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Chatterton S, Xi S, Jia JX, Krause M, Long GV, Atkinson V, Menzies AM, Fernando SL, Boyle T, Kwok S, Duggins A, Karikios D, Parratt JDE. Case series: Immune checkpoint inhibitor-induced transverse myelitis. Front Neurol 2023; 14:1130313. [PMID: 36895912 PMCID: PMC9989185 DOI: 10.3389/fneur.2023.1130313] [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: 12/23/2022] [Accepted: 02/06/2023] [Indexed: 02/25/2023] Open
Abstract
Introduction Increasing implementation of the highly efficacious immune checkpoint inhibitors (ICIs) has raised awareness of their various complications in the form of immune-related adverse events (irAEs). Transverse myelitis following ICIs is thought to be a rare but serious neurologic irAE and knowledge is limited about this distinct clinical entity. Cases We describe four patients across three tertiary centers in Australia with ICI-induced transverse myelitis. Three patients had a diagnosis of stage III-IV melanoma treated with nivolumab and one patient had stage IV non-small cell lung cancer treated with pembrolizumab. All patients had longitudinally extensive transverse myelitis on magnetic resonance imaging (MRI) spine and clinical presentation was accompanied by inflammatory cerebrospinal fluid (CSF) findings. Half of our cohort had received spinal radiotherapy, with the areas of transverse myelitis extending beyond the level of previous radiation field. Inflammatory changes on neuroimaging did not extend to the brain parenchyma or caudal nerve roots, except for one case involving the conus medullaris. All patients received high dose glucocorticoids as first-line therapy, however the majority relapsed or had a refractory state (3/4) despite this, requiring escalation of their immunomodulation, with either induction intravenous immunoglobulin (IVIg) or plasmapheresis. Patients in our cohort who relapsed had a poorer outcome with more severe disability and reduced functional independence following resolution of their myelitis. Two patients had no progression of their malignancy and two patients had malignancy progression. Of the three patients who survived, two had resolution of their neurological symptoms and one remained symptomatic. Conclusion We propose that prompt intensive immunomodulation is favored for patients with ICI-transverse myelitis in an attempt to reduce associated significant morbidity and mortality. Furthermore, there is a significant risk of relapse following cessation of immunomodulatory therapy. We suggest one treatment approach of IVMP and induction IVIg for all patients presenting with ICI-induced transverse myelitis based on such findings. With the increasing use of ICIs across oncology, further studies are required to explore this neurological phenomenon in greater detail to help establish management consensus guidelines.
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Affiliation(s)
- Sophie Chatterton
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Shuo Xi
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Jessica Xi Jia
- Department of Neurology, Nepean Hospital, Sydney, NSW, Australia
| | - Martin Krause
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
| | - Georgina V Long
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Oncology, Melanoma Institute Australia, Wollstonecraft, NSW, Australia.,Department of Medical Oncology, Mater Hospital, Wollstonecraft, NSW, Australia
| | - Victoria Atkinson
- Department of Medical Oncology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Alexander M Menzies
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Royal North Shore Hospital, Sydney, NSW, Australia.,Department of Oncology, Melanoma Institute Australia, Wollstonecraft, NSW, Australia.,Department of Medical Oncology, Mater Hospital, Wollstonecraft, NSW, Australia
| | - Suran L Fernando
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Clinical Immunology and Allergy Department, Royal North Shore Hospital, Sydney, NSW, Australia.,NSW Health Pathology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Thérèse Boyle
- Clinical Immunology and Allergy Department, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Samuel Kwok
- Department of Neurology, Nepean Hospital, Sydney, NSW, Australia
| | - Andrew Duggins
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Westmead Hospital, Sydney, NSW, Australia
| | - Deme Karikios
- Faculty of Medicine, University of Sydney, Sydney, NSW, Australia.,Department of Medical Oncology, Nepean Hospital, Sydney, NSW, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia.,Faculty of Medicine, University of Sydney, Sydney, NSW, Australia
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2
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Triplett JD, Qiu J, O'Brien B, Gopinath S, Trewin B, Spring PJ, Shaffi M, Ip J, Chan F, Chen L, Wilson I, Muller C, Beadnall HN, Boggild M, Van der Walt A, Roxburgh R, Seery N, Kalincik T, Barnett MH, Parratt JDE, Reddel SW, Tsang B, Hardy TA. Diagnosis, differential diagnosis and misdiagnosis of Susac syndrome. Eur J Neurol 2022; 29:1771-1781. [PMID: 35262238 PMCID: PMC9314104 DOI: 10.1111/ene.15317] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Susac syndrome (SuS) is an inflammatory condition of the brain, eye and ear. Diagnosis can be challenging, and misdiagnosis is common. Methods This is a retrospective review of the medical records of 32 adult patients from an Australasian cohort of SuS patients. Results An alternative diagnosis prior to SuS was made in 30 patients (94%) with seven patients receiving two or more diagnoses. The median time to diagnosis of SuS was 3 months (range 0.5–100 months). The commonest misdiagnoses were migraine in 10 patients (31%), cerebral vasculitis in six (19%), multiple sclerosis in five (16%) and stroke in five (16%). Twenty‐two patients were treated for alternative diagnoses, 10 of whom had further clinical manifestations prior to SuS diagnosis. At presentation seven patients (22%) met criteria for definite SuS, 19 (59%) for probable SuS and six (19%) for possible SuS. Six patients (19%) presented with brain–eye–ear involvement, 14 with brain–ear (44%), six with brain–eye (19%) and six (19%) with only brain involvement. In patients with the complete triad of symptoms the median delay to diagnosis was 3 months (range 1–9 months) compared to 5.25 months (range 0.5–100 months) for patients with encephalopathy and ocular symptoms at presentation. Conclusions Susac syndrome patients are frequently misdiagnosed at initial presentation, despite many having symptoms or radiological features that are red flags for the diagnosis. Delayed diagnosis can lead to patient morbidity. The varied ways in which SuS can present, and clinician failure to consider or recognize SuS, appear to be the main factors leading to misdiagnosis.
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Affiliation(s)
- James D Triplett
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Jessica Qiu
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Billy O'Brien
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Sumana Gopinath
- Department of Neurology, Campbelltown Hospital, Sydney, NSW, Australia
| | - Benjamin Trewin
- Department of Neurology, Campbelltown Hospital, Sydney, NSW, Australia
| | - Penelope J Spring
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | | | - Jerome Ip
- Section of Neurology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Fiona Chan
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Luke Chen
- Brain & Mind Centre, University of Sydney, NSW, Australia.,Department of Neurology, The Alfred Hospital, Monash University, Melbourne, Vic, Australia
| | - Ian Wilson
- Department of Neurology, Cairns Hospital, Cairns, Qld, Australia
| | - Claire Muller
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Heidi N Beadnall
- Brain & Mind Centre, University of Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Townsville, Qld, Australia
| | - Anneke Van der Walt
- Department of Neurology, The Alfred Hospital, Monash University, Melbourne, Vic, Australia
| | - Richard Roxburgh
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nabil Seery
- MS Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
| | - Tomas Kalincik
- MS Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Michael H Barnett
- Brain & Mind Centre, University of Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Stephen W Reddel
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Benjamin Tsang
- Department of Neurology, Sunshine Coast Hospital, Sunshine Coast, Qld, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.,Brain & Mind Centre, University of Sydney, NSW, Australia
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3
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Clarke L, Bukhari W, O'Gorman CM, Khalilidehkordi E, Arnett S, Woodhall M, Prain KM, Parratt JDE, Barnett MH, Marriott MP, McCombe PA, Sutton I, Boggild M, Brownlee W, Carroll WM, Hodgkinson S, Macdonell RAL, Mason DF, Pereira J, Slee M, Das C, Henderson APD, Kermode AG, Lechner-Scott J, Waters P, Sun J, Broadley SA. Response to treatment in NMOSD: the Australasian experience. Mult Scler Relat Disord 2022; 58:103408. [PMID: 35216788 DOI: 10.1016/j.msard.2021.103408] [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: 09/30/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disorder (NMOSD) is associated with significant morbidity and mortality. Several therapies have been recommended for NMOSD and more recently clinical trials have demonstrated efficacy for three monoclonal antibody therapies. We present a retrospective observational study of treatment response in NMOSD. METHODS This was a retrospective, unblinded, observational study of treatment efficacy for rituximab and traditional immunosuppressive therapy in patients with AQP4 antibody positive NMOSD. Treatment efficacy was assessed using annualised relapse rates (ARR), time to first relapse and expanded disability status scale (EDSS) scores. RESULTS Complete relapse and treatment data were available for 43/68 (63%) of AQP4 antibody positive NMOSD cases covering 74 episodes of treatment. In a time to first relapse analysis rituximab showed a risk ratio of 0.23 (95% CI 0.08 - 0.65) when compared with no treatment and there was a non-significant reduction in ARR of 35% compared to pre-treatment. β-interferon (p = 0.0002) and cyclophosphamide (p = 0.0034) were associated with an increased ARR compared to pre-treatment. Rituximab (median 4.0 [range 0.0 - 7.0]; p = 0.042) and traditional immunosuppressive therapy (median 4.0 [range 0.0 - 8.0]; p = 0.016) were associated with a lower final EDSS compared to β-interferon (median 6.0 [range 4.0 - 7.5]). CONCLUSIONS These data provide additional support for the use of rituximab in preference to traditional immunosuppressive agents and MS disease modifying therapies as first line treatment of NMOSD.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; St Vincent's Hospital Melbourne, Fitzroy VIC 3065, AustraliA
| | - Cullen M O'Gorman
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology Princess Alexandra Hospital, Woolloongabba QLD 4102, Australia; Department of Neurology, Mater Hospital Brisbane, South Brisbane QLD, 4101, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Infirmary, University of Oxford, Oxford OX3 9DU, UK
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston QLD 4006, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown NSW 2006, Australia
| | - Michael H Barnett
- Brain and Mind Research Institute, University of Sydney, Camperdown NSW 2006, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville VIC 3052, Australia
| | - Pamela A McCombe
- Department of Neurology, Royal Brisbane and Women's Hospital, Herston QLD 4029, Australia; Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston QLD 4029, AustraliA
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Darlinghurst NSW 2010, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas QLD 4814, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand; Institute of Neurology, University College London, Queen Square, London WC1N 3BG, UK
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool NSW 2170, Australia
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch 8140, New Zealand
| | - Jennifer Pereira
- Department of Neurology, Auckland City Hospital, Grafton 1023, New Zealand
| | - Mark Slee
- Flinders Medical Centre, Flinders University, Bedford Park SA 5042, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran ACT 2605, Australia
| | | | - Allan G Kermode
- Centre for Neuromuscular and Neurological Disorders, Perron Institute for Neurological and Translational Science, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands WA 6009, AustraliA; Institute for Immunology and Infectious Disease, Murdoch University, Murdoch WA 6150, AustraliA
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights NSW 2305, AustralIA
| | | | - Patrick Waters
- Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University QLD 4222, Australia; Department of Neurology, Gold Coast University Hospital, Southport QLD 4215, Australia.
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4
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Abstract
This study examined the roles of microglia and monocytes in myelin destruction in patients with early multiple sclerosis (MS). Twenty-two cases were studied; the clinical duration was <9 weeks in 10 cases. Twenty myeloid cell subtypes or categories were identified including 2 cell types not known previously to occur in demyelinating diseases. Commencing myelin breakdown in plaques and in perivascular and subpial tissues occurred in the immediate presence of infiltrating monocytes and was effected by a homogeneous population of IgG-positive Fc receptor-bearing early phagocytes interacting with abnormal myelin. Oligodendrocyte apoptosis was observed in intact myelinated tissue bordering areas of active demyelination. Capillaries in the cerebral cortex plugged by large numbers of monocytes were common in acute cases of MS and in a patient with a neuromyelitis optica variant and extreme systemic recruitment of monocytes. In an MS patient with progressive disease, microglial nodules centered on MHC-II-positive capillaries plugged by monocytes were present in the cerebral cortex. This constitutes a new gray matter lesion in MS.
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Affiliation(s)
- John W Prineas
- From the Department of Medicine, University of Sydney, Camperdown, NSW, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, St. Leonards, NSW, Australia
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5
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Clarke L, Arnett S, Bukhari W, Khalilidehkordi E, Jimenez Sanchez S, O'Gorman C, Sun J, Prain KM, Woodhall M, Silvestrini R, Bundell CS, Abernethy DA, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brownlee W, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Fabis-Pedrini MJ, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Kilpatrick TJ, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell RAL, Mason DF, McCombe PA, Pereira J, Pollard JD, Ramanathan S, Reddel SW, Shaw CP, Spies JM, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AGK, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Brilot F, Vincent A, Waters P, Broadley SA. MRI Patterns Distinguish AQP4 Antibody Positive Neuromyelitis Optica Spectrum Disorder From Multiple Sclerosis. Front Neurol 2021; 12:722237. [PMID: 34566866 PMCID: PMC8458658 DOI: 10.3389/fneur.2021.722237] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/10/2021] [Indexed: 01/01/2023] Open
Abstract
Neuromyelitis optica spectrum disorder (NMOSD) and multiple sclerosis (MS) are inflammatory diseases of the CNS. Overlap in the clinical and MRI features of NMOSD and MS means that distinguishing these conditions can be difficult. With the aim of evaluating the diagnostic utility of MRI features in distinguishing NMOSD from MS, we have conducted a cross-sectional analysis of imaging data and developed predictive models to distinguish the two conditions. NMOSD and MS MRI lesions were identified and defined through a literature search. Aquaporin-4 (AQP4) antibody positive NMOSD cases and age- and sex-matched MS cases were collected. MRI of orbits, brain and spine were reported by at least two blinded reviewers. MRI brain or spine was available for 166/168 (99%) of cases. Longitudinally extensive (OR = 203), "bright spotty" (OR = 93.8), whole (axial; OR = 57.8) or gadolinium (Gd) enhancing (OR = 28.6) spinal cord lesions, bilateral (OR = 31.3) or Gd-enhancing (OR = 15.4) optic nerve lesions, and nucleus tractus solitarius (OR = 19.2), periaqueductal (OR = 16.8) or hypothalamic (OR = 7.2) brain lesions were associated with NMOSD. Ovoid (OR = 0.029), Dawson's fingers (OR = 0.031), pyramidal corpus callosum (OR = 0.058), periventricular (OR = 0.136), temporal lobe (OR = 0.137) and T1 black holes (OR = 0.154) brain lesions were associated with MS. A score-based algorithm and a decision tree determined by machine learning accurately predicted more than 85% of both diagnoses using first available imaging alone. We have confirmed NMOSD and MS specific MRI features and combined these in predictive models that can accurately identify more than 85% of cases as either AQP4 seropositive NMOSD or MS.
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Affiliation(s)
- Laura Clarke
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Simon Arnett
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Wajih Bukhari
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Elham Khalilidehkordi
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Sofia Jimenez Sanchez
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Cullen O'Gorman
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Jing Sun
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Roger Silvestrini
- Department of Immunopathology, Westmead Hospital, Westmead, NSW, Australia
| | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Nedlands, WA, Australia
| | | | - Sandeep Bhuta
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Douglas, QLD, Australia
| | - Karyn Boundy
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce J Brew
- Centre for Applied Medical Research, St. Vincent's Hospital, University of New South Wales, Darlinghurst, NSW, Australia
| | - Wallace Brownlee
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Helmut Butzkueven
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Cella Chen
- Department of Ophthalmology, Flinders Medical Centre, Flinders University, Bedford Park, SA, Australia
| | - Alan Coulthard
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Russell C Dale
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Garran, ACT, Australia
| | - Marzena J Fabis-Pedrini
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - David Gillis
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Simon Hawke
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Robert Heard
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | | | - Saman Heshmat
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | - Trevor J Kilpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - John King
- Department of Neurology, Royal Melbourne Hospital, Parkville, VIC, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Jeannette Lechner-Scott
- Hunter Medical Research Institute, University of Newcastle, New Lambton Heights, NSW, Australia
| | - Ming-Wei Lin
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | | | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Jennifer Pereira
- School of Medicine, University of Auckland, Grafton, New Zealand
| | - John D Pollard
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Sudarshini Ramanathan
- Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia.,Department of Neurology, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Cameron P Shaw
- School of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Judith M Spies
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ian Sutton
- Department of Neurology, St. Vincent's Hospital, Darlinghurst, NSW, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, NSW, Australia
| | - Michael Walsh
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Richard C Wong
- School of Medicine, Royal Brisbane and Women's Hospital, University of Queensland, Herston, QLD, Australia
| | - Eppie M Yiu
- School of Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Allan G K Kermode
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, Perron Institute for Neurological and Translational Science, University of Western Australia, Nedlands, WA, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - John D E Parratt
- Sydney Medical School, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia
| | - Mark Slee
- Department of Neurology, College of Medicine and Public Health, Flinders University, Bedford Park, SA, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, TAS, Australia
| | - Ernest Willoughby
- Department of Neurology, Auckland City Hospital, Grafton, New Zealand
| | - Fabienne Brilot
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Neuroimmunology Group, Kids Neurosciences Centre, Children's Hospital at Westmead, University of Sydney, Westmead, NSW, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- Menzies Health Institute Queensland, Gold Coast, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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6
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Jacob JG, Parratt JDE, Kiely CJ, Fernando SL. Common variable immunodeficiency in association with autoimmune encephalitis, collagenous gastritis, and colitis. Ann Allergy Asthma Immunol 2021; 127:137-138. [PMID: 33812019 DOI: 10.1016/j.anai.2021.03.028] [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] [Received: 01/23/2021] [Revised: 03/25/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Joshua G Jacob
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Immunology Laboratory, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia
| | - John D E Parratt
- University of Sydney, Sydney, Australia; Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | | | - Suran L Fernando
- Department of Clinical Immunology and Allergy, Royal North Shore Hospital, Sydney, Australia; Immunology Laboratory, Royal North Shore Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
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7
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You Y, Barnett MH, Yiannikas C, Parratt JDE, Matthews JG, Graham SL, Klistorner A. Interferon-β Is Less Effective Than Other Drugs in Controlling the Rate of Retinal Ganglion Cell Loss in MS. Neurol Neuroimmunol Neuroinflamm 2021; 8:8/3/e971. [PMID: 33597189 PMCID: PMC8105907 DOI: 10.1212/nxi.0000000000000971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Abstract
Objective To investigate the association between disease-modifying therapies (DMTs) and the rate of progressive retinal ganglion cell (RGC) and nerve fiber loss in MS. Methods One hundred five relapsing-remitting patients with MS were followed annually for a median of 4.0 years using optical coherence tomography. Twenty-five healthy subjects were also included as normal controls. The rates of global peripapillary retinal nerve fiber layer (pRNFL), temporal RNFL (tRNFL), and ganglion cell inner plexiform layer (GCIPL) thinning were analyzed according to DMT type using a linear mixed-effects model. Optic radiation lesion volume was measured on brain MRI and included as a covariate to minimize the effects of retrograde transsynaptic degeneration. Results The annual rates of RNFL and GCIPL thinning were higher in patients treated with “platform” therapies (interferon-β and glatiramer acetate) compared with DMTs of higher clinical efficacy (including fingolimod, dimethyl fumarate, natalizumab, alemtuzumab, rituximab, and ocrelizumab) (difference = −0.22 μm/y, p = 0.02 for pRNFL; difference = −0.34 μm/y, p = 0.009 for tRNFL; and difference = −0.16 μm/y, p = 0.005 for GCIPL). Based on an analysis of individual treatments (interferon-β, glatiramer acetate, fingolimod, and natalizumab), interferon-β was associated with inferior RGC preservation, relative to the other drugs. No effect difference was found between glatiramer acetate, fingolimod, and natalizumab. Conclusions Progressive loss of RGCs in patients with MS is more pronounced in patients treated with interferon-β than other DMTs. This finding may have implications for DMT selection in MS. Classification of Evidence This study provides Class IV evidence that for patients with MS, treatment with interferon-β compared with other DMTs leads to a more pronounced rate of retinal ganglion cell loss.
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Affiliation(s)
- Yuyi You
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia.
| | - Michael H Barnett
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia
| | - Con Yiannikas
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia
| | - John D E Parratt
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia
| | - Jim G Matthews
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia
| | - Stuart L Graham
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia
| | - Alexander Klistorner
- From the Department of Clinical Medicine (Y.Y., S.L.G., A.K.), Macquarie University, NSW, Australia; Save Sight Institute (Y.Y., A.K.), The University of Sydney, NSW, Australia; Brain and Mind Centre (M.H.B.), The University of Sydney, NSW, Australia; Sydney Neuroimaging Analysis Centre (M.H.B.), NSW, Australia; Department of Neurology (C.Y., J.D.E.P.), Royal North Shore Hospital, NSW, Australia; and Sydney Informatics and Data Science Hub (J.G.M.), The University of Sydney, NSW, Australia
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8
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Hardy TA, Taylor RL, Qiu J, O’Brien B, Gopinath S, Trewin B, Spring PJ, Shaffi M, Bolitho SJ, Garsia RJ, Roxburgh R, Mason DF, Ip J, Chan F, Chen L, Wilson I, Beadnall HN, Barnett MH, Parratt JDE, Watson JDG, Welgampola MS, Reddel SW, Tsang B, Halmagyi GM. The neuro-otology of Susac syndrome. J Neurol 2020; 267:3711-3722. [DOI: 10.1007/s00415-020-10086-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/13/2020] [Accepted: 07/14/2020] [Indexed: 11/28/2022]
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9
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Prain K, Woodhall M, Vincent A, Ramanathan S, Barnett MH, Bundell CS, Parratt JDE, Silvestrini RA, Bukhari W, Brilot F, Waters P, Broadley SA. AQP4 Antibody Assay Sensitivity Comparison in the Era of the 2015 Diagnostic Criteria for NMOSD. Front Neurol 2019; 10:1028. [PMID: 31636597 PMCID: PMC6787171 DOI: 10.3389/fneur.2019.01028] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 09/10/2019] [Indexed: 11/24/2022] Open
Abstract
We have compared five different assays for antibodies to aquaporin-4 in 181 cases of suspected Neuromyelitis optica spectrum disorders (NMOSD) and 253 controls to assess their relative utility. As part of a clinically-based survey of NMOSD in Australia and New Zealand, cases of suspected NMOSD were referred from 23 centers. Clinical details and magnetic imaging were reviewed and used to apply the 2015 IPND diagnostic criteria. In addition, 101 age- and sex-matched patients with multiple sclerosis were referred. Other inflammatory disease (n = 49) and healthy controls (n = 103) were also recruited. Samples from all participants were tested using tissue-based indirect immunofluorescence assays and a subset were tested using four additional ELISA and cell-based assays. Antibodies to myelin oligodendrocyte glycoprotein (MOG) were also assayed. All aquaporin-4 antibody assays proved to be highly specific. Sensitivities ranged from 60 to 94%, with cell-based assays having the highest sensitivity. Antibodies to MOG were detected in 8/79 (10%) of the residual suspected cases of NMOSD. Under the 2015 IPND diagnostic criteria for NMOSD, cell-based assays for aquaporin-4 are sensitive and highly specific, performing better than tissue-based and ELISA assays. A fixed cell-based assay showed near-identical results to a live-cell based assay. Antibodies to MOG account for only a small number of suspected cases.
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Affiliation(s)
- Kerri Prain
- Pathology Queensland Central Laboratory, Division of Immunology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Mark Woodhall
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Angela Vincent
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Sudarshini Ramanathan
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Michael H Barnett
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Christine S Bundell
- School of Biomedical Science, Medicine, University of Western Australia, Nedlands, WA, Australia.,PathWest Laboratory Medicine, Department of Immunology, QEII Medical Centre, Nedlands, WA, Australia
| | - John D E Parratt
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia.,Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Roger A Silvestrini
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia
| | - Wajih Bukhari
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
| | | | - Fabienne Brilot
- Brain Autoimmunity Group, Kids Neuroscience Centre, Kids Research at the Children's Hospital, Westmead, NSW, Australia.,Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Simon A Broadley
- School of Medicine, Gold Coast Campus, Griffith University, Southport, QLD, Australia.,Department of Neurology, Gold Coast University Hospital, Southport, QLD, Australia
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10
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Bukhari W, Prain KM, Waters P, Woodhall M, O'Gorman CM, Clarke L, Silvestrini RA, Bundell CS, Abernethy D, Bhuta S, Blum S, Boggild M, Boundy K, Brew BJ, Brown M, Brownlee WJ, Butzkueven H, Carroll WM, Chen C, Coulthard A, Dale RC, Das C, Dear K, Fabis-Pedrini MJ, Fulcher D, Gillis D, Hawke S, Heard R, Henderson APD, Heshmat S, Hodgkinson S, Jimenez-Sanchez S, Killpatrick T, King J, Kneebone C, Kornberg AJ, Lechner-Scott J, Lin MW, Lynch C, Macdonell R, Mason DF, McCombe PA, Pender MP, Pereira JA, Pollard JD, Reddel SW, Shaw C, Spies J, Stankovich J, Sutton I, Vucic S, Walsh M, Wong RC, Yiu EM, Barnett MH, Kermode AG, Marriott MP, Parratt JDE, Slee M, Taylor BV, Willoughby E, Wilson RJ, Vincent A, Broadley SA. Incidence and prevalence of NMOSD in Australia and New Zealand. J Neurol Neurosurg Psychiatry 2017; 88:632-638. [PMID: 28550069 DOI: 10.1136/jnnp-2016-314839] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVES We have undertaken a clinic-based survey of neuromyelitis optica spectrum disorders (NMOSDs) in Australia and New Zealand to establish incidence and prevalence across the region and in populations of differing ancestry. BACKGROUND NMOSD is a recently defined demyelinating disease of the central nervous system (CNS). The incidence and prevalence of NMOSD in Australia and New Zealand has not been established. METHODS Centres managing patients with demyelinating disease of the CNS across Australia and New Zealand reported patients with clinical and laboratory features that were suspicious for NMOSD. Testing for aquaporin 4 antibodies was undertaken in all suspected cases. From this group, cases were identified who fulfilled the 2015 Wingerchuk diagnostic criteria for NMOSD. A capture-recapture methodology was used to estimate incidence and prevalence, based on additional laboratory identified cases. RESULTS NMOSD was confirmed in 81/170 (48%) cases referred. Capture-recapture analysis gave an adjusted incidence estimate of 0.37 (95% CI 0.35 to 0.39) per million per year and a prevalence estimate for NMOSD of 0.70 (95% CI 0.61 to 0.78) per 100 000. NMOSD was three times more common in the Asian population (1.57 (95% CI 1.15 to 1.98) per 100 000) compared with the remainder of the population (0.57 (95% CI 0.50 to 0.65) per 100 000). The latitudinal gradient evident in multiple sclerosis was not seen in NMOSD. CONCLUSIONS NMOSD incidence and prevalence in Australia and New Zealand are comparable with figures from other populations of largely European ancestry. We found NMOSD to be more common in the population with Asian ancestry.
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Affiliation(s)
- Wajih Bukhari
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Kerri M Prain
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | - Laura Clarke
- School of Medicine, Griffith University, Gold Coast, Australia
| | | | - Christine S Bundell
- School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Australia
| | - David Abernethy
- Department of Neurology, Wellington Hospital, Wellington, New Zealand
| | - Sandeep Bhuta
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Stefan Blum
- Department of Neurology, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Townsville, Australia
| | - Karyn Boundy
- Department of Neurology, Royal Adelaide Hospital, Adelaide, Australia
| | - Bruce J Brew
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Matthew Brown
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - Wallace J Brownlee
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, London, UK
| | - Helmut Butzkueven
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - William M Carroll
- Centre for Neuromuscular and Neurological Disorders, Queen Elizabeth II Medical Centre, University of Western Australia, Nedlands, WA, Australia
| | - Celia Chen
- Department of Ophthalmology, Flinders Medical Centre and Flinders University, Adelaide, Australia
| | - Alan Coulthard
- School of Medicine, The University of Queensland, Brisbane, Australia.,Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Russell C Dale
- Childrens Hospital at Westmead Clinical School, University of Sydney, Westmead, NSW, Australia
| | - Chandi Das
- Department of Neurology, Canberra Hospital, Canberra, Australia
| | - Keith Dear
- Global Health Research Centre, Duke Kunshan University, Kunshan, Jiangsu, China
| | | | - David Fulcher
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - David Gillis
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Simon Hawke
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Robert Heard
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | | | - Saman Heshmat
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Suzanne Hodgkinson
- South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, Australia.,South Western Sydney Medical School, Liverpool Hospital, University of New South Wales, Liverpool, NSW, Australia
| | | | - Trevor Killpatrick
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | - John King
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Australia
| | | | - Andrew J Kornberg
- School of Paediatrics, University of Melbourne, Melbourne, Australia
| | | | - Ming-Wei Lin
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Christpher Lynch
- School of Medicine, University of Auckland, Auckland, New Zealand
| | | | - Deborah F Mason
- Department of Neurology, Christchurch Hospital, Christchurch, New Zealand
| | - Pamela A McCombe
- Centre for Clinical Research, University of Queensland, Herston, QLD, Australia
| | - Michael P Pender
- School of Medicine, The University of Queensland, Brisbane, Australia
| | | | - John D Pollard
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Stephen W Reddel
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Cameron Shaw
- Department of Neurology, Geelong Hospital, Geelong, VIC, Australia
| | - Judith Spies
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - James Stankovich
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | - Ian Sutton
- Department of Neurology, St Vincent's Hospital, Sydney, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, Westmead, Australia
| | - Michael Walsh
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Richard C Wong
- School of Medicine, The University of Queensland, Brisbane, Australia
| | - Eppie M Yiu
- Children's Neuroscience Centre, Royal Children's Hospital, Parkville, Australia
| | - Michael H Barnett
- Brain and Mind Centre, The University of Sydney, Camperdown, Australia
| | - Allan G Kermode
- Western Australian Neuroscience Research Institute, Nedlands, Australia
| | - Mark P Marriott
- Melbourne Brain Centre, University of Melbourne, Melbourne, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, Australia
| | - Mark Slee
- Department of Neurology, Flinders Medical Centre, Adelaide, Australia
| | - Bruce V Taylor
- Menzies Research Institute, University of Tasmania, Hobart, Australia
| | | | - Robert J Wilson
- Department of Immunology, Pathology Queensland, Brisbane, Australia
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | - Simon A Broadley
- School of Medicine, Griffith University, Gold Coast, Australia.,Department of Neurology, Gold Coast University Hospital, Gold Coast, QLD, Australia
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11
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Abstract
BACKGROUND It is uncertain whether there are autoantibodies detectable by indirect immunofluorescence in the serum of patients with multiple sclerosis (MS). OBJECTIVE To determine whether there are anti-central nervous system (CNS) autoantibodies detectable by indirect immunofluorescence in the serum of MS patients. METHODS Sera and in some cases cerebrospinal fluid from 106 patients with multiple sclerosis, 156 patients with other neurological diseases, and 70 healthy control subjects were examined by indirect immunofluorescence using cryostat sections of rat cerebrum fixed by perfusion with paraformaldehyde. RESULTS Autoantibodies were detected that recognized more than 30 neuronal, glial, and mesodermal structures in 28 of 106 MS cases. Most were also detected in patients with other related and unrelated neurological diseases and several were also found in healthy controls. Novel anti-CNS autoantibodies recognizing particular sets of interneurons were detected in both normal controls and in subjects with CNS diseases. INTERPRETATION Serum anti-CNS autoantibodies of diverse specificities are common in MS patients. The same anti-CNS autoantibodies are not uncommon in patients with other neurological diseases. The findings provide no support for the proposition that myelin breakdown in MS is caused by exposure of intact myelin sheaths or oligodendrocytes to a pathogenic serum anti-myelin or anti-oligodendrocyte autoantibody.
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Affiliation(s)
- John W Prineas
- Brain and Mind Centre, Department of Medicine, The University of Sydney, Camperdown, NSW, Australia
| | - John D E Parratt
- Parratt Brain and Mind Centre, Department of Medicine, The University of Sydney, Camperdown, NSW, Australia and Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
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12
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Abstract
We report a previously undescribed inflammatory lesion consisting of deposition of activated complement (C3d and C9neo) in association with major histocompatibility complex type II (MHC2)-positive activated microglia in choroid plexus villi exhibiting classical fibrous thickening of the pericapillary filtration membrane. The proportion of villi affected ranged from 5% to 90% in 56 adult subjects with diseases of the CNS and 11 subjects with no preexisting disease of the CNS. In 3 of the 4 children studied, 2% or less of examined villi showed stromal thickening, complement deposition, and the presence of MHC2-positive microglia; in adults, the proportion of villi affected increased with age. Other features of the lesion included loss of capillaries and failure by macrophages to clear extracellular particulate electron-dense material by clathrin-mediated phagocytosis. This choroid plexus lesion may relate pathogenetically to age-related macular degeneration and to Alzheimer disease, 2 other conditions with no known risk factors other than increasing age. All 3 conditions are characterized by the presence of damaged capillaries, inflammatory extracellular aggregates of mixed molecular composition and defective clearance of the deposits by macrophages.
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Affiliation(s)
- John W Prineas
- From the The Institute of Clinical Neurosciences and the Nerve Research Foundation, Department of Medicine, University of Sydney, NSW, Australia (JWP, JDEP)Department of Neurology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia (JDEP)Electron Microscope Unit, Department of Anatomical Pathology, Concord Repatriation Hospital, Concord, Sydney, NSW, Australia (PDK)
| | - John D E Parratt
- From the The Institute of Clinical Neurosciences and the Nerve Research Foundation, Department of Medicine, University of Sydney, NSW, Australia (JWP, JDEP)Department of Neurology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia (JDEP)Electron Microscope Unit, Department of Anatomical Pathology, Concord Repatriation Hospital, Concord, Sydney, NSW, Australia (PDK)
| | - Paul D Kirwan
- From the The Institute of Clinical Neurosciences and the Nerve Research Foundation, Department of Medicine, University of Sydney, NSW, Australia (JWP, JDEP)Department of Neurology, Royal North Shore Hospital, St. Leonards, Sydney, NSW, Australia (JDEP)Electron Microscope Unit, Department of Anatomical Pathology, Concord Repatriation Hospital, Concord, Sydney, NSW, Australia (PDK)
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13
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Ramanathan S, Prelog K, Barnes EH, Tantsis EM, Reddel SW, Henderson APD, Vucic S, Gorman MP, Benson LA, Alper G, Riney CJ, Barnett M, Parratt JDE, Hardy TA, Leventer RJ, Merheb V, Nosadini M, Fung VSC, Brilot F, Dale RC. Radiological differentiation of optic neuritis with myelin oligodendrocyte glycoprotein antibodies, aquaporin-4 antibodies, and multiple sclerosis. Mult Scler 2015; 22:470-82. [PMID: 26163068 DOI: 10.1177/1352458515593406] [Citation(s) in RCA: 216] [Impact Index Per Article: 24.0] [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: 04/01/2015] [Accepted: 06/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recognizing the cause of optic neuritis (ON) affects treatment decisions and visual outcomes. OBJECTIVE We aimed to define radiological features of first-episode demyelinating ON. METHODS We performed blinded radiological assessment of 50 patients presenting with first-episode myelin oligodendrocyte glycoprotein (MOG) antibody-associated ON (MOG-ON; n=19), aquaporin-4 (AQP4) antibody-associated ON (AQP4-ON; n=11), multiple sclerosis (MS)-associated ON (MS-ON; n=13), and unclassified ON (n=7). RESULTS Bilateral involvement was more common in MOG-ON and AQP4-ON than MS-ON (84% vs. 82% vs. 23%), optic nerve head swelling was more common in MOG-ON (53% vs. 9% vs. 0%), chiasmal involvement was more common in AQP4-ON (5% vs. 64% vs. 15%), and bilateral optic tract involvement was more common in AQP4-ON (0% vs. 45% vs. 0%). Retrobulbar involvement was more common in MOG-ON, whereas intracranial involvement was more common in AQP4-ON. MOG-ON and AQP4-ON had longer lesion lengths than MS-ON. The combination of two predictors, the absence of magnetic resonance imaging brain abnormalities and a higher lesion extent score, showed a good ability to discriminate between an autoantibody-associated ON (MOG or AQP4) and MS. AQP4-ON more frequently had severe and sustained visual impairment. CONCLUSION MOG-ON and AQP4-ON are more commonly bilateral and longitudinally extensive. MOG-ON tends to involve the anterior optic pathway, whereas AQP4-ON the posterior optic pathway.
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Affiliation(s)
- Sudarshini Ramanathan
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia/Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Kristina Prelog
- Department of Medical Imaging, the Children's Hospital at Westmead, Sydney, Australia
| | | | - Esther M Tantsis
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Stephen W Reddel
- Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia/Brain and Mind Research Institute, University of Sydney, Sydney, Australia
| | - Andrew P D Henderson
- Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia/Department of Ophthalmology, Westmead Hospital, Sydney, Australia
| | - Steve Vucic
- Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia/Western Clinical School, University of Sydney, Sydney, Australia
| | - Mark P Gorman
- Boston Children's Hospital, Boston, United States of America
| | - Leslie A Benson
- Boston Children's Hospital, Boston, United States of America
| | - Gulay Alper
- Children's Hospital of Pittsburgh, Department of Pediatrics, University of Pittsburgh, School of Medicine, Pittsburgh, United States of America
| | - Catherine J Riney
- Neurosciences Unit, Lady Cilento Children's Hospital, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Michael Barnett
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia/Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Central Clinical School, University of Sydney, Sydney, Australia
| | - Todd A Hardy
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia/Department of Neurology, Concord Repatriation General Hospital, Sydney, Australia
| | - Richard J Leventer
- Department of Neurology, University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute, The Royal Children's Hospital, Melbourne, Australia
| | - Vera Merheb
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Margherita Nosadini
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Victor S C Fung
- Department of Neurology, Westmead Hospital, and Sydney Medical School, University of Sydney, Sydney, Australia
| | - Fabienne Brilot
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Russell C Dale
- Neuroimmunology group, Institute for Neuroscience and Muscle Research, The Kids Research Institute at the Children's Hospital at Westmead, Sydney Medical School, University of Sydney, Sydney, Australia
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14
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Hardy TA, O'Brien B, Gerbis N, Barnett MH, Reddel SW, Brewer J, Herkes GK, Silberstein P, Garsia RJ, Watson JDG, Gupta R, Parratt JDE, Buckland ME. Brain histopathology in three cases of Susac's syndrome: implications for lesion pathogenesis and treatment. J Neurol Neurosurg Psychiatry 2015; 86:582-4. [PMID: 25168394 DOI: 10.1136/jnnp-2014-308240] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 08/10/2014] [Indexed: 11/03/2022]
Affiliation(s)
- Todd A Hardy
- Neuroimmunology Clinic, Concord Hospital and University of Sydney, Sydney, New South Wales, Australia MS Australia Clinic, Brain & Mind Research Institute, Sydney, New South Wales, Australia
| | - Billy O'Brien
- Department of Neurology, Gosford Hospital, Gosford, New South Wales, Australia
| | - Natasha Gerbis
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Michael H Barnett
- MS Australia Clinic, Brain & Mind Research Institute, Sydney, New South Wales, Australia Brain & Mind Research Institute, Sydney, New South Wales, Australia Department of Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Stephen W Reddel
- Neuroimmunology Clinic, Concord Hospital and University of Sydney, Sydney, New South Wales, Australia
| | - Janice Brewer
- Department of Anatomical Pathology, PaLMS, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Geoffrey K Herkes
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Paul Silberstein
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Roger J Garsia
- Department of Immunology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - John D G Watson
- Section of Neurology, Sydney Adventist Hospital, Sydney, New South Wales, Australia Discipline of Medicine, Sydney Adventist Hospital Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ruta Gupta
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital and the University of Sydney, Sydney, New South Wales, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, New South Wales, Australia Department of Medicine, Institute of Clinical Neurosciences, University of Sydney, Camperdown, New South Wales, Australia
| | - Michael E Buckland
- Brain & Mind Research Institute, Sydney, New South Wales, Australia Department of Neuropathology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
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15
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Ramanathan S, Reddel SW, Henderson A, Parratt JDE, Barnett M, Gatt PN, Merheb V, Kumaran RYA, Pathmanandavel K, Sinmaz N, Ghadiri M, Yiannikas C, Vucic S, Stewart G, Bleasel AF, Booth D, Fung VSC, Dale RC, Brilot F. Antibodies to myelin oligodendrocyte glycoprotein in bilateral and recurrent optic neuritis. Neurol Neuroimmunol Neuroinflamm 2014; 1:e40. [PMID: 25364774 PMCID: PMC4215392 DOI: 10.1212/nxi.0000000000000040] [Citation(s) in RCA: 171] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Accepted: 09/11/2014] [Indexed: 12/23/2022]
Abstract
Objective: We examined a cohort of adults with aquaporin-4 (AQP4) antibody–negative neuromyelitis optica/neuromyelitis optica spectrum disorder (NMO/NMOSD) for antibodies to myelin oligodendrocyte glycoprotein (MOG). Methods: We performed a flow cytometry cell-based assay using live human lentivirus–transduced cells expressing full-length surface MOG. Serum was tested in 23 AQP4 antibody–negative NMO/NMOSD patients with bilateral and/or recurrent optic neuritis (BON, n = 11), longitudinally extensive transverse myelitis (LETM, n = 10), and sequential BON and LETM (n = 2), as well as in patients with multiple sclerosis (MS, n = 76) and controls (n = 52). Results: MOG antibodies were detected in 9/23 AQP4 antibody–negative patients with NMO/NMOSD, compared to 1/76 patients with MS and 0/52 controls (p < 0.001). MOG antibodies were detected in 8/11 patients with BON, 0/10 patients with LETM, and 1/2 patients with sequential BON and LETM. Six of 9 MOG antibody–positive patients had a relapsing course. MOG antibody–positive patients had prominent optic disc swelling and were more likely to have a rapid response to steroid therapy and relapse on steroid cessation than MOG antibody–negative patients (p = 0.034 and p = 0.029, respectively). While 8/9 MOG antibody–positive patients had good follow-up visual acuity, one experienced sustained visual impairment, 3 had retinal nerve fiber layer thinning, and one had residual spinal disability. Conclusions: MOG antibodies have a strong association with BON and may be a useful clinical biomarker. MOG antibody–associated BON is a relapsing disorder that is frequently steroid responsive and often steroid dependent. Failure to recognize the disorder early and institute immunotherapy promptly may be associated with sustained impairment. Classification of evidence: This study provides Class II evidence that MOG antibodies are associated with AQP4 antibody–negative BON (sensitivity 69%, 95% confidence interval [CI] 42%–87%; specificity 99%, 95% CI 93.7%–99.8%).
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Affiliation(s)
| | | | | | | | | | | | - Vera Merheb
- Authors' affiliations are listed at the end of the article
| | | | | | - Nese Sinmaz
- Authors' affiliations are listed at the end of the article
| | - Mahtab Ghadiri
- Authors' affiliations are listed at the end of the article
| | - Con Yiannikas
- Authors' affiliations are listed at the end of the article
| | - Steve Vucic
- Authors' affiliations are listed at the end of the article
| | - Graeme Stewart
- Authors' affiliations are listed at the end of the article
| | | | - David Booth
- Authors' affiliations are listed at the end of the article
| | | | - Russell C Dale
- Authors' affiliations are listed at the end of the article
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16
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Blair NF, Parratt JDE, Garsia R, Brazier DH, Cremer PD. Inflammatory trigeminal nerve and tract lesions associated with inferior alveolar nerve anaesthesia. J Clin Neurosci 2013; 20:1608-10. [PMID: 23591181 DOI: 10.1016/j.jocn.2012.10.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/16/2012] [Accepted: 10/06/2012] [Indexed: 10/27/2022]
Abstract
Inferior alveolar nerve blocks are commonly performed for dental anaesthesia. The procedure is generally safe with a low rate of complications. We report a patient with a reproducible, delayed-onset sensory deficit associated with contrast-enhancing lesions in the trigeminal nerve, pons and medulla following inferior alveolar nerve local anaesthesia. We propose that this previously undescribed condition is a form of Type IV hypersensitivity reaction.
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Affiliation(s)
- N F Blair
- Department of Neurology, Royal North Shore Hospital, Pacific Highway, St Leonards, 2065, New South Wales, Australia
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17
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Abstract
There is little agreement among neuropathologists regarding the timing and nature of oligodendrocyte loss in multiple sclerosis (MS). This review describes changes that accompany acute oligodendrocyte loss in new lesions. Included is a description of the immunopathology of new lesions in 23 severe early cases selected from a bank of 300 MS autopsies. Oligodendrocytes in prephagocytic lesions exhibit cytopathic changes that include apoptosis of oligodendrocytes immunoreactive for caspase 3, phagocytosis of apoptotic oligodendrocytes, swelling of cells with abnormal nuclei, complement deposition, and lysis. These are nonspecific changes that provide no clue as to the cause of oligodendrocyte injury. Associated changes include the presence of enlarged immunoglobulin (IgG)(+) microglia and early macrophages, the presence nearby of a focus of inflammatory demyelination, an open blood-brain barrier, and the presence of rare CD8 T cells. Myelin contacted by IgG(+) macrophages is immunoreactive for complement but not for IgG. It is likely that macrophage activity in evolving white and gray matter plaques is scavenging activity directed at nonvital myelin secondary to oligodendrocytes loss. One feature of MS that is not understood is the extraordinarily close resemblance the disease shows pathologically to neuromyelitis optica (NMO), including that demyelination in both is secondary to a loss of caspase 3-positive apoptotic oligodendrocytes. These similarities raise the possibility that like NMO, MS is an autoimmune disease in which oligodendrocyte apoptosis is determined by injury to some other glial or mesenchymal component.
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Affiliation(s)
- John W Prineas
- Institute of Clinical Neurosciences, Department of Medicine, University of Sydney, Camperdown, Australia.
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18
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Femia G, Parratt JDE, Halmagyi GM. Isolated reversible hypoglossal nerve palsy as the initial manifestation of pre-eclampsia. J Clin Neurosci 2012; 19:602-3. [PMID: 22257430 DOI: 10.1016/j.jocn.2011.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2011] [Accepted: 06/29/2011] [Indexed: 11/25/2022]
Abstract
Isolated hypoglossal nerve lesions often reflect sinister neoplastic or vascular pathology. Rarely, reversible lesions occur, perhaps via mechanisms similar to Bell's palsy. We report a patient with reversible isolated hypoglossal nerve palsy as the first and predominant early manifestation of pre-eclampsia and speculate on the pathogenesis behind this abnormality.
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Affiliation(s)
- G Femia
- Department of Neurological Sciences, Royal Prince Alfred Hospital, Missenden Road, Camperdown, New South Wales 2050, Australia.
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19
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Barnett MH, Prineas JW, Buckland ME, Parratt JDE, Pollard JD. Massive astrocyte destruction in neuromyelitis optica despite natalizumab therapy. Mult Scler 2011; 18:108-12. [PMID: 21868485 DOI: 10.1177/1352458511421185] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Auto-antibody mediated astrocyte injury is implicated as a primary event in neuromyelitis optica (NMO) by biomarker, post-mortem and experimental studies that differentiate the condition from multiple sclerosis. We describe the clinical, radiological and neuropathological features of a severe cerebral attack in a natalizumab-treated patient with relapsing myelitis and serum aquaporin-4 antibodies. Our findings support autopsy evidence that abrupt astrocyte destruction precedes demyelination in NMO, and emphasize the importance of serological testing in patients with limited disease. Adherence to current NMO diagnostic criteria may delay treatment, or lead to inappropriate therapy with beta-interferon or natalizumab.
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Affiliation(s)
- M H Barnett
- Brain and Mind Research Institute, University of Sydney, Sydney, Australia.
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20
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Parratt JDE, Prineas JW. Neuromyelitis optica: a demyelinating disease characterized by acute destruction and regeneration of perivascular astrocytes. Mult Scler 2010; 16:1156-72. [PMID: 20823059 DOI: 10.1177/1352458510382324] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND A serum antibody directed against astrocytes is present in a high proportion of patients with neuromyelitis optica (NMO). The pathogenicity of the antibody is uncertain because no consistent astrocyte lesion is known to occur in NMO. OBJECTIVE To determine whether there is an astrocyte lesion in NMO and if this differs from astrocyte changes in multiple sclerosis (MS). METHODS Astrocyte pathology in early (still-myelinated) lesions and subacute NMO and MS lesions was examined immunohistochemically and in sections stained for astrocytes using routine histological techniques. RESULTS Demyelination in early NMO lesions is accompanied by oligodendrocyte apoptosis in a pattern identical to that seen in MS and this is preceded by an abrupt destruction of perivascular astrocytes. Reparative astrogliosis is effected by a population of unipolar, new astrocytes. Evidence of a different type of astrocyte lesion was found in MS. DISCUSSION The findings add to experimental evidence that the antibody is pathogenic. They also raise the possibility that demyelination in MS may be a bystander effect of an astrocyte lesion, i.e. that MS is not a disease primarily of myelin and oligodendrocytes.
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Affiliation(s)
- John D E Parratt
- The Institute of Clinical Neurosciences, Department of Medicine, The University of Sydney, NSW, Australia
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21
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Abstract
OBJECTIVE CD4 T-cell-dependent macrophage activation directed against a myelin or oligodendrocyte antigen is generally thought to be the mechanism causing myelin destruction in multiple sclerosis (MS). However, areas within expanding MS lesions may exhibit prominent oligodendrocyte loss and apoptosis in the absence of infiltrating lymphocytes. The present study was designed to further investigate the inflammatory profile of different regions within rapidly expanding MS lesions. METHODS Twenty-six active lesions from 11 patients with early MS were serially sectioned and immunostained for T and B cells, plasma cells, ramified microglia, macrophages, monocytes, and CD209-positive dendritic cells. Cell counts were compared in prephagocytic, phagocytic, and immediately postphagocytic areas. RESULTS Parenchymal T and B cells were largely absent in areas of initial oligodendrocyte loss and in areas of degenerate and dead myelin infiltrated by myelin phagocytes. In contrast, trailing areas of complete demyelination packed with lipid macrophages, and, in some lesions, regenerating oligodendrocytes, showed large numbers of T cells, B cells, and immunoglobulin G (IgG)-positive plasma cells. Lesions in 2 exceptionally early cases contained relatively few T and B cells, and no IgG-positive plasma cells. INTERPRETATION Early loss of oligodendrocytes is a prominent feature in tissue bordering rapidly expanding MS lesions. Macrophage activity is largely an innate scavenging response to the presence of degenerate and dead myelin. Adaptive immune activity involving T and B cells is conspicuous chiefly in recently demyelinated tissue, which may show signs of oligodendrocyte regeneration. The findings suggest that plaque formation has some basis other than destructive cell-mediated immunity directed against a myelin or oligodendrocyte antigen.
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Affiliation(s)
- Andrew P D Henderson
- Institute of Clinical Neuroscience, Department of Medicine, University of Sydney, Sydney, Australia
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22
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Barnett MH, Parratt JDE, Pollard JD, Prineas JW. MS: is it one disease? Int MS J 2009; 16:57-65. [PMID: 19671369] [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] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 02/24/2008] [Indexed: 05/28/2023]
Abstract
Neuropathological studies of early multiple sclerosis (MS) tissue have shaped prevailing views of the pathogenesis of the disease. The hallmark of the acute MS lesion, inflammatory demyelination, has been largely accepted as evidence of a macrophage-mediated attack on normal myelin, driven by perivascular and parenchymal autoreactive CD4+ Th1 cells primed in the periphery by an unknown self or foreign antigen(s). Predicated largely upon comparisons with experimental allergic encephalomyelitis, this paradigm has, in recent years, been recognized as a simplification of the events that constitute and perhaps presage lesion formation in the human disease; and the importance of the innate immune cells of the central nervous system, humoral factors, cytotoxic CD8+ T-cells and regulatory T-cells has been emphasized. An influential series of publications by one group, based on histopathological examination of actively demyelinating lesions in selected autopsy and biopsy MS tissue, defined four early lesion subtypes. In a given individual, these subtypes were reported to be mutually exclusive, suggesting that disparate pathogenetic pathways separate patients with clinically indistinguishable syndromes. This schema, which has considerable therapeutic implications, has not been independently verified and has recently been questioned by the finding of a uniform pre-phagocytic pathology and overlap of lesion subtypes in individual patients with typical relapsing and remitting disease. The latter findings would suggest that the heterogeneous features observed in active MS lesions sampled at different time-points are a reflection of the evolution of a single pathophysiological process, perhaps modified in part by genetic factors in individual cases.
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Affiliation(s)
- M H Barnett
- Institute of Clinical Neurosciences, University of Sydney, New South Wales, Australia.
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23
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Parratt JDE, O'Riordan JI, Swingler RJ, Parratt D. Re: "antibiotic use and risk of multiple sclerosis". Am J Epidemiol 2006; 164:1253; author reply 1253-4. [PMID: 17095537 DOI: 10.1093/aje/kwk081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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24
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Donnan PT, Parratt JDE, Wilson SV, Forbes RB, O'Riordan JI, Swingler RJ. Multiple sclerosis in Tayside, Scotland: detection of clusters using a spatial scan statistic. Mult Scler 2005; 11:403-8. [PMID: 16042222 DOI: 10.1191/1352458505ms1191oa] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [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: 11/05/2022]
Abstract
Debate continues over the relative importance of genetic factors over infectious agents in the aetiology of multiple sclerosis (MS). Detection of clusters of MS in space and time in the Tayside region of Scotland, UK would provide valuable evidence for the movement of infectious agents into a genetically susceptible population. A spatial scan statistic was used to detect, locate and provide a robust statistical test of any clusters found, without prior knowledge of their location or size. This was applied to a population-based MS register for the Tayside region of Scotland from 1970 to 1997, allowing for age at symptom onset, gender, population density and social deprivation. There were a total of 772 cases during the study period; an annual incidence of 72 per 100000. The mean age of symptom onset was 35.7 (SD = 10.5) and 73.8% of cases were women. There was a general increase in cases over time probably reflecting gradually better detection and diagnosis. There was a peak around the mid-1990s and some evidence of periodicity. There was a highly significant temporal cluster between 1982 and 1995 (P = 0.002) for the whole region. Additionally, a significant spatial cluster for the time period 1993-1995 was found centred in the rural area south-west of Perth (P=0.016). Significant temporal and spatial-temporal clusters are consistent with exogenous factors contributing to the distribution of MS in Tayside, Scotland.
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Affiliation(s)
- Peter T Donnan
- Tayside Centre for General Practice, Kirsty Semple Way, University of Dundee, Dundee DD2 4BF, Scotland, UK.
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