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Nicely P, Sun G, Gupta S, Lawlor M, Selvaraj V. 'I Thought It Was My Diabetes': An Acute Presentation of Neuromyelitis Optica Spectrum Disorder. R I Med J (2013) 2024; 107:10-13. [PMID: 38412346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
Neuromyelitis Optica Spectrum Disorder (NMOSD) is an immune-mediated neuroinflammatory disease of the central nervous system. Patients typically present with sensory deficits, weakness, and incontinence. This is a case of a 43-year-old female with diabetes mellitus admitted for acute onset leg weakness and stool incontinence. Spinal MRI imaging revealed transverse myelitis, and her lab work was significant for an anti-aquaporin 4 (AQP4) antibody titer of 1:2,560. Initial treatment consisted of a high-dose steroid taper and plasmapheresis. This unique case illustrates the importance in recognizing delayed presentations of rare neuroinflammatory conditions previously assumed to be a sequela of diabetic neuropathy.
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Affiliation(s)
- Preston Nicely
- The Warren Alpert Medical School of Brown University, Providence, RI
| | - Grace Sun
- The Warren Alpert Medical School of Brown University; Department of Medicine, The Miriam Hospital, Providence, RI
| | - Simran Gupta
- The Warren Alpert Medical School of Brown University; Department of Medicine, The Miriam Hospital, Providence, RI
| | - Maxwell Lawlor
- The Warren Alpert Medical School of Brown University; Department of Medicine, The Miriam Hospital, Providence, RI
| | - Vijairam Selvaraj
- The Warren Alpert Medical School of Brown University; Department of Medicine, The Miriam Hospital, Providence, RI
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Rohatgi S, Rao P, Nirhale S, Naphade P, Kotharu S, Gupta S. Neuromyelitis Optica Presenting as Non-Communicating Hydrocephalus: A Case Report. Neurol India 2023; 71:1239-1240. [PMID: 38174465 DOI: 10.4103/0028-3886.391387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Neuromyelitis Optica (NMO) is a demyelinating disease predominantly involving optic nerves, spinal cord and peri-ventricular regions which are rich in Aquaporin-4 receptors. Aquaporin-4 (AQP4) antibodies are implicated in the pathogenesis of NMO. Association of hydrocephalus ( communicating and non communicating) with NMO is very rare. We report a case of 32 years old female patient who presented with 2 months history of progressive headache, visual obscurations and gait imbalance . Clinical examination revealed bilateral papilloedema with preserved visual acuity. She had truncal and gait ataxia. Rest of the examination of nervous system was normal. MRI brain showed non- communicating hydrocephalus and T2 and FLAIR hyperintensities in periventricular and periaqueductal regions. AQP4 antibodies were positive in serum and negative in cerebrospinal fluid(CSF). Ventriculo - peritoneal shunt was placed and she was treated with steroids and azathioprine. Her headache and visual symptoms improved. However, after 8 months she presented with acute optic neuritis of right eye which was treated with intravenous methylprednisolone and plasmapharaesis.
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Affiliation(s)
- Shalesh Rohatgi
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Prajwal Rao
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Satish Nirhale
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Pravin Naphade
- Department of Neurology, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Sravya Kotharu
- Department of Medicine, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
| | - Sahil Gupta
- Department of Medicine, Dr D Y Patil Medical College, Hospital and Research Center, Dr DY Patil Vidyapeeth Pune, Maharashtra, India
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Campetella L, Papi C, Spagni G, Sabatelli E, Mariotto S, Gastaldi M, Masi G, Carta S, Ahmad L, Rossi F, Maniscalco GT, De Luca G, Iorio R. A score that predicts aquaporin-4-IgG positivity in patients with longitudinally extensive transverse myelitis. Eur J Neurol 2023. [PMID: 37170839 DOI: 10.1111/ene.15863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/19/2023] [Accepted: 05/09/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Longitudinally extensive transverse myelitis (LETM) associated with aquaporin-4 autoantibodies (AQP4-IgG) can cause severe disability. Early diagnosis and prompt treatment are critical to prevent relapses. We describe a novel score based on clinical and neuroimaging characteristics that predicts AQP4-IgG positivity in patients with LETM. METHODS Patients were enrolled both retrospectively and prospectively from multiple Italian centers. Clinical and neuroimaging characteristics of AQP4-IgG positive and negative patients were compared through univariate and multivariate analysis. RESULTS Sixty-six patients were included. Twenty-seven (41%) were AQP4-IgG positive and median age at onset was 45.5 years old (range 19-81, interquartile range 24). Female sex (odds ratio [OR] 17.9; 95% confidence interval [CI] 2.6-381.9; p=0.014), tonic spasms (OR 45.6; CI 3.1-2197; p=0.017) and lesion hypointensity on T1-weighted images (OR 52.9; CI 6.8-1375; p=0.002) were independently associated with AQP4-IgG positivity. The Aquaporin-4-IgG positivity in Myelitis (AIM) score predicted AQP4-IgG positivity with 85% sensitivity and 95% specificity. Positive and negative likelihood ratio were 16.6 and 0.2 respectively. The inter-rater and intra-rater agreement in the score application were both excellent. CONCLUSIONS The AIM score predicts AQP4-IgG positivity with good sensitivity and specificity in patients with a first episode of LETM. The score may assist clinicians in early diagnosis and treatment of AQP4-IgG positive LETM.
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Affiliation(s)
- Lucia Campetella
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Claudia Papi
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Gregorio Spagni
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
- Neurology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS. Rome, Italy
| | - Eleonora Sabatelli
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Sara Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Matteo Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Gianvito Masi
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
| | - Sara Carta
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Lara Ahmad
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | | | | | | | - Raffaele Iorio
- Neuroscience Department, Catholic University of the Sacred Heart, Rome, Italy
- Neurology Unit, Fondazione Policlinico Universitario "A. Gemelli" IRCCS. Rome, Italy
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Nabizadeh F, Moghadasi AN. Eculizumab in the treatment of neuromyelitis optica spectrum disorder. Curr J Neurol 2023; 22:140-143. [PMID: 38011413 PMCID: PMC10460925 DOI: 10.18502/cjn.v22i2.13342] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 02/02/2023] [Indexed: 11/29/2023]
Abstract
The Article Abstract is not available.
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Affiliation(s)
- Fardin Nabizadeh
- Neuroscience Research Group, Universal Scientific Education and Research Network, Tehran, Iran
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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González-Sansores EE, Bertado-Cortés B, León-Castillo DA, Rubalcava-Sánchez N. [ Neuromyelitis optica spectrum disorder in a patient with human immunodeficiency virus]. Rev Med Inst Mex Seguro Soc 2023; 61:220-226. [PMID: 37201182 PMCID: PMC10396062] [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] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/06/2022] [Indexed: 05/20/2023]
Abstract
Background Neuromyelitis optica spectrum (NMO) is an autoimmune condition with preferential target at the optic nerves and spinal cord. Although HIV infection can also cause neuritis and myelitis, the entity of HIV related to NMO has recently been elucidated, however, little is known about the context of this disease. Objective: To describe the clinical characteristics, imaging, treatment, and functional prognosis in an HIV-positive patient who developed an episode of longitudinally extensive transverse myelitis (LETM) with positive anti-AQP4 antibodies. Clinic case 36-year-old man with a history of HIV diagnosed in 2017, on antiretroviral treatment. On March 2021 he was admitted for study due to complete spinal cord syndrome, corroborating in MRI a longitudinally extensive lesion from T8-L1, with CSF with and AQP4 seropositivity, a diagnosis of NMO was integrated by Wingerchuk criteria and rituximab is started with symptomatic improvement, objectifying it with the Expanded Disability Status Scale (EDSS) from 4 to 1. Conclusion NMO entity related to HIV is rare, this phenomenon being classically found at the time of diagnosis or after the start of treatment when the immune system is still capable of developing an exaggerated immune response, however in the case we report the debut of NMO occurred 3 years after diagnosis, contrasting with previously reported cases, so we suggest that some other mechanisms could be involved, such as altered regulation of B cells and a direct viral effect.
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Affiliation(s)
- Erika Elizabeth González-Sansores
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Neurología. Ciudad de México, México
| | - Brenda Bertado-Cortés
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Neurología. Ciudad de México, México
| | - Daniela Alexia León-Castillo
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Neurología. Ciudad de México, México
| | - Nallely Rubalcava-Sánchez
- Instituto Mexicano del Seguro Social, Centro Médico Nacional Siglo XXI, Hospital de Especialidades "Dr. Bernardo Sepúlveda Gutiérrez", Servicio de Neurología. Ciudad de México, México
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Etemadifar M, Fereidan-Esfahani M, Sedaghat N, Kargaran PK, Mansouri AR, Abhari AP, Aghababaei A, Jannesari A, Salari M, Ganjalikhani-Hakemi M, Nouri H. Non-infectious meningitis and CNS demyelinating diseases: A conceptual review. Rev Neurol (Paris) 2023:S0035-3787(23)00756-7. [PMID: 36781321 DOI: 10.1016/j.neurol.2022.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Revised: 09/11/2022] [Accepted: 10/17/2022] [Indexed: 02/13/2023]
Abstract
Many cases of aseptic meningitis or meningoencephalitis, unresponsive to antimicrobial treatments, have been reported recently in patients with established/new-onset central nervous system (CNS) inflammatory demyelinating diseases (CNSIDDs). Given the higher probability of infectious etiologies, CNSIDDs are rarely considered among the differentials in meningitis or meningoencephalitis cases. We gathered and tabulated cases of non-infectious, steroid-responsive meningitis or meningoencephalitis associated with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-associated disease (MOGAD). This conceptual review highlights the need to bolster routine infectious workups with immunological workups in cases of meningoencephalitis or meningitis where potential autoimmune etiologies can be suspected. Although differentiating CNSIDDs with meningeal involvement from infectious meningitis may not substantially affect acute treatment strategies, long-term management and follow-up of the two are entirely different. We also discuss future research directions and hypotheses on how CNSIDDs may be associated with meningitis-like presentations, e.g. overlapping glial fibrillary acidic protein astrocytopathy or autoimmune encephalitis, alterations in regulatory T-helper cells function, and undetected viral agents.
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Affiliation(s)
- M Etemadifar
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Fereidan-Esfahani
- Department of Neurology, Mayo Clinic Rochester, Rochester, MN, USA; Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic Rochester, Rochester, MN, USA
| | - N Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - P K Kargaran
- Department of Cardiovascular Medicine, Center for Regenerative Medicine, Mayo Clinic, Rochester, Rochester, MN, USA
| | - A R Mansouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A P Abhari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - A Aghababaei
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A Jannesari
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - M Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Ganjalikhani-Hakemi
- Department of Immunology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - H Nouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran; Network of Immunity in Infection, Malignancy, and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran.
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Shafaei M, Ghadiri F, Azimi A, Moghadasi AN, Hakiminezhad M, Sahraian MA. Adding erythropoietin to intravenous methylprednisolone in acute treatment of attacks of neuromyelitis optica spectrum disorders: A randomized controlled trial. Curr J Neurol 2022; 21:201-205. [PMID: 38011377 PMCID: PMC10189199 DOI: 10.18502/cjn.v21i4.11715] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/03/2022] [Indexed: 11/29/2023]
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune disease of the central nervous system (CNS) that prompts immediate potent treatment. Delaying treatment could leave debilitating sequelae. As erythropoietin (EPO) has shown neuroprotective effects, we studied the effects of adding EPO to intravenous methylprednisolone (IVMP) in patients with acute attacks of NMOSD. Methods: NMOSD cases with acute attacks were included. Cases of optic neuritis (ON) and those with myelitis were separated. After randomization [with block sizes of 2 (1:1 ratio)], the patients in the intervention group received IVMP 1000 mg/day and intravenous (IV) EPO 20000 U/day for five days. IVMP 1000 mg/day and normal saline (NS) were administered in the control group. Staged eye score and motor forces were evaluated in the patients with ON and myelitis, respectively, at the time of the attack and three months later. Primary patient allocation and clinical assessments were blinded to the physicians. Results: Mean age of participants was 53.87 ± 11.53 years. At follow-up, in the ON arm, the median improvement in staged eye score was 2 in the control and 5 in the intervention group. The difference was significant (P < 0.001). In the myelitis group, none of the patients in the control group had improvement in motor forces. All the patients in the intervention group showed substantial improvement with minimal or no remaining weakness. The difference was statistically significant (P = 0.029). Conclusion: The results show the possible benefit of adding EPO to the classic IVMP in attacks of NMOSD in both visual and motor aspects.
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Affiliation(s)
- Maryam Shafaei
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Fereshteh Ghadiri
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirreza Azimi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Hakiminezhad
- Department of Colorectal Surgery, School of Medicine, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Kelly H, Johnson J, Jakubecz C, Serra A, Abboud H. Prevalence of iatrogenic CNS inflammation at a tertiary neuroimmunology clinic. J Neuroimmunol 2022; 370:577928. [PMID: 35853358 DOI: 10.1016/j.jneuroim.2022.577928] [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: 04/03/2022] [Revised: 06/29/2022] [Accepted: 07/09/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Various vaccines, tumor-necrosis-factor-alpha inhibitors (TNFAIs), immune-checkpoint inhibitors (ICIs), and other immunomodulators have been linked to inflammatory CNS events. The prevalence of iatrogenic events in the neuroimmunology clinic is unknown. OBJECTIVE To evaluate the prevalence and clinical characteristics of iatrogenic CNS inflammation in a tertiary neuroimmunology clinic. METHODS We analyzed 422 consecutive patients seen over five years at a tertiary neuroimmunology clinic who were systematically screened for exposure to vaccines, TNFAIs, ICIs, or other immunomodulators. In patients with suspected iatrogenic events, the Naranjo Adverse Drug Reaction Probability Scale was used to score the probability of iatrogenicity. RESULTS In total, 27 potential iatrogenic events were observed, accounting for 6.4% of all new referrals. The average Naranjo score was 5.78 +/- 1.65 with 74% of the cases scored as probable and 26% scored as possible. The clinical phenotypes included MS relapses (37%); autoimmune encephalitis (30%); NMOSD attacks (15%); transverse myelitis (11%); optic neuritis (4%); and MOGAD attacks (4%). A monophasic course was observed in 44% of cases while 41% had a relapsing course. All patients stopped or interrupted treatment with the offending agent. In addition, 41% of the iatrogenic events were fully responsive to corticosteroids; 22% were partially responsive; and 15% resolved spontaneously. The most common potential triggers were vaccines (37%) followed by TNFAIs (33%) then ICIs (26%). A significantly higher number of probable iatrogenic events were observed among the ICI and vaccine groups compared to a higher number of possible events among the TNFAI group. The latter group also had a significantly longer interval since exposure. The ICI group was more likely to present with monophasic autoimmune encephalitis. CONCLUSION Iatrogenic CNS inflammation is rare and typically involves steroid-responsive monophasic events. A subset of iatrogenic events can unmask or worsen relapsing disorders. The probability of iatrogenicity was higher in vaccine and ICI-related events compared to TNFAI-related events.
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Affiliation(s)
- Hannah Kelly
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; University Hospitals Specialty Pharmacy, Cleveland, OH, USA; VA Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center, Cleveland, OH, USA
| | - Jessica Johnson
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; University Hospitals Specialty Pharmacy, Cleveland, OH, USA; VA Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center, Cleveland, OH, USA
| | - Collin Jakubecz
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; University Hospitals Specialty Pharmacy, Cleveland, OH, USA; VA Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center, Cleveland, OH, USA
| | - Alessandro Serra
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; University Hospitals Specialty Pharmacy, Cleveland, OH, USA; VA Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center, Cleveland, OH, USA
| | - Hesham Abboud
- Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, USA; Case Western Reserve University School of Medicine, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA; University Hospitals Specialty Pharmacy, Cleveland, OH, USA; VA Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center, Cleveland, OH, USA.
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Parthasarathy D, Lily Therese K, Ambika S, Krishnan S, Priyadarshini Santhakumar D. Simultaneous screening for antibodies to myelin oligodendrocyte glycoprotein and aquaporin-4 in patients with optic neuritis using cell-based assay. Curr J Neurol 2022; 21:29-34. [PMID: 38011487 PMCID: PMC9527861 DOI: 10.18502/cjn.v21i1.9359] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/19/2021] [Indexed: 11/24/2022]
Abstract
Background: This study was aimed to test simultaneous detection of antibodies to myelin oligodendrocyte glycoprotein (MOG)/aquaporin4 (AQP4) in serum samples of patients with clinically-diagnosed optic neuritis (ON), by fixed cell-based immunofluorescence assay (CBIFA). Methods: The study involved 237 serum samples of patients with ON which were tested for MOG and AQP4 antibodies using fixed CBIFA kit which utilizes AQP4 or MOG protein transfected cells as a substrate. Results: Of 237 serum samples, 22 (9%) were positive for AQP4, 66 (28%) were positive for MOG, and 138 (58%) were negative for both AQP4 and MOG antibodies. 11 (5%) patients with clinically-diagnosed multiple sclerosis (MS) were negative for both antibodies. None of the samples were positive for both AQP4 and MOG. Among 237, 132 women [18 (13.6%) and 37 (28%)] and 105 men [4 (3.8%) and 29 (27.6%)] were positive for AQP4/MOG antibodies and remaining percentage belonged to double negative and MS. Seropositivity rate was higher in women than men. Antibodies to MOG were significantly higher than AQP4 antibodies and evenly found in all age groups. There was no ambiguous result encountered in the study. Conclusion: In this study, the seropositivity for antibodies to MOG is more than AQP4 antibody in patients with ON. Fixed CBIFA is a useful tool for laboratory diagnosis of ON in the clinical setting of neuro-ophthalmology to plan the next line of treatment management effectively.
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Affiliation(s)
- Durgadevi Parthasarathy
- L&T Microbiology Research Centre, Kamal Nayan Bajaj Building for Research in Vision and Opthalmology, Vision Research Foundation, Chennai, India
| | - Kulandai Lily Therese
- L&T Microbiology Research Centre, Kamal Nayan Bajaj Building for Research in Vision and Opthalmology, Vision Research Foundation, Chennai, India
| | - Selvakumar Ambika
- Department of Neuro-ophthalmology, Sankara Nethralaya Hospital, Medical Research Foundation, Chennai, India
| | - Selvi Krishnan
- L&T Microbiology Research Centre, Kamal Nayan Bajaj Building for Research in Vision and Opthalmology, Vision Research Foundation, Chennai, India
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Jacob S, Mazibrada G, Irani SR, Jacob A, Yudina A. The Role of Plasma Exchange in the Treatment of Refractory Autoimmune Neurological Diseases: a Narrative Review. J Neuroimmune Pharmacol 2021; 16:806-817. [PMID: 34599742 PMCID: PMC8714620 DOI: 10.1007/s11481-021-10004-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 01/05/2021] [Accepted: 07/22/2021] [Indexed: 11/30/2022]
Abstract
Autoimmune neurological disorders are commonly treated with immunosuppressive therapy. In patients with refractory conditions, standard immunosuppression is often insufficient for complete recovery or to prevent relapses. These patients rely on other treatments to manage their disease. While treatment of refractory cases differs between diseases, intravenous immunoglobulin, plasma exchange (PLEX), and immune-modulating treatments are commonly used. In this review, we focus on five autoimmune neurological disorders that were the themes of the 2018 Midlands Neurological Society meeting on PLEX in refractory neurology: Autoimmune Encephalitis (AE), Multiple Sclerosis (MS), Neuromyelitis Optica Spectrum disorders (NMOSD), Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP) and Myasthenia Gravis (MG). The diagnosis of inflammatory neuropathies is often challenging, and while PLEX can be very effective in refractory autoimmune diseases, its ineffectiveness can be confounded by misdiagnosis. One example is POEMS syndrome (characterized by Polyneuropathy Organomegaly, Endocrinopathy, Myeloma protein, Skin changes), which is often wrongly diagnosed as CIDP; and while CIDP responds well to PLEX, POEMS does not. Accurate diagnosis is therefore essential. Success rates can also differ within 'one' disease: e.g. response rates to PLEX are considerably higher in refractory relapsing remitting MS compared to primary or secondary progressive MS. When sufficient efforts are made to correctly pinpoint the diagnosis along with the type and subtype of refractory autoimmune disease, PLEX and other immunotherapies can play a valuable role in the patient management.
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Affiliation(s)
- Saiju Jacob
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom. .,Department of Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
| | - Gordon Mazibrada
- Department of Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Anu Jacob
- Department of Neurology, The Walton Centre NHS Foundation Trust, NMO Service, Liverpool, United Kingdom.,Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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Abstract
Background Neuromyelitis Optica spectrum disorder is an inflammatory disorder affecting the central nervous system), most commonly attacking the spinal cord or optic nerves. Limited cases of neuromyelitis optica have been reported in east Africa. Based on my review, if published, this would be the second published case of Neuromyelitis Optica spectrum disorder and the first published case of seropositive Neuromyelitis Optica spectrum disorder reported from Ethiopia. It signifies the need to have a high index of suspicion to promptly identify and properly treat these patients. Case Presentation I am reporting a 32 years old female patient from Addis Ababa, Ethiopia, who presented with recurrent lower limb weakness and impairment of right eye vision of two-year duration. She was diagnosed based on Neuromyelitis Optica spectrum disorder diagnostic criteria, by having transverse myelitis, optic neuritis, confirmed by MRI imaging and high level of aquaporin-4-antibodies. Symptoms improved after providing five days of Methylprednisolone followed by low doses of corticosteroids and Azathioprine. The patient is now fully functional except for the right eye vision impairment. Conclusion The patient described here signifies a classic manifestation of Neuromylitis Optica disorder with aquaporin-4-IgG occurring in Ethiopian woman. This case highlights the existence of Devic's disease within our setting and the need to properly diagnose this condition even in a resource-limited setting to avert disability.
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Affiliation(s)
- Dereje Melka
- Department of neurology, college of health sciences, Addis Ababa University, Addis Ababa Ethiopia
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12
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Etemadifar M, Salari M, Aminzade Z, Ebrahimi S, Tehrani-Fateh S. Prevalence of coronavirus disease 2019 in patients with neuromyelitis optica in Isfahan, Iran, and a review on recent reports and literature. Curr J Neurol 2021; 20:139-145. [PMID: 38011481 PMCID: PMC8984777 DOI: 10.18502/cjn.v20i3.7689] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/10/2021] [Indexed: 11/24/2022]
Abstract
Background: Despite many studies, it is still unclear how patients with neuromyelitis optica spectrum disorder (NMOSD) would respond to coronavirus disease 2019 (COVID-19). We conducted a research on prevalence of COVID-19 in patients with NMOSD in Isfahan, Iran. We have also reviewed the recent publications on this issue. Methods: 149 patients with NMOSD who were under medications were monitored for confirmed cases of COVID-19. Prevalence of COVID-19 in addition to mean age, mean duration of disease, and mean age of onset of infected patients and uninfected patients were calculated via Microsoft Excel software. Results: The prevalence of COVID-19 in studied patients with NMOSD was 5.37%. Mean age, mean duration of disease, and mean age of onset of eight patients (male to female ratio: 1:3) diagnosed with COVID-19 were 33.62 ± 5.20 years, 6.87 ± 6.05 years, and 26.75 ± 6.94 years, respectively, while they were 39.97 ± 11.37 years, 7.50 ± 3.91 years, and 32.46 ± 11.29 years for uninfected patients with NMOSD (n = 141). No significant association was observed between the type of medications and prevalence of COVID-19 (P > 0.05). Conclusion: There is not a consensus in the literature on the prevalence of COVID-19 in patients with NMOSD and the effect of NMOSD medications on susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The prevalence of COVID-19 in our sample was 5.37%. The impact of the kind of NMOSD medication on the prevalence of COVID-19 in patients with NMOSD was found to be insignificant. Moreover, the infected patients were relatively younger, and their disease started earlier in comparison to uninfected patients.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehri Salari
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Aminzade
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Ebrahimi
- School of Medicine, Yazd University of Medical Sciences, Yazd, Iran
| | - Sepand Tehrani-Fateh
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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13
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Rezaeimanesh N, Ariyanfar S, Sahraian MA, Moghadasi AN, Ghorbani Z, Razegh-Jahromi S. Whole grains and legumes consumption in association with neuromyelitis optica spectrum disorder odds. Curr J Neurol 2021; 20:131-138. [PMID: 38011447 PMCID: PMC8984782 DOI: 10.18502/cjn.v20i3.7688] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/05/2021] [Indexed: 11/24/2022]
Abstract
Background: The environmental risk factors of neuromyelitis optica spectrum disorder (NMOSD) are not fully specified. Regarding the evidence on the possible protective effects of whole grains and legumes against inflammatory disorders, we examined the association between the mentioned dietary components and NMOSD. Methods: 70 patients with NMOSD with definite diagnosis and 164 hospital-based controls were included in this case-control investigation. Data on demographic, clinical, and anthropometric characteristics were collected. Dietary habits of participants were assessed using a previously validated food frequency questionnaire (FFQ) containing 168 food items. Daily intakes of whole grains and legumes were calculated and classified in quartiles. The odds of suffering from NMOSD according to the quartiles of whole grains and legumes were measured in the form of logistic regression models. Results: The mean amount of whole grains (115.29 vs. 44.14 g) and legumes (59.43 vs. 34.50 g) consumption was significantly higher in the control group versus the case group. There was a reverse association between whole grains or legumes and NMOSD odds in both models [P < 0.05, odds ratio (OR) < 1]. In the fully-adjusted model, 90% [95% confidence interval (CI): 0.02-0.39] and 92% (95% CI: 0.01-0.52) reduction in NMOSD odds was observed in the third and fourth quartiles of whole grains intake, respectively. Higher intake of legumes in the third and fourth quartiles led to 81% (95% CI: 0.05-0.71) and 95% (95% CI: 0.01-0.27) reduction in the odds of NMOSD, respectively. Conclusion: Aligned with the results of other investigations on inflammatory disorders, our results suggested a negative association between whole grains and legumes and NMOSD odds.
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Affiliation(s)
- Nasim Rezaeimanesh
- Student Research Committee, Department of Nutrition Sciences and Food Technology, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Shadi Ariyanfar
- Student Research Committee, Department of Nutrition Sciences and Food Technology, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Sahraian
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Cardiovascular Diseases Research Center, Department of Cardiology, Heshmat Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soodeh Razegh-Jahromi
- Multiple Sclerosis Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Nutrition Sciences and Food Technology, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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14
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Esmaeili S, Abbasi MH, Abolmaali M, Mojtahed M, Alavi SNR, Soleimani S, Mokhtari M, Hatam J, Khotbehsara ST, Motamed MR, Joghataei MT, Mirzaasgari Z, Moghaddasi M. Rituximab and risk of COVID-19 infection and its severity in patients with MS and NMOSD. BMC Neurol 2021; 21:183. [PMID: 33933026 PMCID: PMC8087518 DOI: 10.1186/s12883-021-02218-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 04/26/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Choosing a safe disease modifying therapy during the COVID-19 pandemic is challenging. This case series study was conducted to determine the incidence rate and the course of Covid-19 infection in MS/NMOSD patients treated with Rituximab. METHODS In this study, we designed a web-based questionnaire. Baseline information such as patient- reported walking disability, total number of Rituximab infusions received, delayed injections, occurrence of any relapse, and the use of corticosteroids during the pandemic were collected. Also, information regarding the Covid-19 pandemic such as adherence to self-isolation, any recent exposure to an infected individual and the presence of suggestive symptoms were collected. In case of positive test results, patients were grouped into 2 categories; mild to moderate and seriously ill and outcomes were evaluated as favorable (improved/ discharged) and unfavorable (expired). RESULTS Two hundred fifty-eight patients with Multiple Sclerosis were enrolled in this study, 9 of the subjects (3.4%) were confirmed positive for Covid-19, five of which required hospitalizations (55.5%), two patients required ICU admission (22.2%) and 2 two patients died (22.2%). None of these patients ever mentioned using corticosteroids during the pandemic. In comparison to MS patients who were not receiving disease modifying therapy (DMT), our study indicated a higher incidence of Covid-19 infection, higher ratio of serious illness and a higher fatality ratio. CONCLUSIONS Rituximab seems not to be safe enough during the pandemic.
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Affiliation(s)
- Sara Esmaeili
- Cellular and Molecular Research Center, Iran university of medical sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Hossein Abbasi
- Cellular and Molecular Research Center, Iran university of medical sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Meysam Abolmaali
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Mojtahed
- School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | | | - Sevim Soleimani
- School of Medicine, Shahid Beheshti Medical University, Tehran, Iran
| | - Mahisa Mokhtari
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Jaber Hatam
- Department of Neurosurgery, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohammad Taghi Joghataei
- Cellular and Molecular Research Center, Iran university of medical sciences, Tehran, Iran
- School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Zahra Mirzaasgari
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
| | - Mehdi Moghaddasi
- Department of Neurology, Iran University of Medical Sciences, Tehran, Iran
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15
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Namatame C, Misu T, Takai Y, Nishiyama S, Nakashima I, Fujihara K, Aoki M. CH50 as a putative biomarker of eculizumab treatment in neuromyelitis optica spectrum disorder. Heliyon 2021; 7:e05899. [PMID: 33490671 PMCID: PMC7809378 DOI: 10.1016/j.heliyon.2021.e05899] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 07/07/2020] [Revised: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 12/19/2022] Open
Abstract
Here we report 3 cases of neuromyelitis optica spectrum disorder (NMOSD), who were all treated with eculizumab and could be observed with monitoring serum C3, C4 and 50% hemolytic complement (CH50) before and after the treatment. Serum C3 and C4 were not dramatically changed during the treatment, in contrast serum CH50 level of each patient had diminished and kept under the detection limit after the treatment without clinical worsening, even in the situation of extending dosing. Serum CH50 level is useful to monitor the drug efficacy during eculizumab treatment.
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Affiliation(s)
- Chihiro Namatame
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuro Misu
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yoshiki Takai
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Shuhei Nishiyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Fukushima Medical University, Fukushima, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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16
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Zayet S, Zaghdoudi A, Harrabi H, Goubantini A, Tiouiri Benaissa H. Devic's neuromyelitis optica associated with active pulmonary tuberculosis, Tunisia. New Microbes New Infect 2020; 39:100828. [PMID: 33425364 PMCID: PMC7777500 DOI: 10.1016/j.nmni.2020.100828] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/13/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 12/20/2022] Open
Abstract
Devic's Optic neuromyelitis (OND) is a very rare disease defined as a central nervous system (CNS) inflammation resulting in optic neuritis and/or myelitis. The discovery of a highly specific serum autoantibody biomarker for the diagnosis has triggered a great interest in conducting further research into this disease. The association of OND with Tuberculosis (TB) is even rarer and could be an entirely random conjunction. To our knowledge, we reported the first case of Neuromyelitis Optica associated with pulmonary TB in Tunisia.
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Affiliation(s)
- S Zayet
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia
| | - A Zaghdoudi
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia
| | - H Harrabi
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia.,University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - A Goubantini
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia.,University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - H Tiouiri Benaissa
- Infectious Diseases Department, Hopital La Rabta, Tunis, Tunisia.,University of Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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17
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Shor N, Deschamps R, Cobo Calvo A, Maillart E, Zephir H, Ciron J, Papeix C, Durand-Dubief F, Ruet A, Ayrignac X, Cohen M, Deiva K, Laplaud D, Bourre B, Audoin B, Collongues N, Vukusic S, Cotton F, Marignier R. MRI characteristics of MOG-Ab associated disease in adults: An update. Rev Neurol (Paris) 2020; 177:39-50. [PMID: 33046261 DOI: 10.1016/j.neurol.2020.06.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [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: 05/12/2020] [Revised: 06/20/2020] [Accepted: 06/23/2020] [Indexed: 11/29/2022]
Abstract
Our knowledge of the radiological spectrum of myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is growing rapidly. An update on the radiological features of the disease, and its evolution is thus necessary. Magnetic resonance imaging (MRI) has an increasingly important role in the differential diagnosis of MOGAD particularly from aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD), and multiple sclerosis (MS). Differentiating these conditions is of prime importance because the management is different between the three inflammatory diseases, and thus could prevent further attack-related disability. Therefore, identifying the MRI features suggestive of MOGAD has diagnostic and prognostic implications. We herein review optic nerve, spinal cord and the brain MRI findings from MOGAD adult patients, and compare them to AQP4-NMOSD and MS.
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Affiliation(s)
- N Shor
- Department of Neuroradiology, Pitié Salpêtrière Hospital, APHP, 47-83, boulevard de l'Hôpital, 75013 Paris, France.
| | - R Deschamps
- Department of Neurology, Hôpital Fondation Adolphe de Rothschild Paris Paris, France
| | - A Cobo Calvo
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation-Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, 6977 Lyon, France
| | - E Maillart
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - H Zephir
- Department of Neurology, U 1172,CRC-SEP, University Hospital of Lille, Lille, France
| | - J Ciron
- Department of Neurology, University Hospital of Purpan, Toulouse, France
| | - C Papeix
- Department of Neurology, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - F Durand-Dubief
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation-Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, 6977 Lyon, France
| | - A Ruet
- Department of Neurology, Bordeaux University Hospital, Bordeaux, France
| | - X Ayrignac
- Department of Neurology, Montpellier University Hospital, Montpellier, France
| | - M Cohen
- Service de Neurologie, Université Côte d'Azur, Hôpital Pasteur 2, Nice University Hospital, Nice, France
| | - K Deiva
- National Referral Center for Neuro-Inflammatory Diseases and Pediatric Neurology Department, Kremlin-Bicêtre Hospital, Kremlin-Bicêtre, France
| | - D Laplaud
- Department of Neurology, Nantes University Hospital, Nantes, France
| | - B Bourre
- Department of Neurology, Rouen University Hospital, Rouen, France
| | - B Audoin
- Department of Neurology, Pôle de Neurosciences Cliniques, APHM, Aix Marseille University, Timone Hospital, Marseille, France
| | - N Collongues
- Department of Neurology and Clinical Investigation Center, Strasbourg University Hospital, Strasbourg, France
| | - S Vukusic
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation-Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, 6977 Lyon, France
| | - F Cotton
- Department of Radiology, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, 69310 Pierre-Bénite, France
| | - R Marignier
- Centre de référence des maladies inflammatoires rares du cerveau et de la moelle (MIRCEM)- Service de neurologie, sclérose en plaques, pathologies de la myéline et neuro-inflammation-Hôpital Neurologique Pierre Wertheimer Hospices Civils de Lyon, 6977 Lyon, France
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18
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Etemadifar M, Chitsaz A, Rajabkhah S, Tavakoli H, Shafieyoun A, Noorshargh P, Afzali M. Clinical outcomes of transverse myelitis with myelin oligodendrocyte glycoprotein antibody versus negative cases among adults in Isfahan, Iran: A comparative study. Curr J Neurol 2020; 19:173-179. [PMID: 38011383 PMCID: PMC8236427 DOI: 10.18502/cjn.v19i4.5544] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 08/08/2020] [Indexed: 11/24/2022]
Abstract
Background: The aim of this study was to evaluate the status of anti-myelin oligodendrocyte glycoprotein (MOG) antibodies in patients with transverse myelitis (TM) and compare the clinical and imaging characteristics of MOG immunoglobulin G (IgG)-positive with negative cases. Methods: This cohort study enrolled 71 patients diagnosed with new-onset of TM who were being followed at a referral university clinic in Isfahan, Iran, from November 2016 to January 2019. Magnetic resonance imaging (MRI) images and blood samples for anti-MOG, anti-aquaporin 4 (anti-AQP4) (using the cell-based technique), and vasculitis-related antibodies were collected from patients. Outcomes were assessed by the evolution of the Expanded Disability Status Scale (EDSS) score and brain and spinal cord imaging findings within three months. All patients underwent imaging and clinical assessment during a mean period of one year as a follow-up. We compared the characteristics of clinical and radiological outcomes in MOG-IgG-positive and negative cases. Results: Of the total population studied, there were 26.8% men and 73.2% women, with a mean age of 33 ± 10 years. 12 (16.9%) patients were seropositive for MOG antibody and 17 (89.5%) were positive for anti-AQP4 antibodies. There was no significant association between anti-MOG antibody seropositivity and age, gender distribution, the presence of other autoimmune diseases, and number and interval of relapses. However, the involvement site of the spine at first imaging was significantly different between seronegative and seropositive patients. Conclusion: In patients with MOG antibody disease (MOG-AD) TM, the MRI findings suggest a preferential involvement of the cervical-thoracic section in seropositive cases which may help differentiate from non-MOG demyelination TM.
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Affiliation(s)
- Masoud Etemadifar
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ahmad Chitsaz
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sahebeh Rajabkhah
- Department of Neurology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Tavakoli
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
| | - Arezoo Shafieyoun
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Pegah Noorshargh
- Young Researchers and Elite Club, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran
| | - Mahdieh Afzali
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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19
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Chitsaz N, Dehghani L, Safi A, Esmalian-Afyouni N, Shaygannejad V, Rezvani M, Sohrabi K, Moridi K, Moayednia M. Evaluation of glucose-6-phosphate dehydrogenase serum level in patients with multiple sclerosis and neuromyelitis optica. Iran J Neurol 2019; 18:150-153. [PMID: 32117550 PMCID: PMC7036045] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Multiple sclerosis (MS) and neuromyelitis optica (NMO) are both demyelinating disorders and oxidative stress is suggested to have a role in their pathogenesis. Glucose-6-phosphate dehydrogenase (G6PD) produces nicotinamide adenine dinucleotide phosphate (NADPH) via the pentose phosphate pathway. NADPH is not only involved in the synthesis of fatty acids necessary for myelination, but also it is involved in the defense against oxidative stress. Prescribing supplementary vitamin D as a part of the MS treatment plan can increase G6PD gene expression. The aim of this study was to determine the serum level of G6PD in patients with MS and NMO and its relationship with vitamin D, since it is yet to be explored thoroughly. Methods: In this case-control study, subjects were divided into three experimental and control groups. The experimental groups comprised 50 patients with relapsing-remitting MS (RRMS) who had a history of vitamin D consumption, 50 newly-diagnosed MS patients, and 50 patients with NMO. Control group included 65 healthy individuals. Serum level of G6PD was measured and compared among these groups. Results: No significant difference was seen between the G6PD level in patients with MS and NMO, but it should be noted that this level was significantly lower than the healthy group. G6PD serum level was significantly higher in patients with MS who had previously consumed supplementary vitamin D compared to those who had not. Conclusion: G6PD deficiency is observed in patients with MS and NMO. Also, supplementary vitamin D may induce favorable results on the G6PD level.
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Affiliation(s)
- Niloofar Chitsaz
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Dehghani
- Department of Tissue Engineering and Regenerative Medicine, School of Advanced Technologies in Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Safi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nazgol Esmalian-Afyouni
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Majid Rezvani
- Department of Neurosurgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Karim Sohrabi
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Kaykhosro Moridi
- Department of Biology, School of Advanced Sciences and Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran
| | - Milad Moayednia
- Isfahan Neurosciences Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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20
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Yoo IH, Kim MJ, Kim J, Sung JJ, Park ST, Ahn SW. The Anti-Inflammatory Effect of Sulforaphane in Mice with Experimental Autoimmune Encephalomyelitis. J Korean Med Sci 2019; 34:e197. [PMID: 31327180 PMCID: PMC6639507 DOI: 10.3346/jkms.2019.34.e197] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 07/02/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Multiple sclerosis (MS) is an immune-associated inflammatory disorder of the central nervous system and results in serious disability. Although many disease-modifying therapy drugs have been developed, these drugs have shown limited clinical efficacy and some adverse effects in previous studies, therefore, there has been reasonable need for less harmful and cost-effective therapeutics. Herein, we tested the anti-inflammatory effect of sulforaphane (SFN) in a mouse model of experimental autoimmune encephalomyelitis (EAE). METHODS The EAE mice were randomly assigned into two experimental groups: the phosphate-buffered saline (PBS)-treated EAE group and SFN-treated EAE group. After EAE mice induction by auto-immunization against the myelin oligodendrocyte glycoprotein peptide, we evaluated EAE symptom scores and biochemical analyses such as infiltration of inflammatory cells and demyelination of the spinal cord. Furthermore, western blotting was performed using the spinal cords of EAE mice. RESULTS In the behavioral study, the SFN-treated EAE mice showed favorable clinical scores compared with PBS-treated EAE mice at the 13th day (1.30 ± 0.15 vs. 1.90 ± 0.18; P = 0.043) and 14th day (1.80 ± 0.13 vs. 2.75 ± 0.17; P = 0.003). Additionally, the biochemical studies revealed that SFN treatment inhibited the inflammatory infiltration, demyelinating injury of the spinal cords, and the up-regulation of inducible nitric oxide synthase in the EAE mice. CONCLUSION The SFN treatment showed anti-inflammatory and anti-oxidative effects in the EAE mice. Conclusively, this study suggests that SFN has neuroprotective effects via anti-inflammatory processing, so it could be a new therapeutic or nutritional supplement for MS.
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Affiliation(s)
- Il Han Yoo
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myung Jin Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jiyoung Kim
- Center for Food and Bioconvergence, College of Agriculture and Life Sciences, Seoul National University, Seoul, Korea
| | - Jung Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Sung Taek Park
- Department of Obstetrics and Gynecology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Suk Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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Eskandarieh S, Moghadasi AN, Sahraiain MA, Azimi AR, Molazadeh N. Association of cigarette smoking with neuromyelitis optica-immunoglobulin G sero-positivity in neuromyelitis optica spectrum disorder. Iran J Neurol 2019; 18:93-98. [PMID: 31749929 PMCID: PMC6858599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Neuromyelitis optica spectrum disorder (NMOSD) is a neuroinflammatory demyelinating disease caused by the presence of a highly specific serum autoantibody marker, NMO-immunoglobulin G (NMO-IgG), that reacts against the water channel aquaporin-4 (AQP4). The present study examined the association between NMO-IgG sero-positivity and environmental factors such as cigarette smoking. Methods: A cross-sectional study was conducted in Sina Hospital, a tertiary referral center in Tehran, Iran. All the patients with a definite diagnosis of NMOSD were involved in this study. The enzyme-linked immunosorbent assay (ELISA) was used to examine the AQP4-IgG status. To assess the association between NMO-IgG sero-positivity and cigarette smoking, a researcher-made questionnaire covering patients' lifestyle information on smoking habits was designed and administered using the structured face-to-face interviews with the patients. Results: The positive and negative NMO-IgG results were found in 44 (46.8%) and 50 (53.2%) patients, respectively. The increased NMO-IgG sero-positivity odds were observed among the lifetime smokers [odds ratio (OR) = 3.24, 95% confidence interval (CI): 1.16-9.08], current smokers (OR = 6.08, 95% CI: 1.26-29.39), and passive smokers (OR = 2.22, 95% CI: 1.10-4.50). Conclusion: Lifetime and current smoking as well as passive smoking can be regarded as risk factors for NMO-IgG sero-positivity. Smoking with its immunological effects can lead to the production of autoantibodies such as NMO-IgG.
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Affiliation(s)
- Sung-Min Cho
- Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | | | - Jennifer A Frontera
- Department of Neurology, NYU School of Medicine, 150 55th St. #3516, Brooklyn, NY, 11220, USA.
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Denève M, Biotti D, Patsoura S, Ferrier M, Meluchova Z, Mahieu L, Heran F, Vignal C, Deschamps R, Gout O, Champfleur NM, Ayrignac X, Dallière CC, Labauge P, Dulau C, Tourdias T, Dumas H, Cognard C, Brassat D, Bonneville F. MRI features of demyelinating disease associated with anti-MOG antibodies in adults. J Neuroradiol 2019; 46:312-8. [PMID: 31228536 DOI: 10.1016/j.neurad.2019.06.001] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 05/30/2019] [Accepted: 06/03/2019] [Indexed: 11/20/2022]
Abstract
The spectrum of Myelin Oligodendrocytes Glycoprotein (MOG) antibody disease constitutes a recently described challenging entity, referring to a relatively new spectrum of autoimmune disorders with antibodies against MOG predominantly involving the optic nerve and spinal cord. The purpose of this article is to describe MRI features of MOG-AD involvement in the optic nerves, spinal cord and the brain of adults.
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Shouman K, Prieto PG, Stino AM, Lisak RP. Serum Creatine Kinase in Patients with Neuromyelitis Optica Spectrum Disorder. J Neuroimmunol 2019; 330:87-89. [PMID: 30851543 DOI: 10.1016/j.jneuroim.2018.12.008] [Citation(s) in RCA: 5] [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: 11/25/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES There have been reports of elevated serum creatine kinase (CK) and myopathy in patients with Neuromyelitis Optica Spectrum Disorder (NMOSD). Such findings have raised the possibility that myopathies may be a part of the spectrum of NMOSD. The incidence of elevated CK in NMOSD remains unknown. We sought to assess the potential association between hyperCKemia, myopathy, and NMOSD, and the potential role of screening for muscle involvement using serum CK. METHODS We reviewed records of all aquaporin 4 (AQP4) antibody-seropositive and seronegative NMOSD patients who had CK levels evaluated at two major academic medical centers. RESULTS Of 199 total NMOSD patients, CK levels were checked in 43, and elevated, on at least one occasion, in 4. In 1 patient, CK was elevated during an NMO exacerbation. A myopathic process occurring with NMOSD was suggested in 2 of 4 patients in the form of symptomatic complaint of myalgias and associated MRI signal change. DISCUSSION Unexplained hyperCKemia was found on one or more occasion in 4 of 43 tested NMOSD patients. Testing NMOSD patients for serum CK may reveal otherwise unsuspected myopathy. More formally powered, prospective assessment of the incidence and utility of CK in NMOSD is needed.
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Affiliation(s)
- Kamal Shouman
- Wayne State University, Detroit Medical Center, Detroit, USA.
| | - Pilar G Prieto
- Ohio State University, Wexner Medical Center, Department of Neurology, Columbus, USA
| | - Amro M Stino
- Ohio State University, Wexner Medical Center, Department of Neurology, Columbus, USA
| | - Robert P Lisak
- Wayne State University, Detroit Medical Center, Detroit, USA
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Mehdipour-Dastjerdi R, Ashtari F, Shaygannejad V, Mansourian M, Safaei A. The pathologic and diagnostic in magnetic resonance imaging of brain and cervical spine of patients with neuromyelitis optica spectrum disorder. Iran J Neurol 2018; 17:58-63. [PMID: 30210729 PMCID: PMC6131336] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background: Neuromyelitis optica spectrum disease (NMOSD) is a chronic inflammatory demyelinating disorder that involves central nervous system (CNS) with high affinity for involvement of optic nerve and spinal cord. In current study, due to high prevalence of NMOSD in Isfahan, Iran, we have aimed to assess brain and spine magnetic resonance imaging (MRI) of patients with NMOSD. Methods: This cross-sectional study was performed on 62 patients with diagnosis of NMOSD, who referred to MS clinic of Kashani hospital, Isfahan City, during 2015-17. Patients' age, age of onset, primary brain and spine MRI findings, and expanded disability status scale (EDSS) were recorded in check list. Patients underwent new brain and spine MRI. Data were analyzed with SPSS software. Descriptive data were reported by mean ± standard deviation (SD). Results: 62 known cases of NMOSD including 9 (14.5%) men and 53 (85.5%) women with mean age of 34.32 ± 10.26 years, mean age of onset of 28.03 ± 12.09 years, and mean EDSS of 2.63 ± 1.55 were assessed. 33.9% of patients were anti-neuromyelitis optica (NMO) antibody seropositive. Longitudinal extensive transverse myelitis (LETM) and segmental spinal lesions were found in 66.1% and 29.0% of patients, respectively. Diagnostic NMO brain lesions and posterior periventricular lesions were seen in 38.7% and 67.7% of patients, respectively. Two patients had tumefactive lesions. Conclusion: In current study, we found high rate of posterior periventricular lesions in brain MRI and segmental lesions in spine MRI of both anti-NMO antibody seropositive and seronegative patients. As these lesions are not in NMOSD diagnosis criteria, more considerations are recommended. In addition, tumefactive lesions in patients with NMOSD were an exciting finding of this study that should be discussed about more.
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Affiliation(s)
| | - Fereshteh Ashtari
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Vahid Shaygannejad
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Marjan Mansourian
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Safaei
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
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Sahraian MA, Moghadasi AN, Azimi AR, Asgari N, H Akhoundi F, Abolfazli R, Alaie S, Ashtari F, Ayromlou H, Baghbanian SM, Moghadam NB, Fatehi F, Foroughipour M, Langroodi HG, Majdinasab N, Nickseresht A, Nourian A, Shaygannejad V, Torabi HR. Diagnosis and management of Neuromyelitis Optica Spectrum Disorder (NMOSD) in Iran: A consensus guideline and recommendations. Mult Scler Relat Disord 2017; 18:144-151. [PMID: 29141797 DOI: 10.1016/j.msard.2017.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022]
Abstract
Neuromyelitis Optica Spectrum Disorder (NMOSD) is a relapsing neuro inflammatory disease of the central nervous system that typically presents with optic neuritis or myelitis and may cause severe disability. The diagnostic criteria have been updated and several immunosuppressive agents have been demonstrated to prevent acute exacerbations. As the disease rarely develops in a progressive course, management of acute attacks and proper prevention of exacerbations may change the long term out-come and prevent future disability. Consensus recommendations and guidelines will help the physicians to improve their practice and unify the treatment approaches in different communities. In order to develop a national consensus and recommendations for the diagnosis and management of NMOSD in Iran, a group of neurologists with long term experience in management of NMOSD were gathered to develop this consensus based on available national and international data. The primary draft was prepared and discussed to suggest the most appropriate treatment for these patients. We propose strategies for early diagnosis and treatment for prevention of relapses and minimizing consequences of attacks as a primary therapeutic goal. Attacks are currently treated with intravenous corticosteroids and, in refractory cases, with plasma exchange. All participants agreed on preventive treatment with currently available immunosuppressive agents such as azothioprin, rituximab and mycofenolate mofetil based on previous positive data in NMOSD in order to reduce attack frequency. The current consensus reviews the previous data and provides the clinicians with practical recommendations and advices for the diagnosis and management of NMOSD based on scientific data and clinical experience.
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Affiliation(s)
- Mohammad Ali Sahraian
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran.
| | | | - Amir Reza Azimi
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran
| | - Nasrin Asgari
- Institutes of Regional Health Research and Molecular Medicine, University of Southern Denmark, Denmark
| | - Fahimeh H Akhoundi
- Department of Neurology, Firozgar Hospital, Iran University of Medical Sciences, Iran
| | - Roya Abolfazli
- Department of Neurology, Amiralam Hospital, Tehran University of Medical Sciences, Iran
| | | | - Fereshteh Ashtari
- Department of Neurology, Kashani Hospital, Isfahan University of Medical Sciences, Iran; Isfahan neurosciences research center, Alzahra Hospital, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hormoz Ayromlou
- Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Iran
| | | | - Nahid Beladi Moghadam
- Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Iran
| | - Farzad Fatehi
- Iranian Center for Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Iran; Department of Neurology, Shariati Hospital, Tehran University of Medical Sciences, Iran
| | - Mohsen Foroughipour
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Iran
| | | | - Nastaran Majdinasab
- Department of Neurology, Golestan Hospital, Ahwaz University of Medical Sciences, Iran
| | - Alireza Nickseresht
- Department of Neurology, Namazi Hospital, Shiraz University of Medical Sciences, Iran
| | - Abbas Nourian
- Islamic Azad University, Faculty of Medicine, Khorasan Razavi Branch, Iran
| | - Vahid Shaygannejad
- Isfahan neurosciences research center, Alzahra Hospital, Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
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Fujimori J, Nakashima I, Baba T, Meguro Y, Ogawa R, Fujihara K. Cognitive impairment in neuromyelitis optica spectrum disorders: A comparison of the Wechsler Adult Intelligence Scale-III and the Wechsler Memory Scale Revised with the Rao Brief Repeatable Neuropsychological Battery. eNeurologicalSci 2017; 9:3-7. [PMID: 29260040 PMCID: PMC5731537 DOI: 10.1016/j.ensci.2017.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 09/01/2017] [Accepted: 09/15/2017] [Indexed: 11/26/2022] Open
Abstract
Background Approximately 55% of patients with neuromyelitis optica spectrum disorder (NMOSD) show cognitive impairment as evaluated using the Rao Brief Repeatable Neuropsychological Battery (BRBN), but this frequency appears to be higher than the frequency of specific brain lesions in NMOSD. Objective We studied whether cognitive impairment could be observed in NMOSD patients with no or minor non-specific brain lesions. Methods We evaluated cognitive function in 12 NMOSD and 14 MS patients using the Wechsler Adult Intelligence Scale-III (WAIS-III), the Wechsler Memory Scale-Revised (WMS-R), and the BRBN. We judged as cognitively impaired patients whose scores were below the average by 2 standard deviations or greater in 2 or more cognitive domains. Results Cognitive impairment was observed in 5 MS patients (35.7%) and in the only NMOSD patient (8.3%) with symptomatic brain lesions, but not in the other NMOSD patients who had no or minor non-specific brain lesions. Meanwhile, 5 NMOSD (41.7%) and 4 MS (28.6%) patients who had normal cognition according to the WAIS-III and WMS-R were assessed as cognitively impaired by the BRBN (which is not standardized for age). Conclusions Cognitive function in NMOSD patients with no or mild non-specific brain lesions was preserved according to the WAIS-III and WMS-R. NMOSD patients without symptomatic brain lesions were cognitively intact. BRBN may misevaluate cognitive functions in NMOSD patients over 55 years old. WAIS and WMS are suitable for the cognitive assessments in older NMOSD patients.
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Affiliation(s)
- Juichi Fujimori
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ichiro Nakashima
- Department of Neurology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toru Baba
- Department of Behavioral Neurology and Cognitive Neuroscience, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuko Meguro
- Section of Speech Language Therapy and Neuropsychology, Department of Rehabilitation, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Japan
| | - Ryo Ogawa
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kazuo Fujihara
- Department of Multiple Sclerosis Therapeutics, Tohoku University Graduate School of Medicine, Sendai, Japan
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Okhovat AA, Ansari B, Rezaali S, Altintas A, Naser Moghadasi A. Catastrophic presentation of a patient with combined NMOSD and thrombotic thrombocytopenic purpura/hemolytic uremic syndrome: a case report. Acta Neurol Belg 2017; 117:757-759. [PMID: 27757811 DOI: 10.1007/s13760-016-0710-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/09/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ali Asghar Okhovat
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Behnaz Ansari
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Saeed Rezaali
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ayse Altintas
- Department of Neurology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Abdorreza Naser Moghadasi
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- MS Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
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Malhotra K, Ramanathan RS, Scott TF. Transient IgG deficiency with lesions in brain and spinal cord: a mimicker of common variable immunodeficiency syndrome. Acta Neurol Belg 2017; 117:761-763. [PMID: 27848135 DOI: 10.1007/s13760-016-0722-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Konark Malhotra
- Department of Neurology, Charleston Area Medical Center, West Virginia University, Charleston, WV, USA.
| | | | - Thomas F Scott
- Department of Neurology, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA, USA
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Fastré S, London F, Lelotte J, Camboni A, Jeanjean A. Primary central nervous system lymphoma of T-cell origin: an unusual cause of spinal cord disease. Acta Neurol Belg 2017; 117:765-7. [PMID: 27878765 DOI: 10.1007/s13760-016-0726-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
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Kim MJ, Sung JJ, Kim SH, Kim JM, Jeon GS, Mun SK, Ahn SW. The Anti-Inflammatory Effects of Oral-Formulated Tacrolimus in Mice with Experimental Autoimmune Encephalomyelitis. J Korean Med Sci 2017; 32:1502-1507. [PMID: 28776347 PMCID: PMC5546971 DOI: 10.3346/jkms.2017.32.9.1502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 05/28/2017] [Indexed: 11/20/2022] Open
Abstract
Multiple sclerosis (MS) is a T-lymphocyte-mediated autoimmune disease that is characterized by inflammation in the central nervous system (CNS). Although many disease-modifying therapies (DMTs) are presumed effective in patients with MS, studies on the efficacy and safety of DMTs for preventing MS relapse are limited. Therefore, we tested the immunosuppressive anti-inflammatory effects of oral-formulated tacrolimus (FK506) on MS in a mouse model of experimental autoimmune encephalomyelitis (EAE). The mice were randomly divided into 3 experimental groups: an untreated EAE group, a low-dose tacrolimus-treated EAE group, and a high-dose tacrolimus-treated EAE group. After autoimmunization of the EAE mice with myelin oligodendrocyte glycoprotein, symptom severity scores, immunohistochemistry of the myelination of the spinal cord, and western blotting were used to evaluate the EAE mice. After the autoimmunization, the symptom scores of each EAE group significantly differed at times. The group treated with the larger tacrolimus dose had the lowest symptom scores. The tacrolimus-treated EAE groups exhibited less demyelination and inflammation and weak immunoreactivity for all of the immunization biomarkers. Our results revealed that oral-formulated tacrolimus inhibited the autoimmunization in MS pathogenesis by inactivating inflammatory cells.
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Affiliation(s)
- Myung Jin Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jung Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Neurology, Hanyang University Hospital, Hanyang University College of Medicine, Seoul, Korea
| | - Jeong Min Kim
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Gye Sun Jeon
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seog Kyun Mun
- Department of Otorhinolaryngology, Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Suk Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea.
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Alberga D, Trisciuzzi D, Lattanzi G, Bennett JL, Verkman AS, Mangiatordi GF, Nicolotti O. Comparative molecular dynamics study of neuromyelitis optica-immunoglobulin G binding to aquaporin-4 extracellular domains. Biochim Biophys Acta Biomembr 2017; 1859:1326-34. [PMID: 28477975 DOI: 10.1016/j.bbamem.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 04/27/2017] [Accepted: 05/02/2017] [Indexed: 01/26/2023]
Abstract
Neuromyelitis optica (NMO) is an inflammatory demyelinating disease of the central nervous system in which most patients have serum autoantibodies (called NMO-IgG) that bind to astrocyte water channel aquaporin-4 (AQP4). A potential therapeutic strategy in NMO is to block the interaction of NMO-IgG with AQP4. Building on recent observation that some single-point and compound mutations of the AQP4 extracellular loop C prevent NMO-IgG binding, we carried out comparative Molecular Dynamics (MD) investigations on three AQP4 mutants, TP137-138AA, N153Q and V150G, whose 295-ns long trajectories were compared to that of wild type human AQP4. A robust conclusion of our modeling is that loop C mutations affect the conformation of neighboring extracellular loop A, thereby interfering with NMO-IgG binding. Analysis of individual mutations suggested specific hydrogen bonding and other molecular interactions involved in AQP4-IgG binding to AQP4.
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Khorvash F, Esmaeil N, Mirmosayyeb O, Eskandari N, Salimian H. Neuromyelitis optica in a pregnant woman with systemic lupus erythematous: A case report. Iran J Neurol 2016; 15:232-234. [PMID: 28435633 PMCID: PMC5392198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Received: 06/11/2016] [Accepted: 08/22/2016] [Indexed: 06/07/2023]
Affiliation(s)
- Fariborz Khorvash
- Department of Neurology, Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nafiseh Esmaeil
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Mirmosayyeb
- Neurosciences Research Center, Alzahra Hospital, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahid Eskandari
- Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homayoon Salimian
- School of Medicine, Shahrekord University of Medical Sciences, Shahrekord, Iran
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Mathew T, Nadimpally US, Sarma GRK, Nadig R. Trigeminal autonomic cephalalgia as a presenting feature of Neuromyelitis Optica: "A rare combination of two uncommon disorders". Mult Scler Relat Disord 2016; 6:73-74. [PMID: 27063627 DOI: 10.1016/j.msard.2016.01.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/29/2016] [Indexed: 11/19/2022]
Abstract
Neuromyelitis Optica (NMO) can have atypical presentations like hiccups, vomiting, etc. which is classically described as the area postrema syndrome. Here we report a case of a 39 year old male patient who presented with features of Trigeminal Autonomic Cephalalgia (TAC). MRI spine showed long segment myelitis. Diagnosis of NMO was confirmed by a positive Anti aquaporin 4 antibody assay. TACs are a rare group of headache disorders characterized by severe unilateral headache in the V1 distribution of the trigeminal nerve and autonomic symptoms. This presentation in NMO is hitherto unreported in literature.
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Affiliation(s)
| | | | - G R K Sarma
- St.John's Medical College and Hospital, India.
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Kashipazha D, Mohammadianinejad SE, Majdinasab N, Azizi M, Jafari M. A descriptive study of prevalence, clinical features and other findings of neuromyelitis optica and neuromyelitis optica spectrum disorder in Khuzestan Province, Iran. Iran J Neurol 2015; 14:204-10. [PMID: 26885339 PMCID: PMC4754599] [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] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Neuromyelitis optica (NMO) is an uncommon neuro-inflammatory syndrome that has shown to be distinct from multiple sclerosis (MS) and associated with the autoantibody marker NMO-immunoglobulin G (IgG). There are still only a few studies regarding the epidemiology of NMO in Iran. In the present study, we tried to describe the epidemiology of NMO in Khuzestan as one of the densely populated regions in Iran. METHODS A cross-sectional study was performed during the period 2013-2014. Multiple regional sources of data were used including hospital records, details from neurologists and MS society database. The diagnosis of NMO was based on clinical presentation, abnormal findings on neuroimaging and serological tests. RESULTS A 51 Caucasian patients (36 patients with NMO and 15 with NMO-spectrum disorder) were identified with a female/male ratio of 7.5:1.0. The crude prevalence of NMO was 1.1/100,000 population. The mean age at onset was 29.2 ± 6.1 years and the mean duration of symptoms was 5.0 ± 0.4 years. The majority of patients (60.8%) were classified as having mild disability (Expanded Disability Status Scale = 0-3.5). Among of 35 patients whose titer of NMO-IgG was measured, 19 (54.2%) were seropositive. CONCLUSION Our study suggests that NMO prevalence rate in South West Iran (Khuzestan Province) is much lower than that reported for MS prevalence rate (16.2/100,000) and our patients had a lower age at onset presentation and milder course of the disease than western countries.
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Affiliation(s)
- Davood Kashipazha
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | | | - Nastaran Majdinasab
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Mostafa Azizi
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Majid Jafari
- 1 Department of Neurology, Golestan Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
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Mutch K, Zhao S, Hamid S, Methley A, Elsone L, Singh G, Young C, Emmanuel A, Panicker J, Jacob A. Bladder and bowel dysfunction affect quality of life. A cross sectional study of 60 patients with aquaporin-4 antibody positive Neuromyelitis Optica spectrum disorder. Mult Scler Relat Disord 2015; 4:614-8. [PMID: 26590671 DOI: 10.1016/j.msard.2015.07.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [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: 05/05/2015] [Revised: 06/22/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Transverse myelitis (TM) associated with Neuromyelitis Optica (NMO) can be severe and is well known to reduce mobility early in the disease. However the burden of bladder and bowel dysfunction is unknown and overlooked. We studied the frequency of bladder and bowel dysfunction and their impact on quality of life. METHODS A cross-sectional study of 60 patients who had AQP4-IgG positive NMO associated TM was performed using the Bladder Control Scale, Lower Urinary Tract Quality of Life, Bowel Control Scale and Neurogenic Bowel Score, Short-Form-36 Health Survey and EDSS. The relationships between the variables were analysed with multiple linear regression. RESULTS Fifty women and 10 men participated. 78% (47/60) patients reported bladder symptoms and a similar number reported bowel problems. 87% (52/60) patients reported either bladder or bowel dysfunction. 65% (39/60) developed residual symptoms after the first episode of myelitis and the remaining by the second episode. Both bladder and bowel dysfunction reduced quality of life and required modification of lifestyle in 83% (39/47) and 70% (33/47) respectively. CONCLUSION Bladder and bowel dysfunction is very common in NMO associated myelitis developing early in the disease and significantly affects quality of life.
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Affiliation(s)
- Kerry Mutch
- Walton Centre Foundation Trust, Liverpool, UK.
| | | | - Shahd Hamid
- The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, UK.
| | | | | | | | | | - Anton Emmanuel
- The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, UK.
| | - Jalesh Panicker
- The National Hospital for Neurology and Neurosurgery and UCL Institute of Neurology, Queen Square, London, UK.
| | - Anu Jacob
- Walton Centre Foundation Trust, Liverpool, UK.
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Owens GP, Ritchie A, Rossi A, Schaller K, Wemlinger S, Schumann H, Shearer A, Verkman AS, Bennett JL. Mutagenesis of the aquaporin 4 extracellular domains defines restricted binding patterns of pathogenic neuromyelitis optica IgG. J Biol Chem 2015; 290:12123-34. [PMID: 25792738 PMCID: PMC4424347 DOI: 10.1074/jbc.m115.647149] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [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: 02/25/2015] [Indexed: 11/18/2022] Open
Abstract
Neuromyelitis optica-immunoglobulin G (NMO-IgG) binds to aquaporin-4 (AQP4) water channels in the central nervous system leading to immune-mediated injury. We have previously demonstrated that a high proportion of CSF plasma cells of NMO patients produce antibody to the extracellular domains of the AQP4 protein and that recombinant IgG (rAb) derived from these cells recapitulate pathogenic features of disease. We performed a comprehensive mutational analysis of the three extracellular loops of the M23 isoform of human AQP4 using both serial and single point mutations, and we evaluated the effects on binding of NMO AQP4-reactive rAbs by quantitative immunofluorescence. Whereas all NMO rAbs required conserved loop C (137TP138 and Val150) and loop E (230HW231) amino acids for binding, two broad patterns of NMO-IgG recognition could be distinguished based on differential sensitivity to loop A amino acid changes. Pattern 1 NMO rAbs were insensitive to loop A mutations and could be further discriminated by differential sensitivity to amino acid changes in loop C (148TM149 and His151) and loop E (Asn226 and Glu228). Alternatively, pattern 2 NMO rAbs showed significantly reduced binding following amino acid changes in loop A (63EKP65 and Asp69) and loop C (Val141, His151, and Leu154). Amino acid substitutions at 137TP138 altered loop C conformation and abolished the binding of all NMO rAbs and NMO-IgG, indicating the global importance of loop C conformation to the recognition of AQP4 by pathogenic NMO Abs. The generation of human NMO rAbs has allowed the first high resolution mapping of extracellular loop amino acids critical for NMO-IgG binding and identified regions of AQP4 extracellular structure that may represent prime targets for drug therapy.
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Affiliation(s)
| | | | - Andrea Rossi
- the Department III-Developmental Genetics, Max Planck Institute for Heart and Lung Research, Ludwigstrasse 43, 61231 Bad Nauheim, Germany, and
| | | | | | | | | | - Alan S Verkman
- the Departments of Medicine and Physiology, University of California, San Francisco, San Francisco, California 94143
| | - Jeffrey L Bennett
- From the Departments of Neurology and Ophthalmology and Neuroscience Program, University of Colorado at Denver, Anschutz Medical Campus, Aurora, Colorado 80045,
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Pisani F, Mola MG, Simone L, Rosito S, Alberga D, Mangiatordi GF, Lattanzi G, Nicolotti O, Frigeri A, Svelto M, Nicchia GP. Identification of a point mutation impairing the binding between aquaporin-4 and neuromyelitis optica autoantibodies. J Biol Chem 2014; 289:30578-30589. [PMID: 25239624 DOI: 10.1074/jbc.m114.582221] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [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: 11/06/2022] Open
Abstract
Neuromyelitis optica (NMO) is characterized by the presence of pathogenic autoantibodies (NMO-IgGs) against supra-molecular assemblies of aquaporin-4 (AQP4), known as orthogonal array of particles (OAPs). NMO-IgGs have a polyclonal origin and recognize different conformational epitopes involving extracellular AQP4 loops A, C, and E. Here we hypothesize a pivotal role for AQP4 transmembrane regions (TMs) in epitope assembly. On the basis of multialignment analysis, mutagenesis, NMO-IgG binding, and cytotoxicity assay, we have disclosed the key role of aspartate 69 (Asp(69)) of TM2 for NMO-IgG epitope assembly. Mutation of Asp(69) to histidine severely impairs NMO-IgG binding for 85.7% of the NMO patient sera analyzed here. Although Blue Native-PAGE, total internal reflection fluorescence microscopy, and water transport assays indicate that the OAP Asp(69) mutant is similar in structure and function to the wild type, molecular dynamic simulations have revealed that the D(69)H mutation has the effect of altering the structural rearrangements of extracellular loop A. In conclusion, Asp(69) is crucial for the spatial control of loop A, the particular molecular conformation of which enables the assembly of NMO-IgG epitopes. These findings provide additional clues for new strategies for NMO treatment and a wealth of information to better approach NMO pathogenesis.
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Affiliation(s)
- Francesco Pisani
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari
| | - Maria Grazia Mola
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari
| | - Laura Simone
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari
| | - Stefania Rosito
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari
| | - Domenico Alberga
- Dipartimento Interateneo di Fisica "M. Merlin", INFN and TIRES, Università di Bari "Aldo Moro", via Orabona, 4, 70126 Bari, Italy
| | - Giuseppe Felice Mangiatordi
- Dipartimento di Farmacia-Scienze del Farmaco, Via Orabona, 4, Università di Bari "Aldo Moro", Bari, 70126 Bari, and
| | - Gianluca Lattanzi
- Dipartimento Interateneo di Fisica "M. Merlin", INFN and TIRES, Università di Bari "Aldo Moro", via Orabona, 4, 70126 Bari, Italy
| | - Orazio Nicolotti
- Dipartimento di Farmacia-Scienze del Farmaco, Via Orabona, 4, Università di Bari "Aldo Moro", Bari, 70126 Bari, and
| | - Antonio Frigeri
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari
| | - Maria Svelto
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari
| | - Grazia Paola Nicchia
- Department of Bioscience, Biotechnologies and Biopharmaceutics and Center of Excellence in Comparative Genomics, University of Bari "Aldo Moro," 70126 Bari,.
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Ayrignac X, Dalière CC, Nerrant E, Vincent T, De Seze J, Labauge P. Extensive cerebral white matter involvement in a patient with NMO spectrum disorder. Mult Scler 2014; 20:1401-3. [PMID: 24852925 DOI: 10.1177/1352458514536253] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [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]
Abstract
Abnormal brain MRI has been described in up to 60% of patients with NMO patients. However, white matter T2 hyperintensities have been rarely observed. We report the case of a 49-year-old woman with long-lasting neuromyelitis optica (NMO) spectrum disorder and diffuse cerebral white matter T2-weighted hyperintensities. Our case suggests that some NMO patients can progressively develop l extensive cerebral involvement.
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Etemadifar M, Mehrbod N, Dehghani L, Golabbakhsh A, Fereidan-Esfahani M, Akbari M, Nasr Z. Prevalence of Lhermitte's sign in multiple sclerosis versus neuromyelitis optica. Iran J Neurol 2014; 13:50-1. [PMID: 24800049 PMCID: PMC3968359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/25/2013] [Accepted: 11/26/2013] [Indexed: 11/08/2022]
Affiliation(s)
- Masoud Etemadifar
- Department of Neurology, Isfahan Neurosciences Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Noushin Mehrbod
- Department of Neurology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Dehghani
- Department of Medical Sciences, School of Medicine, Islamic Azad University, Najafabad Branch, Isfahan, Iran
| | - Aryan Golabbakhsh
- Medical Students’ Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahboobeh Fereidan-Esfahani
- Medical Students’ Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- Department of Epidemiology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Nasr
- Medical Students’ Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Bell JC, Liu Q, Gan Y, Liu Q, Liu Y, Shi FD, Turner GH. Visualization of inflammation and demyelination in 2D2 transgenic mice with rodent MRI. J Neuroimmunol 2013; 264:35-40. [PMID: 24094460 DOI: 10.1016/j.jneuroim.2013.09.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [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: 05/14/2013] [Revised: 09/06/2013] [Accepted: 09/10/2013] [Indexed: 10/26/2022]
Abstract
Research tools are urgently needed to elucidate the specificities of NMO and MS due to their clinical similarity at the early stage of the diseases. Herein, using high-field-strength MRI we characterized the optic nerve and spinal cord lesions in 2D2(tg) mice (MOG 35-55 specific TCR). Specifically, early Blood-brain Barrier breakdown was observed in 86% of the 2D2(tg) mice, while the majority of mice showed little to no brain lesions. Further, immunohistology showed inflammatory infiltrates and demyelination in the brain and spinal cord that mirrored sites of MRI lesions, along with a decrease in AQP4 protein at lesion sites. Collectively, 2D2(tg) mice develop optic and spinal cord lesions that can be visualized by high-field rodent MRI and verified by pathological assessment. The similarity of these lesions with those seen in NMO patients suggests that the 2D2(tg) mouse might serve as a model for NMO research.
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Affiliation(s)
- Jordan C Bell
- Department of Neurology and BNI-ASU Center for Preclinical Imaging, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, United States
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Spillane J, Christofi G, Sidle KC, Kullmann DM, Howard RS. Myasthenia gravis and neuromyelitis opica: A causal link. Mult Scler Relat Disord 2013; 2:233-7. [PMID: 25877729 DOI: 10.1016/j.msard.2013.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [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: 09/07/2012] [Revised: 12/17/2012] [Accepted: 01/21/2013] [Indexed: 10/27/2022]
Abstract
Neuromyelitis Optica (NMO) and Myasthenia Gravis (MG) are rare antibody mediated disorders of the central nervous system (CNS) and neuromuscular junction (NMJ) respectively. Both diseases are predominantly mediated by IgG1 antibodies that activate complement. There have been increasing reports of patients who develop both disorders. Given the rarity of both diseases it would seem that these occurrences are not purely coincidental. There is heterogeneity between the cases described in the literature but common trends are observed in patients who develop both disorders. Most patients described are female. Typically the MG precedes the NMO and the majority of patients have undergone thymectomy. Generally, the symptoms of MG are mild but the NMO tends to follow a more aggressive clinical course. The pathogenesis of NMO in combination with MG is unknown, but thymectomy has been implicated in a subset of patients. We present the case of a female patient who developed NMO on a background of sero-positive MG and discuss the relevant literature.
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Affiliation(s)
- J Spillane
- UCL Institute of Neurology, Queen Square, London, UK.
| | - G Christofi
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - K C Sidle
- UCL Institute of Neurology, Queen Square, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - D M Kullmann
- UCL Institute of Neurology, Queen Square, London, UK; National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - R S Howard
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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