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Ganelin-Cohen E, Shelly S, Schiller Y, Vaknin-Dembinsky A, Shachor M, Rechtman A, Osherov M, Duvdevan N, Rozenberg A. Dual positivity for anti-MOG and oligoclonal bands: Unveiling unique clinical profiles and implications. Mult Scler Relat Disord 2023; 79:105034. [PMID: 37801958 DOI: 10.1016/j.msard.2023.105034] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 09/14/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Distinguishing between MOG-associated disease (MOGAD) and multiple sclerosis (MS) presents a considerable challenge, as there are instances of overlapping clinical presentations. This complexity is further magnified in cases where patients concurrently exhibit both anti-myelin oligodendrocyte glycoprotein (anti-MOG) positivity and detectable oligoclonal bands (OCBs) This retrospective study investigates the clinical and imaging attributes of dual-positive patients, those with both anti-MOG positivity and OCBs, The study aims to show potential areas of overlap between multiple sclerosis (MS) and MOGAD. METHODS Utilizing data gathered from three medical centers, we evaluated a cohort of 45 patients, stratifying them into two groups: those exclusively positive for anti-MOG antibodies and those displaying dual positivity. Our analysis encompassed a wide range of clinical and imaging parameters. The statistical techniques employed comprised Fisher's Exact Test along with Benjamini-Hochberg correction to ensure robustness of the findings. RESULTS The study involved 45 patients with anti-MOG antibodies; 30 exhibited isolated anti-MOG positivity without OCBs, while 15 were dual-positive. The first group's average age was 10±7 years, compared to 28±17 years in the double-positive group (p = 0.001). CSF analysis showed no significant differences in pleocytosis, protein levels, or opening pressure between the groups. In the exclusive anti-MOG positivity cohort, 9 out of 15 patients received IVIG treatment; a larger subgroup with dual positivity chose anti-CD20 treatment. Notably, papilledema incidence was higher in the single-positive group (p = 0.014). Optic nerve enhancement (p = 0.0038) and nerve thickening (p = 0.0017) were markedly elevated in the single-positive population, with a trend towards pre-chiasmatic lesions (p = 0.06). Double-positive cases exhibited more polyfocal presentation (p = 0.013) and higher attacks per case (p = 0.002, HR=10.2, 95 % CI: 2.19 to 49.23). The double-positive group had more brain lesions (p = 0.0063) but no significant distinctions in other aspects. CONCLUSION The results emphasize the challenges inherent in differentiating between MS and a more MOGAD. While the data suggest two plausible scenarios-either falling within the spectrum of MS or representing an intensified MOGAD-we recognize the need for stronger evidence to definitively classify these instances. This study underscores the imperative for thorough investigations to ascertain whether these cases align with the MS spectrum or denote an inflammatory variant of MOGAD.
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Affiliation(s)
- Esther Ganelin-Cohen
- Neuroimmunological Clinic, Institute of Pediatric Neurology, Schneider Children's Medical Center of Israel, Petah Tikva 4920235, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Shahar Shelly
- Department of Neurology, Rambam Health Care Campus, Haifa 3525408, Israel; Neuroimmunology Laboratory, Department of Neurology, Rambam Health Care Campus and Ruth and Bruce Rapaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3525408, Israel
| | - Yael Schiller
- Department of Neurology, Rambam Health Care Campus, Haifa 3525408, Israel
| | - Adi Vaknin-Dembinsky
- Unit for Neuro-Immunology, Multiple Sclerosis & Cell Therapy, Department of Neurology, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Maayan Shachor
- Department of Pediatric, C. Schneider Children's Medical Center of Israel, Petah Tikva, 4920235, Israel
| | - Ariel Rechtman
- Unit for Neuro-Immunology, Multiple Sclerosis & Cell Therapy, Department of Neurology, Hadassah Medical Center, The Hebrew University of Jerusalem, Jerusalem 91120, Israel
| | - Michael Osherov
- The Neuroimmunology and Multiple Sclerosis Unit, Neurology Institute, Barzilay Ashkelon Israel
| | - Nitsan Duvdevan
- The Neuro-ophthalmology unit Rambam Health Care Campus, Haifa, 3525408, Israel
| | - Ayal Rozenberg
- Department of Neurology, Rambam Health Care Campus, Haifa 3525408, Israel; Neuroimmunology Laboratory, Department of Neurology, Rambam Health Care Campus and Ruth and Bruce Rapaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 3525408, Israel.
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Menendez L, Osherov M, Nitsan Z, Alkrenawi M, Gelfand A, Hovel N, Appel S, Milo R. The consequences of switching Gilenya to generics for Fingolimod. Mult Scler Relat Disord 2023; 74:104692. [PMID: 37099833 DOI: 10.1016/j.msard.2023.104692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 03/22/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND On May 2017, two generic drugs for fingolimod were introduced into the market in Israel, and most MS patients treated with Gilenya® (Novartis) were switched to fingolimod (Teva), or to Finolim (Rafa). In this study we analyzed the consequences of switching to generic fingolimod in a single MS center. METHODS Study population included relapsing MS patients who were treated with Gilenya® for at least two year before May 2017, switched to generic fingolimod and remained on treatment for at least 2 years thereafter. Data before and after the switch were compared. RESULTS Twenty-seven patients fulfilled the inclusion criteria (F = 20, RRMS=20, SPMS=7, average age 49±11.4 years, average disease duration=16.6 ± 7.6 years). Seventeen patients had to be switched back to the original Gilenya® due to intolerable new or worsening clinical adverse events (n = 9), clinical relapse (n = 1), clinical relapse with adverse events (n = 3), elevation of liver enzymes > X3 ULN (n = 3) and elevation of amylase (n = 1). Expanded Disability Status Scale (EDSS) score increased in 4 patients during the year before the switch, and in 12 patients during the year of treatment with generic fingolimod (p = 0.036). CONCLUSION The tolerability, retention rate and probably efficacy of generic fingolimod seems to be lower than the original Gilenya®.
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Alkrenawi M, Osherov M, Simonovich A, Droujin J, Milo R, Appel S. Association between cervical disc disease and lesions of multiple sclerosis. Neuroradiol J 2021; 34:200-204. [PMID: 33393859 DOI: 10.1177/1971400920983565] [Citation(s) in RCA: 1] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cervical discopathy and demyelinating lesions often co-exist in patients with multiple sclerosis (MS). Our study examines the possible association between these two pathologies. METHODS Medical records and cervical magnetic resonance imaging scans of MS patients with cervical discopathy who were seen at our MS clinic during 2018 were retrospectively reviewed. The severity of the disc disease was classified as grade I (no compression), grade II (compression of the dural sac) and grade III (cord compression). The spinal cord in each scan was divided into six segments corresponding to the intervertebral space of the spine (C1-C6). Each segment was defined as containing demyelinating lesion and disc pathology (group 1), demyelinating lesion without disc pathology (group 2), disc pathology without demyelinating lesion (group 3) and no demyelinating lesion or disc pathology (group 4). Fisher's exact test was used to test the association between demyelinating lesions and disc pathology. RESULTS Thirty-four MS patients with cervical discopathy were included in the study (26 females; average age 42.9 ± 13.7 years; average disease duration 8.4 ± 5.4 years). A total of 204 spinal cord segments were evaluated. Twenty-four segments were classified as group 1, 27 segments as group 2, 52 segments as group 3 and 101 segments as group 4. There was no association between demyelinating lesions and the grade of disc disease (p = 0.1 for grade I, p = 0.3 for grade II and p = 1 for grade III disc disease). CONCLUSION Our study did not find any association between cervical disc disease and demyelinating spinal cord lesion.
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Affiliation(s)
- Marwan Alkrenawi
- Department of Neurology, Barzilai University Medical Centre, Israel
| | - Michael Osherov
- Department of Neurology, Barzilai University Medical Centre, Israel
| | - Azaria Simonovich
- Department of Radiology, Barzilai University Medical Centre, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Jonathan Droujin
- Department of Radiology, Barzilai University Medical Centre, Israel
| | - Ron Milo
- Department of Neurology, Barzilai University Medical Centre, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
| | - Shmuel Appel
- Department of Neurology, Barzilai University Medical Centre, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Israel
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Nitsan Z, Cohen OS, Chapman J, Kahana E, Korczyn AD, Appel S, Osherov M, Rosenmann H, Milo R. Familial Creutzfeldt-Jakob disease homozygous to the E200K mutation: clinical characteristics and disease course. J Neurol 2020; 267:2455-2458. [PMID: 32367297 DOI: 10.1007/s00415-020-09826-z] [Citation(s) in RCA: 4] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To characterize the demographic, clinical features and disease course of familial Creutzfeldt-Jakob disease (fCJD) patients homozygous to the E200K mutation. METHODS The Israeli National CJD Database was screened for patients homozygous to the E200K mutation. Patients' demographic data, clinical presentation and neurological findings, tau protein levels in the cerebrospinal fluid (CSF) and EEG, were assessed. RESULTS Ten homozygous E200K patients were identified (80% males). Average age of onset was 47.5 ± 6.1 years (range 40-56) and the average age of death was 49.3 ± 7. 7 years (range 42-63) with average disease duration of 27.7 ± 9.7 months (range 2-97). Initial clinical presentation included behavioral change in 4/10 patients, cognitive decline in 3/10 patients and focal neurological deficits in 2/10 patients. Throughout the disease course, the clinical signs in descending order of prevalence included cerebellar (70%), brainstem (60%), extrapyramidal (50%), pyramidal (50%), frontal lobe signs (30%), and disturbances of ocular motility (30%) Compared to the 228 heterozygous E200K fCJD patients, the 10 homozygous patients were significantly younger at disease onset (47.5 vs 59.7 years, p < 0.001), had a longer disease duration (27.7 vs 8.5 months, p < 0.001) and presented more frequently with behavioral changes as initial manifestation (4/10 vs. 34/228, p = 0.05). CONCLUSIONS Homozygous E200K fCJD patients are characterized by a relatively younger age of onset and longer disease duration. Behavioral changes as a presenting symptom were more common in homozygous patients and cerebellar dysfunction was the most common neurological manifestation throughout the disease course.
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Affiliation(s)
- Zeev Nitsan
- Department of Neurology, Barzilai University Medical Center, 2 Hahistadrut St., 7830604, Ashkelon, Israel. .,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel.
| | - Oren S Cohen
- Department of Neurology, Assaf Harofeh Medical Center, Zerifin, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Joab Chapman
- Department of Neurology, The Sagol Neuroscience Center, Chaim Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Esther Kahana
- Department of Neurology, Barzilai University Medical Center, 2 Hahistadrut St., 7830604, Ashkelon, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Amos D Korczyn
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Shmuel Appel
- Department of Neurology, Barzilai University Medical Center, 2 Hahistadrut St., 7830604, Ashkelon, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Osherov
- Department of Neurology, Barzilai University Medical Center, 2 Hahistadrut St., 7830604, Ashkelon, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Hanna Rosenmann
- Department of Neurology, The Agnes Ginges Center for Human Neurogenetics, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ron Milo
- Department of Neurology, Barzilai University Medical Center, 2 Hahistadrut St., 7830604, Ashkelon, Israel.,Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
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Abstract
The traditional view of multiple sclerosis (MS) as a T cell mediated autoimmune disease of the central nervous system (CNS) has evolved into a concept of an immune-mediated disease where complex bi-directional interactions between T cells, B cells and myeloid cells underlie and shape CNS-directed autoimmunity. B cells are now recognized as major contributors to the pathogenesis of MS, largely due to increased understanding of their biology and the profound anti-inflammatory effects demonstrated by B cell depletion in MS. In this chapter we discuss the fundamental roles B cells play in the pathogenesis of MS and review current and future therapeutic strategies targeting B cells in MS, including B cell depletion with various monoclonal antibodies (mAbs) against the B cell surface markers CD20 and CD19, anti-B cell cytokine therapies, blocking Bruton's tyrosine kinase (BTK) in B cells, and various immunomodulatory and immunosuppressive effects exerted on B cells by virtually all other approved therapies for MS.
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Affiliation(s)
- Michael Osherov
- Department of Neurology, Barzilai University Medical Center 2 Hahistadrut St. Ashkelon 7830604 Israel
| | - Ron Milo
- Department of Neurology, Barzilai University Medical Center 2 Hahistadrut St. Ashkelon 7830604 Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev Beer-Sheva Israel
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Abstract
PURPOSE The objective of this study is to examine the rate of horizontal canal BPPV recurrence of the same type and search for predisposing factors.
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Affiliation(s)
- L Pollak
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel.
| | - R Huna-Baron
- Goldschleger Eye Institute, Sheba Medical Center, Ramat Gan, Israel affiliated to Sackler Faculty of Medicine Tel Aviv University, Israel
| | - Michael Osherov
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Milo Roni
- Department of Neurology, Barzilai Medical Center, Ashkelon, Israel affiliated to Ben Gurion University of the Negev, Beer Sheva, Israel
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Nitsan Z, Kucuk N, Appel S, Tichmanovich N, Osherov M, Milo R. Mycosis fungoides – A cutaneous lymphoproliferative disorder in a patient treated with fingolimod for multiple sclerosis. J Clin Neurosci 2018; 48:102-103. [DOI: 10.1016/j.jocn.2017.10.077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
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Affiliation(s)
- Michael Osherov
- Department of Neurology, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkelon, Israel
| | - Ron Milo
- Department of Neurology, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkelon, Israel
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Abstract
Daclizumab is a humanized monoclonal antibody that binds to the a-subunit (CD25) of the interleukin-2 receptor (IL-2R), thus blocking the formation of the high-affinity IL-2R which is expressed mainly on activated and regulatory T cells. IL-2R modulation by daclizumab results primarily in the expansion of regulatory CD56(bright) natural killer cells that are capable of killing activated T cells, rather than direct suppression of activated T cells. The pharmacokinetic profile of its currently available form, daclizumab high-yield process (DAC-HYP, Zinbryta), suggests high subcutaneous bioavailability, linear pharmacokinetics and an effective half-life suitable for monthly administration. A comprehensive clinical program in relapsing-remitting multiple sclerosis demonstrated an impressive effect of DAC-HYP on inflammatory and clinical disease activity compared with placebo or interferon beta, which led to its recent approval for the treatment of relapsing forms of multiple sclerosis. Several serious adverse events and risks call for the implementation of a risk management program in multiple sclerosis patients treated with DAC-HYP.
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Affiliation(s)
- R Milo
- Department of Neurology, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkelon, Israel.
| | - M Osherov
- Department of Neurology, Barzilai University Medical Center, Ashkelon, Faculty of Health Sciences, Ben-Gurion University of the Negev, Ashkelon, Israel
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Pollak L, Osherov M, Berkovitz N, Beckerman I, Stryjer R, Tal S. Magnetic resonance brain imaging in patients with visual vertigo. Brain Behav 2015; 5:e00402. [PMID: 26664788 PMCID: PMC4667762 DOI: 10.1002/brb3.402] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 08/22/2015] [Accepted: 09/02/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patients with visual vertigo (VV) report dizziness provoked by moving visual surroundings. It has been suggested that these subjects develop a compensation strategy for a vestibulo-proprioceptive deficit and rely excessively on visual input. We have postulated that patients with VV might have brain abnormalities that interfere with appropriate processing of visual stimulation and performed a brain MRI study to verify this hypothesis. MATERIALS AND METHODS Patients with VV of more than 3 months duration were included. They were asked to complete the Situational Characteristic Questionnaire (SCQ) that scores for the symptoms of VV. Dizzy patients without VV served as controls. A brain MRI was performed with a Siemens 1.5 Tesla scanner in patients and controls. RESULTS Twenty-four patients with VV were included. Their mean SCQ score was 1.45 ± 0.9 (normal 0.16 ± 0.28). In 50% of patients, abnormalities in MRI imaging were found. Thirty-three percent of 27 controls demonstrated an abnormal brain MRI. The two groups were similar in respect to the prevalence of a localized hemispheric or posterior fossa lesion (P = 0.13), but VV patients had more unspecific white matter brain changes than controls (P = 0.009). Patients and controls did not differ in age and gender distribution (P = 0.9) or the history of a neurotological event preceding their symptoms (P = 0.3). CONCLUSIONS Our study suggests that multiple white matter lesions might contribute to occurrence of the phenomenon of VV. Future prospective large-scale studies by specific MR techniques are indicated to validate our preliminary findings and elucidate the pathological mechanism of VV.
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Affiliation(s)
- Lea Pollak
- Department of Neurology The Assaf Harofeh Medical Center Zerifin Israel ; Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Michael Osherov
- Department of Neurology The Assaf Harofeh Medical Center Zerifin Israel ; Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel
| | - Nadav Berkovitz
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Department of Radiology The Assaf Harofeh Medical Center Zerifin Israel
| | - Inessa Beckerman
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Department of Radiology The Assaf Harofeh Medical Center Zerifin Israel
| | - Rafael Stryjer
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Public Health Hospital Beer Yaacov Israel
| | - Sigal Tal
- Affiliated to The Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel ; Department of Radiology The Assaf Harofeh Medical Center Zerifin Israel
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