
- María José Sá
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Faculty of Health Sciences, University Fernando Pessoa, Rua Carlos da Maia, Porto, Portugal.
| | - Ricardo Soares Dos Reis
- Department of Neurology, Centro Hospitalar Universitário de São João, Alameda Prof. Hernáni Monteiro, Porto, Portugal.
- Department of Clinical Neurosciences and Mental Health, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Ayse Altintas
- Department of Neurology, School of Medicine, Koç University, Istanbul, Turkey
| | - Elisabeth Gulowsen Celius
- Department of Neurology, Oslo University Hospital, Ullevål, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Giancarlo Comi
- Department of Neurology, University Vita-Salute San Raffaele, Milan, Italy
| | - Francesc Graus
- Department of Neurology, August Pi i Sunyer Biomedical Research Institute (IDIBAPS) Hospital Clínic, Barcelona, Spain
| | - Jan Hillert
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jeremy Hobart
- Department of Neurology, University Hospitals Plymouth, Plymouth, UK
- Peninsula Schools of Medicine and Dentistry, University of Plymouth, Plymouth, UK
| | - Gulfaraz Khan
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Najib Kissani
- Neurology Department, Marrakech University Hospital Mohammed VI, Marrakech, Morocco
- Neuroscience Research Laboratory, Marrakesh Medical School, Cadi Ayyad University, Marrakech, Morocco
| | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Darin T Okuda
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | | | - Fu-Dong Shi
- Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| |
Collapse
|
23
|
Wang L, Zhou L, ZhangBao J, Huang W, Chang X, Lu C, Wang M, Li W, Xia J, Li X, Chen L, Qiu W, Lu J, Zhao C, Quan C. Neuromyelitis optica spectrum disorder: pregnancy-related attack and predictive risk factors. J Neurol Neurosurg Psychiatry 2020; 92:jnnp-2020-323982. [PMID: 33219038 PMCID: PMC7803904 DOI: 10.1136/jnnp-2020-323982] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/29/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To investigate the influence of pregnancy on patients with neuromyelitis optica spectrum disorder (NMOSD) and to identify risk factors that predict pregnancy-related attack. METHODS From January 2015 to April 2019, 418 female patients with NMOSD were registered at Huashan Hospital. We retrospectively reviewed their medical records and identified 110 patients with 136 informative pregnancies, of whom 83 were aquaporin-4 antibody (AQP4-ab)-positive and 21 were myelin oligodendrocyte glycoprotein-antibody-positive. Pregnancy-related attack was defined as an attack that occurred during pregnancy or within 1 year after delivery/abortion. We compared annualised relapse rate (ARR) during 12 months before pregnancy with that during every trimester of pregnancy and after delivery/abortion. Multivariate analyses were used to explore the independent risk factors involved and a nomogram was generated for the prediction of pregnancy-related attack. Thirty-five female patients from 3 other centres formed an external cohort to validate this nomogram. RESULTS ARR increased significantly during the first trimester after delivery (p<0.001) or abortion (p=0.019) compared with that before pregnancy. Independent risk factors predicting pregnancy-related attack included age at delivery/abortion (20-26.5, p=0.018; 26.5-33, p=0.001), AQP4-ab titre (≥1:100, p=0.049) and inadequate treatment during pregnancy and postpartum period (p=0.004). The concordance index of nomogram was 0.87 and 0.77 using bootstrap resampling in internal and external validation. CONCLUSIONS The first trimester post partum is a high-risk period for NMOSD recurrence. Patients with younger age, higher AQP4-ab titre and inadequate treatment are at higher risk for pregnancy-related attack.
Collapse
Affiliation(s)
- Liang Wang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Lei Zhou
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jingzi ZhangBao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenjuan Huang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xuechun Chang
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chuanzhen Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Min Wang
- Department of Ophthalmology and Vision Science, Eye Ear Nose and Throat Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wenyu Li
- Department of Neurology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Junhui Xia
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang Li
- Department of Neurology, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Lilin Chen
- Xiuquan Community Health Service Center, Guangzhou, Guangdong, China
| | - Wei Qiu
- Department of Neurology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| | - Chao Quan
- Department of Neurology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
| |
Collapse
|
24
|
D'Souza R, Wuebbolt D, Andrejevic K, Ashraf R, Nguyen V, Zaffar N, Rotstein D, Wyne A. Pregnancy and Neuromyelitis Optica Spectrum Disorder - Reciprocal Effects and Practical Recommendations: A Systematic Review. Front Neurol 2020; 11:544434. [PMID: 33178102 PMCID: PMC7596379 DOI: 10.3389/fneur.2020.544434] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 08/31/2020] [Indexed: 01/01/2023] Open
Abstract
Introduction: Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory disorder of the central nervous system characterized by severe, antibody-mediated astrocyte loss with secondary demyelination and axonal damage, predominantly targeting optic nerves and the spinal cord. Recent publications have alluded to increased disease activity during pregnancy, and adverse maternal and fetal outcomes in patients with NMOSD. Our objective was to systematically review published literature to help counsel and manage women with NMOSD contemplating pregnancy. Methods: We searched five databases including MEDLINE and EMBASE, for English-language publications describing pregnancies in women with NMOSD. Article selection, data extraction, and risk-of-bias assessment using Joanna Briggs' critical appraisal tool for case reports and case series, were performed in duplicate. Pooled incidences were calculated where possible, and a narrative summary was provided. Results: Of 2,118 identified titles, 22 case reports and seven case series, representing 595 pregnancies in 389 women, were included. The mean maternal age was 28.12 ± 5.19 years. At least 20% of cases were first diagnosed during pregnancy. There were no maternal deaths. Pooled estimates for clinical outcomes could not be obtained due to inadequate reporting. NMOSD-related disability and relapses increased considerably during pregnancy and especially in the immediate postpartum period. Although a high proportion of early pregnancy losses were reported, an association with disease activity or therapeutic interventions could not be established. Apart from one publication which reported an increased risk of preeclampsia, there was no increase in adverse obstetric outcomes including preterm birth, fetal growth restriction or congenital malformations. Initial attacks and relapses were successfully managed with oral or intravenous corticosteroids and immunosuppressants, and refractory cases with immunoglobulin, plasma exchange and immunoadsorption. Conclusion: Increased NMOSD-related disability and relapses during pregnancy the postpartum period may respond to aggressive management with corticosteroids and immunosuppressants such as azathioprine, which are safely administered during pregnancy and lactation. Emerging safety data on monoclonal antibodies during pregnancy, make these attractive options, while intravenous immunoglobulin, plasma exchange and immunoadsorption can be safely used to treat severe relapses. The complex interplay between NMOSD and pregnancy outcomes would be best understood through prospective analysis of data collected through an international registry. Disclosure: Dalia Rotstein has served as a consultant or speaker for Alexion and Roche. She has received research support from Roche Canada. Rohan D'Souza has served as a consultant and speaker for Ferring Canada Inc and Ferring Global Inc, on topics unrelated to this manuscript. The other authors have no relevant relationships to disclose.
Collapse
Affiliation(s)
- Rohan D'Souza
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Danielle Wuebbolt
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland.,Department of Obstetrics & Gynaecology, University of Ottawa, Ottawa, ON, Canada
| | - Katarina Andrejevic
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Faculty of Medicine, University of Western Ontario, London, ON, Canada
| | - Rizwana Ashraf
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | - Vanessa Nguyen
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | - Nusrat Zaffar
- Division of Maternal and Fetal Medicine, Department of Obstetrics & Gynaecology, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada.,Child Health Evaluative Sciences Program, Division of Paediatric Medicine, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Dalia Rotstein
- Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Toronto, ON, Canada
| | - Ahraaz Wyne
- General Internal and Obstetrical Medicine, Department of Medicine, Hamilton Health Sciences Center, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
25
|
Carnero Contentti E, Rojas JI, Cristiano E, Marques VD, Flores-Rivera J, Lana-Peixoto M, Navas C, Papais-Alvarenga R, Sato DK, Soto de Castillo I, Correale J. Latin American consensus recommendations for management and treatment of neuromyelitis optica spectrum disorders in clinical practice. Mult Scler Relat Disord 2020; 45:102428. [DOI: 10.1016/j.msard.2020.102428] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 02/06/2023]
|
26
|
Altintas A, Dargvainiene J, Schneider-Gold C, Asgari N, Ayzenberg I, Ciplea AI, Junker R, Leypoldt F, Wandinger KP, Hellwig K. Gender issues of antibody-mediated diseases in neurology: (NMOSD/autoimmune encephalitis/MG). Ther Adv Neurol Disord 2020; 13:1756286420949808. [PMID: 32922516 PMCID: PMC7450460 DOI: 10.1177/1756286420949808] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/22/2020] [Indexed: 12/13/2022] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD), autoimmune encephalitis (AE), myasthenia gravis (MG) and Lambert-Eaton myasthenic syndrome (LEMS) are antibody-mediated neurological diseases. They have mostly female predominance, affecting many women during childbearing age. Interactions between the underlying disease (or necessary treatment) and pregnancy can occur in every of these illnesses. Herein, we present the characteristics of NMOSD, AE, MG and LEMS in general, and review published data regarding the influence of the different diseases on fertility, pregnancy, puerperium, treatment strategy during pregnancy and post-partum period, and menopause but also male factors. We summarise key elements that should be borne in mind when confronted with such cases.
Collapse
Affiliation(s)
- Ayse Altintas
- Department of Neurology, School of Medicine, Koc University, Istanbul, Turkey
| | - Justina Dargvainiene
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany
| | | | - Nasrin Asgari
- Department of Neurology, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Ilya Ayzenberg
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Germany
| | - Andrea I Ciplea
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Germany
| | - Ralf Junker
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Frank Leypoldt
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Klaus-Peter Wandinger
- Institute of Clinical Chemistry, University Hospital Schleswig-Holstein, Schleswig-Holstein, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef Hospital Bochum, Ruhr University of Bochum, Gudrunstrasse 56, Bochum, 44791, Germany
| |
Collapse
|
27
|
Ashtari F, Mehdipour R, Shaygannejad V, Asgari N. Pre-pregnancy, obstetric and delivery status in women with neuromyelitis optica spectrum disorder. Mult Scler Relat Disord 2020; 44:102252. [PMID: 32535502 DOI: 10.1016/j.msard.2020.102252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/27/2020] [Accepted: 05/30/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is a potentially disabling disease which affects predominantly women of reproductive age. OBJECTIVES To evaluate the pre-pregnancy condition and to investigate the prevalence of obstetrical and neonatal complaints in NMOSD. METHODS An observational retrospective study of 37 NMOSD patients positive for aquaporin-4-immunoglobulin-IgG. Age at menarche, menstrual cycle, gravidity, type of delivery obstetrical complications and perinatal problems were recorded. We assessed the annualized relapse rate (ARR). RESULTS A total of 23 patients (62%) suffered from irregular menstruations and two from infertility after disease onset. 11 patients had 20 informative pregnancies with 14 deliveries (5 cesareans) and six abortions, four spontaneous, and two ectopic pregnancies after the first trimester. Additionally, three patients experienced threatening abortion and one preeclampsia. No stillbirth or premature birth was recorded. None of the patients experienced attacks during pregnancy, but postpartum relapses occurred after 10 deliveries (71,4%) with the highest ARR (0.937; p = 0.037) during the first three months postpartum compared to pre-pregnancy ARR (0.375). Four patients (10.8%) developed the initial symptoms of NMOSD postpartum. CONCLUSION Irregular menstruation in more than half of NMOSD patients may reflect a hormonal imbalance. Pregnancies were associated with obstetrical complications and increased disease activity postpartum.
Collapse
Affiliation(s)
- Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Roshanak Mehdipour
- Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Nasrin Asgari
- Department of Neurology, Slagelse Hospital, Institute of Regional Health Research, Denmark; Department of Neurobiology, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark.
| |
Collapse
|
28
|
Kim S, Huh S, Jang H, Park NY, Kim Y, Jung JY, Lee MY, Hyun J, Kim HJ. Outcome of pregnancies after onset of the neuromyelitis optica spectrum disorder. Eur J Neurol 2020; 27:1546-1555. [DOI: 10.1111/ene.14274] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 04/17/2020] [Indexed: 01/05/2023]
Affiliation(s)
- S.‐H. Kim
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - S.‐Y. Huh
- Department of Neurology Kosin University College of Medicine Busan Korea
| | - H. Jang
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - N. Y. Park
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - Y. Kim
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - J. Y. Jung
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - M. Y. Lee
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - J.‐W. Hyun
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| | - H. J. Kim
- Department of Neurology Research Institute and Hospital of National Cancer Center Goyang‐si Korea
| |
Collapse
|
29
|
Mao-Draayer Y, Thiel S, Mills EA, Chitnis T, Fabian M, Katz Sand I, Leite MI, Jarius S, Hellwig K. Neuromyelitis optica spectrum disorders and pregnancy: therapeutic considerations. Nat Rev Neurol 2020; 16:154-170. [PMID: 32080393 DOI: 10.1038/s41582-020-0313-y] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2020] [Indexed: 12/18/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are a type of neurological autoimmune disease characterized by attacks of CNS inflammation that are often severe and predominantly affect the spinal cord and optic nerve. The majority of individuals with NMOSD are women, many of whom are of childbearing age. Although NMOSD are rare, several small retrospective studies and case reports have indicated that pregnancy can worsen disease activity and might contribute to disease onset. NMOSD disease activity seems to negatively affect pregnancy outcomes. Moreover, some of the current NMOSD treatments are known to pose risks to the developing fetus and only limited safety data are available for others. Here, we review published studies regarding the relationship between pregnancy outcomes and NMOSD disease activity. We also assess the risks associated with using disease-modifying therapies for NMOSD during the course of pregnancy and breastfeeding. On the basis of the available evidence, we offer recommendations regarding the use of these therapies in the course of pregnancy planning in individuals with NMOSD.
Collapse
Affiliation(s)
- Yang Mao-Draayer
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA.,Graduate Program in Immunology, Program in Biomedical Sciences, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sandra Thiel
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Elizabeth A Mills
- Department of Neurology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Tanuja Chitnis
- Department of Neurology, Brigham and Women's Hospital and Massachusetts General Hospital, Boston, MA, USA
| | - Michelle Fabian
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ilana Katz Sand
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | - Kerstin Hellwig
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany.
| |
Collapse
|
30
|
Simaniv TO, Vasiliev AV, Askarova LS, Zakharova MN. [Neuromyelitis optica and neuromyelitis optica spectrum disorders]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:35-48. [PMID: 31934987 DOI: 10.17116/jnevro20191191035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The review is devoted to up-to-date data on epidemiology, aspects of the pathogenesis of neuromyelitis optica (NMO) and neuromyelitis optica spectrum disorders (NMOSD). The authors consider a role of myelin oligodendrocyte glycoprotein immunoglobulin G (MOG-IgG) in the syndromes phenotypically similar to NMO and NMOSD. Special attention is drawn to the methods of MOG-IgG antibodies detection and indications for testing. The approaches and management for treatment and prevention of NMO relapses, risks of complications during pregnancy and immediately after delivery, as well as methods for their prevention and treatment, are described.
Collapse
Affiliation(s)
- T O Simaniv
- Research Center of Neurology, Moscow, Russia
| | | | | | | |
Collapse
|
31
|
Levin S, Rimmer K, Vargas WS. Neuroimmunologic disorders in pregnancy. HANDBOOK OF CLINICAL NEUROLOGY 2020; 172:105-123. [PMID: 32768083 DOI: 10.1016/b978-0-444-64240-0.00006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Pregnancy influences the course of neuroimmunologic conditions, which include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, and autoimmune encephalitis. The outcomes differ significantly for each disorder, reflecting the impact of hormonal changes, T-cell subsets, and placental factors on disease pathogenesis. In recent years, numerous data have emerged regarding MS activity throughout pregnancy and postpartum. Historically, the misconception that pregnancy worsens MS outcomes led patients to abstain from childbearing. Now, more women with these disorders, empowered by up-to-date information and better baseline disease control, are choosing to conceive. Nevertheless, the management of MS and related disorders in the pregnancy and postpartum period is complicated and requires a nuanced approach. Since standardized treatment guidelines around pregnancy are currently lacking, neurologists, together with obstetricians, must engage patients in a shared decision-making process that weighs the benefits to the mother and risks to the fetus. This chapter outlines the pathophysiology of neuroimmunologic disorders during pregnancy and postpartum, the impact of these diseases on childbearing, including fertility, pregnancy, delivery, and peurperium, as well as existing recommendations for treatment.
Collapse
Affiliation(s)
- Seth Levin
- Department of Neurology, Columbia University Multiple Sclerosis Center, New York, NY, United States
| | - Kathryn Rimmer
- Department of Neurology, Columbia University Multiple Sclerosis Center, New York, NY, United States
| | - Wendy S Vargas
- Department of Neurology, Columbia University Multiple Sclerosis Center, New York, NY, United States; Department of Neurology, Division of Child Neurology, Columbia University Irving Medical Center, New York, NY, United States.
| |
Collapse
|
32
|
Qiu K, He Q, Chen X, Liu H, Deng S, Lu W. Pregnancy-Related Immune Changes and Demyelinating Diseases of the Central Nervous System. Front Neurol 2019; 10:1070. [PMID: 31649614 PMCID: PMC6794637 DOI: 10.3389/fneur.2019.01070] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 09/23/2019] [Indexed: 12/31/2022] Open
Abstract
Demyelinating diseases of the central nervous system comprise a heterogeneous group of autoimmune disorders characterized by myelin loss with relative sparing of axons occurring on a background of inflammation. Some of the most common demyelinating diseases are multiple sclerosis, acute disseminated encephalomyelitis, and neuromyelitis optica spectrum disorders. Besides showing clinical, radiological, and histopathological features that complicate their diagnosis, demyelinating diseases often involve different immunological processes that produce distinct inflammatory patterns. Evidence of demyelination diseases derives mostly from animal studies of experimental autoimmune encephalomyelitis (EAE), a model that relies on direct antibody–antigen interactions induced by encephalitogenic T cells. Pregnancy is characterized by non-self-recognition, immunomodulatory changes and an altered Th1/Th2 balance, generally considered a Th2-type immunological state that protects the mother from infections. During pregnancy, the immune response of patients with autoimmune disease complicated with pregnancy is different. Immune tolerance in pregnancy may affect the course of some diseases, which may reach remission or be exacerbated. In this review, we summarize current knowledge on the immune status during pregnancy and discuss the relationship between pregnancy-related immune changes and demyelinating diseases of the central nervous system.
Collapse
Affiliation(s)
- Ke Qiu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qiang He
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiqian Chen
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Hui Liu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Shuwen Deng
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wei Lu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| |
Collapse
|
33
|
Miranda-Acuña J, Rivas-Rodríguez E, Levy M, Ansari M, Stone R, Patel V, Amezcua L. Rituximab during pregnancy in neuromyelitis optica: A case report. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2019; 6:e542. [PMID: 30800724 PMCID: PMC6384016 DOI: 10.1212/nxi.0000000000000542] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 12/10/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Jahir Miranda-Acuña
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Erica Rivas-Rodríguez
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Michael Levy
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Mustafa Ansari
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Roslynn Stone
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Vivek Patel
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| | - Lilyana Amezcua
- USC MS Comprehensive Care Center (J.M.-A., E.R.-R., M.A., L.A.), Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA; Department of Neurology (M.L.), Johns Hopkins University, Baltimore, MD; Department of Neurology and Pharmacology (R.S.), University of Southern California; and Department of Ophthalmology (V.P.), Roski Eye Institute, University of Southern California, Los Angeles, CA
| |
Collapse
|
34
|
|
35
|
Epidural Labor Analgesia for a Patient with Neuromyelitis Optica: A Case Report and Review of the Literature. Case Rep Anesthesiol 2018; 2018:2404756. [PMID: 30627444 PMCID: PMC6304564 DOI: 10.1155/2018/2404756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/21/2018] [Indexed: 11/18/2022] Open
Abstract
Neuromyelitis optica (NMO) is a rare demyelinating disorder affecting the spinal cord and optic nerves. Like multiple sclerosis (MS), it predominantly affects women during childbearing years. The impact of neuraxial anesthesia on the course of NMO is uncertain. There are no large studies available to draw definitive conclusions regarding the safety of neuraxial anesthesia in this population. A review of the current literature suggests that neuraxial anesthesia is unlikely to exacerbate neurologic symptoms in pregnant patients with NMO. However, given the rarity of this disease entity among patients requesting epidural labor analgesia, we recommend taking a cautious approach.
Collapse
|
36
|
Tong Y, Liu J, Yang T, Kang Y, Wang J, Zhao T, Cheng C, Fan Y. Influences of pregnancy on neuromyelitis optica spectrum disorders and multiple sclerosis. Mult Scler Relat Disord 2018; 25:61-65. [DOI: 10.1016/j.msard.2018.07.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
37
|
Borisow N, Hellwig K, Paul F. Neuromyelitis optica spectrum disorders and pregnancy: relapse-preventive measures and personalized treatment strategies. EPMA J 2018; 9:249-256. [PMID: 30174761 PMCID: PMC6107451 DOI: 10.1007/s13167-018-0143-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 07/11/2018] [Indexed: 12/19/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that predominately affect women. Some of these patients are of childbearing age at NMOSD onset. This study reviews, on the one hand, the role NMOSD play in fertility, pregnancy complications and pregnancy outcome, and on the other, the effect of pregnancy on NMOSD disease course and treatment options available during pregnancy. Animal studies show lower fertility rates in NMOSD; however, investigations into fertility in NMOSD patients are lacking. Pregnancies in NMOSD patients are associated with increased disease activity and more severe disability postpartum. Some studies found higher risks of pregnancy complications, e.g., miscarriages and preeclampsia. Acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. A decision to either stop or continue immunosuppressive therapy with azathioprine or rituximab during pregnancy should be evaluated carefully and factor in the patient's history of disease activity. To this end, involving neuroimmunological specialist centers in the treatment and care of pregnant NMOSD patients is recommended, particularly in specific situations like pregnancy.
Collapse
Affiliation(s)
- Nadja Borisow
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
| | - Kerstin Hellwig
- Clinic for Neurology, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Germany
| | - Friedemann Paul
- NeuroCure Clinical Research Center, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117 Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
38
|
Li LM, Zhang C, Zhang LJ, Guo HY, Yang CS, Zhang R, Li YJ, Shi FD, Yang L. Relapse of neuromyelitis optica associated with oral progestin. J Neurol Neurosurg Psychiatry 2018; 89:788-789. [PMID: 28993474 PMCID: PMC6031264 DOI: 10.1136/jnnp-2017-316356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 09/18/2017] [Accepted: 09/22/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Li-Min Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Lin-Jie Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Hui-Yue Guo
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Chun-Sheng Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Rui Zhang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yu-Jing Li
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Fu-Dong Shi
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China.,Department of Neurology, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Li Yang
- Department of Neurology, Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
39
|
Baghbanian SM, Asgari N, Sahraian MA, Moghadasi AN. A comparison of pediatric and adult neuromyelitis optica spectrum disorders: A review of clinical manifestation, diagnosis, and treatment. J Neurol Sci 2018; 388:222-231. [DOI: 10.1016/j.jns.2018.02.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 12/19/2017] [Accepted: 02/16/2018] [Indexed: 12/12/2022]
|
40
|
Wu Q, Chen B, Liu N, Hu Y, Pan C, Zhang P, Tang ZP, Bu BT. Insights into Initial Demyelinating Episodes of Central Nervous System during Puerperium. Chin Med J (Engl) 2018; 130:1791-1795. [PMID: 28748851 PMCID: PMC5547830 DOI: 10.4103/0366-6999.211542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background: Inflammatory demyelinating disease of central nervous system (CNS) is an inflammatory disease characterized by a high childbearing female predominance. Labor-related alterations for postpartum demyelinating attacks are not entirely clear. This study aimed to summarize clinical features of female patients of reproductive age with initial CNS inflammatory demyelinating attacks during puerperium. Methods: Fourteen female patients with initial demyelinating events during puerperium between January 2013 and December 2016 were retrospectively studied. Records of clinical features, neuroimaging, serum antibodies, cerebrospinal fluid (CSF) findings, annualized relapse rate (ARR), and treatment were analyzed. Results: Among 14 patients, 5 patients were diagnosed with multiple sclerosis (MS), four as neuromyelitis optica (NMO), two as longitudinal extensive transverse myelitis, two as clinical isolated syndrome (CIS), and one as acute brainstem syndrome. All the 14 puerperal female patients presented with more than one manifestation of hemiplegia, paraplegia, uroschesis, visual loss or dysarthria, and with mild to moderate abnormalities of CSF. Attacks occurred during the first trimester postpartum and cesarean section was the main delivery way (n = 10). Median Expanded Disability Status Scale (EDSS) scores were 5.0 (range: 2.0–9.0) at the onset and 2.5 (range: 0–7.0) at the end of follow-ups. Patients with MS and CIS had a significantly lower EDSS scores than patients with NMO spectrum disorders (P < 0.05). Median ARR was 0.46 (range: 0–1.16); all patients had a low ARR (0.49 ± 0.34, 95% confidence interval: 0.29–0.69) with standardized treatments. Conclusion: Labor-related alterations in the mother's immune system might result in newly-onset demyelinating diseases of central nervous system.
Collapse
Affiliation(s)
- Qian Wu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bo Chen
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Na Liu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Yang Hu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Chao Pan
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Ping Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Zhou-Ping Tang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| | - Bi-Tao Bu
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
| |
Collapse
|
41
|
Ciron J, Audoin B, Bourre B, Brassat D, Durand-Dubief F, Laplaud D, Maillart E, Papeix C, Vukusic S, Zephir H, Marignier R, Collongues N. Recommendations for the use of Rituximab in neuromyelitis optica spectrum disorders. Rev Neurol (Paris) 2018; 174:255-264. [DOI: 10.1016/j.neurol.2017.11.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/07/2017] [Indexed: 01/08/2023]
|
42
|
Borisow N, Hellwig K, Paul F. [Neuromyelitis optica spectrum disorder and pregnancy]. DER NERVENARZT 2018; 89:666-673. [PMID: 29383411 DOI: 10.1007/s00115-018-0486-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorders (NMOSD) are autoimmune inflammatory diseases of the central nervous system that mainly affect women. In some of these patients NMOSD occurs during fertile age. For this reason, treating physicians may be confronted with questions concerning family planning, pregnancy and birth. OBJECTIVE This study provides an overview on the influence of NMOSD on fertility, pregnancy complications and pregnancy outcome. The effect of pregnancy on NMOSD course and therapy options during pregnancy are discussed. MATERIAL AND METHODS A search of the current literature was carried out using the PubMed database. RESULTS AND CONCLUSION Animal studies have shown lower fertility rates in NMOSD; however, studies investigating fertility in NMOSD patients are lacking. Pregnancy in NMOSD patients are associated with an increase in postpartum disease activity and a higher grade of disability after pregnancy. Some studies showed higher risks of pregnancy complications e. g. spontaneous abortions and preeclampsia. With a few limitations, acute relapses during pregnancy can be treated with methylprednisolone and/or plasma exchange/immunoadsorption. Stopping or continuing immunosuppressive therapy with azathioprine or rituximab during pregnancy should be critically weighed considering previous and current disease activity. Therefore, a joint supervision by a specialized center is recommended, particularly in specific situations such as pregnancy.
Collapse
Affiliation(s)
- N Borisow
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - K Hellwig
- Klinik für Neurologie, St. Josef Hospital, Ruhr Universität Bochum, Bochum, Deutschland
| | - F Paul
- NeuroCure Clinical Research Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charitéplatz 1, 10117, Berlin, Deutschland
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| |
Collapse
|
43
|
Shosha E, Pittock SJ, Flanagan E, Weinshenker BG. Neuromyelitis optica spectrum disorders and pregnancy: Interactions and management. Mult Scler 2017; 23:1808-1817. [DOI: 10.1177/1352458517740215] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Neuromyelitis optica spectrum disorders (NMOSD) predominantly affect women who are of childbearing age. Understanding the interactions between pregnancy and NMOSD is important for clinical management. Aquaporin-4 (AQP4), the most common target antigen in NMOSD, is expressed on placenta in early pregnancy. A variety of immune and cytokine changes in pregnancy may impact pregnancy outcomes in NMOSD patients. Relapses continue during pregnancy and increase in frequency postpartum. Preeclampsia and fetal loss are more frequent in NMOSD than in controls. Transfer of AQP4-immunoglobulin G (IgG) from mother to baby occurs but appears not to cause disease. Several treatment options are relatively safe and mitigate the risk of relapse during pregnancy and postpartum. For patients with active NMOSD, it may be advisable to continue immunotherapy during pregnancy.
Collapse
Affiliation(s)
- Eslam Shosha
- Department of Neurology, Mayo Clinic, Rochester, MN, USA/College of Medicine, Al Majmaah University, Riyadh, Saudi Arabia
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA/ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Eoin Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA/ Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | |
Collapse
|
44
|
Klawiter EC, Bove R, Elsone L, Alvarez E, Borisow N, Cortez M, Mateen F, Mealy MA, Sorum J, Mutch K, Tobyne SM, Ruprecht K, Buckle G, Levy M, Wingerchuk D, Paul F, Cross AH, Jacobs A, Chitnis T, Weinshenker B. High risk of postpartum relapses in neuromyelitis optica spectrum disorder. Neurology 2017; 89:2238-2244. [PMID: 29093070 DOI: 10.1212/wnl.0000000000004681] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Accepted: 08/29/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To study the effect of pregnancy on the frequency of neuromyelitis optica spectrum disorder (NMOSD) relapse and evaluate rates of pregnancy-related complications in an international multicenter setting. METHODS We administered a standardized survey to 217 women with NMOSD from 7 medical centers and reviewed their medical records. We compared the annualized relapse rate (ARR) during a baseline period 2 years prior to a participant's first pregnancy to that during pregnancy and to the 9 months postpartum. We also assessed pregnancy-related complications. RESULTS There were 46 informative pregnancies following symptom onset in 31 women with NMOSD. Compared to baseline (0.17), ARR was increased both during pregnancy (0.44; p = 0.035) and during the postpartum period (0.69; p = 0.009). The highest ARR occurred during the first 3 months postpartum (ARR 1.33). A total of 8 of 76 (10.5%) with onset of NMOSD prior to age 40 experienced their initial symptom during the 3 months postpartum, 2.9 times higher than expected. CONCLUSIONS The postpartum period is a particularly high-risk time for initial presentation of NMOSD. In contrast to published observations in multiple sclerosis, in neuromyelitis optica, relapse rate during pregnancy was also increased, although to a lesser extent than after delivery.
Collapse
Affiliation(s)
- Eric C Klawiter
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA.
| | - Riley Bove
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Liene Elsone
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Enrique Alvarez
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Nadja Borisow
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Melissa Cortez
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Farrah Mateen
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Maureen A Mealy
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Jaime Sorum
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Kerry Mutch
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Sean M Tobyne
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Klemens Ruprecht
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Guy Buckle
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Michael Levy
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Dean Wingerchuk
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Friedemann Paul
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Anne H Cross
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Anu Jacobs
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Tanuja Chitnis
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| | - Brian Weinshenker
- From Massachusetts General Hospital (E.C.K., F.M., S.M.T.) and Brigham and Women's Hospital (R.B., G.B., T.C.), Harvard Medical School, Boston; University of California (R.B.), San Francisco; Walton Centre for Neurology and Neurosurgery and University of Liverpool (L.E., K.M., A.J.), UK; Washington University in St. Louis (E.A., A.H.C.), MO; University of Colorado School of Medicine (E.A.), Aurora; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; Mayo Clinic (M.C., D.W.), Scottsdale, AZ; University of Utah (M.C.), Salt Lake City; Johns Hopkins University School of Medicine (F.M., M.A.M., M.L.), Baltimore, MD; Mayo Clinic (J.S., B.W.), Rochester, MN; Shepherd Center in Atlanta (G.B.), GA
| |
Collapse
|
45
|
Shi B, Zhao M, Geng T, Qiao L, Zhao Y, Zhao X. Effectiveness and safety of immunosuppressive therapy in neuromyelitis optica spectrum disorder during pregnancy. J Neurol Sci 2017; 377:72-76. [PMID: 28477712 DOI: 10.1016/j.jns.2017.03.051] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 03/09/2017] [Accepted: 03/29/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To evaluate the effectiveness and safety of immunosuppressive therapy in neuromyelitis optica spectrum disorder (NMOSD) during pregnancy. METHODS Sixteen NMOSD patients who had at least one pregnancy after NMOSD onset were enrolled. The patients were divided into two groups according to whether they received immunosuppressive therapy during pregnancy. The annual relapse rate (ARR) before pregnancy (BP); during the first (DP1), second (DP2), and third trimesters (DP3); first trimester postpartum (PP1); and second trimester postpartum (PP2) were calculated. The Expanded Disability Status Scale (EDSS) was used to evaluate the degree of disability. Pregnancy outcomes were recorded and the children were followed up and their health condition was evaluated. RESULTS In the group taking prednisone alone or in combination with azathioprine as immunosuppressive therapies, there was no difference among ARRs of each period (DP1, DP2, DP3, PP1, PP2) and BP. Compared with EDSS BP, EDSS increased slightly 6months postpartum with no statistical significance (p=0.102). In the group without immunosuppressive therapy, ARR increased during PP1 (p=0.014) and EDSS increased 6months postpartum as compared to BP (p=0.017). Moreover, the added EDSS value was higher in the group without immunosuppressive therapy than in the group with therapy (p=0.038). In 22 pregnancies from 16 patients, 16 pregnancies ended in live births and 6 pregnancies ended in abortions, including 2 spontaneous and 4 induced abortions. None of the children had congenital diseases or malformations. There were no records of abnormal growth among the children during 6months to 12years of follow-up. CONCLUSION Untreated women showed a propensity for disease relapse in PP1 and increased degree of disability postpartum. Immunosuppressive therapy during pregnancy and postpartum period can reduce the risk of relapse and degree of disability. Immunosuppressive therapy with low-dose prednisone was relatively safe. However, the safety of azathioprine during pregnancy remains unclear and needs future reevaluation.
Collapse
Affiliation(s)
- Bingxin Shi
- Department of Neurology, Yuquan Hospital, Clinical Neuroscience Institute, Medical Center, Tsinghua University, Beijing 100049, PR China
| | - Mangsuo Zhao
- Department of Neurology, Yuquan Hospital, Clinical Neuroscience Institute, Medical Center, Tsinghua University, Beijing 100049, PR China
| | - Tongchao Geng
- Department of Neurology, Yuquan Hospital, Clinical Neuroscience Institute, Medical Center, Tsinghua University, Beijing 100049, PR China.
| | - Liyan Qiao
- Department of Neurology, Yuquan Hospital, Clinical Neuroscience Institute, Medical Center, Tsinghua University, Beijing 100049, PR China.
| | - Yapeng Zhao
- Department of Neurosurgery, Yuquan Hospital, Clinical Neuroscience Institute, Medical Center, Tsinghua University, Beijing 100049, PR China
| | - Xiuli Zhao
- Department of Neurology, Yuquan Hospital, Clinical Neuroscience Institute, Medical Center, Tsinghua University, Beijing 100049, PR China
| |
Collapse
|
46
|
Bove R, Elsone L, Alvarez E, Borisow N, Cortez MM, Mateen FJ, Mealy MA, Mutch K, Tobyne S, Ruprecht K, Buckle G, Levy M, Wingerchuk DM, Paul F, Cross AH, Weinshenker B, Jacob A, Klawiter EC, Chitnis T. Female hormonal exposures and neuromyelitis optica symptom onset in a multicenter study. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2017; 4:e339. [PMID: 28382320 PMCID: PMC5366671 DOI: 10.1212/nxi.0000000000000339] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 01/26/2017] [Indexed: 12/03/2022]
Abstract
Objective: To study the association between hormonal exposures and disease onset in a cohort of women with neuromyelitis optica spectrum disorder (NMOSD). Methods: Reproductive history and hormone use were assessed using a standardized reproductive survey administered to women with NMOSD (82% aquaporin-4 antibody positive) at 8 clinical centers. Using multivariable regression, we examined the association between reproductive exposures and age at first symptom onset (FS). Results: Among 217 respondents, the mean age at menarche was 12.8 years (SD 1.7). The mean number of pregnancies was 2.1 (SD 1.6), including 0.3 (SD 0.7) occurring after onset of NMOSD symptoms. In the 117 participants who were postmenopausal at the time of the questionnaire, 70% reported natural menopause (mean age: 48.9 years [SD 3.9]); fewer than 30% reported systemic hormone therapy (HT) use. Mean FS age was 40.1 years (SD 14.2). Ever-use of systemic hormonal contraceptives (HC) was marginally associated with earlier FS (39 vs 43 years, p = 0.05). Because HC use may decrease parity, when we included both variables in the model, the association between HC use and FS age became more significant (estimate = 2.7, p = 0.007). Among postmenopausal participants, 24% reported NMOSD onset within 2 years of (before or after) menopause. Among these participants, there was no association between age at menopause or HT use and age at NMOSD onset. Conclusions: Overall, age at NMOSD onset did not show a strong relationship with endogenous hormonal exposures. An earlier onset age did appear to be marginally associated with systemic HC exposure, an association that requires confirmation in future studies.
Collapse
Affiliation(s)
- Riley Bove
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Liene Elsone
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Enrique Alvarez
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Nadja Borisow
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Melissa M Cortez
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Farrah J Mateen
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Maureen A Mealy
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Kerry Mutch
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Sean Tobyne
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Klemens Ruprecht
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Guy Buckle
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Michael Levy
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Dean M Wingerchuk
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Friedemann Paul
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Anne H Cross
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Brian Weinshenker
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Anu Jacob
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Eric C Klawiter
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| | - Tanuja Chitnis
- Brigham and Women's Hospital (R.B., T.C.), Boston, MA; Harvard Medical School (R.B., F.J.M., E.C.K., T.C.), Boston, MA; The Walton Centre NHS Foundation Trust (L.E., K.M., A.J.), Liverpool, UK; Washington University School of Medicine (E.A., A.H.C.), St. Louis, MO; Charité-Universitätsmedizin Berlin (N.B., K.R., F.P.), Germany; University of Utah Imaging & Neurosciences Center (M.M.C.), Salt Lake City; Massachusetts General Hospital (F.J.M., S.T., E.C.K.), Boston; Johns Hopkins Medical Institute (M.A.M., M.L.), Baltimore, MD; MS Institute at Shepherd Center (G.B.), Atlanta, GA; Mayo Clinic (B.W.), Rochester, MN; and Mayo Clinic (D.M.W.), Scottsdale, AZ
| |
Collapse
|
47
|
Bakulin IS, Simaniv TO, Konovalov RN, Zakharova MN. Area postrema lesion as a cause of intractable nausea, vomiting and hiccups in neuromyelitis optica spectrum disorders. Zh Nevrol Psikhiatr Im S S Korsakova 2017; 117:20-23. [DOI: 10.17116/jnevro201711710220-23] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
48
|
Zare-Shahabadi A, Langroodi HG, Azimi AR, Sahraian MA, Harirchian MH, Baghbanian SM. Neuromyelitis optica and pregnancy. Acta Neurol Belg 2016; 116:431-438. [PMID: 27306993 DOI: 10.1007/s13760-016-0654-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 05/19/2016] [Indexed: 12/29/2022]
Abstract
Neuromyelitis optica (NMO) and the associated NMO spectrum disorders are demyelinating disorders affecting the spinal cord and optic nerves. It has prominent female predominance and many of these patients are in their childbearing years. As pregnancy seems to have a major impact on this disease course, in this review, recent studies with a focus on this disease and pregnancy and safety of available treatment options during this period are discussed.
Collapse
Affiliation(s)
- Ameneh Zare-Shahabadi
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Ghalyanchi Langroodi
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
| | - Amir Reza Azimi
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
| | - Mohammad Ali Sahraian
- Department of Neurology, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Imam Khomeini Ave., Hasan Abad Sq., Tehran, Iran
| | - Mohammad Hossein Harirchian
- Iranian Center of Neurological Researches, Imam Khomeini Hospital, Tehran University of Medical Science, Keshavarz Blvd., Tehran, Iran
| | - Seyed Mohammad Baghbanian
- Neurology Department, Booalisina Hospital, Mazandaran University of Medical Science, Pasdaran Boulevard, Sari, Iran.
| |
Collapse
|
49
|
Davoudi V, Keyhanian K, Bove RM, Chitnis T. Immunology of neuromyelitis optica during pregnancy. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 3:e288. [PMID: 27761482 PMCID: PMC5056648 DOI: 10.1212/nxi.0000000000000288] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 08/02/2016] [Indexed: 12/26/2022]
Abstract
Anti–aquaporin-4 (AQP4) autoantibody plays a key role in the pathogenesis of neuromyelitis optica (NMO). Studies have shown increased relapse rates in patients with NMO during pregnancy and postpartum. High estrogen levels during pregnancy can increase activation-induced cytidine deaminase expression, which is responsible for immunoglobulin production. Additionally, sex hormones may influence antibody glycosylation, with effects on antibody function. Estrogen decreases apoptosis of self-reactive B cells, through upregulation of antiapoptotic molecules. Furthermore, high estrogen levels during pregnancy can boost B-cell activating factor and type 1 interferon (IFN) production, facilitating development of self-reactive peripheral B cells in association with increased disease activity. Elevated levels of estrogen during pregnancy decrease IFN-γ generation, which causes a shift toward T helper (Th) 2 immunity, thereby propagating NMO pathogenesis. Women with NMO have an elevated rate of pregnancy complications including miscarriage and preeclampsia, which are associated with increased Th17 cells and reduction of T-regulatory cells. These in turn can enhance inflammation in NMO. Increased regulatory natural killer cells (CD56−) during pregnancy can enhance Th2-mediated immunity, thereby increasing inflammation. In the placenta, trophoblasts express AQP4 antigen and are exposed to maternal blood containing anti-AQP4 antibodies. Animal models have shown that anti-AQP4 antibodies can bind to AQP4 antigen in placenta leading to complement deposition and placental necrosis. Reduction of regulatory complements has been associated with placental insufficiency, and it is unclear whether these are altered in NMO. Further studies are required to elucidate the specific mechanisms of disease worsening, as well as the increased rate of complications during pregnancy in women with NMO.
Collapse
Affiliation(s)
- Vahid Davoudi
- Ann Romney Center for Neurologic Diseases (V.D., K.K., T.C.), Harvard Medical School (V.D., K.K., T.C.), Boston, MA; Department of Neurology (R.M.B.), University of California, San Francisco; and Partners Multiple Sclerosis Center (R.M.B., T.C.), Department of Neurology, Brigham and Women's Hospital, Brookline, MA
| | - Kiandokht Keyhanian
- Ann Romney Center for Neurologic Diseases (V.D., K.K., T.C.), Harvard Medical School (V.D., K.K., T.C.), Boston, MA; Department of Neurology (R.M.B.), University of California, San Francisco; and Partners Multiple Sclerosis Center (R.M.B., T.C.), Department of Neurology, Brigham and Women's Hospital, Brookline, MA
| | - Riley M Bove
- Ann Romney Center for Neurologic Diseases (V.D., K.K., T.C.), Harvard Medical School (V.D., K.K., T.C.), Boston, MA; Department of Neurology (R.M.B.), University of California, San Francisco; and Partners Multiple Sclerosis Center (R.M.B., T.C.), Department of Neurology, Brigham and Women's Hospital, Brookline, MA
| | - Tanuja Chitnis
- Ann Romney Center for Neurologic Diseases (V.D., K.K., T.C.), Harvard Medical School (V.D., K.K., T.C.), Boston, MA; Department of Neurology (R.M.B.), University of California, San Francisco; and Partners Multiple Sclerosis Center (R.M.B., T.C.), Department of Neurology, Brigham and Women's Hospital, Brookline, MA
| |
Collapse
|
50
|
MOG-IgG in NMO and related disorders: a multicenter study of 50 patients. Part 2: Epidemiology, clinical presentation, radiological and laboratory features, treatment responses, and long-term outcome. J Neuroinflammation 2016; 13:280. [PMID: 27793206 PMCID: PMC5086042 DOI: 10.1186/s12974-016-0718-0] [Citation(s) in RCA: 615] [Impact Index Per Article: 76.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Accepted: 09/09/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND A subset of patients with neuromyelitis optica spectrum disorders (NMOSD) has been shown to be seropositive for myelin oligodendrocyte glycoprotein antibodies (MOG-IgG). OBJECTIVE To describe the epidemiological, clinical, radiological, cerebrospinal fluid (CSF), and electrophysiological features of a large cohort of MOG-IgG-positive patients with optic neuritis (ON) and/or myelitis (n = 50) as well as attack and long-term treatment outcomes. METHODS Retrospective multicenter study. RESULTS The sex ratio was 1:2.8 (m:f). Median age at onset was 31 years (range 6-70). The disease followed a multiphasic course in 80 % (median time-to-first-relapse 5 months; annualized relapse rate 0.92) and resulted in significant disability in 40 % (mean follow-up 75 ± 46.5 months), with severe visual impairment or functional blindness (36 %) and markedly impaired ambulation due to paresis or ataxia (25 %) as the most common long-term sequelae. Functional blindess in one or both eyes was noted during at least one ON attack in around 70 %. Perioptic enhancement was present in several patients. Besides acute tetra-/paraparesis, dysesthesia and pain were common in acute myelitis (70 %). Longitudinally extensive spinal cord lesions were frequent, but short lesions occurred at least once in 44 %. Fourty-one percent had a history of simultaneous ON and myelitis. Clinical or radiological involvement of the brain, brainstem, or cerebellum was present in 50 %; extra-opticospinal symptoms included intractable nausea and vomiting and respiratory insufficiency (fatal in one). CSF pleocytosis (partly neutrophilic) was present in 70 %, oligoclonal bands in only 13 %, and blood-CSF-barrier dysfunction in 32 %. Intravenous methylprednisolone (IVMP) and long-term immunosuppression were often effective; however, treatment failure leading to rapid accumulation of disability was noted in many patients as well as flare-ups after steroid withdrawal. Full recovery was achieved by plasma exchange in some cases, including after IVMP failure. Breakthrough attacks under azathioprine were linked to the drug-specific latency period and a lack of cotreatment with oral steroids. Methotrexate was effective in 5/6 patients. Interferon-beta was associated with ongoing or increasing disease activity. Rituximab and ofatumumab were effective in some patients. However, treatment with rituximab was followed by early relapses in several cases; end-of-dose relapses occurred 9-12 months after the first infusion. Coexisting autoimmunity was rare (9 %). Wingerchuk's 2006 and 2015 criteria for NMO(SD) and Barkhof and McDonald criteria for multiple sclerosis (MS) were met by 28 %, 32 %, 15 %, 33 %, respectively; MS had been suspected in 36 %. Disease onset or relapses were preceded by infection, vaccination, or pregnancy/delivery in several cases. CONCLUSION Our findings from a predominantly Caucasian cohort strongly argue against the concept of MOG-IgG denoting a mild and usually monophasic variant of NMOSD. The predominantly relapsing and often severe disease course and the short median time to second attack support the use of prophylactic long-term treatments in patients with MOG-IgG-positive ON and/or myelitis.
Collapse
|