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Syc-Mazurek SB, Zhao-Fleming H, Guo Y, Tisavipat N, Chen JJ, Zekeridou A, Kournoutas I, Orme JJ, Block MS, Lucchinetti CF, Mustafa R, Flanagan EP. MOG Antibody-Associated Disease in the Setting of Metastatic Melanoma Complicated by Immune Checkpoint Inhibitor Use. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200249. [PMID: 38696737 PMCID: PMC11068306 DOI: 10.1212/nxi.0000000000200249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 03/13/2024] [Indexed: 05/04/2024]
Abstract
OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disease rarely associated with malignancy. We report the clinical, MRI, immunopathology, and treatment response in a person with MOGAD and melanoma. METHODS This is a case report of a person with a multidisciplinary evaluation at a tertiary referral center. RESULTS A 52-year-old man presented with progressive encephalomyelitis that led to identification of metastatic melanoma. Investigations revealed positive MOG-IgG at high titers in serum (1:1,000; normal, <1:20) and CSF (1:4,096; normal, <1:2). MRI demonstrated multifocal T2 lesions with enhancement in the brain and spine. Brain biopsy showed demyelination and inflammation. MOG immunostaining was not present in the tumor tissue. He initially improved with methylprednisolone, plasmapheresis, prolonged oral steroid taper, and cancer-directed treatment with BRAF and MEK 1/2 inhibitors, but then developed bilateral optic neuritis. IV immunoglobulin (IVIG) was initiated. Five months later, he developed metastases and immune checkpoint inhibitor (ICI) treatment was started, which precipitated optic neuritis and myelitis despite IVIG and prednisone. Tocilizumab, an interleukin-6 receptor blocker, was started with excellent and sustained clinical and radiologic response. DISCUSSION This case revealed a presentation of MOGAD concurrent with melanoma without tumor MOG immunostaining. We highlight tocilizumab as a dual-purpose treatment of MOGAD and the neurologic immune-related adverse effect of ICI.
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Affiliation(s)
- Stephanie B Syc-Mazurek
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Hannah Zhao-Fleming
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Yong Guo
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Nanthaya Tisavipat
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - John J Chen
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Anastasia Zekeridou
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Ioannis Kournoutas
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Jacob J Orme
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Matthew S Block
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Claudia F Lucchinetti
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Rafid Mustafa
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
| | - Eoin P Flanagan
- From the Departments of Neurology (S.B.S.-M., H.Z.-F., Y.G., N.T., J.J.C., A.Z., C.F.L., R.M., E.P.F.), Ophthalmology (J.J.C.), Internal Medicine (I.K.), and Oncology (J.J.O., M.S.B.), Mayo Clinic, Rochester, MN; and Neurology (C.F.L.), University of Texas at Austin
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Tisavipat N, Stiebel-Kalish H, Palevski D, Bialer OY, Moss HE, Chaitanuwong P, Padungkiatsagul T, Henderson AD, Sotirchos ES, Singh S, Salman AR, Tajfirouz DA, Chodnicki KD, Pittock SJ, Flanagan EP, Chen JJ. Acute Optic Neuropathy in Older Adults: Differentiating Between MOGAD Optic Neuritis and Nonarteritic Anterior Ischemic Optic Neuropathy. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200214. [PMID: 38547435 DOI: 10.1212/nxi.0000000000200214] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 01/12/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND OBJECTIVES Myelin oligodendrocyte glycoprotein antibody-associated disease optic neuritis (MOGAD-ON) and nonarteritic anterior ischemic optic neuropathy (NAION) can cause acute optic neuropathy in older adults but have different managements. We aimed to determine differentiating factors between MOGAD-ON and NAION and the frequency of serum MOG-IgG false positivity among patients with NAION. METHODS In this international, multicenter, case-control study at tertiary neuro-ophthalmology centers, patients with MOGAD presenting with unilateral optic neuritis as their first attack at age 45 years or older and age-matched and sex-matched patients with NAION were included. Comorbidities, clinical presentations, acute optic disc findings, optical coherence tomography (OCT) findings, and outcomes were compared between MOGAD-ON and NAION. Multivariate analysis was performed to find statistically significant predictors of MOGAD-ON. A separate review of consecutive NAION patients seen at Mayo Clinic, Rochester, from 2018 to 2022, was conducted to estimate the frequency of false-positive MOG-IgG in this population. RESULTS Sixty-four patients with unilateral MOGAD-ON were compared with 64 patients with NAION. Among patients with MOGAD-ON, the median age at onset was 56 (interquartile range [IQR] 50-61) years, 70% were female, and 78% were White. Multivariate analysis showed that eye pain was strongly associated with MOGAD-ON (OR 32.905; 95% CI 2.299-473.181), while crowded optic disc (OR 0.033; 95% CI 0.002-0.492) and altitudinal visual field defect (OR 0.028; 95% CI 0.002-0.521) were strongly associated with NAION. On OCT, peripapillary retinal nerve fiber layer (pRNFL) thickness in unilateral MOGAD-ON was lower than in NAION (median 114 vs 201 μm, p < 0.001; median pRNFL thickening 25 vs 102 μm, p < 0.001). MOGAD-ON had more severe vision loss at nadir (median logMAR 1.0 vs 0.3, p < 0.001), but better recovery (median logMAR 0.1 vs 0.3, p = 0.002). In the cohort of consecutive NAION patients, 66/212 (31%) patients with NAION were tested for MOG-IgG and 8% (95% CI 1%-14%) of those had false-positive serum MOG-IgG at low titers. DISCUSSION Acute unilateral optic neuropathy with optic disc edema in older adults can be caused by either MOGAD-ON or NAION. Detailed history, the degree of pRNFL swelling on OCT, and visual outcomes can help differentiate the entities and prevent indiscriminate serum MOG-IgG testing in all patients with acute optic neuropathy.
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Affiliation(s)
- Nanthaya Tisavipat
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Hadas Stiebel-Kalish
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Dahlia Palevski
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Omer Y Bialer
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Heather E Moss
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pareena Chaitanuwong
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Tanyatuth Padungkiatsagul
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Amanda D Henderson
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elias S Sotirchos
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Shonar Singh
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Abdul-Rahman Salman
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Deena A Tajfirouz
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Kevin D Chodnicki
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology (N.T., D.A.T., S.J.P., E.P.F., J.J.C.); Center for MS and Autoimmune Neurology (N.T., S.J.P., E.P.F., J.J.C.), Mayo Clinic, Rochester, MN; Neuro-Ophthalmology Division (H.S.-K., D.P., O.Y.B.), Department of Ophthalmology, Rabin Medical Center and Faculty of Medicine; Felsenstein Medical Research Center (H.S.-K.), Tel Aviv University, Israel; Department of Neurology and Neurological Sciences (H.E.M.); Department of Ophthalmology (H.E.M., P.C.), Stanford University, Palo Alto, CA; Department of Ophthalmology (P.C.), Rajavithi Hospital; Department of Ophthalmology (T.P.), Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Department of Neurology (A.D.H., E.S.S.), Johns Hopkins University; Department of Ophthalmology (A.D.H., S.S.), Johns Hopkins University School of Medicine, Baltimore, MD; George Washington University School of Medicine and Health Sciences (A.-R.S.), Washington, DC; Department of Ophthalmology (D.A.T., K.D.C., J.J.C.); and Department of Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
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3
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Pinto E Vairo F, Kemppainen JL, Vitek CRR, Whalen DA, Kolbert KJ, Sikkink KJ, Kroc SA, Kruisselbrink T, Shupe GF, Knudson AK, Burke EM, Loftus EC, Bandel LA, Prochnow CA, Mulvihill LA, Thomas B, Gable DM, Graddy CB, Garzon GGM, Ekpoh IU, Porquera EMC, Fervenza FC, Hogan MC, El Ters M, Warrington KJ, Davis JM, Koster MJ, Orandi AB, Basiaga ML, Vella A, Kumar S, Creo AL, Lteif AN, Pittock ST, Tebben PJ, Abate EG, Joshi AY, Ristagno EH, Patnaik MS, Schimmenti LA, Dhamija R, Sabrowsky SM, Wierenga KJ, Keddis MT, Samadder NJJ, Presutti RJ, Robinson SI, Stephens MC, Roberts LR, Faubion WA, Driscoll SW, Wong-Kisiel LC, Selcen D, Flanagan EP, Ramanan VK, Jackson LM, Mauermann ML, Ortega VE, Anderson SA, Aoudia SL, Klee EW, McAllister TM, Lazaridis KN. Correction: Implementation of genomic medicine for rare disease in a tertiary healthcare system: Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD). J Transl Med 2024; 22:400. [PMID: 38689323 PMCID: PMC11061992 DOI: 10.1186/s12967-024-05185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024] Open
Affiliation(s)
- Filippo Pinto E Vairo
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Kemppainen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Denise A Whalen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kayla J Kolbert
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kaitlin J Sikkink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sarah A Kroc
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Teresa Kruisselbrink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gabrielle F Shupe
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alyssa K Knudson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth M Burke
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elle C Loftus
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lorelei A Bandel
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Lindsay A Mulvihill
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Dale M Gable
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Courtney B Graddy
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Idara U Ekpoh
- Center for Individualized Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Mireille El Ters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | | | - Amir B Orandi
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Basiaga
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ana L Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter J Tebben
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Avni Y Joshi
- Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth H Ristagno
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal S Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Radhika Dhamija
- Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
| | | | - Klaas J Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Mira T Keddis
- Division of Nephrology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Michael C Stephens
- Department of Pediatric Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Duygu Selcen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Sarah A Anderson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Eric W Klee
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Tammy M McAllister
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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4
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Redenbaugh V, Fryer JP, Cacciaguerra L, Chen JJ, Greenwood TM, Gilligan M, Thakolwiboon S, Majed M, Chia NH, McKeon A, Mills JR, Lopez Chiriboga AS, Tillema JM, Yang B, Abdulrahman Y, Guo K, Vorasoot N, Valencia Sanchez C, Tajfirouz DA, Toledano M, Zekeridou A, Dubey D, Gombolay GY, Caparó-Zamalloa C, Kister I, Pittock SJ, Flanagan EP. Diagnostic Utility of MOG Antibody Testing in Cerebrospinal Fluid. Ann Neurol 2024. [PMID: 38591875 DOI: 10.1002/ana.26931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/09/2024] [Accepted: 03/15/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE The aim of this study was to assess the diagnostic utility of cerebrospinal fluid (CSF) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) testing. METHODS We retrospectively identified patients for CSF MOG-IgG testing from January 1, 1996, to May 1, 2023, at Mayo Clinic and other medical centers that sent CSF MOG-IgG for testing including: controls, 282; serum MOG-IgG positive MOG antibody-associated disease (MOGAD), 74; serum MOG-IgG negative high-risk phenotypes, 73; serum false positive MOG-IgG with alternative diagnoses, 18. A live cell-based assay assessed CSF MOG-IgG positivity (IgG-binding-index [IBI], ≥2.5) using multiple anti-human secondary antibodies and end-titers were calculated if sufficient sample volume. Correlation of CSF MOG-IgG IBI and titer was assessed. RESULTS The pan-IgG Fc-specific secondary was optimal, yielding CSF MOG-IgG sensitivity of 90% and specificity of 98% (Youden's index 0.88). CSF MOG-IgG was positive in: 4/282 (1.4%) controls; 66/74 (89%) serum MOG-IgG positive MOGAD patients; and 9/73 (12%) serum MOG-IgG negative patients with high-risk phenotypes. Serum negative but CSF positive MOG-IgG accounted for 9/83 (11%) MOGAD patients, and all fulfilled 2023 MOGAD diagnostic criteria. Subgroup analysis of serum MOG-IgG low-positives revealed CSF MOG-IgG positivity more in MOGAD (13/16[81%]) than other diseases with false positive serum MOG-IgG (3/15[20%]) (p = 0.01). CSF MOG-IgG IBI and CSF MOG-IgG titer (both available in 29 samples) were correlated (Spearman's r = 0.64, p < 0.001). INTERPRETATION CSF MOG-IgG testing has diagnostic utility in patients with a suspicious phenotype but negative serum MOG-IgG, and those with low positive serum MOG-IgG results and diagnostic uncertainty. These findings support a role for CSF MOG-IgG testing in the appropriate clinical setting. ANN NEUROL 2024.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - James P Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Laura Cacciaguerra
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John J Chen
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Tammy M Greenwood
- Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michael Gilligan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Neurology, St Vincent's University Hospital, Dublin, Ireland
| | - Smathorn Thakolwiboon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Masoud Majed
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nicholas H Chia
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | | | - Jan-Mendelt Tillema
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Binxia Yang
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Yahya Abdulrahman
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Kai Guo
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Nisa Vorasoot
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | | | - Deena A Tajfirouz
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Ophthalmology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Michel Toledano
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Grace Y Gombolay
- Emory University, Children's Healthcare of Atlanta: Pediatrics Institute, Atlanta, Georgia, USA
| | - César Caparó-Zamalloa
- Basic Research Center in Dementia and Central Nervous System Demyelinating Diseases, Instituto Nacional de Ciencias Neurológicas, Lima, Peru
| | - Ilya Kister
- Department of Neurology, Comprehensive MS Center, NYU Grossman School of Medicine, New York, New York, USA
| | - Sean J Pittock
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology and Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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5
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Gupta P, Paul P, Redenbaugh V, Guo Y, Lucchinetti C, Abdulrahman Y, Datta A, Shah S, Klein CJ, Pittock SJ, Flanagan EP, Dubey D. Peripheral nervous system manifestations of MOG antibody associated disease. Ann Clin Transl Neurol 2024; 11:1046-1052. [PMID: 38234084 PMCID: PMC11021676 DOI: 10.1002/acn3.52001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/26/2023] [Accepted: 12/30/2023] [Indexed: 01/19/2024] Open
Abstract
Recent studies have reported the involvement of peripheral nervous system (PNS) in association with MOG-IgG, including isolated neuropathies. In this retrospective study we characterized the PNS involvement in MOG antibody associated disease (MOGAD). Six out of 215 MOGAD patients had PNS involvement (all polyradiculopathy) that occurred concurrently with a CNS demyelinating episode. We also demonstrated MOG expression in healthy human controls' proximal nerve root. Nine patients with true-positive MOG-IgG1 had PNS involvement temporally unrelated to a CNS demyelinating event. All these patients had an alternate etiology of PNS involvement. Isolated peripheral neuropathy is not a feature of MOGAD, but inflammatory nerve root involvement can occur concurrently with CNS demyelinating events.
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Affiliation(s)
- Pranjal Gupta
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Pritikanta Paul
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Vyanka Redenbaugh
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Yong Guo
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Claudia Lucchinetti
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Yahya Abdulrahman
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Abhigyan Datta
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Shailee Shah
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Christopher J. Klein
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Sean J. Pittock
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Eoin P. Flanagan
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
| | - Divyanshu Dubey
- Departments of Laboratory Medicine and PathologyMayo Clinic College of MedicineRochesterMinnesotaUSA
- Department of NeurologyMayo Clinic College of MedicineRochesterMinnesotaUSA
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6
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Hagbohm C, Ouellette R, Flanagan EP, Jonsson DI, Piehl F, Banwell B, Wickström R, Iacobaeus E, Granberg T, Ineichen BV. Clinical and neuroimaging phenotypes of autoimmune glial fibrillary acidic protein astrocytopathy: A systematic review and meta-analysis. Eur J Neurol 2024:e16284. [PMID: 38506182 DOI: 10.1111/ene.16284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 03/21/2024]
Abstract
OBJECTIVE This study was undertaken to provide a comprehensive review of neuroimaging characteristics and corresponding clinical phenotypes of autoimmune glial fibrillary acidic protein astrocytopathy (GFAP-A), a rare but severe neuroinflammatory disorder, to facilitate early diagnosis and appropriate treatment. METHODS A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis)-conforming systematic review and meta-analysis was performed on all available data from January 2016 to June 2023. Clinical and neuroimaging phenotypes were extracted for both adult and paediatric forms. RESULTS A total of 93 studies with 681 cases (55% males; median age = 46, range = 1-103 years) were included. Of these, 13 studies with a total of 535 cases were eligible for the meta-analysis. Clinically, GFAP-A was often preceded by a viral prodromal state (45% of cases) and manifested as meningitis, encephalitis, and/or myelitis. The most common symptoms were headache, fever, and movement disturbances. Coexisting autoantibodies (45%) and neoplasms (18%) were relatively frequent. Corticosteroid treatment resulted in partial/complete remission in a majority of cases (83%). Neuroimaging often revealed T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities (74%) as well as perivascular (45%) and/or leptomeningeal (30%) enhancement. Spinal cord abnormalities were also frequent (49%), most commonly manifesting as longitudinally extensive myelitis. There were 88 paediatric cases; they had less prominent neuroimaging findings with lower frequencies of both T2/FLAIR hyperintensities (38%) and contrast enhancement (19%). CONCLUSIONS This systematic review and meta-analysis provide high-level evidence for clinical and imaging phenotypes of GFAP-A, which will benefit the identification and clinical workup of suspected cases. Differential diagnostic cues to distinguish GFAP-A from common clinical and imaging mimics are provided as well as suitable magnetic resonance imaging protocol recommendations.
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Affiliation(s)
- Caroline Hagbohm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Eoin P Flanagan
- Department of Neurology, Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Dagur I Jonsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurophysiology, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Piehl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Neurology, Academic Specialist Centre, Karolinska University Hospital, Stockholm, Sweden
| | - Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ronny Wickström
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Ellen Iacobaeus
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Benjamin V Ineichen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Reproducible Science, University of Zürich, Zürich, Switzerland
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7
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Kelly MJ, Grant E, Murchison AG, Binks S, Ramanathan S, Michael S, Handel AE, Handunnetthi L, Uy CE, Soltys JN, Dubey D, Day GS, Lopez-Chiriboga AS, Flanagan EP, Sheerin F, Irani SR. Magnetic Resonance Imaging Characteristics of LGI1-Antibody and CASPR2-Antibody Encephalitis. JAMA Neurol 2024:2816477. [PMID: 38497971 PMCID: PMC10949153 DOI: 10.1001/jamaneurol.2024.0126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Importance Rapid and accurate diagnosis of autoimmune encephalitis encourages prompt initiation of immunotherapy toward improved patient outcomes. However, clinical features alone may not sufficiently narrow the differential diagnosis, and awaiting autoantibody results can delay immunotherapy. Objective To identify simple magnetic resonance imaging (MRI) characteristics that accurately distinguish 2 common forms of autoimmune encephalitis, LGI1- and CASPR2-antibody encephalitis (LGI1/CASPR2-Ab-E), from 2 major differential diagnoses, viral encephalitis (VE) and Creutzfeldt-Jakob disease (CJD). Design, Setting, and Participants This cross-sectional study involved a retrospective, blinded analysis of the first available brain MRIs (taken 2000-2022) from 192 patients at Oxford University Hospitals in the UK and Mayo Clinic in the US. These patients had LGI1/CASPR2-Ab-E, VE, or CJD as evaluated by 2 neuroradiologists (discovery cohort; n = 87); findings were validated in an independent cohort by 3 neurologists (n = 105). Groups were statistically compared with contingency tables. Data were analyzed in 2023. Main Outcomes and Measures MRI findings including T2 or fluid-attenuated inversion recovery (FLAIR) hyperintensities, swelling or volume loss, presence of gadolinium contrast enhancement, and diffusion-weighted imaging changes. Correlations with clinical features. Results Among 192 participants with MRIs reviewed, 71 were female (37%) and 121 were male (63%); the median age was 66 years (range, 19-92 years). By comparison with VE and CJD, in LGI1/CASPR2-Ab-E, T2 and/or FLAIR hyperintensities were less likely to extend outside the temporal lobe (3/42 patients [7%] vs 17/18 patients [94%] with VE; P < .001, and 3/4 patients [75%] with CJD; P = .005), less frequently exhibited swelling (12/55 [22%] with LGI1/CASPR2-Ab-E vs 13/22 [59%] with VE; P = .003), and showed no diffusion restriction (0 patients vs 16/22 [73%] with VE and 8/10 [80%] with CJD; both P < .001) and rare contrast enhancement (1/20 [5%] vs 7/17 [41%] with VE; P = .01). These findings were validated in an independent cohort and generated an area under the curve of 0.97, sensitivity of 90%, and specificity of 95% among cases with T2/FLAIR hyperintensity in the hippocampus and/or amygdala. Conclusions and Relevance In this study, T2 and/or FLAIR hyperintensities confined to the temporal lobes, without diffusion restriction or contrast enhancement, robustly distinguished LGI1/CASPR2-Ab-E from key differential diagnoses. These observations should assist clinical decision-making toward expediting immunotherapy. Their generalizability to other forms of autoimmune encephalitis and VE should be examined in future studies.
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Affiliation(s)
- Mark J Kelly
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
- Department of Physiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Eleanor Grant
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Andrew G Murchison
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sophie Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Sudarshini Ramanathan
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Translational Neuroimmunology Group, Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Department of Neurology, Concord Hospital, Sydney, Australia
| | - Sophia Michael
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
- Department of Neurology, Queen Elizabeth Hospital, Birmingham, United Kingdom
| | - Adam E Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Lahiru Handunnetthi
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
| | - Christopher E Uy
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
- Division of Neurology, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - John N Soltys
- Department of Neurosciences, Mayo Clinic, Jacksonville, Florida
| | | | - Gregory S Day
- Department of Neurosciences, Mayo Clinic, Jacksonville, Florida
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
| | | | | | - Fintan Sheerin
- Department of Radiology, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom
- Department of Neurosciences, Mayo Clinic, Jacksonville, Florida
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
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Mangioris G, Halfdanarson TR, Lennon VA, Chang BK, Dubey D, Dyck PJB, Flanagan EP, McKeon A, Mills JR, Pittock SJ, Zekeridou A. Neurological autoimmunity in patients with non-pulmonary neuroendocrine neoplasms: clinical manifestations and neural autoantibody profiles. Eur J Neurol 2024:e16273. [PMID: 38466015 DOI: 10.1111/ene.16273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 02/16/2024] [Accepted: 02/21/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND AND PURPOSE Paraneoplastic neurological autoimmunity is well described with small-cell lung cancer, but information is limited for other neuroendocrine neoplasms (NENs). METHODS Adult patients with histopathologically confirmed non-pulmonary NENs, neurological autoimmunity within 5 years of NEN diagnosis, and neural antibody testing performed at the Mayo Clinic Neuroimmunology Laboratory (January 2008 to March 2023) were retrospectively identified. Control sera were available from patients with NENs without neurological autoimmunity (116). RESULTS Thirty-four patients were identified (median age 68 years, range 31-87). The most common primary tumor sites were pancreas (nine), skin (Merkel cell, eight), small bowel/duodenum (seven), and unknown (seven). Five patients received immune checkpoint inhibitor (ICI) therapy before symptom onset; symptoms preceded cancer diagnosis in 62.1% of non-ICI-treated patients. The most frequent neurological phenotypes (non-ICI-treated) were movement disorders (12; cerebellar ataxia in 10), dysautonomia (six), peripheral neuropathy (eight), encephalitis (four), and neuromuscular junction disorders (four). Neural antibodies were detected in 55.9% of patients studied (most common specificities: P/Q-type voltage-gated calcium channel [seven], muscle-type acetylcholine receptor [three], anti-neuronal nuclear antibody type 1 [three], and neuronal intermediate filaments [two]), but in only 6.9% of controls. Amongst patients receiving cancer or immunosuppressive therapy, 51.6% had partial or complete recovery. Outcomes were unfavorable in 48.3% (non-ICI-treated) and neural autoantibody positivity was associated with poor neurological outcome. DISCUSSION Neurological autoimmunity associated with non-pulmonary NENs is often multifocal and can be treatment responsive, underscoring the importance of rapid recognition and early treatment.
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Affiliation(s)
- Georgios Mangioris
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Vanda A Lennon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Immunology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryce K Chang
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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9
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Kraker JA, Xu SC, Flanagan EP, Foster R, Wang F, Chen JJ. Ocular Manifestations of Multiple Sclerosis: A Population-Based Study. J Neuroophthalmol 2024:00041327-990000000-00593. [PMID: 38457238 DOI: 10.1097/wno.0000000000002116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2024]
Abstract
BACKGROUND To evaluate the population-based frequency and severity of multiple sclerosis (MS)-related ocular diseases. METHODS Retrospective, population-based study examining patients with MS between January 1, 1998 and December 31, 2011. Patients were identified using the Rochester Epidemiology Project, which is a record-linkage system of medical records for all patient-physician encounters among Olmsted County, Minnesota residents. Diagnosis of MS was confirmed based on neuroimaging, cerebrospinal fluid studies, and serum studies for each patient according to the 2017 McDonald criteria. Patient data were obtained using the medical records and followed through April 1, 2018. RESULTS Of the 116 patients with MS, 66% were female and the median age of onset was 36 years (interquartile range 27.5-43.5 years). About half (61/116, 53%) had MS-related neuro-ophthalmic manifestations during their disease course, and about one-fourth (33/116, 28%) had visual symptoms as their presenting symptom of MS, most commonly as optic neuritis (26/116, 22%). Optic neuritis was the leading MS-related ocular condition (37%), followed by internuclear ophthalmoplegia (16%) and nystagmus (13%). Optic neuritis was mostly unilateral (40/43, 93%), with 16% (6/43) having a visual acuity of 20/200 or worse at nadir but ultimately 95% (35/37) improving to a visual acuity of 20/40 or better. CONCLUSIONS This study provides the population-based frequency of MS-related ocular disease, which demonstrates a high frequency of ocular manifestations in MS both at disease onset and during the disease course, emphasizing the utility of neuro-ophthalmologists, or collaboration between neurologists and ophthalmologists, in the care of patients with MS.
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Affiliation(s)
- Jessica A Kraker
- Department of Ophthalmology (JAK, SCX, RF, FW, JJC), Mayo Clinic Hospital, Rochester, Minnesota; and Department of Neurology (EPF, JJC), Mayo Clinic Hospital, Rochester, Minnesota
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10
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Flanagan EP. Aspergillus myelitis: Breaking the mold to make a diagnosis. Mult Scler 2024:13524585241237385. [PMID: 38450617 DOI: 10.1177/13524585241237385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
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11
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Budhram A, Irani SR, Flanagan EP. Looking Beyond Syndrome-Based Criteria for Autoimmune Encephalitis-The Need for Complementary Neural Antibody-Based Diagnostic Criteria. JAMA Neurol 2024; 81:227-228. [PMID: 38147324 DOI: 10.1001/jamaneurol.2023.4894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
This Viewpoint discusses how neural antibody–based diagnostic criteria for autoimmune encephalitis would complement the syndrome-based diagnostic algorithm to improve sensitivity while maintaining high specificity.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada
- Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Sarosh R Irani
- Department of Neurology, Mayo Clinic, Jacksonville, Florida
- Department of Neuroscience, Mayo Clinic, Jacksonville, Florida
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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12
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Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
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Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
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13
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Carta S, Dinoto A, Capobianco M, Valentino P, Montarolo F, Sala A, Reindl M, Lo Re M, Chiodega V, Branger P, Audoin B, Aboab J, Papeix C, Collongues N, Kerschen P, Zephir H, Créange A, Bourre B, Schanda K, Flanagan EP, Redenbaugh V, Villacieros-Álvarez J, Arrambide G, Cobo-Calvo A, Ferrari S, Marignier R, Mariotto S. Serum Biomarker Profiles Discriminate AQP4 Seropositive and Double Seronegative Neuromyelitis Optica Spectrum Disorder. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200188. [PMID: 38134369 PMCID: PMC10753928 DOI: 10.1212/nxi.0000000000200188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/10/2023] [Indexed: 12/24/2023]
Abstract
BACKGROUND AND OBJECTIVES Glial fibrillary acidic protein (GFAP) and neurofilament light chain (NfL) serum levels are useful to define disease activity in different neurologic conditions. These biomarkers are increased in patients with aquaporin-4 antibody-positive NMOSD (AQP4+NMOSD) during clinical attacks suggesting a concomitant axonal and glial damage. However, there are contradictory results in double seronegative NMOSD (DS-NMOSD). The aim of this study was to characterize the neuronal, axonal, and glial damage of DS-NMOSD in comparison with AQP4+NMOSD. METHODS Patients with DS-NMOSD (i.e., for AQP4 and myelin oligodendrocyte glycoprotein antibodies-MOG-Abs) and age-matched AQP4+NMOSD diagnosed according to the latest diagnostic criteria and with available serum samples obtained within 3 months from onset/relapse were retrospectively enrolled from 14 international centers. Clinical and radiologic data were collected. Serum NfL, GFAP, tau, and UCH-L1 levels were determined using an ultrasensitive paramagnetic bead-based ELISA (SIMOA). Statistical analysis was performed using nonparametric tests and receiver-operating characteristic (ROC) curve analysis. RESULTS We included 25 patients with AQP4+NMOSD and 26 with DS-NMOSD. The median age at disease onset (p = 0.611) and female sex predominance (p = 0.072) were similar in the 2 groups. The most common syndromes at sampling in both AQP4+NMOSD and DS-NMOSD were myelitis (56% vs 38.5%) and optic neuritis (34.6% vs 32%), with no statistical differences (p = 0.716). Median EDSS at sampling was 3.2 (interquartile range [IQR] 2-7.7) in the AQP4+NMOSD group and 4 (IQR [3-6]) in the DS-NMOSD group (p = 0.974). Serum GFAP, tau, and UCH-L1 levels were higher in patients with AQP4+NMOSD compared with those with DS-NMOSD (median 308.3 vs 103.4 pg/mL p = 0.001; median 1.2 vs 0.5 pg/mL, p = 0.001; and median 61.4 vs 35 pg/mL, p = 0.006, respectively). The ROC curve analysis showed that GFAP, tau, and UCH-L1, but not NfL, values were able to discriminate between AQP4+ and DS-NMOSD (area under the curve (AUC) tau: 0.782, p = 0.001, AUC GFAP: 0.762, p = 0.001, AUC UCH-L1: 0.723, p = 0.006). NfL levels were associated with EDSS at nadir only in patients with AQP4+NMOSD. DISCUSSION Serum GFAP, tau, and UCH-L1 levels discriminate between AQP4+NMOSD and DS-NMOSD. The different biomarker profile of AQP4+NMOSD vs DS-NMOSD suggests heterogeneity of diseases within the latter category and provides useful data to improve our understanding of this disease.
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Affiliation(s)
- Sara Carta
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Alessandro Dinoto
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Marco Capobianco
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Paola Valentino
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Francesca Montarolo
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Arianna Sala
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Markus Reindl
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Marianna Lo Re
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Vanessa Chiodega
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Pierre Branger
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Bertrand Audoin
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Jennifer Aboab
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Caroline Papeix
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Nicolas Collongues
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Philippe Kerschen
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Helene Zephir
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Alain Créange
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Bertrand Bourre
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Kathrin Schanda
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Eoin P Flanagan
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Vyanka Redenbaugh
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Javier Villacieros-Álvarez
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Georgina Arrambide
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Alvaro Cobo-Calvo
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Sergio Ferrari
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Romain Marignier
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
| | - Sara Mariotto
- From the Department of Neuroscience, Biomedicine, and Movement Science (S.C., A.D., V.C., S.M., S.F.), University of Verona; S. Croce e Carle Hospital (M.C.), Cuneo; CRESM Biobank (M.C.), Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (P.V., M.L.R.); CRESM Biobank (P.V., M.L.R.), University Hospital San Luigi, Orbassano; Neurobiology Laboratory, Department of Neurology (A.S.), University Hospital San Luigi, Orbassano; Neuroscience Institute Cavalieri Ottolenghi (NICO) (F.M.), University of Turin, Italy; Clinical Department of Neurology (M.R., K.S.), Innsbruck Medical University, Austria; Department of Neurology (P.B.), CHU de Caen Normandie; Department of Neurology (B.A.), Pôle de Neurosciences Cliniques, APHM, Hôpital de la Timone, Aix Marseille University; Department of Internal Medecine (J.A.), Centre Hospitalier National des Quinze-Vingts, Paris Cedex; Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (C.P.), Institut du Cerveau, CIC Neuroscience, ICM, Hôpital de la Pitié Salpêtrière, Sorbonne Université, Paris; Service de Neurologie and CIC INSERM 1434 (N.C.), CHU de Strasbourg, France; Centre Hospitalier de Luxembourg (P.K.), Luxembourg City, Luxemburg; Department of Neurology (H.Z.), U 1172, CRC-SEP, University Hospital of Lille, France; Service de Neurologie (A.C.), Centre de Ressources et de Compétences-Sclérose en Plaques, Assistance Publique des Hôpitaux de Paris, Groupe Hospitalier Henri Mondor, Université Paris-Est Créteil, Créteil; Department of Neurology (B.B.), Rouen University Hospital, France; Mayo Clinic College of Medicine and Science (E.P.F., V.R.), Department of Neurology, Department of Laboratory Medicine and Pathology, Rochester; Centre d'Esclerosi Múltiple de Catalunya (J.V.-Á., G.A., A.C.-C.), (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Servei de Neurologia-Neuroimmunologia, Barcelona; and Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle (R.M.), Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, France
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14
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Budhram A, Flanagan EP. Optimizing the diagnostic performance of neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice. Handb Clin Neurol 2024; 200:365-382. [PMID: 38494290 DOI: 10.1016/b978-0-12-823912-4.00002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
The detection of neural antibodies in patients with paraneoplastic and autoimmune encephalitis has majorly advanced the diagnosis and management of neural antibody-associated diseases. Although testing for these antibodies has historically been restricted to specialized centers, assay commercialization has made this testing available to clinical chemistry laboratories worldwide. This improved test accessibility has led to reduced turnaround time and expedited diagnosis, which are beneficial to patient care. However, as the utilization of these assays has increased, so too has the need to evaluate how they perform in the clinical setting. In this chapter, we discuss assays for neural antibody detection that are in routine use, draw attention to their limitations and provide strategies to help clinicians and laboratorians overcome them, all with the aim of optimizing neural antibody testing for paraneoplastic and autoimmune encephalitis in clinical practice.
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Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, ON, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, ON, Canada.
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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15
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Montalvo M, Flanagan EP. Paraneoplastic/autoimmune myelopathies. Handb Clin Neurol 2024; 200:193-201. [PMID: 38494277 DOI: 10.1016/b978-0-12-823912-4.00017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Paraneoplastic myelopathies are a rare but important category of myelopathy. They usually present with an insidious or subacute progressive neurologic syndrome. Risk factors include tobacco use and family history of cancer. Cerebrospinal fluid analysis usually shows lymphocytic pleocytosis with elevated protein. MRI findings suggest that paraneoplastic myelopathies include longitudinally extensive T2 hyperintensities that are tract-specific and accompanied by enhancement, but spinal MRIs can also be normal. The most commonly associated neural antibodies include amphiphysin and collapsin-response-mediator-protein-5 (CRMP5/anti-CV2) antibodies with lung and breast cancers being the most frequent oncologic accompaniments. The differential diagnosis of paraneoplastic myelopathies includes nutritional deficiency myelopathy (B12, copper) as well as autoimmune/inflammatory conditions such as primary progressive multiple sclerosis or spinal cord sarcoidosis. Patients treated with immune checkpoint inhibitors for cancer may develop myelitis, that can be considered along the spectrum of paraneoplastic myelopathies. Management of paraneoplastic myelopathy includes oncologic treatment and immunotherapy. Despite these treatments, the prognosis is poor and the majority of patients eventually become wheelchair-dependent.
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Affiliation(s)
- Mayra Montalvo
- Department of Neurology, University of Florida, Gainesville, FL, United States
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States.
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16
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Elsbernd P, Cacciaguerra L, Krecke KN, Chen JJ, Gritsch D, Lopez-Chiriboga AS, Sechi E, Redenbaugh V, Morris PP, Carter JL, Wingerchuk DM, Tillema JM, Valencia-Sanchez C, Thakolwiboon S, Pittock SJ, Flanagan EP. Cerebral enhancement in MOG antibody-associated disease. J Neurol Neurosurg Psychiatry 2023; 95:14-18. [PMID: 37221051 PMCID: PMC10679850 DOI: 10.1136/jnnp-2023-331137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/08/2023] [Indexed: 05/25/2023]
Abstract
INTRODUCTION Limited data exist on brain MRI enhancement in myelin-oligodendrocyte-glycoprotein (MOG) antibody-associated disease (MOGAD) and differences from aquaporin-4-IgG-positive-neuromyelitis-optica-spectrum-disorder (AQP4+NMOSD), and multiple sclerosis (MS). METHODS In this retrospective observational study, we identified 122 Mayo Clinic MOGAD patients (1 January 1996-1 July 2020) with cerebral attacks. We explored enhancement patterns using a discovery set (n=41). We assessed enhancement frequency and Expanded Disability Status Scale scores at nadir and follow-up in the remainder (n=81). Two raters assessed T1-weighted-postgadolinium MRIs (1.5T/3T) for enhancement patterns in MOGAD, AQP4+NMOSD (n=14) and MS (n=26). Inter-rater agreement was assessed. Leptomeningeal enhancement clinical correlates were analysed. RESULTS Enhancement occurred in 59/81 (73%) MOGAD cerebral attacks but did not influence outcome. Enhancement was often patchy/heterogeneous in MOGAD (33/59 (56%)), AQP4+NMOSD (9/14 (64%); p=0.57) and MS (16/26 (62%); p=0.63). Leptomeningeal enhancement favoured MOGAD (27/59 (46%)) over AQP4+NMOSD (1/14 (7%); p=0.01) and MS (1/26 (4%); p<0.001) with headache, fever and seizures frequent clinical correlates. Ring enhancement favoured MS (8/26 (31%); p=0.006) over MOGAD (4/59 (7%)). Linear ependymal enhancement was unique to AQP4+NMOSD (2/14 (14%)) and persistent enhancement (>3 months) was rare (0%-8%) across all groups. Inter-rater agreement for enhancement patterns was moderate. CONCLUSIONS Enhancement is common with MOGAD cerebral attacks and often has a non-specific patchy appearance and rarely persists beyond 3 months. Leptomeningeal enhancement favours MOGAD over AQP4+NMOSD and MS.
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Affiliation(s)
- Paul Elsbernd
- Department of Neurology, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Laura Cacciaguerra
- Department of Neurology, Vita-Salute San Raffaele University, Milano, Italy
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Karl N Krecke
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
| | - David Gritsch
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
- Department of Neurology, Mass General Brigham Inc, Boston, Massachusetts, USA
| | | | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | | | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of pediatrics, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Rode MM, Itoh C, Martinez-Sosa S, Ebner BA, Chang BK, Flanagan EP, Pinto MV. Systematic approach to diagnosing suspected Creutzfeldt-Jakob disease. BMJ Case Rep 2023; 16:e255174. [PMID: 38061853 PMCID: PMC10711900 DOI: 10.1136/bcr-2023-255174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
Evaluation of rapidly progressive dementia (RPD) is usually challenging. In most cases, patients progress to dementia in weeks to months, and the differential diagnosis is broad. In this case, a woman in her 60s presented with a 1-month history of episodic vertigo, cognitive decline, ataxia and myoclonus. Cerebrospinal fluid total tau was markedly elevated, which was helpful in establishing the diagnosis and discussing prognosis/end-of-life measures with the patient's family. This case summarises a stepwise diagnostic approach for patients with RPD and highlights recent literature on biomarkers of Creutzfeldt-Jakob disease and autoimmune encephalitis.
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Affiliation(s)
- Matthew M Rode
- Mayo Clinic Alix School of Medicine, Rochester, Minnesota, USA
| | | | | | - Blake A Ebner
- Department of Pathology, Mayo Clinic, Rochester, MN, USA
| | - Bryce K Chang
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marcus V Pinto
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Cohen DA, Tajfirouz D, Vodopivec I, Kyle K, Bouffard MA, Bhattacharyya S, Douglas VC, Rasool N, Bhatti MT, McKeon A, Pittock S, Flanagan EP, Prasad S, Nagagopal V, Egan RA, Chen JJ, Chwalisz BK. Fluorescein Angiography Findings in Susac Syndrome: A Multicenter Retrospective Case Series. J Neuroophthalmol 2023; 43:481-490. [PMID: 37075250 DOI: 10.1097/wno.0000000000001826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
BACKGROUND Susac syndrome is a vasculopathy, resulting in the classic triad of branch retinal artery occlusion (BRAO), inner ear ischemia, and brain ischemia. In this retrospective chart review, we characterize fluorescein angiography (FA) findings and other ancillary studies in Susac syndrome, including the appearance of persistent disease activity and the occurrence of new subclinical disease on FA. METHODS This multicenter, retrospective case series was institutional review board-approved and included patients with the complete triad of Susac syndrome evaluated with FA, contrasted MRI of the brain, and audiometry from 2010 to 2020. The medical records were reviewed for these ancillary tests, along with demographics, symptoms, visual acuity, visual field defects, and findings on fundoscopy. Clinical relapse was defined as any objective evidence of disease activity during the follow-up period after initial induction of clinical quiescence. The main outcome measure was the sensitivity of ancillary testing, including FA, MRI, and audiometry, to detect relapse. RESULTS Twenty of the 31 (64%) patients had the complete triad of brain, retinal, and vestibulocochlear involvement from Susac syndrome and were included. Median age at diagnosis was 43.5 years (range 21-63), and 14 (70%) were women. Hearing loss occurred in 20 (100%), encephalopathy in 13 (65%), vertigo in 15 (75%), and headaches in 19 (95%) throughout the course of follow-up. Median visual acuity at both onset and final visit was 20/20 in both eyes. Seventeen (85%) had BRAO at baseline, and 10 (50%) experienced subsequent BRAO during follow-up. FA revealed nonspecific leakage from previous arteriolar damage in 20 (100%), including in patients who were otherwise in remission. Of the 11 episodes of disease activity in which all testing modalities were performed, visual field testing/fundoscopy was abnormal in 4 (36.4%), MRI brain in 2 (18.2%), audiogram in 8 (72.7%), and FA in 9 (81.8%). CONCLUSIONS New leakage on FA is the most sensitive marker of active disease. Persistent leakage represents previous damage, whereas new areas of leakage suggest ongoing disease activity that requires consideration of modifying immunosuppressive therapy.
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Affiliation(s)
- Devon A Cohen
- Cleveland Clinic (DAC), Cleveland, Ohio; Mayo Clinic (DT, MTB, AM, SP, EPF, JJC), Rochester, Minnesota; Roche (IV), Basel, Switzerland; Massachusetts General Hospital (KK, VN, BKC), Boston, Massachusetts; Beth Israel Deaconess (MAB), Boston, Massachusetts; Brigham and Women's Hospital (SB, SP), Boston, Massachusetts; UCSF (VD, NR), San Francisco, California; and Eye and Vascular Neurology (RE), Carlton, Oregon
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Samadzadeh S, Olesen MN, Wirenfeldt M, Möller S, Misu T, Soelberg K, Frederiksen JL, Heegaard S, Mariotto S, Fujihara K, Ruprecht K, Andersen TL, Marignier R, Lillevang ST, Flanagan EP, Pittock SJ, Kim HJ, Bennett JL, Paul F, Sorensen GL, Weinshenker BG, Lassmann H, Asgari N. Microfibrillar-associated protein 4 as a potential marker of acute relapse in inflammatory demyelinating diseases of the central nervous system: Pathological and clinical aspects. Mult Scler 2023; 29:1721-1735. [PMID: 37830484 PMCID: PMC10880047 DOI: 10.1177/13524585231200720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Microfibrillar-associated protein 4 (MFAP4) is an extracellular matrix protein not previously described in the human central nervous system (CNS). OBJECTIVES We determined MFAP4 CNS expression and measured cerebrospinal fluid (CSF) and serum levels. METHODS Tissue was sampled at autopsy from patients with acute multiple sclerosis (MS) (n = 3), progressive MS (n = 3), neuromyelitis optica spectrum disorder (NMOSD) (n = 2), and controls (n = 9), including 6 healthy controls (HC). MFAP4 levels were measured in 152 patients: 49 MS, 62 NMOSD, 22 myelin oligodendrocyte glycoprotein-associated disease (MOGAD), and 19 isolated optic neuritis (ION). RESULTS MFAP4 localized to meninges and vascular/perivascular spaces, intense in the optic nerve. At sites of active inflammation, MFAP4 reactivity was reduced in NMOSD and acute MS and less in progressive MS. CSF MFAP4 levels were reduced during relapse and at the onset of diseases (mean U/mL: MS 14.3, MOGAD 9.7, and ION 14.6 relative to HC 17.9. (p = 0.013, p = 0.000, and p = 0.019, respectively). Patients with acute ON (n = 68) had reduced CSF MFAP4 (mean U/mL: 14.5, p = 0.006). CSF MFAP4 levels correlated negatively with relapse severity (rho = -0.41, p = 0.017). CONCLUSION MFAP4 immunoreactivity was reduced at sites of active inflammation. CSF levels of MFAP4 were reduced following relapse and may reflect disease activity.
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Affiliation(s)
- Sara Samadzadeh
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Mads Nikolaj Olesen
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Neurology, Slagelse Hospital, Slagelse, Denmark/Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Martin Wirenfeldt
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Pathological Anatomy and Molecular Biology, Hospital South West Jutland, Esbjerg, Denmark
| | - Sören Möller
- Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kerstin Soelberg
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Jette Lautrup Frederiksen
- Danish Multiple Sclerosis Center, Department of Neurology, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | - Steffen Heegaard
- Departments of Ophthalmology and Pathology, Rigshospitalet, Glostrup, Denmark
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, Verona, Italy
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan
- Multiple Sclerosis and Neuromyelitis Optica Center, Southern Tohoku Research Institute for Neuroscience, Koriyama, Japan
| | - Klemens Ruprecht
- Department of Neurology, Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Levin Andersen
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
- Department of Pathology, Odense University Hospital, Odense, Denmark
| | - Romain Marignier
- Service de Neurologie, Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, Lyon, France
| | | | - Eoin P Flanagan
- Department Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, Republic of Korea
| | - Jeffrey L Bennett
- Department of Neurology & Ophthalmology, Programs in Neuroscience & Immunology University of Colorado, Anschutz, CO, USA
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Grith Lykke Sorensen
- Cancer and Inflammation, Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark
| | | | - Hans Lassmann
- Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Nasrin Asgari
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Molecular Medicine, University of Southern Denmark, Odense, Denmark Department of Neurology, Slagelse Hospital, Slagelse, Denmark
- Open Patient Data Explorative Network, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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20
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Li X, Krecke KN, Weinshenker BG, Clarke MJ, Zekeridou A, Toledano M, Flanagan EP. Hemicord White Matter Enhancement and the Croissant Sign in Cervical Spondylotic Myelopathy. Neurology 2023; 101:968-969. [PMID: 37648534 PMCID: PMC10663031 DOI: 10.1212/wnl.0000000000207793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/06/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Xiaoyang Li
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN
| | - Karl N Krecke
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN
| | - Brian G Weinshenker
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN
| | - Michelle J Clarke
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN
| | - Anastasia Zekeridou
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN
| | - Michel Toledano
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology (X.L., A.Z., M.T., E.P.F.), and Department of Radiology (K.N.K.), Mayo Clinic, Rochester, MN; Department of Neurology (B.G.W.), University of Virginia, Charlottesville; and Department of Neurosurgery (M.J.C.), and Department of Laboratory Medicine and Pathology (A.Z., E.P.F.), Mayo Clinic, Rochester, MN.
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21
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Griffin KJ, Toledano M, Flanagan EP, Mustafa R. "Trident Sign" in Primary CNS B-Cell Spinal Cord Lymphoma. Neurology 2023; 101:857-858. [PMID: 37648533 PMCID: PMC10662997 DOI: 10.1212/wnl.0000000000207671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 06/05/2023] [Indexed: 09/01/2023] Open
Affiliation(s)
- Kim J Griffin
- From the Department of Neurology (K.J.G., M.T., R.M.); and Neurology and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic Rochester
| | - Michel Toledano
- From the Department of Neurology (K.J.G., M.T., R.M.); and Neurology and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic Rochester
| | - Eoin P Flanagan
- From the Department of Neurology (K.J.G., M.T., R.M.); and Neurology and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic Rochester
| | - Rafid Mustafa
- From the Department of Neurology (K.J.G., M.T., R.M.); and Neurology and Laboratory Medicine and Pathology (E.P.F.), Mayo Clinic Rochester.
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22
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Mustafa R, Flanagan EP, Duffy DJ, Weinshenker BG, Soldán MMP, Kunchok A, Kaisey M, Solomon AJ. Laboratory evaluation for the differential diagnosis of possible multiple sclerosis in the United States: A physician survey. J Neurol Sci 2023; 453:120781. [PMID: 37688999 DOI: 10.1016/j.jns.2023.120781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND There is limited evidence and lack of guidelines for diagnostic laboratory evaluation of patients with possible multiple sclerosis (MS). OBJECTIVE To survey neurologists on their practice of laboratory testing in patients with possible MS. METHODS An online survey was developed to query the frequency of serum and cerebrospinal fluid (CSF) studies ordered in the routine evaluation of patients with possible MS, and in three hypothetical clinical cases. Non-MS specialist neurologists who evaluate patients for MS in their practice were invited to participate by MedSurvey (a medical market research company). RESULTS The survey was completed by 190 neurologists. A mean of 17.2 (SD: 17.0) tests in serum and CSF were reported "always" ordered in the evaluation of patients with possible MS. CSF oligoclonal bands was the most frequently selected ("always" among 73.7% of participants). Antinuclear antibody (43.2%), erythrocyte sedimentation rate (34.2%), and thyroid stimulating hormone (31.6%) were also among the most frequently ordered. DISCUSSION Extensive laboratory evaluations are often completed in the evaluation of possible MS. However, many of these tests have poor specificity and false positive results could yield unnecessary increased costs, diagnostic delay, and potentially misdiagnosis. Further research is needed to identify optimal laboratory approaches for possible MS.
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Affiliation(s)
- Rafid Mustafa
- Departments of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA.
| | - Eoin P Flanagan
- Departments of Neurology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Dustin J Duffy
- Biostatistics, Mayo Clinic College of Medicine & Science, Rochester, MN, USA
| | - Brian G Weinshenker
- Department of Neurology, University of Virginia Health, Charlottesville, VA, USA
| | - M Mateo Paz Soldán
- Department of Neurology, University of Utah Health, Salt Lake City, UT, USA
| | - Amy Kunchok
- Department of Neurology, Mellen Center for Multiple Sclerosis, Cleveland Clinic and Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Marwa Kaisey
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at The University of Vermont Medical Center, Burlington, VT, USA
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23
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Hasan S, Zorio O, Keegan BM, Weinshenker BG, Flanagan EP, Tobin WO, Kantarci OH, Toledano M, Pittock SJ, Lopez-Chiriboga S, Zekeridou A, Valencia-Sanchez C. Frequency of demyelinating disease activity following immune checkpoint inhibitor cancer immunotherapy. J Neurol 2023; 270:4707-4712. [PMID: 37597071 DOI: 10.1007/s00415-023-11933-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/03/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Shemonti Hasan
- Department of Neurology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Onilia Zorio
- Department of Neurology, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - B Mark Keegan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - Brian G Weinshenker
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - W Oliver Tobin
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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24
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Majed M, Valencia Sanchez C, Bennett JL, Fryer J, Mulligan MD, Redenbaugh V, McKeon A, Mills JR, Wingerchuk DM, Lennon VA, Weinshenker B, Chen JJ, Flanagan EP, Pittock SJ, Kunchok A. Alterations in Aquaporin-4-IgG Serostatus in 986 Patients: A Laboratory-Based Longitudinal Analysis. Ann Neurol 2023; 94:727-735. [PMID: 37314750 DOI: 10.1002/ana.26722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/05/2023] [Accepted: 06/08/2023] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was undertaken to investigate factors associated with aquaporin-4 (AQP4)-IgG serostatus change using a large serological database. METHODS This retrospective study utilizes Mayo Clinic Neuroimmunology Laboratory data from 2007 to 2021. We included all patients with ≥2 AQP4-IgG tests (by cell-based assay). The frequency and clinical factors associated with serostatus change were evaluated. Multivariable logistic regression analysis examined whether age, sex, or initial titer was associated with serostatus change. RESULTS There were 933 patients who had ≥2 AQP4-IgG tests with an initial positive result. Of those, 830 (89%) remained seropositive and 103 (11%) seroreverted to negative. Median interval to seroreversion was 1.2 years (interquartile range [IQR] = 0.4-3.5). Of those with sustained seropositivity, titers were stable in 92%. Seroreversion was associated with age ≤ 20 years (odds ratio [OR] = 2.25; 95% confidence interval [CI] = 1.09-4.63; p = 0.028) and low initial titer of ≤1:100 (OR = 11.44, 95% CI = 3.17-41.26, p < 0.001), and 5 had clinical attacks despite seroreversion. Among 62 retested after seroreversion, 50% returned to seropositive (median = 224 days, IQR = 160-371). An initial negative AQP4-IgG test occurred in 9,308 patients. Of those, 99% remained seronegative and 53 (0.3%) seroconverted at a median interval of 0.76 years (IQR = 0.37-1.68). INTERPRETATION AQP4-IgG seropositivity usually persists over time with little change in titer. Seroreversion to negative is uncommon (11%) and associated with lower titers and younger age. Seroreversion was often transient, and attacks occasionally occurred despite prior seroreversion, suggesting it may not reliably reflect disease activity. Seroconversion to positive is rare (<1%), limiting the utility of repeat testing in seronegative patients unless clinical suspicion is high. ANN NEUROL 2023;94:727-735.
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Affiliation(s)
- Masoud Majed
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - James Fryer
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Martin D Mulligan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Vyankya Redenbaugh
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - John R Mills
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | | | - Vanda A Lennon
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Immunology, Mayo Clinic, Rochester, MN, USA
| | - Brian Weinshenker
- Department of Neurology, University of Virginia, Charlottesville, VA, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
- Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Amy Kunchok
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
- Mellen Center for Multiple Sclerosis, Cleveland Clinic, Cleveland, OH, USA
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25
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Zara P, Dinoto A, Carta S, Floris V, Turilli D, Budhram A, Ferrari S, Milia S, Solla P, Mariotto S, Flanagan EP, Chiriboga ASL, Sechi E. Non-demyelinating disorders mimicking and misdiagnosed as NMOSD: a literature review. Eur J Neurol 2023; 30:3367-3376. [PMID: 37433584 PMCID: PMC10530555 DOI: 10.1111/ene.15983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/30/2023] [Accepted: 07/06/2023] [Indexed: 07/13/2023]
Abstract
BACKGROUND Differentiating neuromyelitis optica spectrum disorder (NMOSD) from its mimics is crucial to avoid misdiagnosis, especially in the absence of aquaporin-4-IgG. While multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein-IgG associated disease (MOGAD) represent major and well-defined differential diagnoses, non-demyelinating NMOSD mimics remain poorly characterized. METHODS We conducted a systematic review on PubMed/MEDLINE to identify reports of patients with non-demyelinating disorders that mimicked or were misdiagnosed as NMOSD. Three novel cases seen at the authors' institutions were also included. The characteristics of NMOSD mimics were analyzed and red flags associated with misdiagnosis identified. RESULTS A total of 68 patients were included; 35 (52%) were female. Median age at symptoms onset was 44 (range, 1-78) years. Fifty-six (82%) patients did not fulfil the 2015 NMOSD diagnostic criteria. The clinical syndromes misinterpreted for NMOSD were myelopathy (41%), myelopathy + optic neuropathy (41%), optic neuropathy (6%), or other (12%). Alternative etiologies included genetic/metabolic disorders, neoplasms, infections, vascular disorders, spondylosis, and other immune-mediated disorders. Common red flags associated with misdiagnosis were lack of cerebrospinal fluid (CSF) pleocytosis (57%), lack of response to immunotherapy (55%), progressive disease course (54%), and lack of magnetic resonance imaging gadolinium enhancement (31%). Aquaporin-4-IgG positivity was detected in five patients by enzyme-linked immunosorbent assay (n = 2), cell-based assay (n = 2: serum, 1; CSF, 1), and non-specified assay (n = 1). CONCLUSIONS The spectrum of NMOSD mimics is broad. Misdiagnosis frequently results from incorrect application of diagnostic criteria, in patients with multiple identifiable red flags. False aquaporin-4-IgG positivity, generally from nonspecific testing assays, may rarely contribute to misdiagnosis.
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Affiliation(s)
- Pietro Zara
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Sara Carta
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Valentina Floris
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Davide Turilli
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London, Ontario, Canada
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Stefania Milia
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Paolo Solla
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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26
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Cacciaguerra L, Redenbaugh V, Chen JJ, Morris P, Sechi E, Syc-Mazurek SB, Lopez-Chiriboga AS, Tillema JM, Rocca MA, Filippi M, Pittock SJ, Flanagan EP. Timing and Predictors of T2-Lesion Resolution in Patients With Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Neurology 2023; 101:e1376-e1381. [PMID: 37336767 PMCID: PMC10558168 DOI: 10.1212/wnl.0000000000207478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/17/2023] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES To determine the timing and predictors of T2-lesion resolution in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS This retrospective observational study using standard-of-care data had inclusion criteria of MOGAD diagnosis, ≥2 MRIs 12 months apart, and ≥1 brain/spinal cord T2-lesion. The median (interquartile range [IQR]) number of MRIs (82% at disease onset) per-patient were: brain, 5 (2-8); spine, 4 (2-8). Predictors of T2-lesion resolution were assessed with age- and sex-adjusted generalized estimating equations and stratified by T2-lesion size (small <1 cm; large ≥1 cm). RESULTS We studied 583 T2-lesions (brain, 512 [88%]; spinal cord, 71 [12%]) from 55 patients. At last MRI (median follow-up 54 months [IQR 7-74]) 455 T2-lesions (78%) resolved. The median (IQR) time to resolution was 3 months (1.4-7.0). Small T2-lesions resolved more frequently and faster than large T2-lesions. Acute T1-hypointensity decreased the likelihood (odds ratio [95% CI]) of T2-lesion resolution independent of size (small: 0.23 [0.09-0.60], p = 0.002; large: 0.30 [0.16-0.55], p < 0.001), whereas acute steroids favored resolution of large T2-lesions (1.75 [1.01-3.03], p = 0.046). Notably, 32/55 (58%) T2-lesions resolved without treatment. DISCUSSION The high frequency of spontaneous T2-lesion resolution suggests that this represents MOGAD's natural history. The speed of T2-lesion resolution and influence of size, corticosteroids, and T1-hypointensity on this phenomenon gives insight into MOGAD pathogenesis.
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Affiliation(s)
- Laura Cacciaguerra
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Vyanka Redenbaugh
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pearse Morris
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elia Sechi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Stephanie B Syc-Mazurek
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Jan-Mendelt Tillema
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Maria A Rocca
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Massimo Filippi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., V.R., J.J.C., S.B.S.-M., J.-M.T., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Ophthalmology (J.J.C.), and Department of Radiology (P.M.), Mayo Clinic, Rochester, MN; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Neurology Unit (M.A.R., M.F.), Neurorehabilitation Unit (M.F.), and Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN.
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Fereidan‐Esfahani M, Decker PA, Weigand SD, Lopez Chiriboga AS, Flanagan EP, Tillema J, Lucchinetti CF, Eckel‐Passow JE, Tobin WO. Defining the natural history of tumefactive demyelination: A retrospective cohort of 257 patients. Ann Clin Transl Neurol 2023; 10:1544-1555. [PMID: 37443413 PMCID: PMC10502639 DOI: 10.1002/acn3.51844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
OBJECTIVE To describe demographic, clinical, and radiographic features of tumefactive demyelination (TD) and identify factors associated with severe attacks and poor outcomes. METHODS Retrospective review of TD cases seen at Mayo Clinic, 1990-2021. RESULTS Of 257 patients with TD, 183/257 (71%) fulfilled the 2017 multiple sclerosis (MS) McDonald criteria at the last follow-up, 12/257 (5%) had myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), 0 had aquaporin-4-IgG seropositive neuromyelitis optic spectrum disorders (AQP4+ NMOSD), and 62/257 (24%) were cryptogenic. Onset before age 18 was present in 18/257 (7%). Female to male ratio was 1.3:1. Cerebrospinal fluid oligoclonal (CSF) bands were present in 95/153 (62%). TD was the first demyelinating attack in 176/257 (69%). At presentation, 59/126 (47%) fulfilled Barkhof criteria for dissemination in space, 59/100 (59%) had apparent diffusion coefficient (ADC) restriction, and 57/126 (45%) had mass effect. Despite aggressive clinical presentation at onset, 181/257 (70%) of patients remained fully ambulatory (Expanded Disability Status Scale [EDSS] ≤4) after a 3.0-year median follow-up duration. Severe initial attack-related disability (EDSS ≥4) was more common in patients with motor symptoms (81/143 vs. 35/106, p < 0.0001), encephalopathy (20/143 vs. 2/106, p < 0.0001) and ADC restriction on initial MRI (42/63 vs. 15/33, p = 0.04). Poor long-term outcome (EDSS ≥4) was more common in patients with older onset age (41.9 ± 15 vs. 36.8 ± 15.6, p = 0.02) and motor symptoms at onset (49/76 vs. 66/171, p < 0.0001). INTERPRETATION Most TD patients should be considered part of the MS spectrum after excluding MOGAD and NMOSD. Motor symptoms and older age at presentation portend a poor outcome.
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Affiliation(s)
- Mahboubeh Fereidan‐Esfahani
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Dell Medical SchoolUniversity of TexasAustinTexasUSA
| | - Paul A Decker
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | - Stephen D. Weigand
- Department of Quantitative Health SciencesMayo ClinicRochesterMinnesotaUSA
| | | | - Eoin P Flanagan
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
- Department of Laboratory Medicine and PathologyMinneapolisMinnesotaUSA
| | - Jan‐Mendelt Tillema
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | - Claudia F Lucchinetti
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
| | | | - W. Oliver Tobin
- Department of NeurologyMayo ClinicRochesterMinnesotaUSA
- Center for Multiple Sclerosis and Autoimmune NeurologyMayo ClinicRochesterMinnesotaUSA
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28
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McCombe JA, Klassen BT, Flanagan EP, Teener JW, Zekeridou A, Pittock SJ, McKeon A. Eculizumab for the treatment of glycine receptor antibody associated stiff-person syndrome. J Neurol 2023; 270:4555-4557. [PMID: 37199764 PMCID: PMC10421785 DOI: 10.1007/s00415-023-11777-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/09/2023] [Accepted: 05/10/2023] [Indexed: 05/19/2023]
Affiliation(s)
- Jennifer A McCombe
- Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - James W Teener
- Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA.
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA.
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29
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McKeon A, Lesnick C, Vorasoot N, Buckley MW, Dasari S, Flanagan EP, Gilligan M, Lafrance-Corey R, Miske R, Pittock SJ, Scharf M, Yang B, Zekeridou A, Dubey D, Mills J. Utility of Protein Microarrays for Detection of Classified and Novel Antibodies in Autoimmune Neurologic Disease. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200145. [PMID: 37550073 PMCID: PMC10406426 DOI: 10.1212/nxi.0000000000200145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/01/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND AND OBJECTIVES Neural antibodies are detected by tissue-based indirect immunofluorescence assay (IFA) in Mayo Clinic's Neuroimmunology Laboratory practice, but the process of characterizing and validating novel antibodies is lengthy. We report our assessment of human protein arrays. METHODS Assessment of arrays (81% human proteome coverage) was undertaken using diverse known positive samples (17 serum and 14 CSF). Samples from patients with novel neural antibodies were reflexed from IFA to arrays. Confirmatory assays were cell-based (CBA) or line blot. Epitope mapping was undertaken using phage display immunoprecipitation sequencing (PhiPSeq). RESULTS Control positive samples known to be reactive with linear epitopes of intracellular antigens (e.g., ANNA-1 [anti-Hu]) were readily identified by arrays in 20 of 21 samples. By contrast, 10 positive controls known to be enriched with antibodies against cell surface protein conformational epitopes (e.g., GluN1 subunit of NMDA-R) were indistinguishable from background signal. Three antibodies, previously characterized by other investigators (but unclassified in our laboratory), were unmasked in 4 patients using arrays (July-December 2022): Neurexin-3α, 1 patient; regulator of gene protein signaling (RGS)8, 1 patient; and seizure-related homolog like 2 (SEZ6L2), 2 patients. All were accompanied by previously reported phenotypes (encephalitis, 1; cerebellar ataxia, 3). Patient 1 had subacute onset of seizures and encephalopathy. Neurexin-3α ranked high in CSF (second ranked neural protein) but low in serum (660th overall). Neurexin-3α CBA was positive in both samples. Patient 2 presented with rapidly progressive cerebellar ataxia. RGS8 ranked the highest neural protein in available CSF sample by array (third overall). RGS8-specific line blot was positive. Patients 3 and 4 had rapidly progressive cerebellar ataxia. SEZ6L2 was the highest ranked neural antigen by arrays in all samples (CSF, 1, serum, 2; Patient 3, ranked 9th overall in CSF, 11th in serum; Patient 4, 6th overall in serum]). By PhIPSeq, diverse neurexin-3α epitopes (including cell surface) were detected in CSF from patient 1, but no SEZ6L2 peptides were detected for serum or CSF samples from Patient 3. DISCUSSION Individualized autoimmune neurologic diagnoses may be accelerated using protein arrays. They are optimal for detection of intracellular antigen-reactive antibodies, though certain cell surface-directed antibodies (neurexin-3α and SEZ6L2) may also be detected.
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Affiliation(s)
- Andrew McKeon
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany.
| | - Connie Lesnick
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Nisa Vorasoot
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Monica W Buckley
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Surendra Dasari
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Eoin P Flanagan
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Michael Gilligan
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Reghann Lafrance-Corey
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Ramona Miske
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Sean J Pittock
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Madeleine Scharf
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Binxia Yang
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Anastasia Zekeridou
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - Divyanshu Dubey
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
| | - John Mills
- From the Departments of Laboratory Medicine and Pathology and Neurology (A.M., E.P.F., S.J.P., B.Y., A.Z., D.D.); Department of Laboratory Medicine and Pathology (C.L., N.V., M.G., R.L.-C., J.M.); Khon Kaen University (N.V.), Thailand; University of Virginia (M.W.B.); Division of Biomedical Statistics and Informatics (S.D.), Mayo Clinic, Rochester, MN; The Institute for Experimental Immunology (R.M., M.S.), affiliated to Euroimmun AG, Lubeck, Germany
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Chen B, Gomez-Figueroa E, Redenbaugh V, Francis A, Satukijchai C, Wu Y, Messina S, Sa M, Woodhall M, Paul F, Robertson NP, Lim M, Wassmer E, Kneen R, Huda S, Blain C, Halfpenny C, Hemingway C, O'Sullivan E, Hobart J, Fisniku LK, Martin RJ, Dobson R, Cooper SA, Williams V, Waters P, Chen JJ, Pittock SJ, Ramdas S, Leite MI, Flanagan EP, Geraldes R, Palace J. Do Early Relapses Predict the Risk of Long-Term Relapsing Disease in an Adult and Paediatric Cohort with MOGAD? Ann Neurol 2023; 94:508-517. [PMID: 37394961 DOI: 10.1002/ana.26731] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/21/2023] [Accepted: 05/31/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can be monophasic or relapsing, with early relapse being a feature. However, the relevance of early relapse on longer-term relapse risk is unknown. Here, we investigate whether early relapses increase longer-term relapse risk in patients with MOGAD. METHODS A retrospective analysis of 289 adult- and pediatric-onset patients with MOGAD followed for at least 2 years in 6 specialized referral centers. "Early relapses" were defined as attacks within the first 12 months from onset, with "very early relapses" defined within 30 to 90 days from onset and "delayed early relapses" defined within 90 to 365 days. "Long-term relapses" were defined as relapses beyond 12 months. Cox regression modeling and Kaplan-Meier survival analysis were used to estimate the long-term relapse risk and rate. RESULTS Sixty-seven patients (23.2%) had early relapses with a median number of 1 event. Univariate analysis revealed an elevated risk for long-term relapses if any "early relapses" were present (hazard ratio [HR] = 2.11, p < 0.001), whether occurring during the first 3 months (HR = 2.70, p < 0.001) or the remaining 9 months (HR = 1.88, p = 0.001), with similar results yielded in the multivariate analysis. In children with onset below aged 12 years, only delayed early relapses were associated with an increased risk of long-term relapses (HR = 2.64, p = 0.026). INTERPRETATION The presence of very early relapses and delayed early relapses within 12 months of onset in patients with MOGAD increases the risk of long-term relapsing disease, whereas a relapse within 90 days appears not to indicate a chronic inflammatory process in young pediatric-onset disease. ANN NEUROL 2023;94:508-517.
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Affiliation(s)
- Bo Chen
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Tongji Hospital of Tongji Medical College, Huazhong University of Science of Technology, Wuhan, China
| | - Enrique Gomez-Figueroa
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Department of Neurology, Civil Hospital of Guadalajara, University of Guadalajara, Guadalajara, Mexico
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN
| | - Anna Francis
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | | | - Yan Wu
- Department of Neurology, First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Silvia Messina
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Mario Sa
- Department of Paediatric Neurology, Oxford University NHS Foundation Trust, Oxford, UK
| | - Mark Woodhall
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Neil P Robertson
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité Universitaetsmedizin Berlin
| | - Ming Lim
- Department of Neurology, Division of Psychological Medicine and Clinical Neuroscience, Cardiff University, University Hospital of Wales, Cardiff, UK
- Children's Neuroscience Centre, Evelina London Children's Hospital, London, UK
| | - Evangeline Wassmer
- Women and Children's Department, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Rachel Kneen
- Department of Paediatric Neurology, Birmingham Women and Children's Hospital, Birmingham, UK
| | - Saif Huda
- Department of Paediatric Neurology, Alder Hey Children's NHS Foundation Trust and Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Camilla Blain
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Christopher Halfpenny
- Department of Neurology, St. George's University Hospitals National Health Service Foundation Trust, London, UK
| | - Cheryl Hemingway
- Department of Neurology, Southampton General Hospital, Southampton, UK
| | - Eoin O'Sullivan
- Department of Paediatric Neurology, Great Ormond St. Hospital for Children, London, UK
| | - Jeremy Hobart
- Department of Ophthalmology, King's College Hospital NHS Foundation Trust, London, UK
| | - Leonora K Fisniku
- Department of Neurology, University Hospitals Plymouth National Health Service Foundation Trust, Devon, UK
| | - Roswell J Martin
- Department of Neurosciences, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Ruth Dobson
- Department of Neurology, Gloucestershire Hospitals National Health Service Foundation Trust, Gloucestershire, UK
| | - Sarah A Cooper
- Preventive Neurology Unit, Queen Mary University London, London, UK
| | - Victoria Williams
- Department of Neurology, University Hospitals Sussex National Health Service Foundation Trust, Brighton, UK
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Diagnostic Laboratory, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - John J Chen
- Department of Neurology, Guy's and St. Thomas' National Health Service Foundation Trust, London, UK
| | - Sean J Pittock
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN
| | - Sithara Ramdas
- Centre MS and Autoimmune Neurology, Department Neurology, Mayo Clinic, Rochester, MN
- MDUK Neuromuscular Centre, Department of Paediatrics, University of Oxford, Oxford, UK
| | - Maria Isabel Leite
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
| | - Eoin P Flanagan
- Department of Paediatric Neurology, John Radcliffe Hospital, Oxford, UK
| | - Ruth Geraldes
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
- Neurology Department, Wexham Park Hospital, Frimley Foundation Health Trust, Slough, UK
| | - Jacqueline Palace
- Nuffield Department of Clinical Neurosciences, Oxford University Hospitals, Oxford, UK
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Smith KM, Britton JW, Thakolwiboon S, Chia NH, Gupta P, Flanagan EP, Zekeridou A, Lopez Chiriboga AS, Valencia Sanchez C, McKeon A, Pittock SJ, Dubey D. Seizure characteristics and outcomes in patients with neurological conditions related to high-risk paraneoplastic antibodies. Epilepsia 2023; 64:2385-2398. [PMID: 37366270 DOI: 10.1111/epi.17695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 06/28/2023]
Abstract
OBJECTIVE Seizures are a common manifestation of paraneoplastic neurologic syndromes. The objective of this study was to describe the seizure characteristics and outcomes in patients with high-risk paraneoplastic autoantibodies (>70% cancer association) and to determine factors associated with ongoing seizures. METHODS Patients from 2000 to 2020 with seizures and high-risk paraneoplastic autoantibodies were retrospectively identified. Factors associated with ongoing seizures at last follow-up were evaluated. RESULTS Sixty patients were identified (34 males, median age at presentation = 52 years). ANNA1-IgG (Hu; n = 24, 39%), Ma2-IgG (n = 14, 23%), and CRMP5-IgG (CV2; n = 11, 18%) were the most common underlying antibodies. Seizures were the initial presenting symptom in 26 (43%), and malignancy was present in 38 (63%). Seizures persisted for >1 month in 83%, and 60% had ongoing seizures, with almost all patients (55/60, 92%) still being on antiseizure medications at last follow-up a median of 25 months after seizure onset. Ongoing seizures at last follow-up were associated with Ma2-IgG or ANNA1-IgG compared to other antibodies (p = .04), highest seizure frequency being at least daily (p = .0002), seizures on electroencephalogram (EEG; p = .03), and imaging evidence of limbic encephalitis (LE; p = .03). Death occurred in 48% throughout the course of follow-up, with a higher mortality in patients with LE than in those without LE (p = .04). Of 31 surviving patients at last follow-up, 55% continued to have intermittent seizures. SIGNIFICANCE Seizures in the setting of high-risk paraneoplastic antibodies are frequently resistant to treatment. Ongoing seizures are associated with ANNA1-IgG and Ma2-IgG, high seizure frequency, and EEG and imaging abnormalities. Although a subset of patients may respond to immunotherapy and achieve seizure freedom, poor outcomes are frequently encountered. Death was more common among patients with LE.
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Affiliation(s)
- Kelsey M Smith
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Nicholas H Chia
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pranjal Gupta
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
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Lotan I, Chen JJ, Hacohen Y, Abdel-Mannan O, Mariotto S, Huda S, Gibbons E, Wilf-Yarkoni A, Hellmann MA, Stiebel-Kalish H, Pittock SJ, Flanagan EP, Molazadeh N, Anderson M, Salky R, Romanow G, Schindler P, Duchow AS, Paul F, Levy M. Intravenous immunoglobulin treatment for acute attacks in myelin oligodendrocyte glycoprotein antibody disease. Mult Scler 2023; 29:1080-1089. [PMID: 37431144 DOI: 10.1177/13524585231184738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
BACKGROUND The potential therapeutic benefit of intravenous immunoglobulins (IVIGs) for acute attacks of myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is unknown. OBJECTIVE The objective was to describe the outcomes of IVIG treatment for acute MOGAD attacks. METHODS A retrospective observational study involving seven tertiary neuroimmunology centers. Data collection included patients' demographics, Expanded Disability Status Scale (EDSS), and visual acuity (VA) before the attack, at the nadir of the attack before IVIG treatment, and at follow-up visits ⩾3 months after treatment. RESULTS Thirty-nine patients were included, of which 21 (53.8%) were female. The median age was 23 years (range 5-74 years), and the median disease duration was 4 months (range 0-93 months). The most common type of attack treated with IVIG was isolated optic neuritis (ON) (unilateral n = 14, bilateral n = 5, associated with transverse myelitis (TM), n = 1), followed by acute disseminated encephalomyelitis (ADEM) (n = 8), multifocal (n = 7), TM (n = 3), brainstem (n = 1), and other encephalitis (n = 1). A significant improvement in both the EDSS and VA measures was observed at follow-up compared to the time of IVIG treatment initiation (p < 0.0001 for both outcome measures). CONCLUSION IVIG may be an effective treatment option for acute MOGAD attacks. Further prospective studies are warranted to validate our results.
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Affiliation(s)
- Itay Lotan
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John J Chen
- Department of Ophthalmology and Neurology, Mayo Clinic, Rochester, MN, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Yael Hacohen
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Omar Abdel-Mannan
- Queen Square Multiple Sclerosis Centre, UCL Institute of Neurology, Faculty of Brain Sciences, University College London, London, UK
- Department of Neurology, Great Ormond Street Hospital for Children, London, UK
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Saif Huda
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Emily Gibbons
- Department of Neurology, Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Adi Wilf-Yarkoni
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mark A Hellmann
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadas Stiebel-Kalish
- Rabin Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Negar Molazadeh
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Monique Anderson
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rebecca Salky
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Gabriela Romanow
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Patrick Schindler
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ankelien Solveig Duchow
- Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, Berlin, Germany
- Department of Neurology, Charité - Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Friedemann Paul
- Charité - Universitätsmedizin Berlin, Freie Universität Berlin, Humboldt-Universität zu Berlin, NeuroCure Clinical Research Center, Berlin, Germany
- Max Delbrueck Center for Molecular Medicine, Experimental and Clinical Research Center, Berlin, Germany
| | - Michael Levy
- Neuroimmunology Clinic and Research Laboratory, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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Solomon AJ, Arrambide G, Brownlee WJ, Flanagan EP, Amato MP, Amezcua L, Banwell BL, Barkhof F, Corboy JR, Correale J, Fujihara K, Graves J, Harnegie MP, Hemmer B, Lechner-Scott J, Marrie RA, Newsome SD, Rocca MA, Royal W, Waubant EL, Yamout B, Cohen JA. Differential diagnosis of suspected multiple sclerosis: an updated consensus approach. Lancet Neurol 2023; 22:750-768. [PMID: 37479377 DOI: 10.1016/s1474-4422(23)00148-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/14/2023] [Accepted: 03/31/2023] [Indexed: 07/23/2023]
Abstract
Accurate diagnosis of multiple sclerosis requires careful attention to its differential diagnosis-many disorders can mimic the clinical manifestations and paraclinical findings of this disease. A collaborative effort, organised by The International Advisory Committee on Clinical Trials in Multiple Sclerosis in 2008, provided diagnostic approaches to multiple sclerosis and identified clinical and paraclinical findings (so-called red flags) suggestive of alternative diagnoses. Since then, knowledge of disorders in the differential diagnosis of multiple sclerosis has expanded substantially. For example, CNS inflammatory disorders that present with syndromes overlapping with multiple sclerosis can increasingly be distinguished from multiple sclerosis with the aid of specific clinical, MRI, and laboratory findings; studies of people misdiagnosed with multiple sclerosis have also provided insights into clinical presentations for which extra caution is warranted. Considering these data, an update to the recommended diagnostic approaches to common clinical presentations and key clinical and paraclinical red flags is warranted to inform the contemporary clinical evaluation of patients with suspected multiple sclerosis.
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Affiliation(s)
- Andrew J Solomon
- Department of Neurological Sciences, Larner College of Medicine at the University of Vermont, University Health Center, Burlington, VT, USA.
| | - Georgina Arrambide
- Servei de Neurologia-Neuroimmunologia, Centre d'Esclerosi Múltiple de Catalunya (Cemcat), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Wallace J Brownlee
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Eoin P Flanagan
- Departments of Neurology and Laboratory Medicine and Pathology and the Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Maria Pia Amato
- Department NEUROFARBA, University of Florence, Florence, Italy; IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | - Lilyana Amezcua
- Department of Neurology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Brenda L Banwell
- Department of Neurology, University of Pennsylvania, Division of Child Neurology, Philadelphia, PA, USA; Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Frederik Barkhof
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands; Queen Square Institute of Neurology and Centre for Medical Image Computing, University College London, London, UK
| | - John R Corboy
- Department of Neurology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jorge Correale
- Department of Neurology, Fleni Institute of Biological Chemistry and Physical Chemistry (IQUIFIB), Buenos Aires, Argentina; National Council for Scientific and Technical Research/University of Buenos Aires, Buenos Aires, Argentina
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Koriyama, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Jennifer Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | | | - Bernhard Hemmer
- Department of Neurology, Klinikum rechts der Isar, Medical Faculty, Technische Universität München, Munich, Germany; Munich Cluster for Systems Neurology, Munich, Germany
| | - Jeannette Lechner-Scott
- Department of Neurology, John Hunter Hospital, Newcastle, NSW Australia; Hunter Medical Research Institute Neurology, University of Newcastle, Newcastle, NSW, Australia
| | - Ruth Ann Marrie
- Departments of Internal Medicine and Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Scott D Newsome
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, Neurology Unit, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Walter Royal
- Department of Neurobiology and Neuroscience Institute, Morehouse School of Medicine, Atlanta, GA, USA
| | - Emmanuelle L Waubant
- Weill Institute for Neuroscience, University of California, San Francisco, San Francisco, CA, USA
| | - Bassem Yamout
- Neurology Institute, Harley Street Medical Center, Abu Dhabi, United Arab Emirates
| | - Jeffrey A Cohen
- Mellen Center for MS Treatment and Research, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Webb LM, Cacciaguerra L, Krecke KN, Chen JJ, Sechi E, Redenbaugh V, Dubey D, Pittock SJ, Flanagan EP. Marked central canal T2-hyperintensity in MOGAD myelitis and comparison to NMOSD and MS. J Neurol Sci 2023; 450:120687. [PMID: 37201267 PMCID: PMC10492002 DOI: 10.1016/j.jns.2023.120687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To assess marked central canal T2-hyperintensity in patients with myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) myelitis compared to myelitis patients with aquaporin-4-antibody-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS). MATERIAL/METHODS Two blinded raters evaluated spinal cord magnetic resonance imaging (MRIs) of myelitis patients with MOGAD (n = 63), AQP4 + NMOSD (n = 37), and MS (n = 26), assessing for marked central canal T2-hyperintensity and its evolution. If there were conflicting results, a third neurologist assessed the MRI. RESULTS Marked central canal T2-hyperintensity was more frequent in patients with MOGAD (18/63[29%]) than MS (1/26[4%]; p = 0.01) myelitis but did not differ from AQP4 + NMOSD (13/37[35%]; p = 0.49). Marked central canal T2-hyperintensity had completely resolved on follow-up axial MRI for most MOGAD (12/14[86%]) and AQP4 + NMOSD (10/10[100%]; p = 0.49) patients. CONCLUSIONS Marked central canal T2-hyperintensity is a common transient radiologic accompaniment of MOGAD and AQP4 + NMOSD myelitis, but not MS myelitis.
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Affiliation(s)
- Lauren M Webb
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Laura Cacciaguerra
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Karl N Krecke
- Department of Radiology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Department of Ophthalmology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Elia Sechi
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA.
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Meiling JB, Ha CT, Garlanger KL, Snider BA, Flanagan EP, Reeves RK. Inpatient rehabilitation outcomes in patients with the new diagnosis of COVID-19 tractopathy: a case series. Spinal Cord Ser Cases 2023; 9:25. [PMID: 37393353 DOI: 10.1038/s41394-023-00586-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Revised: 06/20/2023] [Accepted: 06/23/2023] [Indexed: 07/03/2023] Open
Abstract
STUDY DESIGN Retrospective Case Series. OBJECTIVES Describe the inpatient rehabilitation outcomes of four patients with COVID-19 tractopathy. SETTING Olmsted County, Minnesota, United States of America. METHODS Retrospective review of medical records was performed to collect patient data. RESULTS Four individuals (n = 4, 3 men and 1 woman, mean age 58.25 years [range 56-61]) completed inpatient rehabilitation during the COVID-19 pandemic. All presented after COVID-19 infection and were admitted to acute care with progressive paraparesis. None were able to ambulate on admission to acute care. All received extensive evaluations which were largely negative except for mildly elevated CSF protein and MRI findings of longitudinally extensive T2 hyperintensity signal changes in the lateral (n = 3) and dorsal (n = 1) columns. All patients experienced incomplete spastic paraparesis. All patients experienced neurogenic bowel dysfunction; a majority experienced neuropathic pain (n = 3); half experienced impaired proprioception (n = 2); and a minority experienced neurogenic bladder dysfunction (n = 1). Between rehabilitation admission and discharge, the median improvement in lower extremity motor score was 5 (0-28). All patients were discharged home, but only one was a functional ambulator at time of discharge. CONCLUSION While the underlying mechanism is yet to be elucidated, in rare cases a COVID-19 infection can lead to a tractopathy, presenting as weakness, sensory deficits, spasticity, neuropathic pain, and neurogenic bladder/bowel. Patients with COVID-19 tractopathy would benefit from inpatient rehabilitation to enhance their functional mobility and independence.
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Affiliation(s)
- James B Meiling
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
| | - Christopher T Ha
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | - Kristin L Garlanger
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | | | - Ronald K Reeves
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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36
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Tisavipat N, Chang BK, Ali F, Pittock SJ, Kammeyer R, Declusin A, Cohn SJ, Flanagan EP. Subacute Horizontal Diplopia, Jaw Dystonia, and Laryngospasm. Neurol Neuroimmunol Neuroinflamm 2023; 10:e200128. [PMID: 37311643 DOI: 10.1212/nxi.0000000000200128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 04/06/2023] [Indexed: 06/15/2023]
Abstract
Jaw dystonia and laryngospasm in the context of subacute brainstem dysfunction have been described in a small number of diseases, including antineuronal nuclear antibody type 2 (ANNA-2, also known as anti-Ri) paraneoplastic neurologic syndrome. Severe episodes of laryngospasms causing cyanosis are potentially fatal. Jaw dystonia can also cause eating difficulty, resulting in severe weight loss and malnutrition. In this report, we highlight the multidisciplinary management of this syndrome associated with ANNA-2/anti-Ri paraneoplastic neurologic syndrome and discuss its pathogenesis.
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Affiliation(s)
- Nanthaya Tisavipat
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Bryce K Chang
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Farwa Ali
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Sean J Pittock
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Ryan Kammeyer
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Anthony Declusin
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Samuel J Cohn
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO
| | - Eoin P Flanagan
- From the Department of Neurology (N.T., B.K.C., F.A., S.J.P., E.P.F.), Mayo Clinic, Rochester, MN; Childrens Hospital Colorado (R.K.); Anschutz Medical Campus (A.D.), University of Colorado; and Colorado Permanente Medical Group (S.J.C.), Denver, CO.
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Pinto E Vairo F, Kemppainen JL, Vitek CRR, Whalen DA, Kolbert KJ, Sikkink KJ, Kroc SA, Kruisselbrink T, Shupe GF, Knudson AK, Burke EM, Loftus EC, Bandel LA, Prochnow CA, Mulvihill LA, Thomas B, Gable DM, Graddy CB, Garzon GGM, Ekpoh IU, Porquera EMC, Fervenza FC, Hogan MC, El Ters M, Warrington KJ, Davis JM, Koster MJ, Orandi AB, Basiaga ML, Vella A, Kumar S, Creo AL, Lteif AN, Pittock ST, Tebben PJ, Abate EG, Joshi AY, Ristagno EH, Patnaik MS, Schimmenti LA, Dhamija R, Sabrowsky SM, Wierenga KJ, Keddis MT, Samadder NJJ, Presutti RJ, Robinson SI, Stephens MC, Roberts LR, Faubion WA, Driscoll SW, Wong-Kisiel LC, Selcen D, Flanagan EP, Ramanan VK, Jackson LM, Mauermann ML, Ortega VE, Anderson SA, Aoudia SL, Klee EW, McAllister TM, Lazaridis KN. Implementation of genomic medicine for rare disease in a tertiary healthcare system: Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD). J Transl Med 2023; 21:410. [PMID: 37353797 PMCID: PMC10288779 DOI: 10.1186/s12967-023-04183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/05/2023] [Indexed: 06/25/2023] Open
Abstract
BACKGROUND In the United States, rare disease (RD) is defined as a condition that affects fewer than 200,000 individuals. Collectively, RD affects an estimated 30 million Americans. A significant portion of RD has an underlying genetic cause; however, this may go undiagnosed. To better serve these patients, the Mayo Clinic Program for Rare and Undiagnosed Diseases (PRaUD) was created under the auspices of the Center for Individualized Medicine (CIM) aiming to integrate genomics into subspecialty practice including targeted genetic testing, research, and education. METHODS Patients were identified by subspecialty healthcare providers from 11 clinical divisions/departments. Targeted multi-gene panels or custom exome/genome-based panels were utilized. To support the goals of PRaUD, a new clinical service model, the Genetic Testing and Counseling (GTAC) unit, was established to improve access and increase efficiency for genetic test facilitation. The GTAC unit includes genetic counselors, genetic counseling assistants, genetic nurses, and a medical geneticist. Patients receive abbreviated point-of-care genetic counseling and testing through a partnership with subspecialty providers. RESULTS Implementation of PRaUD began in 2018 and GTAC unit launched in 2020 to support program expansion. Currently, 29 RD clinical indications are included in 11 specialty divisions/departments with over 142 referring providers. To date, 1152 patients have been evaluated with an overall solved or likely solved rate of 17.5% and as high as 66.7% depending on the phenotype. Noteworthy, 42.7% of the solved or likely solved patients underwent changes in medical management and outcome based on genetic test results. CONCLUSION Implementation of PRaUD and GTAC have enabled subspecialty practices advance expertise in RD where genetic counselors have not historically been embedded in practice. Democratizing access to genetic testing and counseling can broaden the reach of patients with RD and increase the diagnostic yield of such indications leading to better medical management as well as expanding research opportunities.
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Affiliation(s)
- Filippo Pinto E Vairo
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Kemppainen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carolyn R Rohrer Vitek
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Denise A Whalen
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kayla J Kolbert
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Kaitlin J Sikkink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Sarah A Kroc
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Teresa Kruisselbrink
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Gabrielle F Shupe
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Alyssa K Knudson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elizabeth M Burke
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Elle C Loftus
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Lorelei A Bandel
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Lindsay A Mulvihill
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Dale M Gable
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Courtney B Graddy
- Center for Individualized Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | - Idara U Ekpoh
- Center for Individualized Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | - Marie C Hogan
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Mireille El Ters
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | | | - John M Davis
- Division of Rheumatology, Mayo Clinic, Rochester, MN, USA
| | | | - Amir B Orandi
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Matthew L Basiaga
- Department of Pediatric Rheumatology, Mayo Clinic, Rochester, MN, USA
| | - Adrian Vella
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Ana L Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Aida N Lteif
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Siobhan T Pittock
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Peter J Tebben
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Avni Y Joshi
- Division of Pediatric Allergy and Immunology, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth H Ristagno
- Division of Pediatric Infectious Diseases, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mrinal S Patnaik
- Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Radhika Dhamija
- Department of Clinical Genomics, Mayo Clinic, Phoenix, AZ, USA
| | | | - Klaas J Wierenga
- Department of Clinical Genomics, Mayo Clinic, Jacksonville, FL, USA
| | - Mira T Keddis
- Division of Nephrology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Michael C Stephens
- Department of Pediatric Gastroenterology, Mayo Clinic, Rochester, MN, USA
| | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - William A Faubion
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sherilyn W Driscoll
- Division of Pediatric Rehabilitation Medicine, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | - Duygu Selcen
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Victor E Ortega
- Division of Respiratory Medicine, Mayo Clinic, Scottsdale, AZ, USA
| | - Sarah A Anderson
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | | | - Eric W Klee
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
- Department of Clinical Genomics, Mayo Clinic, Rochester, MN, USA
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Tammy M McAllister
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Konstantinos N Lazaridis
- Center for Individualized Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
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Yandamuri SS, Filipek B, Obaid AH, Lele N, Thurman JM, Makhani N, Nowak RJ, Guo Y, Lucchinetti CF, Flanagan EP, Longbrake EE, O'Connor KC. MOGAD patient autoantibodies induce complement, phagocytosis, and cellular cytotoxicity. JCI Insight 2023; 8:e165373. [PMID: 37097758 PMCID: PMC10393237 DOI: 10.1172/jci.insight.165373] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 04/20/2023] [Indexed: 04/26/2023] Open
Abstract
Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an inflammatory demyelinating CNS condition characterized by the presence of MOG autoantibodies. We sought to investigate whether human MOG autoantibodies are capable of mediating damage to MOG-expressing cells through multiple mechanisms. We developed high-throughput assays to measure complement activity (CA), complement-dependent cytotoxicity (CDC), antibody-dependent cellular phagocytosis (ADCP), and antibody-dependent cellular cytotoxicity (ADCC) of live MOG-expressing cells. MOGAD patient sera effectively mediate all of these effector functions. Our collective analyses reveal that (a) cytotoxicity is not incumbent on MOG autoantibody quantity alone; (b) engagement of effector functions by MOGAD patient serum is bimodal, with some sera exhibiting cytotoxic capacity while others did not; (c) the magnitude of CDC and ADCP is elevated closer to relapse, while MOG-IgG binding is not; and (d) all IgG subclasses can damage MOG-expressing cells. Histopathology from a representative MOGAD case revealed congruence between lesion histology and serum CDC and ADCP, and we identified NK cells, mediators of ADCC, in the cerebrospinal fluid of relapsing patients with MOGAD. Thus, MOGAD-derived autoantibodies are cytotoxic to MOG-expressing cells through multiple mechanisms, and assays quantifying CDC and ADCP may prove to be effective tools for predicting risk of future relapses.
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Affiliation(s)
- Soumya S Yandamuri
- Department of Neurology and
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Beata Filipek
- Department of Neurology and
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, USA
- Department of Pharmaceutical Microbiology and Biochemistry, Medical University of Lodz, Lodz, Poland
| | - Abeer H Obaid
- Department of Neurology and
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, USA
- Institute of Biomedical Studies, Baylor University, Waco, Texas, USA
| | | | - Joshua M Thurman
- Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Naila Makhani
- Department of Neurology and
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Yong Guo
- Department of Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia F Lucchinetti
- Department of Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eoin P Flanagan
- Department of Neurology and Center for MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Kevin C O'Connor
- Department of Neurology and
- Department of Immunobiology, Yale School of Medicine, New Haven, Connecticut, USA
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Redenbaugh V, Chia NH, Cacciaguerra L, McCombe JA, Tillema JM, Chen JJ, Chiriboga ASL, Sechi E, Hacohen Y, Pittock SJ, Flanagan EP. Comparison of MRI T2-lesion evolution in pediatric MOGAD, NMOSD, and MS. Mult Scler 2023; 29:799-808. [PMID: 37218499 PMCID: PMC10626581 DOI: 10.1177/13524585231166834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) T2-lesions resolve more often in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) than aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS) in adults but few studies analyzed children. OBJECTIVE The main objective of this study is to investigate MRI T2-lesion evolution in pediatric MOGAD, AQP4 + NMOSD, and MS. METHODS Inclusion criteria were as follows: (1) first clinical attack; (2) abnormal MRI (⩽6 weeks); (3) follow-up MRI beyond 6 months without relapses in that region; and (4) age < 18 years. An index T2-lesion (symptomatic/largest) was identified, and T2-lesion resolution or persistence on follow-up MRI was determined. RESULTS We included 56 patients (MOGAD, 21; AQP4 + NMOSD, 8; MS, 27) with 69 attacks. Index T2-lesion resolution was more frequent in MOGAD (brain 9 of 15 [60%]; spine 8 of 12 [67%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]) and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Resolution of all T2-lesions occurred more often in MOGAD (brain 6 of 15 [40%]; spine 7 of 12 [58%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]), and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Reductions in median index T2-lesion area were greater in MOGAD (brain, 305 mm; spine, 23 mm) than MS (brain, 42 mm [p<0.001]; spine, 10 mm [p<0.001]) without differing from AQP4 + NMOSD (brain, 133 mm [p=0.42]; spine, 19.5 mm [p=0.69]). CONCLUSION In children, MRI T2-lesions resolved more often in MOGAD than AQP4 + NMOSD and MS which is similar to adults suggesting these differences are related to pathogenesis rather than age.
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Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nicholas H. Chia
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura Cacciaguerra
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jennifer A. McCombe
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Neurology, Department of Medicine, University of Alberta, Alberta, Canada
| | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John J. Chen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, United Kingdom
| | - Sean J. Pittock
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Orozco E, Valencia-Sanchez C, Britton J, Dubey D, Flanagan EP, Lopez-Chiriboga AS, Zalewski N, Zekeridou A, Pittock SJ, McKeon A. Autoimmune Encephalitis Criteria in Clinical Practice. Neurol Clin Pract 2023; 13:e200151. [PMID: 37124463 PMCID: PMC10132262 DOI: 10.1212/cpj.0000000000200151] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/13/2023] [Indexed: 05/02/2023]
Abstract
Background and Objectives To assess the clinical practice applicability of autoimmune encephalitis (AE) criteria (2016). Methods Medical records of 538 adults diagnosed with AE or related autoimmune encephalopathy at Mayo Clinic (not including pure movement disorders) were reviewed and AE guideline criteria applied. Results Of 538 patients, 288 were male (52%). The median symptom onset age was 55 years (range, 11-97 years; 16 had onset as children). All had other non-AE diagnoses reasonably excluded. Of 538 patients, 361 (67%) met at least possible criteria, having all 3 of subacute onset; memory deficits, altered mental status or psychiatric symptoms, and ≥1 supportive feature (new focal objective CNS finding, N = 285; new-onset seizures, N = 283; supportive MRI findings, N = 251; or CSF pleocytosis, N = 160). Of 361 patients, AE subgroups were as follows: definite AE (N = 221, 61%, [87% AE-specific IgG positive]), probable seronegative AE (N = 18, 5%), Hashimoto encephalopathy (N = 20, 6%), or possible AE not otherwise categorizable (N = 102, 28%). The 221 patients with definite AE had limbic encephalitis (N = 127, 57%), anti-NMDA-R encephalitis (N = 32, 15%), ADEM (N = 8, 4%), or other AE-specific IgG defined (N = 54, 24%). The 3 most common definite AE-IgGs detected were as follows: LGI1 (76, 34%), NMDA-R (32, 16%), and high-titer GAD65 (23, 12%). The remaining 177 patients (33%) not meeting possible AE criteria had the following: seizures only (65, 12% of all 538 patients), brainstem encephalitis without supratentorial findings (55, 10%; none had Bickerstaff encephalitis), or other (57, 11%). Those 57 "others" lacked sufficient supportive clinical, radiologic, or CSF findings (N = 26), had insidious or initially episodic onset of otherwise typical disorders (N = 21), or had atypical syndromes without clearcut memory deficits, altered mental status, or psychiatric symptoms (N = 10). Fifteen of 57 were AE-specific IgG positive (26%). Among the remaining 42, evidence of other organ-specific autoimmunity (mostly thyroid) was encountered in 31 (74%, ≥1 coexisting autoimmune disease [21, 50%] or ≥1 non-AE-specific antibodies detected [23, 53%]), and all but 1 had an objective immunotherapy response (97%). Discussion The 2016 AE guidelines permit autoimmune causation assessment in subacute encephalopathy and are highly specific. Inclusion could be improved by incorporating AE-IgG-positive patients with isolated seizures or brainstem disorders. Some patients with atypical presentations but with findings supportive of autoimmunity may be immune therapy responsive.
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Affiliation(s)
- Emma Orozco
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Cristina Valencia-Sanchez
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Jeffrey Britton
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Divyanshu Dubey
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Eoin P Flanagan
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - A Sebastian Lopez-Chiriboga
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Nicholas Zalewski
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Anastasia Zekeridou
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Sean J Pittock
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
| | - Andrew McKeon
- Department of Laboratory Medicine and Pathology (EO, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; Department of Neurology (CV-S, NZ), Mayo Clinic, AZ; Department of Neurology (JB, DD, EPF, AZ, SJP, AM), Mayo Clinic, Rochester, MN; and Department of Neurology (ASL-C), Mayo Clinic, FL
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Flanagan EP, Waters PJ. Serum MOG-IgG titers should be performed routinely in the diagnosis and follow-up of MOGAD: No. Mult Scler 2023:13524585231172942. [PMID: 37227113 DOI: 10.1177/13524585231172942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Affiliation(s)
- Eoin P Flanagan
- Eoin P Flanagan Department of Neurology, Mayo Clinic, Rochester, MN, USA/Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Patrick J Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Chia NH, McKeon A, Dalakas MC, Flanagan EP, Bower JH, Klassen BT, Dubey D, Zalewski NL, Duffy D, Pittock SJ, Zekeridou A. Stiff person spectrum disorder diagnosis, misdiagnosis, and suggested diagnostic criteria. Ann Clin Transl Neurol 2023. [PMID: 37212351 DOI: 10.1002/acn3.51791] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 05/02/2023] [Indexed: 05/23/2023] Open
Abstract
BACKGROUND Stiff person spectrum disorder (SPSD) is heterogeneous, and accurate diagnosis can be challenging. METHODS Patients referred for diagnosis/suspicion of SPSD at the Mayo Autoimmune Neurology Clinic from July 01, 2016, to June 30, 2021, were retrospectively identified. SPSD diagnosis was defined as clinical SPSD manifestations confirmed by an autoimmune neurologist and seropositivity for high-titer GAD65-IgG (>20.0 nmol/L), glycine-receptor-IgG or amphiphysin-IgG, and/or confirmatory electrodiagnostic studies (essential if seronegative). Clinical presentation, examination, and ancillary testing were compared to differentiate SPSD from non-SPSD. RESULTS Of 173 cases, 48 (28%) were diagnosed with SPSD and 125 (72%) with non-SPSD. Most SPSD were seropositive (41/48: GAD65-IgG 28/41, glycine-receptor-IgG 12/41, amphiphysin-IgG 2/41). Pain syndromes or functional neurologic disorder were the most common non-SPSD diagnoses (81/125, 65%). SPSD patients more commonly reported exaggerated startle (81% vs. 56%, p = 0.02), unexplained falls (76% vs. 46%, p = 0.001), and other associated autoimmunity (50% vs. 27%, p = 0.005). SPSD more often had hypertonia (60% vs. 24%, p < 0.001), hyperreflexia (71% vs. 43%, p = 0.001), and lumbar hyperlordosis (67% vs. 9%, p < 0.001) and less likely functional neurologic signs (6% vs. 33%, p = 0.001). SPSD patients more frequently had electrodiagnostic abnormalities (74% vs. 17%, p < 0.001), and at least moderate symptomatic improvement with benzodiazepines (51% vs. 16%, p < 0.001) or immunotherapy (45% vs. 13% p < 0.001). Only 4/78 non-SPSD patients who received immunotherapy had alternative neurologic autoimmunity. INTERPRETATION Misdiagnosis was threefold more common than confirmed SPSD. Functional or non-neurologic disorders accounted for most misdiagnoses. Clinical and ancillary testing factors can reduce misdiagnosis and exposure to unnecessary treatments. SPSD diagnostic criteria are suggested.
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Affiliation(s)
- Nicholas H Chia
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Marinos C Dalakas
- Department of Neurology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Neuroimmunology Unit, National and Kapodistrian University of Athens, Athens, Greece
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - James H Bower
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bryan T Klassen
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nicholas L Zalewski
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Dustin Duffy
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, Minnesota, USA
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Rizzo SA, Flanagan EP, Trejo-Lopez JA, Toledano M, Chia NH. Clinical Reasoning: New-Onset Diplopia and Headache in a Patient With Metastatic Breast Cancer. Neurology 2023; 100:927-931. [PMID: 36805434 PMCID: PMC10186217 DOI: 10.1212/wnl.0000000000206856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 12/07/2022] [Indexed: 02/22/2023] Open
Affiliation(s)
- Skylar A Rizzo
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
| | - Jorge A Trejo-Lopez
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
| | - Michel Toledano
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN.
| | - Nicholas H Chia
- From the Mayo Clinic Medical Scientist Training Program (S.A.R.); Department of Neurology (E.P.F., M.T., N.H.C.) and Department of Laboratory Medicine and Pathology (E.P.F., J.A.T.-L.), Mayo Clinic, Rochester, MN
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Valencia-Sanchez C, Sechi E, Dubey D, Flanagan EP, McKeon A, Pittock SJ, Zekeridou A. Immune Checkpoint Inhibitor Associated Central Nervous System Autoimmunity. Eur J Neurol 2023. [PMID: 37151179 DOI: 10.1111/ene.15835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 03/08/2023] [Accepted: 04/11/2023] [Indexed: 05/09/2023]
Abstract
BACKGROUND Outcome and re-challenge data of central nervous system (CNS) autoimmunity triggered by immune checkpoint inhibitors (ICI) are limited. We aim to describe a large series of ICI-triggered CNS-autoimmunity, and to compare these patients with spontaneous paraneoplastic syndromes (PNS). METHODS Retrospective review of Mayo Clinic patients with ICI-triggered CNS-autoimmunity (2/2015-6/2021). Clinical characteristics were compared to spontaneous PNS patients (with antineuronal nuclear antibody [ANNA]-1 or (anti-Hu) and/or neuroendocrine tumors [NET] within the same period. RESULTS Thirty-one patients were included, 55% female, median age 63 years (range 39-76). Median time from ICI initiation was 3.65 months (range 0.8-44.5). Most common associated malignancies were melanoma and small-cell lung cancer. CNS manifestations included encephalitis (16), meningoencephalitis (8), cerebellar ataxia (4), demyelinating syndrome (2), myelopathy (1). MRI was abnormal in 62%. CSF was inflammatory in 70%. Neural autoantibodies were identified in 47%, more frequently in patients with NET (P=0.046). ICI was discontinued in 97%; 90% received immunosuppressive treatment. After median 6.8 months follow-up (range 0.7-46), 39% had unfavorable outcomes (grade ≥3). This associated with higher severity degree at onset, shorter period from ICI to neurological onset, and encephalitis. Four patients were re-challenged with ICI and one relapsed. Patients with NET and with ANNA-1 ICI-triggered CNS autoimmunity had associated peripheral nervous system manifestations more frequently than their spontaneous counterparts (P=0.007 and P=0.028, respectively). CONCLUSIONS One third of ICI-related CNS-autoimmunity patients have unfavorable outcomes related to their clinical presentation. Relapses may occur after ICI re-challenge. Neural autoantibodies are often present, more commonly in patients with NET.
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Affiliation(s)
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, Minnesota
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
- Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN
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Tisavipat N, Flanagan EP. Current perspectives on the diagnosis and management of acute transverse myelitis. Expert Rev Neurother 2023; 23:389-411. [PMID: 37026545 DOI: 10.1080/14737175.2023.2195095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
INTRODUCTION Acute transverse myelitis (ATM) is a term that encompasses a wide range of etiologies from immune-mediated to infectious. Management and prognosis differ for each specific etiology, and thus determining the disease-specific diagnosis of ATM is crucial. AREAS COVERED The distinguishing clinical, radiologic, serologic, and cerebrospinal fluid features for common etiologies of ATM, such as multiple sclerosis, aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD), myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), and spinal cord sarcoidosis, are covered. Acute flaccid myelitis variant of ATM is also explored. Red flags suggesting ATM mimics are briefly reviewed. Management of ATM in this review mainly focuses on treatment for immune-mediated causes and is divided into acute treatment, preventive treatment for certain etiologies, and supportive management. Although maintenance attack-prevention treatment for immune-mediated ATM is mainly guided by observational studies and expert opinion, clinical trials have been completed in AQP4+NMOSD and are underway in MOGAD to help provide solid evidence for treatment efficacy. EXPERT OPINION The term ATM should be replaced by a disease-specific diagnosis to direct management. Discovery of disease-associated antibodies has changed the landscape of ATM diagnosis and allowed research on disease mechanisms. Translating our knowledge on pathophysiology into targeted therapy with monoclonal antibodies has provided new treatment options for patients.
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Affiliation(s)
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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Cacciaguerra L, Morris P, Tobin WO, Chen JJ, Banks SA, Elsbernd P, Redenbaugh V, Tillema JM, Montini F, Sechi E, Lopez-Chiriboga AS, Zalewski N, Guo Y, Rocca MA, Filippi M, Pittock SJ, Lucchinetti CF, Flanagan EP. Tumefactive Demyelination in MOG Ab-Associated Disease, Multiple Sclerosis, and AQP-4-IgG-Positive Neuromyelitis Optica Spectrum Disorder. Neurology 2023; 100:e1418-e1432. [PMID: 36690455 PMCID: PMC10065219 DOI: 10.1212/wnl.0000000000206820] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Studies on tumefactive brain lesions in myelin oligodendrocyte glycoprotein-immunoglobulin G (IgG)-associated disease (MOGAD) are lacking. We sought to characterize the frequency clinical, laboratory, and MRI features of these lesions in MOGAD and compare them with those in multiple sclerosis (MS) and aquaporin-4-IgG-positive neuromyelitis optica spectrum disorder (AQP4+NMOSD). METHODS We retrospectively searched 194 patients with MOGAD and 359 patients with AQP4+NMOSD with clinical/MRI details available from the Mayo Clinic databases and included those with ≥1 tumefactive brain lesion (maximum transverse diameter ≥2 cm) on MRI. Patients with tumefactive MS were identified using the Mayo Clinic medical record linkage system. Binary multivariable stepwise logistic regression identified independent predictors of MOGAD diagnosis; Cox proportional regression models were used to assess the risk of relapsing disease and gait aid in patients with tumefactive MOGAD vs those with nontumefactive MOGAD. RESULTS We included 108 patients with tumefactive demyelination (MOGAD = 43; AQP4+NMOSD = 16; and MS = 49). Tumefactive lesions were more frequent among those with MOGAD (43/194 [22%]) than among those with AQP4+NMOSD (16/359 [5%], p < 0.001). Risk of relapse and need for gait aid were similar in tumefactive and nontumefactive MOGAD. Clinical features more frequent in MOGAD than in MS included headache (18/43 [42%] vs 10/49 [20%]; p = 0.03) and somnolence (12/43 [28%] vs 2/49 [4%]; p = 0.003), the latter also more frequent than in AQP4+NMOSD (0/16 [0%]; p = 0.02). The presence of peripheral T2-hypointense rim, T1-hypointensity, diffusion restriction (particularly an arc pattern), ring enhancement, and Baló-like or cystic appearance favored MS over MOGAD (p ≤ 0.001). MRI features were broadly similar in MOGAD and AQP4+NMOSD, except for more frequent diffusion restriction in AQP4+NMOSD (10/15 [67%]) than in MOGAD (11/42 [26%], p = 0.005). CSF analysis revealed less frequent positive oligoclonal bands in MOGAD (2/37 [5%]) than in MS (30/43 [70%], p < 0.001) and higher median white cell count in MOGAD than in MS (33 vs 6 cells/μL, p < 0.001). At baseline, independent predictors of MOGAD diagnosis were the presence of somnolence/headache, absence of T2-hypointense rim, lack of T1-hypointensity, and no diffusion restriction (Nagelkerke R 2 = 0.67). Tumefactive lesion resolution was more common in MOGAD than in MS or AQP4+NMOSD and improved model performance. DISCUSSION Tumefactive lesions are frequent in MOGAD but not associated with a worse prognosis. The clinical, MRI, and CSF attributes of tumefactive MOGAD differ from those of tumefactive MS and are more similar to those of tumefactive AQP4+NMOSD with the exception of lesion resolution, which favors MOGAD.
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Affiliation(s)
- Laura Cacciaguerra
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Pearse Morris
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - W Oliver Tobin
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - John J Chen
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Samantha A Banks
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Paul Elsbernd
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Vyanka Redenbaugh
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Jan-Mendelt Tillema
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Federico Montini
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Elia Sechi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - A Sebastian Lopez-Chiriboga
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Nicholas Zalewski
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Yong Guo
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Maria A Rocca
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Massimo Filippi
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Sean J Pittock
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Claudia F Lucchinetti
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN
| | - Eoin P Flanagan
- From the Department of Neurology and Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology (L.C., W.O.T., J.J.C., S.A.B., V.R., J.-M.T., Y.G., S.J.P., C.F.L., E.P.F.), Mayo Clinic, Rochester, MN; Vita-Salute San Raffaele University (L.C., F.M., M.A.R., M.F.); Neuroimaging Research Unit (L.C., M.A.R., M.F.), Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Department of Radiology (P.M.), Department of Ophthalmology (J.J.C.), Mayo Clinic, Rochester, MN; Department of Neurology (P.E.), San Antonio Military Medical Center, Fort Sam Houston, TX; Neurology Unit (F.M., M.A.R., M.F.), IRCCS San Raffaele Scientific Institute, Milan; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology (A.S.L.-C.), Mayo Clinic, Jacksonville, FL; Department of Neurology (N.Z.), Mayo Clinic, Scottsdale, AZ; Neurorehabilitation Unit (M.F.), IRCCS San Raffaele Scientific Institute; Neurophysiology Service (M.F.), IRCCS San Raffaele Scientific Institute, Milan, Italy; and Laboratory Medicine and Pathology (S.J.P., E.P.F.), Mayo Clinic, Rochester, MN.
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Carta S, Cobo Calvo Á, Armangué T, Saiz A, Lechner C, Rostásy K, Breu M, Baumann M, Höftberger R, Ayzenberg I, Schwake C, Sepulveda M, Martínez-Hernández E, Olivé-Cirera G, Arrambide G, Tintoré M, Bernard-Valnet R, Du Pasquier R, Brilot F, Ramanathan S, Schanda K, Gajofatto A, Ferrari S, Sechi E, Flanagan EP, Pittock SJ, Redenbaugh V, Reindl M, Marignier R, Mariotto S. Significance of Myelin Oligodendrocyte Glycoprotein Antibodies in CSF: A Retrospective Multicenter Study. Neurology 2023; 100:e1095-e1108. [PMID: 36526426 PMCID: PMC10074465 DOI: 10.1212/wnl.0000000000201662] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Although the diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is based on serum MOG antibodies (MOG-Abs) positivity, patients with coexisting or restricted MOG-Abs in the CSF have been reported. The aim of this study is to characterize the relevance of CSF MOG-Abs positivity in clinical practice. METHODS Eleven medical centers retrospectively collected clinical and laboratory data of adult and pediatric patients with suspected inflammatory CNS disease and MOG-Abs positivity in serum and/or CSF using live cell-based assays. Comparisons were performed using parametric or nonparametric tests, as appropriate. Potential factors of unfavorable outcomes were explored by Cox proportional hazard models and logistic regression. RESULTS The cohort included 255 patients: 139 (55%) women and 132 (52%) children (i.e., <18-year-old). Among them, 145 patients (56.8%) had MOG-Abs in both serum and CSF (MOG-Abs seropositive and CSF positive), 79 (31%) only in serum (MOG-Abs seropositive and CSF negative), and 31 (12%) only in CSF (MOG-Abs seronegative and CSF positive). MOG-Abs seronegative and CSF positive predominated in adults (22% vs 3% of children), presented more commonly with motor (n = 14, 45%) and sensory symptoms (n = 13, 42%), and all but 4 (2 multiple sclerosis, 1 polyradiculoneuritis, and 1 Susac syndrome) had a final diagnosis compatible with MOGAD. When comparing seropositive patients according to MOG-Abs CSF status, MOG-Abs seropositive and CSF positive patients had a higher Expanded Disability Status Scale (EDSS) at nadir during the index event (median 4.5, interquartile range [IQR] 3.0-7.5 vs 3.0, IQR 2.0-6.8, p = 0.007) and presented more commonly with sensory (45.5% vs 24%, p = 0.002), motor (33.6% vs 19%, p = 0.021), and sphincter symptoms (26.9% vs 7.8%, p = 0.001) than MOG-Abs seropositive and CSF negative. At the last follow-up, MOG-Abs seropositive and CSF positive cases had more often persistent sphincter dysfunction (17.3% vs 4.3%, p = 0.008). Compared with seropositive patients, those MOG-Abs seronegative and CSF positive had higher disability at the last follow-up (p ≤ 0.001), and MOG-Abs seronegative and CSF positive status were independently associated with an EDSS ≥3.0. DISCUSSION Paired serum and CSF MOG-Abs positivity are common in MOGAD and are associated with a more severe clinical presentation. CSF-only MOG-Abs positivity can occur in patients with a phenotype suggestive of MOGAD and is associated with a worse outcome. Taken together, these data suggest a clinical interest in assessing CSF MOG-Abs in patients with a phenotype suggestive of MOGAD, regardless of the MOG-Abs serostatus.
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Affiliation(s)
- Sara Carta
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Álvaro Cobo Calvo
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Thaís Armangué
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Albert Saiz
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Christian Lechner
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Kevin Rostásy
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Markus Breu
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Matthias Baumann
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Romana Höftberger
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Ilya Ayzenberg
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Carolin Schwake
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Maria Sepulveda
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Eugenia Martínez-Hernández
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Gemma Olivé-Cirera
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Georgina Arrambide
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Mar Tintoré
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Raphael Bernard-Valnet
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Renaud Du Pasquier
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Fabienne Brilot
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sudarshini Ramanathan
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Kathrin Schanda
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Alberto Gajofatto
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sergio Ferrari
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Elia Sechi
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Eoin P Flanagan
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sean J Pittock
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Vyanka Redenbaugh
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Markus Reindl
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Romain Marignier
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | - Sara Mariotto
- From the Neurology Unit (S.C., A.G., S.F., S.M.), Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Italy; Servei de Neurologia-Neuroimmunologia (A.C.C., G.A., M.T.), Centre d'Esclerosi Múltiple de Catalunya, (CEMCAT), Vall d'Hebron Institut de Recerca, Vall d'Hebron Hospital Universitari, Universitat Autònoma de Barcelona, Spain; Pediatric Neuroimmunology Unit (T.A.), Sant Joan de Déu Children's Hospital, University of Barcelona, Spain; Neuroimmunology and Multiple Sclerosis Unit (T.A., A.S., M.S., E.M-H., G.O-C.), Service of Neurology, Hospital Clinic de Barcelona, Neuroimmunology Program, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) and, University of Barcelona, Spain; Division of Pediatric Neurology (C.L., M.B.), Department of Pediatric and Adolescent Medicine, Medical University of Innsbruck, Austria; Division of Pediatric Neurology (K.R.), University of Witten/Herdecke Childrens' Hospital, Datteln, Germany; Division of Pediatric Pulmonology (M.B.), Allergology and Endocrinology, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria; Division of Neuropathology and Neurochemistry (R.H.), Department of Neurology, Medical University of Vienna, Austria; Department of Neurology (I.A., C.S.), St. Josef-Hospital, Ruhr-University Bochum, Germany; Department of Clinical Neurosciences (R.B-V., R.d.P.), Service of Neurology, Lausanne University Hospital and University of Lausanne, Switzerland; Faculty of Medicine and Health and Brain and Mind Centre (F.B.), Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, School of Medical Sciences, The University of Sydney, Australia; Translational Neuroimmunology Group (S.R.), Kids Neuroscience Centre, Children's Hospital at Westmead; Sydney Medical School and Brain and Mind Centre, Faculty of Medicine and Health, University of Sydney; Department of Neurology (S.R.), Concord Hospital, Sydney, Australia; Clinical Department of Neurology (K.S., M.R.), Medical University of Innsbruck, Austria; Department of Medical, Surgical and Experimental Sciences (E.S.), University of Sassari, Italy; Department of Neurology, Department of Laboratory Medicine and Pathology (E.P.F., S.J.P., V.R.), Mayo Clinic College of Medicine and Science, Rochester; Service de Neurologie (R.M.), Sclérose en Plaques, Pathologies de la Myéline et Neuro-inflammation, Centre de Référence des Maladies Inflammatoires Rares du Cerveau et de la Moelle, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France.
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48
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Banwell B, Bennett JL, Marignier R, Kim HJ, Brilot F, Flanagan EP, Ramanathan S, Waters P, Tenembaum S, Graves JS, Chitnis T, Brandt AU, Hemingway C, Neuteboom R, Pandit L, Reindl M, Saiz A, Sato DK, Rostasy K, Paul F, Pittock SJ, Fujihara K, Palace J. Diagnosis of myelin oligodendrocyte glycoprotein antibody-associated disease: International MOGAD Panel proposed criteria. Lancet Neurol 2023; 22:268-282. [PMID: 36706773 DOI: 10.1016/s1474-4422(22)00431-8] [Citation(s) in RCA: 214] [Impact Index Per Article: 214.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 09/07/2022] [Accepted: 10/13/2022] [Indexed: 01/26/2023]
Abstract
Serum antibodies directed against myelin oligodendrocyte glycoprotein (MOG) are found in patients with acquired CNS demyelinating syndromes that are distinct from multiple sclerosis and aquaporin-4-seropositive neuromyelitis optica spectrum disorder. Based on an extensive literature review and a structured consensus process, we propose diagnostic criteria for MOG antibody-associated disease (MOGAD) in which the presence of MOG-IgG is a core criterion. According to our proposed criteria, MOGAD is typically associated with acute disseminated encephalomyelitis, optic neuritis, or transverse myelitis, and is less commonly associated with cerebral cortical encephalitis, brainstem presentations, or cerebellar presentations. MOGAD can present as either a monophasic or relapsing disease course, and MOG-IgG cell-based assays are important for diagnostic accuracy. Diagnoses such as multiple sclerosis need to be excluded, but not all patients with multiple sclerosis should undergo screening for MOG-IgG. These proposed diagnostic criteria require validation but have the potential to improve identification of individuals with MOGAD, which is essential to define long-term clinical outcomes, refine inclusion criteria for clinical trials, and identify predictors of a relapsing versus a monophasic disease course.
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Affiliation(s)
- Brenda Banwell
- Division of Child Neurology, Children's Hospital of Philadelphia, Department of Neurology and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, PA, USA.
| | - Jeffrey L Bennett
- Departments of Neurology and Ophthalmology, Programs in Neuroscience and Immunology, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Romain Marignier
- 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, Hôpital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France; Centre de Recherche en Neurosciences de Lyon, Lyon, France; Université Claude Bernard Lyon, Lyon, France
| | - Ho Jin Kim
- Department of Neurology, Research Institute and Hospital of National Cancer Center, Goyang, South Korea
| | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital at Westmead, Sydney, Australia; School of Medical Sciences, Faculty of Medicine and Health and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Eoin P Flanagan
- Departments of Neurology, Laboratory Medicine and Pathology and Center MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Sudarshini Ramanathan
- Department of Neurology, Concord Hospital, Translational Neuroimmunology Group, Kids Neuroscience Centre, Children's Hospital at Westmead, Sydney, Australia; Brain and Mind Centre and Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Silvia Tenembaum
- Paediatric Neuroimmunology Clinic, Department of Neurology, National Paediatric Hospital Dr J P Garrahan, Ciudad de Buenos Aires, Argentina
| | - Jennifer S Graves
- Department of Neurosciences, University of California, San Diego, CA, USA
| | - Tanuja Chitnis
- Department of Pediatric Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Cheryl Hemingway
- Department of Paediatric Neurology, Great Ormond Street Hospital, London, UK; Institute of Neurology, UCL, London, UK
| | - Rinze Neuteboom
- Department of Neurology, MS Center ErasMS, Sophia Children's Hospital, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Lekha Pandit
- Center for Advanced Neurological Research, Nitte University Mangalore, Mangalore, India
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Albert Saiz
- Neuroimmunology and Multiple Sclerosis Unit, Service of Neurology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Barcelona, Spain; Facultat de Medicina i Ciencies de la Salut, Universitat de Barcelona, Barcelona, Spain
| | - Douglas Kazutoshi Sato
- School of Medicine and Institute for Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Kevin Rostasy
- Department of Paediatric Neurology, Children'sHospital Datteln, University Witten and Herdecke, Datteln, Germany
| | - Friedemann Paul
- Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sean J Pittock
- Departments of Neurology, Laboratory Medicine, and Pathology and Center MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University School of Medicine, Fukushima, Japan; Multiple Sclerosis and Neuromyelitis Optica Center, Southern TOHOKU Research Institute for Neuroscience, Koriyama, Japan
| | - Jacqueline Palace
- Department of Neurology John Radcliffe Hospital Oxford and Nuffield Department of Clinical Neurosciences Oxford University, Oxford, UK
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49
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Dinoto A, Zara P, Mariotto S, Ferrari S, Flanagan EP, Budhram A, Orellana D, Turilli D, Solla P, Day GS, Sechi E, Lopez-Chiriboga AS. Autoimmune encephalitis misdiagnosis and mimics. J Neuroimmunol 2023; 378:578071. [PMID: 36989703 DOI: 10.1016/j.jneuroim.2023.578071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 03/03/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
The diagnosis of autoimmune encephalitis (AE) requires reasonable exclusion of other conditions. The aim of this study is to characterize mimickers and misdiagnoses of AE, thus we performed an independent PubMed search for mimickers of AEs or patients with alternative neurological disorders misdiagnosed as AE. Fifty-eight studies with 66 patients were included. Neoplastic (n = 17), infectious (n = 15), genetic (n = 13), neurodegenerative (n = 8), and other neurological (n = 8) or systemic autoimmune (n = 5) disorders were misdiagnosed as AE. The lack of fulfillment of diagnostic criteria for AE, atypical neuroimaging findings, non-inflammatory CSF findings, non-specific autoantibody specificities and partial response to immunotherapy were major confounding factors.
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Affiliation(s)
- Alessandro Dinoto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Pietro Zara
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, USA; Department of Laboratory Medicine and Pathology, Neuroimmunology Laboratory, Mayo Clinic, Rochester, MN, USA
| | - Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada
| | - Daniela Orellana
- Department of Neurology, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Davide Turilli
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Paolo Solla
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
| | - Gregory S Day
- Department of Neurology, Mayo Clinic College of Medicine, Jacksonville, FL, USA
| | - Elia Sechi
- Department of Medical, Surgical and Experimental Sciences, University of Sassari, Sassari, Italy
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50
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McCombe JA, Zivelonghi C, Vorasoot N, Majed M, Flanagan EP, Dubey D, Pittock SJ, McKeon A, Zekeridou A. AMPAR autoimmunity: Neurological and oncological accompaniments and co-existing neural autoantibodies. J Neuroimmunol 2023; 375:578012. [PMID: 36608398 PMCID: PMC9905297 DOI: 10.1016/j.jneuroim.2022.578012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 12/08/2022] [Accepted: 12/21/2022] [Indexed: 12/24/2022]
Abstract
α -amino-3-hydroxy-5-methyl-4-isoxazole propionic acid receptor (AMPAR) encephalitis is rare but treatable. We reviewed the clinical and autoantibody profiles of 52 AMPAR-IgG-positive patients (median age 48 years [range 12-81]; 38 female) identified at the Mayo Clinic neuroimmunology laboratory. Main presentation was encephalitis; symptoms other than encephalitis associated with co-existing antibodies (p = 0.004). A tumor was found in 33/44; mostly thymoma. Most patients had partial (14/29) or complete (11/29) immunotherapy response. Thirty-one patients had at least one co-existing antibody that predicted thymoma in paraneoplastic patients (p = 0.008). In conclusion, in AMPAR encephalitis co-existing antibodies predict clinical presentation other than encephalitis and thymoma.
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Affiliation(s)
- Jennifer A McCombe
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Division of Neurology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Cecilia Zivelonghi
- Department of Neurology and Stroke Unit, University Hospital of Verona, Verona, Italy
| | - Nisa Vorasoot
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Division of Neurology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Masoud Majed
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Anastasia Zekeridou
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America; Center of MS and Autoimmune Neurology, Mayo Clinic, Rochester, MN, United States of America.
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