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Carnero Contentti E, Okuda DT, Rojas JI, Chien C, Paul F, Alonso R. MRI to differentiate multiple sclerosis, neuromyelitis optica, and myelin oligodendrocyte glycoprotein antibody disease. J Neuroimaging 2023; 33:688-702. [PMID: 37322542 DOI: 10.1111/jon.13137] [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] [Received: 05/08/2023] [Revised: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023] Open
Abstract
Differentiating multiple sclerosis (MS) from other relapsing inflammatory autoimmune diseases of the central nervous system such as neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is crucial in clinical practice. The differential diagnosis may be challenging but making the correct ultimate diagnosis is critical, since prognosis and treatments differ, and inappropriate therapy may promote disability. In the last two decades, significant advances have been made in MS, NMOSD, and MOGAD including new diagnostic criteria with better characterization of typical clinical symptoms and suggestive imaging (magnetic resonance imaging [MRI]) lesions. MRI is invaluable in making the ultimate diagnosis. An increasing amount of new evidence with respect to the specificity of observed lesions as well as the associated dynamic changes in the acute and follow-up phase in each condition has been reported in distinct studies recently published. Additionally, differences in brain (including the optic nerve) and spinal cord lesion patterns between MS, aquaporin4-antibody-positive NMOSD, and MOGAD have been described. We therefore present a narrative review on the most relevant findings in brain, spinal cord, and optic nerve lesions on conventional MRI for distinguishing adult patients with MS from NMOSD and MOGAD in clinical practice. In this context, cortical and central vein sign lesions, brain and spinal cord lesions characteristic of MS, NMOSD, and MOGAD, optic nerve involvement, role of MRI at follow-up, and new proposed diagnostic criteria to differentiate MS from NMOSD and MOGAD were discussed.
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Affiliation(s)
| | - Darin T Okuda
- Department of Neurology, Neuroinnovation Program, Multiple Sclerosis & Neuroimmunology Imaging Program, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Juan I Rojas
- Centro de esclerosis múltiple de Buenos Aires, Buenos Aires, Argentina
| | - Claudia Chien
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemman Paul
- NeuroCure Clinical Research Center, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ricardo Alonso
- Centro Universitario de Esclerosis Múltiple (CUEM), Hospital Ramos Mejía, Buenos Aires, Argentina
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Russo C, Muto G, Giordano F, Masala S, Muto M. Imaging of Common Spinal Cord Diseases. Semin Musculoskelet Radiol 2022; 26:510-520. [PMID: 36103892 DOI: 10.1055/s-0042-1755345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Spinal cord evaluation is an integral part of spine assessment, and its reliable imaging work-up is mandatory because even localized lesions may produce serious effects with potentially irreversible sequelae. Spinal cord alterations are found both incidentally during spine evaluation in otherwise neurologically asymptomatic patients or during neurologic/neuroradiologic assessment in myelopathic patients. Myelopathy (an umbrella term for any neurologic deficit that refers to spinal cord impairment) can be caused by intrinsic lesions or extrinsic mechanical compression, and its etiology may be both traumatic and/or nontraumatic. The symptoms largely depend on the size/extension of lesions, ranging from incontinence to ataxia, from spasticity to hyperreflexia, from numbness to weakness. Magnetic resonance imaging is the reference imaging modality in spinal cord evaluation, ensuring the best signal and spatial resolution. We provide an overview of the most common spinal cord disorders encountered by radiologists and describe the technical measures that offer optimal spinal cord visualization.
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Affiliation(s)
- Camilla Russo
- Diagnostic and Interventional Neuroradiology Unit, Dipartimento delle Tecnologie Avanzate Diagnostico-Terapeutiche e dei Servizi sanitari, A.O.R.N. Cardarelli, Naples, Italy.,Department of Electrical Engineering and Information Technology (DIETI), Università Degli Studi di Napoli Federico II, Naples, Italy
| | - Gianluca Muto
- Service de Radiologie, Hôpitaux Universitaires de Genève (HUG), Geneva, Switzerland
| | - Flavio Giordano
- Diagnostic and Interventional Neuroradiology Unit, Dipartimento delle Tecnologie Avanzate Diagnostico-Terapeutiche e dei Servizi sanitari, A.O.R.N. Cardarelli, Naples, Italy
| | - Salvatore Masala
- Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiation Therapy, Università degli Studi di Roma Tor Vergata, Rome, Italy
| | - Mario Muto
- Diagnostic and Interventional Neuroradiology Unit, Dipartimento delle Tecnologie Avanzate Diagnostico-Terapeutiche e dei Servizi sanitari, A.O.R.N. Cardarelli, Naples, Italy
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Tang J, Zeng X, Yang J, Zhang L, Li H, Chen R, Tang S, Luo Y, Qin X, Feng J. Expression and Clinical Correlation Analysis Between Repulsive Guidance Molecule a and Neuromyelitis Optica Spectrum Disorders. Front Immunol 2022; 13:766099. [PMID: 35185873 PMCID: PMC8850277 DOI: 10.3389/fimmu.2022.766099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives This study sought to explore the expression patterns of repulsive guidance molecules a (RGMa) in neuromyelitis optica spectrum disorders (NMOSD) and to explore the correlation between RGMa and the clinical features of NMOSD. Methods A total of 83 NMOSD patients and 22 age-matched healthy controls (HCs) were enrolled in the study from October 2017 to November 2021. Clinical parameters, including Expanded Disability Status Scale (EDSS) score, degree of MRI enhancement, and AQP4 titer were collected. The expression of serum RGMa was measured by enzyme-linked immunosorbent assay (ELISA) and compared across the four patient groups. The correlation between serum RGMa levels and different clinical parameters was also assessed. Results The average serum expression of RGMa in the NMOSD group was significantly higher than that in the HC group (p < 0.001). Among the patient groups, the acute phase group exhibited significantly higher serum RGMa levels than did the remission group (p < 0.001). A multivariate analysis revealed a significant positive correlation between RGMa expression and EDSS score at admission, degree of MRI enhancement, and segmental length of spinal cord lesions. There was a significant negative correlation between the expression of RGMa in NMOSD and the time from attack to sampling or delta EDSS. Conclusions The current study suggests that RGMa may be considered a potential biomarker predicting the severity, disability, and clinical features of NMOSD.
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Affiliation(s)
- Jinhua Tang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- Department of Neurology, People's Hospital of Chongqing Hechuan, Chongqing, China
| | - Xiaopeng Zeng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jun Yang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Lei Zhang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Hang Li
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Rui Chen
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shi Tang
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yetao Luo
- Department of Biostatistics, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Xinyue Qin
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Jinzhou Feng
- Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Etemadifar M, Salari M, Etemadifar MR, Sabeti F, Fateh ST, Aminzade Z. Centrally-located Transverse Myelitis would facilitate the differentiation of NMOSD and MOG-AD from MS. Mult Scler Relat Disord 2022; 60:103664. [DOI: 10.1016/j.msard.2022.103664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 01/04/2022] [Accepted: 02/03/2022] [Indexed: 10/19/2022]
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Rivera VM. Editorial of Special Issue "Multiple Sclerosis: Diagnosis and Treatment II". Biomedicines 2021; 9:biomedicines9111605. [PMID: 34829833 PMCID: PMC8615709 DOI: 10.3390/biomedicines9111605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 10/30/2021] [Indexed: 11/16/2022] Open
Abstract
The special issue on Multiple Sclerosis: Diagnosis and Treatment II, reflects advances and discoveries in the molecular and cellular mechanisms of disease, and novel laboratory techniques providing more sensitivity to diagnostic techninques and the understanding of neuroinflammation. Mitochondrial-mediated apoptosis in isolated peripheral blood mononuclear cells and the role of reactive oxygen species are studied as indicators of activity of MS. In these cells, downregulation of circular and linera RNAs are reported as markers of highly active disease in MS. Progress and importance of Neurofilaments determinations in early diagnosis and as a marker of disease activity, and the analysis of the complex mechanisms and therapeutic potential of Sphingosine-1-phosphate receptor modulator are discussed. Epidemiologic observations from a highly diversified area of the world provide more insights into this important aspect of MS; discussions on the clinical challenges posed by spinal cord involvement in demyelinatind disorders and the latest aspects of pediatric onset MS, complement this fine collection of scientific papers.
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Affiliation(s)
- Victor M Rivera
- Department of Neurology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
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Zouari Mallouli S, Ben Nsir S, Bouchaala W, Kamoun Feki F, Charfi Triki C. Acute Demyelinating Syndromes: A report of child neurology department of Sfax University Hospital. Mult Scler Relat Disord 2021; 56:103291. [PMID: 34624647 DOI: 10.1016/j.msard.2021.103291] [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: 07/30/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The yearly incidence of Acute Demyelinating Syndromes (ADS) in a multiethnic cohort of children published by Langer-Gould and al in 2011 was estimated at about 1.66 per 100,000. Nevertheless, the real incidence for these disorders is still underestimated as the iterative revision for diagnosis criteria have failed to classify a significant number of children with ADS. PURPOSE This work was aimed to describe clinical and paraclinical characteristics of ADS in a pediatric population. MATERIAL AND METHODS Demographic, clinical and paraclinical data of 42 children (24 females; 18 male; SR = 1.33), were collected from the medical records of patients admitted to the child neurology department of Sfax University Hospital between 2008 and 2021 for clinical events with presumed inflammatory origin. Next, patients were categorized as per M. N. Nouri and al. up dated classification for ADS. Finally, characteristics of different ADS categories were compared. RESULTS The mean age onset was 6 years (± 3.5 years). For a mean follow-up period of 28 months, 69% of patients had a monophasic course. ADS in our pediatric population were Acute disseminated encephalomyelitis (ADEM) (36%), Clinically isolated syndrome (CIS) (24%), Multiple sclerosis (MS) (19%), Neuromyelitis optica spectrum disorder (NMOSD) (7%), Myelin oligodendrocyte glycoprotein antibodies-associated diseases (MOGAD) (2%) and Recurrent demyelinating disease not otherwise specified (RD-NOS) (10%). At presentation, patients showed different clinical picture according to ADS-subtype with more patients with epileptic seizure in ADEM-group (53.3%), optic neuritis in CIS-group (70%), motor deficit in MS-group (62.5%), area postrema syndrome in NMOSD-group (33.3%) and vesico-sphincter dysfunction in RD-NOS-group (75%). Among patients presenting with visual impairment (21.4%), Visual evoked potential (VEP) guided the diagnosis of NMOSD in 22.2% by objectifying axonal optic nerve damage. Different ADS subtypes were identified according to MRI results in 100% of ADEM-patients and 75% of MS-patients and on antibody testing in three patients. The ADS-subtype was recognized based on antibody testing in three patients. Two patients from CIS-group: the first with isolated optic neuritis (ON) was positive for antiaquaporin 4 antibodies (anti-AQP4) and the other with clinically polyfocal ADS was positive for antinuclear antibodies (ANA) type anti-RNP. The remaining patients who presented with ADEM-phenotype was positive for anti-myelin oligodendrocyte glycoprotein (anti-MOG). SIGNIFICANCE Recognizing distinctive features of each ADS category may improve diagnosis accuracy as well as the indication of suitable treatment.
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Affiliation(s)
- Salma Zouari Mallouli
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Tunisia; Research laboratory LR19ES15, Sfax University, Tunisia.
| | - Sihem Ben Nsir
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Tunisia; Research laboratory LR19ES15, Sfax University, Tunisia
| | - Wafa Bouchaala
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Tunisia; Research laboratory LR19ES15, Sfax University, Tunisia
| | - Fatma Kamoun Feki
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Tunisia; Research laboratory LR19ES15, Sfax University, Tunisia
| | - Chahnez Charfi Triki
- Child Neurology Department, Hedi Chaker Sfax University Hospital, Tunisia; Research laboratory LR19ES15, Sfax University, Tunisia
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Imaging of the Spinal Cord in Multiple Sclerosis: Past, Present, Future. Brain Sci 2020; 10:brainsci10110857. [PMID: 33202821 PMCID: PMC7696997 DOI: 10.3390/brainsci10110857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 10/30/2020] [Accepted: 11/11/2020] [Indexed: 11/17/2022] Open
Abstract
Spinal cord imaging in multiple sclerosis (MS) plays a significant role in diagnosing and tracking disease progression. The spinal cord is one of four key areas of the central nervous system where documenting the dissemination in space in the McDonald criteria for diagnosing MS. Spinal cord lesion load and the severity of cord atrophy are believed to be more relevant to disability than white matter lesions in the brain in different phenotypes of MS. Axonal loss contributes to spinal cord atrophy in MS and its degree correlates with disease severity and prognosis. Therefore, measures of axonal loss are often reliable biomarkers for monitoring disease progression. With recent technical advances, more and more qualitative and quantitative MRI techniques have been investigated in an attempt to provide objective and reliable diagnostic and monitoring biomarkers in MS. In this article, we discuss the role of spinal cord imaging in the diagnosis and prognosis of MS and, additionally, we review various techniques that may improve our understanding of the disease.
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Sen MK, Almuslehi MSM, Shortland PJ, Coorssen JR, Mahns DA. Revisiting the Pathoetiology of Multiple Sclerosis: Has the Tail Been Wagging the Mouse? Front Immunol 2020; 11:572186. [PMID: 33117365 PMCID: PMC7553052 DOI: 10.3389/fimmu.2020.572186] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/27/2020] [Indexed: 12/18/2022] Open
Abstract
Multiple Sclerosis (MS) is traditionally considered an autoimmune-mediated demyelinating disease, the pathoetiology of which is unknown. However, the key question remains whether autoimmunity is the initiator of the disease (outside-in) or the consequence of a slow and as yet uncharacterized cytodegeneration (oligodendrocytosis), which leads to a subsequent immune response (inside-out). Experimental autoimmune encephalomyelitis has been used to model the later stages of MS during which the autoimmune involvement predominates. In contrast, the cuprizone (CPZ) model is used to model early stages of the disease during which oligodendrocytosis and demyelination predominate and are hypothesized to precede subsequent immune involvement in MS. Recent studies combining a boost, or protection, to the immune system with disruption of the blood brain barrier have shown CPZ-induced oligodendrocytosis with a subsequent immune response. In this Perspective, we review these recent advances and discuss the likelihood of an inside-out vs. an outside-in pathoetiology of MS.
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Affiliation(s)
- Monokesh K Sen
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Mohammed S M Almuslehi
- School of Medicine, Western Sydney University, Penrith, NSW, Australia.,Department of Physiology, College of Veterinary Medicine, University of Diyala, Baqubah, Iraq
| | - Peter J Shortland
- School of Science, Western Sydney University, Penrith, NSW, Australia
| | - Jens R Coorssen
- Departments of Health Sciences and Biological Sciences, Faculties of Applied Health Sciences and Mathematics & Science, Brock University, St. Catharines, ON, Canada
| | - David A Mahns
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
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