1
|
Trivedi RR, Archambault AS, Pavlak C, Gastaldi M, Cantoni C, Ghezzi L, Cross AH, Miller TM, Wu GF. Prevalence of anti-myelin oligodendrocyte glycoprotein antibodies across neuroinflammatory and neurodegenerative diseases. J Neurol Sci 2024; 461:123041. [PMID: 38744216 DOI: 10.1016/j.jns.2024.123041] [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: 02/18/2024] [Revised: 04/14/2024] [Accepted: 05/07/2024] [Indexed: 05/16/2024]
Abstract
Inflammatory central nervous system (CNS) diseases, such as multiple sclerosis (MS) and myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD), are characterized by humoral immune abnormalities. Anti-MOG antibodies are not specific to MOGAD, with their presence described in MS. Autoantibodies may also be present and play a role in various neurodegenerative diseases. Amyotrophic lateral sclerosis (ALS) is a fatal neurodegenerative disease driven by motor neuron dysfunction. While immune involvement in ALS has been recognized, the presence of antibodies targeting CNS myelin antigens has not been established. We aimed to establish a live cell-based assay for quantification of serum anti-MOG IgG1 in patients with CNS diseases, including MS and ALS. In total, 771 serum samples from the John L. Trotter MS Center and the Northeast ALS Consortium were examined using a live cell-based assay for detection of anti-MOG IgG1. Samples from three cohorts were tested in blinded fashion: healthy control (HC) subjects, patients with clinically diagnosed MOGAD, and an experimental group of ALS and MS patients. All samples from established MOGAD cases were positive for anti-MOG antibodies, while all HC samples were negative. Anti-MOG IgG1 was detected in 65 of 658 samples (9.9%) from MS subjects and 4 of 108 (3.7%) samples from ALS subjects. The presence of serum anti-MOG IgG1 in MS and ALS patients raises questions about the contribution of these antibodies to disease pathophysiology as well as accuracy of diagnostic approaches for CNS inflammatory diseases.
Collapse
Affiliation(s)
- Ritu R Trivedi
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Angela S Archambault
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Clarice Pavlak
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Matteo Gastaldi
- Fondazione "Istituto Neurologico Casimiro Mondino" Pavia, 27100, Italy
| | - Claudia Cantoni
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Laura Ghezzi
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Anne H Cross
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Timothy M Miller
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America
| | - Gregory F Wu
- Department of Neurology, Washington University School of Medicine, St. Louis, MO 63110, United States of America; Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, MO 63110, United States of America; Neurology service, Veterans Affairs Saint Louis Health Care System, Saint Louis, MO 63106, United States of America.
| |
Collapse
|
2
|
Budhram A. Exclusion of alternative diagnoses: A component of the 2023 MOGAD criteria that belongs at the forefront, not in the background. Mult Scler Relat Disord 2024; 85:105544. [PMID: 38467091 DOI: 10.1016/j.msard.2024.105544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 03/06/2024] [Indexed: 03/13/2024]
Abstract
A recent study evaluating the diagnostic performance of the 2023 MOGAD criteria found that it had relatively low specificity. However, this study did not apply the component of these criteria that requires exclusion of alternative diagnoses (item C) when evaluating its performance, raising questions surrounding the relevance of the study's findings to the use of these criteria in routine practice. This correspondence acknowledges the challenge of clinically applying this component of diagnostic criteria, discusses what exclusion of alterative diagnoses actually entails conceptually, and emphasizes the importance of its inclusion in future studies aimed at evaluating the performance of proposed criteria.
Collapse
Affiliation(s)
- Adrian Budhram
- Department of Clinical Neurological Sciences, Western University, London Health Sciences Centre, London, Ontario, Canada; Department of Pathology and Laboratory Medicine, Western University, London Health Sciences Centre, London, Ontario, Canada.
| |
Collapse
|
3
|
Burton JM, Youn S, Al-Ani A, Costello F. Patterns and utility of myelin oligodendrocyte glycoprotein ( MOG) antibody testing in cerebrospinal fluid. J Neurol 2024; 271:2662-2671. [PMID: 38366070 DOI: 10.1007/s00415-024-12213-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/20/2024] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) is an idiopathic central nervous system (CNS) demyelinating disease gaining recognition with wider availability of cell-based assay (CBA) testing and recently published diagnostic criteria. However, uncertainty remains regarding the interpretation of antibody titers, particularly cerebrospinal fluid (CSF) MOG antibody titers. METHODS All MOG IgG CBA results performed by the provincial MitogenDx laboratory in Alberta from July 2017 to July 2023 were retrieved. Chart review was performed in patients with both serum and CSF testing and ≥ 1 positive MOG antibody result. Demographics, antibody titers, clinical and imaging features, treatment, and diagnosis were analyzed based on serum/CSF status. RESULTS Among 4494 MOG CBA assays, there were 413 CSF samples in 402 patients, and 268 patients had at least one associated serum sample. Mean time between CSF and serum testing was 20.9 days (range 0-870 days), most with testing within 30 days. Five of the 268 patients had serum positive/CSF positive MOG antibodies, 4 with acute disseminated encephalomyelitis and 1 with longitudinally extensive transverse myelitis. Twenty-three patients had serum positive/CSF negative MOG and 13/23 with optic neuritis. CSF MOG antibody positive patients were younger, and more likely to remain MOG seropositive versus CSF negative patients. No seronegative patient had MOG antibodies in CSF. CONCLUSIONS In province-wide testing, CSF MOG antibodies were rare, only in MOG seropositive patients and none with optic neuritis. Our study does not support a clear role for CSF MOG antibody testing in the majority of patients, although further study is required.
Collapse
MESH Headings
- Humans
- Myelin-Oligodendrocyte Glycoprotein/immunology
- Male
- Female
- Adult
- Middle Aged
- Autoantibodies/cerebrospinal fluid
- Autoantibodies/blood
- Aged
- Adolescent
- Young Adult
- Child
- Aged, 80 and over
- Child, Preschool
- Demyelinating Autoimmune Diseases, CNS/cerebrospinal fluid
- Demyelinating Autoimmune Diseases, CNS/immunology
- Demyelinating Autoimmune Diseases, CNS/diagnosis
- Demyelinating Autoimmune Diseases, CNS/blood
- Encephalomyelitis, Acute Disseminated/diagnosis
- Encephalomyelitis, Acute Disseminated/cerebrospinal fluid
- Encephalomyelitis, Acute Disseminated/immunology
- Encephalomyelitis, Acute Disseminated/blood
- Retrospective Studies
- Optic Neuritis/cerebrospinal fluid
- Optic Neuritis/immunology
- Optic Neuritis/diagnosis
- Optic Neuritis/blood
Collapse
Affiliation(s)
- Jodie M Burton
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cumming School of Medicine, Health Sciences Centre, Room 1007C, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.
| | - Saerom Youn
- Department of Surgery (Ophthalmology), University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Abdullah Al-Ani
- Department of Surgery (Ophthalmology), University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| | - Fiona Costello
- Division of Neurology, Department of Clinical Neurosciences, University of Calgary, Cumming School of Medicine, Health Sciences Centre, Room 1007C, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
- Department of Surgery (Ophthalmology), University of Calgary, Cumming School of Medicine, Calgary, AB, Canada
| |
Collapse
|
4
|
Nowacka B, Lubiński W, Kaźmierczak B. Myelin Oligodendrocyte Glycoprotein ( MOG) Antibody-Associated Optic Neuritis - A Case Report and Literature Review. Int Med Case Rep J 2024; 17:391-399. [PMID: 38708316 PMCID: PMC11069371 DOI: 10.2147/imcrj.s459799] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/17/2024] [Indexed: 05/07/2024] Open
Abstract
Background Myelin oligodendrocyte glycoprotein (MOG)-IgG-associated optic neuritis (ON) is a new subset of demyelinating optic neuropathy. Case Report This study presents a case of a 49-year-old woman with MOG-IgG-positive ON, who reported to the ophthalmic emergency room with decreased visual acuity, retrobulbar pain and red color desaturation in her left eye. Abnormalities in the ophthalmological examination were: decreased Snellen's distance best-corrected visual acuity (DBCVA) to 0.04 in her left eye, slightly elevated optic nerve disc in the left eye confirmed by increased peripapillary retinal nerve fiber layer (RNFL) thickness in SD-OCT, abnormalities in pattern visual evoked potentials in both eyes. The preliminary diagnosis was demyelinating optic neuritis left for observation. However, two weeks after the first symptoms, treatment with intravenous methylprednisolone was initiated due to a decrease in DBCVA to no light perception. Intravenous steroids were followed by oral prednisone and later also by mycophenolate mofetil. The patient experienced slow but gradual improvement. One year after the occurrence of the initial symptoms, DBCVA was 0.5 in the left eye, however partial atrophy of the optic nerve developed, confirmed by macular ganglion cell layer (GCL) thickness and RNFL atrophy in SD-OCT, while visual pathway function improved. Conclusion All atypical cases of ON should be primarily considered for cell-based assays. MOG-IgG-positive ON usually responds well to steroid drugs and delaying immunosuppressive treatment may cause irreversible damage to the optic nerve.
Collapse
Affiliation(s)
- Barbara Nowacka
- 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Wojciech Lubiński
- 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| | - Beata Kaźmierczak
- 2nd Department of Ophthalmology, Pomeranian Medical University, Szczecin, Poland
| |
Collapse
|
5
|
Goldman-Yassen A, Lee A, Gombolay G. Leptomeningeal Enhancement in Pediatric Anti-Myelin Oligodendrocyte Glycoprotein Antibody Disease, Multiple Sclerosis, and Neuromyelitis Optica Spectrum Disorder. Pediatr Neurol 2024; 153:125-130. [PMID: 38382244 PMCID: PMC10940200 DOI: 10.1016/j.pediatrneurol.2024.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND Anti-myelin oligodendrocyte glycoprotein (MOG) antibody disease (MOGAD) is a type of acquired demyelinating disease that is distinct from multiple sclerosis (MS) and aquaporin-4 antibody neuromyelitis optica spectrum disorder (AQP4-NMOSD). Leptomeningeal enhancement (LME) has been reported in children and adults with MOGAD, and in adults with MS and AQP4-NMOSD, but less is known about LME in pediatric-onset MS (POMS) and pediatric AQP4-NMOSD. Here we compare the rates of LME in children with MOGAD, POMS, and AQP4-NMOSD. METHODS A retrospective chart review was performed in patients with MOGAD, POMS, and AQP4-NMOSD who presented to our institution. Clinical characteristics, imaging features, and relapsing data were included. Descriptive statistics were used, including chi-square or Fischer exact test, to compare proportions. The Benjamini-Hochberg procedure was used to correct for multiple comparisons. RESULTS A total of 42 children were included: 16 with POMS, six with AQP4-NMOSD, and 20 with MOGAD. Brain LME was only observed in the MOGAD group (six of 20 = 30%) when compared with zero (0%) POMS and AQP4-NMOSD (P = 0.012). Relapsing disease occurred in nine of 20 (45%), but LME did not associate with relapse. CONCLUSIONS LME is only observed in pediatric MOGAD and not in POMS or pediatric AQP4-NMOSD. LME did not predict relapses in MOGAD. Further work is needed to determine the clinical significance of LME in pediatric MOGAD.
Collapse
Affiliation(s)
- Adam Goldman-Yassen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta Georgia
| | - Azalea Lee
- Emory University School of Medicine, Atlanta, Georgia
| | - Grace Gombolay
- Division of Pediatric Neurology, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia.
| |
Collapse
|
6
|
Schanda K, Mariotto S, Rudzki D, Bauer A, Dinoto A, Rossi P, Ferrari S, Jarius S, Wildemann B, Boso F, Giometto B, Engels D, Kümpfel T, Wendel EM, Rostasy K, Reindl M. Is there an immunological cross-reactivity of antibodies to the myelin oligodendrocyte glycoprotein and coronaviruses? Brain Commun 2024; 6:fcae106. [PMID: 38576796 PMCID: PMC10994262 DOI: 10.1093/braincomms/fcae106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/08/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024] Open
Abstract
Recent reports indicated that myelin oligodendrocyte glycoprotein antibody-associated disease might be a rare complication after severe acute respiratory syndrome coronavirus 2 infection or vaccination. It is unclear whether this is an unspecific sequel of infection or vaccination or caused by possible immunological cross-reactivity of severe acute respiratory syndrome coronavirus 2 proteins and myelin oligodendrocyte glycoprotein. The aim of this study was therefore to elucidate whether there is an immunological cross-reactivity between severe acute respiratory syndrome coronavirus 2 spike or nucleocapsid proteins and myelin oligodendrocyte glycoprotein and to explore the relation of antibody responses against myelin oligodendrocyte glycoprotein and severe acute respiratory syndrome coronavirus 2 and other coronaviruses. We analysed serum samples from patients with severe acute respiratory syndrome coronavirus 2 infection and neurological symptoms with (myelin oligodendrocyte glycoprotein antibody-associated disease, n = 12) or without myelin oligodendrocyte glycoprotein-antibodies (n = 10); severe acute respiratory syndrome coronavirus 2 infection without neurological symptoms (n = 32); vaccinated patients with no history of severe acute respiratory syndrome coronavirus 2 infection and neurological symptoms with (myelin oligodendrocyte glycoprotein antibody-associated disease, n = 10) or without myelin oligodendrocyte glycoprotein-antibodies (n = 9); and severe acute respiratory syndrome coronavirus 2 negative/naïve unvaccinated patients with neurological symptoms with (myelin oligodendrocyte glycoprotein antibody-associated disease, n = 47) or without myelin oligodendrocyte glycoprotein-antibodies (n = 20). All samples were analysed for serum antibody responses to myelin oligodendrocyte glycoprotein, severe acute respiratory syndrome coronavirus 2, and other common coronaviruses (CoV-229E, CoV-HKU1, CoV-NL63 and CoV-OC43). Based on sample amount and antibody titres, 21 samples were selected for analysis of antibody cross-reactivity between myelin oligodendrocyte glycoprotein and severe acute respiratory syndrome coronavirus 2 spike and nucleocapsid proteins using affinity purification and pre-absorption. Whereas we found no association of immunoglobulin G and A myelin oligodendrocyte glycoprotein antibodies with coronavirus antibodies, infections with severe acute respiratory syndrome coronavirus 2 correlated with an increased immunoglobulin M myelin oligodendrocyte glycoprotein antibody response. Purified antibodies showed no cross-reactivity between severe acute respiratory syndrome coronavirus 2 spike protein and myelin oligodendrocyte glycoprotein. However, one sample of a patient with myelin oligodendrocyte glycoprotein antibody-associated disease following severe acute respiratory syndrome coronavirus 2 infection showed a clear immunoglobulin G antibody cross-reactivity to severe acute respiratory syndrome coronavirus 2 nucleocapsid protein and myelin oligodendrocyte glycoprotein. This patient was also seropositive for other coronaviruses and showed immunological cross-reactivity of severe acute respiratory syndrome coronavirus 2 and CoV-229E nucleocapsid proteins. Overall, our results indicate that an immunoglobulin G antibody cross-reactivity between myelin oligodendrocyte glycoprotein and severe acute respiratory syndrome coronavirus 2 proteins is rare. The presence of increased myelin oligodendrocyte glycoprotein-immunoglobulin M antibodies after severe acute respiratory syndrome coronavirus 2 infection may either be a consequence of a previous infection with other coronaviruses or arise as an unspecific sequel after viral infection. Furthermore, our data indicate that myelin oligodendrocyte glycoprotein-immunoglobulin A and particularly myelin oligodendrocyte glycoprotein-immunoglobulin M antibodies are a rather unspecific sequel of viral infections. Finally, our findings do not support a causative role of coronavirus infections for the presence of myelin oligodendrocyte glycoprotein-immunoglobulin G antibodies.
Collapse
Affiliation(s)
- Kathrin Schanda
- Clinical Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Sara Mariotto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37100 Verona, Italy
| | - Dagmar Rudzki
- Clinical Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Angelika Bauer
- Institute of Hygiene and Medical Microbiology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Alessandro Dinoto
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37100 Verona, Italy
| | - Patrizia Rossi
- Neurology Unit, St Bassiano Hospital, Bassano del Grappa, 36100 Vicenza, Italy
| | - Sergio Ferrari
- Neurology Unit, Department of Neurosciences, Biomedicine, and Movement Sciences, University of Verona, 37100 Verona, Italy
| | - Sven Jarius
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Brigitte Wildemann
- Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, 69120 Heidelberg, Germany
| | - Federica Boso
- Neurology Unit, Trento Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, 38122 Trento, Italy
| | - Bruno Giometto
- Neurology Unit, Trento Hospital, Azienda Provinciale per i Servizi Sanitari (APSS) di Trento, 38122 Trento, Italy
| | - Daniel Engels
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität München, 81375 Munich, Germany
| | - Tania Kümpfel
- Institute of Clinical Neuroimmunology, University Hospital, Ludwig-Maximilians-Universität München, 81375 Munich, Germany
| | - Eva-Maria Wendel
- Department of Neuropediatrics, Olgahospital/Klinikum Stuttgart, 70174 Stuttgart, Germany
| | - Kevin Rostasy
- Paediatric Neurology, Witten/Herdecke University, Children's Hospital Datteln, 45711 Datteln, Germany
| | - Markus Reindl
- Clinical Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| |
Collapse
|
7
|
Papantoniou M, Panagopoulos G. Concurrent acute sensorimotor axonal neuropathy and disseminated encephalitis associated with Chlamydia pneumoniae in an adult patient with anti- MOG and anti-sulfatide antibodies: a case report. Ther Adv Neurol Disord 2024; 17:17562864241237850. [PMID: 38495363 PMCID: PMC10944586 DOI: 10.1177/17562864241237850] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/07/2024] [Indexed: 03/19/2024] Open
Abstract
Acute disseminated encephalomyelitis and Guillain-Barré syndrome refer to post-infectious or post-vaccination inflammatory demyelinating disorders of central and peripheral nervous system, respectively. We report the case of a 60-year-old male patient presenting with irritability, gait difficulty, asymmetric quadriparesis (mostly in his left extremities), distal sensory loss for pain and temperature in left limbs, and reduced tendon reflexes in his upper limbs and absent in his lower limbs, following an upper respiratory tract infection, 3 weeks earlier. Brain magnetic resonance imaging revealed abnormal T2 signal and peripherally enhancing lesions in hemispheres, brainstem, and cerebellum. Nerve conduction studies were compatible with acute motor and sensory axonal neuropathy. Serology revealed positive IgM and IgG antibodies for Chlamydia pneumoniae, and he also tested positive for myelin oligodendrocyte glycoprotein (MOG) and sulfatide antibodies. Treatment with intravenous immunoglobulin and methylprednisolone led to clinical and radiological recovery within weeks. Even though several cases of combined central and peripheral demyelination have been reported before, it is the first case report with seropositive anti-sulfatide and anti-MOG acute sensorimotor axonal neuropathy and disseminated encephalitis associated with C. pneumoniae.
Collapse
Affiliation(s)
- Michail Papantoniou
- Laboratory of Clinical Neurophysiology, First Department of Neurology, School of Medicine, National and Kapodistrian University of Athens, Vas. Sofias Avenue 72–74, Athens 11528, Greece
| | | |
Collapse
|
8
|
Tesfagiorgis Y, Kemal EA, Craig HC, Parham KA, Kerfoot SM. Systemic administration of anti-CD20 indirectly reduces B cells in the inflamed meninges in a chronic model of central nervous system autoimmunity. J Neuroimmunol 2024; 387:578267. [PMID: 38155065 DOI: 10.1016/j.jneuroim.2023.578267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/26/2023] [Accepted: 12/12/2023] [Indexed: 12/30/2023]
Abstract
Anti-CD20 B cell depleting therapies have demonstrated that B cells are important drivers of disease progress in Multiple Sclerosis, although the pathogenic mechanisms are not well understood. A population of B cells accumulates in the inflamed meninges in MS and also some chronic animal models of disease, typically adjacent to demyelinating lesions. The role of these meningeal B cells in disease is not known, nor is their susceptibility to anti-CD20 therapy. Here, we administered anti-CD20 to 2D2 IgHMOG spontaneous experimental autoimmune encephalomyelitis mice in the chronic phase of disease, after the establishment of meningeal B cell clusters. Compared to the circulation, lymph nodes, and spleen, B cell depletion from the meninges was delayed and not evident until 7d post-administration of anti-CD20. Further, we did not find evidence that anti-CD20 accessed meningeal B cells directly, but rather that depletion was indirect and the result of ongoing turnover of the meningeal population and elimination of the peripheral pool from which it is sustained.
Collapse
Affiliation(s)
- Yodit Tesfagiorgis
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Eden A Kemal
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Heather C Craig
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Kate A Parham
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada
| | - Steven M Kerfoot
- Department of Microbiology and Immunology, University of Western Ontario, London, Ontario, Canada; Robarts Research Institute, University of Western Ontario, London, Ontario, Canada.
| |
Collapse
|
9
|
Tan Z, Chia YMF, Mu X, Tan YJ. Inherited chromosomally-integrated human herpes virus 6 confounding test results in a patient with myelitis and optic neuritis - A case report. J Neuroimmunol 2024; 387:578283. [PMID: 38184892 DOI: 10.1016/j.jneuroim.2024.578283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 12/25/2023] [Accepted: 12/31/2023] [Indexed: 01/09/2024]
Abstract
A case of the 'perfect storm' of myelin oligodendrocyte glycoprotein (MOG) antibody-mediated myelitis, human herpesvirus 6 (HHV-6) reactivation, and COVID-19 infection was reported in 2021. This article reports a case of a similarly observed clinical triad, but with a different conclusion and explanation supported by laboratory test results and evidence from our literature review.
Collapse
Affiliation(s)
- Zhibin Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Neuroscience Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore.
| | | | - Xiaomin Mu
- Department of Neurology, National Neuroscience Institute, Singapore
| | - You-Jiang Tan
- Department of Neurology, National Neuroscience Institute, Singapore; Neuroscience Academic Clinical Programme, SingHealth Duke-NUS Academic Medical Centre, Singapore
| |
Collapse
|
10
|
Cacciaguerra L, Flanagan EP. Updates in NMOSD and MOGAD Diagnosis and Treatment: A Tale of Two Central Nervous System Autoimmune Inflammatory Disorders. Neurol Clin 2024; 42:77-114. [PMID: 37980124 PMCID: PMC10658081 DOI: 10.1016/j.ncl.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2023]
Abstract
Aquaporin-4-IgG positive neuromyelitis optica spectrum disorder (AQP4+NMOSD) and myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are antibody-associated diseases targeting astrocytes and oligodendrocytes, respectively. Their recognition as distinct entities has led to each having its own diagnostic criteria that require a combination of clinical, serologic, and MRI features. The therapeutic approach to acute attacks in AQP4+NMOSD and MOGAD is similar. There is now class 1 evidence to support attack-prevention medications for AQP4+NMOSD. MOGAD lacks proven treatments although clinical trials are now underway. In this review, we will outline similarities and differences between AQP4+NMOSD and MOGAD in terms of diagnosis and treatment.
Collapse
Affiliation(s)
- Laura Cacciaguerra
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic Center for Multiple Sclerosis and Autoimmune Neurology, Mayo Clinic, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
11
|
Kang Q, Kang H, Liu S, Feng M, Zhou Z, Jiang Z, Wu L. Clinical characteristics of Chinese pediatric patients positive for anti-NMDAR and MOG antibodies: a case series. Front Neurol 2024; 14:1279211. [PMID: 38249740 PMCID: PMC10796507 DOI: 10.3389/fneur.2023.1279211] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction The cases of MOG-AD (MOG antibody-associated disorder) and anti-NMDAR encephalitis overlapping syndrome (MNOS) are rare, especially among pediatric patients, and their clinical understanding is limited. This study aimed to investigate the clinical manifestations, imaging findings, treatments, and prognosis of Chinese pediatric patients who tested positive for anti-NMDAR and MOG antibodies. Methods This retrospective study enrolled 10 MNOS pediatric patients, 50 MOG-AD (anti-NMDAR antibody-negative), and 81 anti-NMDAR encephalitis (MOG antibody-negative) pediatric patients who were admitted from July 2016 to June 2022 and used their clinical data for comparison. Results The MNOS patients had a significantly lower incidence of psycho-behavioral abnormalities and involuntary movements than anti-NMDAR antibody (+)/MOG antibody (-) patients and had a significantly higher incidence of sleep disorders, seizures, and psycho-behavioral abnormalities than MOG antibody (+)/anti-NMDAR antibody (-) patients. The MNOS patients had a significantly higher incidence of MRI abnormalities than the anti-NMDAR antibody (+)/MOG antibody (-) patients, while there was no significant difference in the incidence between the MNOS patients and the MOG antibody (+)/anti-NMDAR antibody (-) patients. No significant difference was seen in the initial mRS score between the three groups of patients. The anti-NMDAR antibody (+)/MOG antibody (-) patients had a higher rate of admission to the ICU, a longer length of in-hospital stay, and a higher rate of introduction to second-line treatment than the other two groups of patients. No significant difference was seen in the mRS score at the last follow-up and in the disease recurrence rate between the three groups. All these patients respond well to immunosuppressive therapy. Discussion In the presence of psycho-behavioral abnormalities, sleep disorders, and frequent seizures in MOG-AD patients or demyelinating symptoms of the central nervous system or demyelinating lesions on head MRI in anti-NMDAR encephalitis patients, the coexistence of MOG and anti-NMDAR antibodies should be considered and would suggest a diagnosis of MNOS for these patients. Immunotherapy is effective among these patients and should be given possibly earlier.
Collapse
Affiliation(s)
- Qingyun Kang
- Department of Neurology, Hunan Children’s Hospital, Changsha, China
| | - Hui Kang
- Department of Orthopaedics, General Hospital of Central Theater Command, Wuhan, Hubei, China
| | - Shulei Liu
- Department of Neurology, Hunan Children’s Hospital, Changsha, China
| | - Mei Feng
- Department of Neurology, Hunan Children’s Hospital, Changsha, China
| | - Zhen Zhou
- Department of Neurology, Hunan Children’s Hospital, Changsha, China
| | - Zhi Jiang
- Department of Neurology, Hunan Children’s Hospital, Changsha, China
| | - Liwen Wu
- Department of Neurology, Hunan Children’s Hospital, Changsha, China
| |
Collapse
|
12
|
Alaboudi M, Morgan M, Serra A, Abboud H. Utility of the 2023 international MOGAD panel proposed criteria in clinical practice: An institutional cohort. Mult Scler Relat Disord 2024; 81:105150. [PMID: 38043365 DOI: 10.1016/j.msard.2023.105150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/28/2023] [Accepted: 11/20/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a recently defined demyelinating disorder with a rapidly evolving clinical spectrum. Recently, consensus criteria have been proposed (Banwell et al., 2023) to help with disease diagnosis. However, validation of the proposed criteria in real-life MOGAD patients is lacking. In this study, we applied the proposed criteria to an institutional cohort of MOG antibody-positive patients. METHODS A retrospective study was conducted at a tertiary neuroimmunology clinic from 2018 to 2023. Patients who had at least one core clinical feature of MOGAD and positive serum MOG antibody by cell-based assay were included. Demographics and clinical data were recorded and analyzed. Cases were divided into definite MOGAD, questionable MOGAD, and false-positive MOG antibody as determined by the treating neuroimmunology and/or neuro-ophthalmology specialists prior to applying the new MOGAD criteria by an independent investigator. We then calculated the sensitivity, specificity, positive predictive value, and negative predictive value of the new criteria compared to the treating physicians' assessment. RESULTS A total of 27 patients were included of which, 19 (70.4%) were female, the average age of the sample was 44 +/- 15 years. High titer MOG antibody (≥ 1:100) was found in 11 patients (40.7%); low titer (< 1: 100) in 13 (48.1%), and unreported titer in 3 patients. As determined by expert opinion; 18 (66.7%) were identified as definitive MOGAD, 6 (22.2%) as false-positive MOG antibody, and 3 (11.1%) as questionable MOGAD. All 18 patients identified by clinicians as definite MOGAD met the new 2023 criteria. Of the 9 patients with questionable MOGAD or false-positive MOG antibody, four patients met the 2023 MOGAD criteria. Those four patients had the following final diagnoses: CNS vasculitis, primary progressive MS with activity and progression, pseudotumor cerebri, and bevacizumab-induced anterior ischemic optic neuropathy in the setting of paraneoplastic retinopathy. Compared to clinician assessment, applying the 2023 MOGAD criteria to our institutional cohort yielded a sensitivity of 100%, a specificity of 55.5%, a positive predictive value of 81.5% and a negative predictive value of 100%. CONCLUSION These findings suggest that the 2023 MOGAD criteria are highly sensitive for detection of definite MOGAD but has modest specificity. A number of MOGAD mimickers can resemble the core clinical events of MOGAD and share similar supportive clinical and MRI features. Clinicians should practice caution when evaluating patients with low titer MOG antibody even if they meet the additional supportive features proposed by the 2023 criteria. Further studies are needed to evaluate the 2023 criteria in larger cohorts and in the pediatric population.
Collapse
Affiliation(s)
- Malak Alaboudi
- Case Western Reserve University School of Medicine; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Michael Morgan
- Case Western Reserve University School of Medicine; Ophthalmology Department, University Hospitals Cleveland Medical Center
| | - Alessandro Serra
- Case Western Reserve University School of Medicine; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; VA Multiple Sclerosis Center of Excellence, Cleveland VA Medical Center, Cleveland, OH, United States
| | - Hesham Abboud
- Case Western Reserve University School of Medicine; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
| |
Collapse
|
13
|
van Noort JM, Baker D, Kipp M, Amor S. The pathogenesis of multiple sclerosis: a series of unfortunate events. Clin Exp Immunol 2023; 214:1-17. [PMID: 37410892 PMCID: PMC10711360 DOI: 10.1093/cei/uxad075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 06/10/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023] Open
Abstract
Multiple sclerosis (MS) is characterized by the chronic inflammatory destruction of myelinated axons in the central nervous system. Several ideas have been put forward to clarify the roles of the peripheral immune system and neurodegenerative events in such destruction. Yet, none of the resulting models appears to be consistent with all the experimental evidence. They also do not answer the question of why MS is exclusively seen in humans, how Epstein-Barr virus contributes to its development but does not immediately trigger it, and why optic neuritis is such a frequent early manifestation in MS. Here we describe a scenario for the development of MS that unifies existing experimental evidence as well as answers the above questions. We propose that all manifestations of MS are caused by a series of unfortunate events that usually unfold over a longer period of time after a primary EBV infection and involve periodic weakening of the blood-brain barrier, antibody-mediated CNS disturbances, accumulation of the oligodendrocyte stress protein αB-crystallin and self-sustaining inflammatory damage.
Collapse
Affiliation(s)
- Johannes M van Noort
- Department of Pathology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | - David Baker
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Markus Kipp
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| | - Sandra Amor
- Department of Pathology, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
- Institute of Anatomy, Rostock University Medical Center, Rostock, Germany
| |
Collapse
|
14
|
Greco G, Colombo E, Gastaldi M, Ahmad L, Tavazzi E, Bergamaschi R, Rigoni E. Beyond Myelin Oligodendrocyte Glycoprotein and Aquaporin-4 Antibodies: Alternative Causes of Optic Neuritis. Int J Mol Sci 2023; 24:15986. [PMID: 37958968 PMCID: PMC10649355 DOI: 10.3390/ijms242115986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 10/27/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Optic neuritis (ON) is the most common cause of vision loss in young adults. It manifests as acute or subacute vision loss, often accompanied by retrobulbar discomfort or pain during eye movements. Typical ON is associated with Multiple Sclerosis (MS) and is generally mild and steroid-responsive. Atypical forms are characterized by unusual features, such as prominent optic disc edema, poor treatment response, and bilateral involvement, and they are often associated with autoantibodies against aquaporin-4 (AQP4) or Myelin Oligodendrocyte Glycoprotein (MOG). However, in some cases, AQP4 and MOG antibodies will return as negative, plunging the clinician into a diagnostic conundrum. AQP4- and MOG-seronegative ON warrants a broad differential diagnosis, including autoantibody-associated, granulomatous, and systemic disorders. These rare forms need to be identified promptly, as their management and prognosis are greatly different. The aim of this review is to describe the possible rarer etiologies of non-MS-related and AQP4- and MOG-IgG-seronegative inflammatory ON and discuss their diagnoses and treatments.
Collapse
Affiliation(s)
- Giacomo Greco
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy
| | - Elena Colombo
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Matteo Gastaldi
- Neuroimmunology Research Unit, IRCCS Mondino Foundation, 27100 Pavia, Italy;
| | - Lara Ahmad
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Eleonora Tavazzi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Roberto Bergamaschi
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| | - Eleonora Rigoni
- Multiple Sclerosis Centre, IRCCS Mondino Foundation, 27100 Pavia, Italy; (G.G.); (E.C.); (L.A.); (E.T.); (R.B.)
| |
Collapse
|
15
|
Jain K, Anita M, Netravathi M. Double hit - A case in point for dual seropositivity to AQP4 and MOG antibodies. J Neuroimmunol 2023; 383:578198. [PMID: 37716133 DOI: 10.1016/j.jneuroim.2023.578198] [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: 08/08/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/18/2023]
Abstract
AQP4-IgG NMOSD (anti-aquaporin-4 neuromyelitis optica spectrum disorder) and MOGAD (myelin oligodendrocyte glycoprotein antibody associated disease) are unique disorders among themselves, with rare reports of dual seropositivity being described. Evaluation with cell-based assays reduces the incidence of false positivity. The clinical features of these cases may either have a dominant phenotype or may evolve into one subsequently. We describe a young girl aged 18-year-old who presented with longitudinally extensive transverse myelitis and dual seropositivity to both AQP4 and MOG antibodies.
Collapse
Affiliation(s)
- Kshiteeja Jain
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
| | - M Anita
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India.
| |
Collapse
|
16
|
Kannan V, Sandweiss AJ, Erickson TA, Yarimi JM, Ankar A, Hardwick VA, Shukla NM, Lotze TE, Risen SR, Riviello JJ, Lai YC, Moeller KK, Fisher K. Fulminant Anti-Myelin Oligodendrocyte Glycoprotein-Associated Cerebral Cortical Encephalitis: Case Series of a Severe Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease Phenotype. Pediatr Neurol 2023; 147:36-43. [PMID: 37544084 DOI: 10.1016/j.pediatrneurol.2023.07.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/27/2023] [Accepted: 07/05/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND We describe a cohort of children with severe myelin oligodendrocyte glycoprotein (MOG)-IgG-associated cerebral cortical encephalitis (CCE), manifesting with bilateral cortical cytotoxic edema and critical neurological illness. METHODS We retrospectively reviewed our pediatric MOG antibody-associated disease (MOGAD) database and identified patients with specific radiographic pattern of bilateral, multifocal cortical cytotoxic lesions. We collected demographic, clinical, and outcomes data from these patients and compared select variables with radiographically distinct cerebral MOGAD syndromes (case-control analysis). We assessed the correlation of quantitative clinical variables with severity/outcomes measures using simple linear regression. RESULTS Sixty-five of 88 total MOGAD cases had cerebral disease, and six of 88 met inclusion criteria for fulminant CCE (f-CCE). Age range was 2 to 7 years; five of six were male. Six of six were critically ill with severe encephalopathy and seizures, two of six required barbiturate coma, and two of six required invasive intracranial pressure monitoring. Six of six required treatment escalation beyond steroids. Four of six had favorable outcome; two of six had moderate-severe disability. Compared with other cerebral MOGAD cases (n = 59), children with f-CCE were more likely to have critical illness and poor neurological outcomes scores. Neurofilament light chain and treatment latency positively correlated with intensive care unit length of stay and outcomes scores; cerebrospinal fluid (CSF) white blood cell count and neutrophil-to-lymphocyte ratio did not. CONCLUSIONS Pediatric CCE with bilateral cytotoxicity is associated with more fulminant disease and worse outcomes than other cerebral MOGAD syndromes.
Collapse
Affiliation(s)
- Varun Kannan
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas.
| | - Alexander J Sandweiss
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Timothy A Erickson
- Department of Pediatrics, Section of Pediatric Tropical Medicine, Center for Human Immunobiology, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Jonathan M Yarimi
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Alexander Ankar
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Victoria A Hardwick
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Nikita M Shukla
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Timothy E Lotze
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Sarah R Risen
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - James J Riviello
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Yi-Chen Lai
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Karen K Moeller
- Department of Radiology, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| | - Kristen Fisher
- Department of Pediatrics, Section of Neurology and Developmental Neuroscience, Baylor College of Medicine at Texas Children's Hospital, Houston, Texas
| |
Collapse
|
17
|
Li Z, Lin D, Xu X, Liu X, Zhang J, Huang K, Wang F, Liu J, Zhang Z, Tao E. Central nervous system complications in SARS-CoV-2-infected patients. J Neurol 2023; 270:4617-4631. [PMID: 37573554 PMCID: PMC10511589 DOI: 10.1007/s00415-023-11912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To investigate the clinical manifestations, treatment and prognosis of COVID-19-associated central nervous system (CNS) complications. METHODS In this single-centre observation study, we recruited patients with COVID-19-associated CNS complications at the neurology inpatient department of the Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen) from Dec 2022 to Feb 2023. Patients were analysed for demographics, clinical manifestations, cerebrospinal fluid properties, electroencephalographic features, neuroimaging characteristics, and treatment outcome. All patients were followed-up at 1 and 2 months after discharge until Apr 2023. RESULTS Of the 12 patients with COVID-19-associated CNS complications, the CNS symptoms occur between 0 days and 4 weeks after SARS-CoV-2 infection. The most common CNS symptoms were memory deficits (4/12, 33%), Unresponsiveness (4/12, 33%), mental and behavioural disorders (4/12, 33%). Seven of 12 cases can be categorized as probable SARS-CoV-2 encephalitis, and 5 cases can be described as brainstem encephalitis, acute disseminated encephalomyelitis, optic neuritis, multiple sclerosis or tremor probably associated with SARS-CoV-2 infection. Six patients received antiviral therapy, and 11 patients received glucocorticoid therapy, of which 3 patients received human immunoglobulin synchronously. Nine patients recovered well, two patients had residual neurological dysfunction, and one patient passed away from complications associated with tumor. CONCLUSION In this observational study, we found that the inflammatory or immune-related complications were relatively common manifestations of COVID-19-associated CNS complications, including different phenotypes of encephalitis and CNS inflammatory demyelinating diseases. Most patients recovered well, but a few patients had significant neurological dysfunctions remaining.
Collapse
Affiliation(s)
- Zhonggui Li
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Danyu Lin
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Xiaoshuang Xu
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Xiaohuan Liu
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Jieli Zhang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Kaixun Huang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Feiyifan Wang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Jianfeng Liu
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Zhi Zhang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Enxiang Tao
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China.
| |
Collapse
|
18
|
Jamali Dogahe S, Pakravan P, Pakravan M. Acute Optic Neuritis: An Update on Approach and Management. J Ophthalmic Vis Res 2023; 18:433-440. [PMID: 38250236 PMCID: PMC10794797 DOI: 10.18502/jovr.v18i4.14556] [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: 04/19/2023] [Accepted: 07/17/2023] [Indexed: 01/23/2024] Open
Abstract
This review discusses the physical examination and diagnostic tests necessary to diagnose optic neuritis (ON) and provides an update on the approach and management of acute ON. A comprehensive search of the PubMed database was conducted, limited to English-language journals and recent publications. A total of 160 articles were initially screened by title, of which 73 articles were included in the narrative synthesis. ON is an inflammation of the optic nerve that can be caused by different systemic and neurological disorders. It is commonly presented as a subacute unilateral painful vision loss, and based on its clinical manifestation, it can be classified as typical or atypical. Atypical ON is bilateral with visual acuity of worse than 20/200 or has an atypical demographic presentation for demyelination, such as a non-Caucasian male with optic disc swelling, for which neuromyelitis optica spectrum disorder (NMOSD), myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD), or other etiologies should be considered. Steroids and immunosuppressants are the main treatment options for ON, and timely treatment initiation is critical to preventing irreversible vision loss, especially in atypical cases.
Collapse
|
19
|
Shi M, Luo D, Li Z, Li M, Jin S, Yang D, Guo J, Chen G. A case report of neurosyphilis coexisting with a positive MOG antibody manifested as optic neuritis. Front Neurol 2023; 14:1258043. [PMID: 37859651 PMCID: PMC10583717 DOI: 10.3389/fneur.2023.1258043] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/19/2023] [Indexed: 10/21/2023] Open
Abstract
Background Neurosyphilis refers to an infection of the central nervous system by Treponema pallidum. The clinical manifestations of neurosyphilis are diverse, making it easy to miss or misdiagnose. Anti-myelin oligodendrocyte glycoprotein antibody-associated disease is a recently defined immune-mediated inflammatory demyelinating central nervous system disease. Few studies have reported the coexistence of the two diseases. Case presentation This case report presents a 37 years-old male patient with neurosyphilis manifested as optic neuritis with a positive myelin oligodendrocyte glycoprotein (MOG) antibody. This patient received intravenous administration of 3.2 million units of procaine penicillin every 4 h for 2 weeks, followed by a two-week intramuscular injection of benzathine penicillin. Additionally, methylprednisolone sodium succinate was administered intravenously at 1,000 mg/day, gradually reduced to 500 mg/day and 240 mg/day every 3 days. Subsequently, prednisone tablets at a dosage of 60 mg/day were orally administered, with a gradual reduction of 5 mg/day every 3 days until reaching a dosage of 30 mg/day. The patient's visual acuity was improved after 26 days of hospitalization. However, the visual field and color vision did not. At 3 months of follow-up, the symptoms remained unchanged despite the patient continued taking oral prednisone tablets at a dosage of 30 mg/day. Conclusion Neurosyphilis could be a potential triggering factor for MOGAD. In patients with neurosyphilis, it is strongly recommended to perform testing for MOG antibody along with other brain disease antibodies.
Collapse
Affiliation(s)
- Min Shi
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Danqing Luo
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhaoying Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Man Li
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shuoguo Jin
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Dongdong Yang
- Department of Neurology, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Jun Guo
- Department of Neurology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing, China
| | - Guo Chen
- Department of Infectious Diseases, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| |
Collapse
|
20
|
Handzic A, Tien M, O'Cearbhaill RM, Xie JS, Zaslavsky K, Micieli J, Margolin E. Predictors of Poor Visual Outcome in Myelin Oligodendrocyte Glycoprotein-Related Optic Neuritis. Ophthalmology 2023; 130:993-995. [PMID: 37225022 DOI: 10.1016/j.ophtha.2023.05.024] [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: 04/30/2023] [Revised: 05/12/2023] [Accepted: 05/16/2023] [Indexed: 05/26/2023] Open
Affiliation(s)
- Armin Handzic
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Marko Tien
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Roisin Maire O'Cearbhaill
- Division of Neuroradiology, Department of Radiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jim Shenchu Xie
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kirill Zaslavsky
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jonathan Micieli
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Kensington Vision and Research Center, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Neurology, Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| |
Collapse
|
21
|
Webb LM, Cacciaguerra L, Krecke KN, Chen JJ, Sechi E, Redenbaugh V, Dubey D, Pittock SJ, Flanagan EP. Marked central canal T2-hyperintensity in MOGAD myelitis and comparison to NMOSD and MS. J Neurol Sci 2023; 450:120687. [PMID: 37201267 PMCID: PMC10492002 DOI: 10.1016/j.jns.2023.120687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/20/2023]
Abstract
OBJECTIVE To assess marked central canal T2-hyperintensity in patients with myelin-oligodendrocyte glycoprotein antibody-associated disease (MOGAD) myelitis compared to myelitis patients with aquaporin-4-antibody-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS). MATERIAL/METHODS Two blinded raters evaluated spinal cord magnetic resonance imaging (MRIs) of myelitis patients with MOGAD (n = 63), AQP4 + NMOSD (n = 37), and MS (n = 26), assessing for marked central canal T2-hyperintensity and its evolution. If there were conflicting results, a third neurologist assessed the MRI. RESULTS Marked central canal T2-hyperintensity was more frequent in patients with MOGAD (18/63[29%]) than MS (1/26[4%]; p = 0.01) myelitis but did not differ from AQP4 + NMOSD (13/37[35%]; p = 0.49). Marked central canal T2-hyperintensity had completely resolved on follow-up axial MRI for most MOGAD (12/14[86%]) and AQP4 + NMOSD (10/10[100%]; p = 0.49) patients. CONCLUSIONS Marked central canal T2-hyperintensity is a common transient radiologic accompaniment of MOGAD and AQP4 + NMOSD myelitis, but not MS myelitis.
Collapse
Affiliation(s)
- Lauren M Webb
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Laura Cacciaguerra
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Karl N Krecke
- Department of Radiology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - John J Chen
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Department of Ophthalmology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Elia Sechi
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Sean J Pittock
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA; Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, 200 1(st) St. SW, Rochester, MN, USA.
| |
Collapse
|
22
|
Takegami N, Murai H, Mori H, Yamaguchi-Takegami N, Toda T, Iwata NK, Goto J. Multiple cortical lesions with grainy enhancement of magnetic resonance imaging in anti-myelin oligodendrocyte glycoprotein ( MOG) antibody-associated encephalitis with seizures (FLAMES). J Neurol Sci 2023; 451:120729. [PMID: 37473617 DOI: 10.1016/j.jns.2023.120729] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023]
Affiliation(s)
- Naoki Takegami
- Department of Neurology, International University of Health and Welfare Mita Hospital, Tokyo, Japan; Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
| | - Hiroyuki Murai
- Department of Neurology, International University of Health and Welfare Mita Hospital, Tokyo, Japan; Department of Neurology, International University of Health and Welfare Narita Hospital, Narita, Japan
| | - Harushi Mori
- Department of Radiology, Jichi Medical University, Tochigi, Japan
| | | | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Nobue K Iwata
- Department of Neurology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Jun Goto
- Department of Neurology, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| |
Collapse
|
23
|
Sarin S, Modak N, Sun R, Subei O, Serra A, Morgan M, Abboud H. Predicting the final clinical phenotype after the first attack of optic neuritis. J Neuroimmunol 2023; 381:578130. [PMID: 37343437 DOI: 10.1016/j.jneuroim.2023.578130] [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: 03/22/2023] [Revised: 06/09/2023] [Accepted: 06/13/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND AND OBJECTIVES To evaluate the factors determining the final clinical phenotype after an initial isolated attack of optic neuritis (ON). ON could be an isolated event or the initial presentation of a chronic neuroimmunological condition. METHODS This was a retrospective analysis of patients presenting to University Hospitals Cleveland Medical Center for an initial, isolated attack of ON. Final clinical phenotypes were idiopathic ON, multiple sclerosis (MS), neuromyelitis optica spectrum disorder (NMOSD), myelin oligodendrocyte glycoprotein associated disease (MOGAD), or secondary ON (e.g. neurosarcoidosis). Several potential predictors at the time of initial presentation were compared among the different phenotypes to determine early predictors. Categorical variables were compared using Pearson χ2 or Fisher's exact test, and continuous variables were compared using independent t-test. RESULTS Sixty-four patients met criteria (average age 41.3 ± 13.3, 78.1% females). Average time to final diagnosis was 8.3 months, and average follow-up was 47 months. The final phenotypes were MS (22, 34%), idiopathic ON (14, 22%), MOGAD (11, 17%), NMOSD (10, 16%), and secondary ON (7, 11%). White race, unilateral ON, short segment hyperintensity on orbital MRI, classical demyelination on brain MRI, and not requiring PLEX were associated with MS. Older age, poor steroid responsiveness, and requiring PLEX were associated with NMOSD. African American race, bilateral ON, papillitis on fundoscopy, long segment hyperintensity on orbital MRI, and normal brain MRI were associated with MOGAD. Normal or thinned retinal nerve fiber layer on OCT, short segment hyperintensity on orbital MRI, and normal brain MRI were associated with idiopathic ON. CONCLUSION The final clinical phenotype may be predictable at the time of initial ON presentation. This requires a careful evaluation of patient demographics, treatment response, funduscopic findings, OCT, and orbital and brain MRIs. Utilizing early predictors in clinical practice could better inform prognosis and management decisions.
Collapse
Affiliation(s)
- Shlok Sarin
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Nikhil Modak
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America
| | - Rongyi Sun
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America
| | - Omar Subei
- Duke University Medical Center, Durham, NC, United States of America
| | - Alessandro Serra
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; MS Center of Excellence, Cleveland Veterans Affairs Medical Center, United States of America
| | - Michael Morgan
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America; Department of Ophthalmology, University Hospitals Cleveland Medical Center, United States of America
| | - Hesham Abboud
- Case Westerns Reserve University School of Medicine, Cleveland, OH, United States of America; Multiple Sclerosis and Neuroimmunology Program, University Hospitals Cleveland Medical Center, Cleveland, OH, United States of America.
| |
Collapse
|
24
|
Redenbaugh V, Chia NH, Cacciaguerra L, McCombe JA, Tillema JM, Chen JJ, Chiriboga ASL, Sechi E, Hacohen Y, Pittock SJ, Flanagan EP. Comparison of MRI T2-lesion evolution in pediatric MOGAD, NMOSD, and MS. Mult Scler 2023; 29:799-808. [PMID: 37218499 PMCID: PMC10626581 DOI: 10.1177/13524585231166834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Magnetic resonance imaging (MRI) T2-lesions resolve more often in myelin oligodendrocyte glycoprotein (MOG) antibody-associated disease (MOGAD) than aquaporin-4 IgG-positive neuromyelitis optica spectrum disorder (AQP4 + NMOSD) and multiple sclerosis (MS) in adults but few studies analyzed children. OBJECTIVE The main objective of this study is to investigate MRI T2-lesion evolution in pediatric MOGAD, AQP4 + NMOSD, and MS. METHODS Inclusion criteria were as follows: (1) first clinical attack; (2) abnormal MRI (⩽6 weeks); (3) follow-up MRI beyond 6 months without relapses in that region; and (4) age < 18 years. An index T2-lesion (symptomatic/largest) was identified, and T2-lesion resolution or persistence on follow-up MRI was determined. RESULTS We included 56 patients (MOGAD, 21; AQP4 + NMOSD, 8; MS, 27) with 69 attacks. Index T2-lesion resolution was more frequent in MOGAD (brain 9 of 15 [60%]; spine 8 of 12 [67%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]) and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Resolution of all T2-lesions occurred more often in MOGAD (brain 6 of 15 [40%]; spine 7 of 12 [58%]) than AQP4 + NMOSD (brain 1 of 4 [25%]; spine 0 of 7 [0%]), and MS (brain 0 of 18 [0%]; spine 1 of 13 [8%]), p < 0.01. Reductions in median index T2-lesion area were greater in MOGAD (brain, 305 mm; spine, 23 mm) than MS (brain, 42 mm [p<0.001]; spine, 10 mm [p<0.001]) without differing from AQP4 + NMOSD (brain, 133 mm [p=0.42]; spine, 19.5 mm [p=0.69]). CONCLUSION In children, MRI T2-lesions resolved more often in MOGAD than AQP4 + NMOSD and MS which is similar to adults suggesting these differences are related to pathogenesis rather than age.
Collapse
Affiliation(s)
- Vyanka Redenbaugh
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Nicholas H. Chia
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Laura Cacciaguerra
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Vita-Salute San Raffaele University, Milan, Italy
- Neuroimaging Research Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Jennifer A. McCombe
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Division of Neurology, Department of Medicine, University of Alberta, Alberta, Canada
| | - Jan-Mendelt Tillema
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - John J. Chen
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Ophthalmology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | | | | - Yael Hacohen
- Department of Neuroinflammation, Queen Square Multiple Sclerosis Centre, University College London Institute of Neurology, London, United Kingdom
| | - Sean J. Pittock
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Eoin P. Flanagan
- Department of Neurology, Mayo Clinic College of Medicine, Rochester, MN, USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic College of Medicine, Rochester, MN, USA
| |
Collapse
|
25
|
Harrison KL, Gaudioso C, Levasseur VA, Dunham SR, Schanzer N, Keuchel C, Salter A, Goyal MS, Mar S. Central Vein Sign in Pediatric Multiple Sclerosis and Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease. Pediatr Neurol 2023; 146:21-25. [PMID: 37406422 DOI: 10.1016/j.pediatrneurol.2023.05.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 05/17/2023] [Accepted: 05/18/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND The central vein sign (CVS) on brain magnetic resonance imaging (MRI) is a promising diagnostic marker for distinguishing adult multiple sclerosis (MS) from other demyelinating conditions, but its prevalence is not well-established in pediatric-onset multiple sclerosis (POMS) versus myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). MOGAD can mimic MS radiologically. This study seeks to determine the utility of CVS, together with other radiological findings, in distinguishing POMS from MOGAD in children. METHODS Children with POMS or MOGAD were identified in a pediatric demyelinating database. Two reviewers, blinded to diagnosis, fused fluid-attenuated inversion recovery sequences and susceptibility-weighted imaging from clinical imaging to identify CVS. Agreement in CVS number was reported using intraclass correlation coefficients (ICC). We performed topographic analyses as well as characterization of the clinical information and lesions on brain, spinal cord, and orbital MRI when available. RESULTS Twenty children, 10 with POMS and 10 with MOGAD, were assessed. The median lesion percentage of CVS was higher in POMS versus MOGAD for both raters (rater 1: 80% vs 9.8%; rater 2: 22.7% vs 7.5%). Inter-rater reliability for identifying total white matter lesions was strong (ICC 0.94 [95% confidence interval [CI] 0.84, 0.97]); however, it was poor for detecting CVS lesions (ICC -0.17 [95% CI: -0.37, 0.58]). CONCLUSION The CVS can be a useful diagnostic tool for differentiating POMS from MOGAD. However, advanced clinical imaging tools that can better detect CVS are needed to increase inter-rater reliability before clinical application.
Collapse
Affiliation(s)
- Kimystian L Harrison
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri.
| | - Cristina Gaudioso
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Victoria A Levasseur
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - S Richard Dunham
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Natalie Schanzer
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Connor Keuchel
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Amber Salter
- Department of Biostatistics, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Manu S Goyal
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri; Department of Radiology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Soe Mar
- Department of Neurology, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| |
Collapse
|
26
|
Dong X, Jiang Y, Yuan P, Fan X, Ma J, Wu P, Jiang L, Li X. Clinical, radiological, therapeutic and prognostic differences between MOG-seropositive and MOG-seronegative pediatric acute disseminated encephalomyelitis patients: a retrospective cohort study. Front Neurosci 2023; 17:1128422. [PMID: 37274199 PMCID: PMC10235790 DOI: 10.3389/fnins.2023.1128422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 04/25/2023] [Indexed: 06/06/2023] Open
Abstract
Objective This study aimed to compare the clinical, radiological, therapeutic, and prognostic differences between pediatric patients showing acute disseminated encephalomyelitis (ADEM) with and without myelin oligodendrocyte glycoprotein (MOG) antibodies. Methods We retrospectively collected all available data of children diagnosed with ADEM and tested for serum MOG antibodies at the Children's Hospital of Chongqing Medical University from January 2017 to May 2021. Results A total of 62 patients were included in our cohort, of which 35 were MOG-seropositive and 27 were MOG-seronegative. MOG-seropositive ADEM children presented with significantly lower rates of seizures (P = 0.038) and cranial nerve (III-XII) palsy (P = 0.003). Isolated leukocytosis in the blood was more common in ADEM children with MOG antibodies (P < 0.001). The two groups showed no significant differences in the distributions and extent of the MRI lesions as well as the appearance of typical/atypical magnetic resonance imaging (MRI) features. MOG-seropositive children were more likely to relapse (P = 0.017) despite having slower oral prednisolone tapering after acute treatments (P = 0.028). In scoring performed on the basis of two neurological function scoring systems, MOG-seropositive children showed milder neurological disability status at onset (P = 0.017 and 0.025, respectively) but showed no difference during follow-up. Conclusion In summary, the differences in the clinical manifestations and auxiliary examination findings for MOG-seropositive and MOG-seronegative ADEM children lacked significance and specificity, making early identification difficult. MOG-seropositive children were more likely to relapse and showed slower steroid tapering. Moreover, MOG-seronegative children tended to have more severe neurological impairments at onset with no difference during follow-up.
Collapse
Affiliation(s)
- Xueshan Dong
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Yan Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Ping Yuan
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiao Fan
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
- Department of Radiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
| | - Jiannan Ma
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Peng Wu
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Li Jiang
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| | - Xiujuan Li
- Department of Neurology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, China
- China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, China
- Chongqing Key Laboratory of Pediatrics, Chongqing, China
| |
Collapse
|
27
|
Alatrash R, Golubenko M, Martynova E, Garanina E, Mukhamedshina Y, Khaiboullina S, Rizvanov A, Salafutdinov I, Arkhipova S. Genetically Engineered Artificial Microvesicles Carrying Nerve Growth Factor Restrains the Progression of Autoimmune Encephalomyelitis in an Experimental Mouse Model. Int J Mol Sci 2023; 24:ijms24098332. [PMID: 37176039 PMCID: PMC10179478 DOI: 10.3390/ijms24098332] [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: 04/17/2023] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023] Open
Abstract
Multiple sclerosis (MS) is an incurable, progressive chronic autoimmune demyelinating disease. Therapy for MS is based on slowing down the processes of neurodegeneration and suppressing the immune system of patients. MS is accompanied by inflammation, axon-degeneration and neurogliosis in the central nervous system. One of the directions for a new effective treatment for MS is cellular, subcellular, as well as gene therapy. We investigated the therapeutic potential of adipose mesenchymal stem cell (ADMSC) derived, cytochalasin B induced artificial microvesicles (MVs) expressing nerve growth factor (NGF) on a mouse model of multiple sclerosis experimental autoimmune encephalomyelitis (EAE). These ADMSC-MVs-NGF were tested using histological, immunocytochemical and molecular genetic methods after being injected into the tail vein of animals on the 14th and 21st days post EAE induction. ADMSC-MVs-NGF contained the target protein inside the cytoplasm. Their injection into the caudal vein led to a significant decrease in neurogliosis at the 14th and 21st days post EAE induction. Artificial ADMSC-MVs-NGF stimulate axon regeneration and can modulate gliosis in the EAE model.
Collapse
Affiliation(s)
- Reem Alatrash
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Maria Golubenko
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Ekaterina Martynova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Ekaterina Garanina
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Yana Mukhamedshina
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia
| | - Svetlana Khaiboullina
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Albert Rizvanov
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
| | - Ilnur Salafutdinov
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia
| | - Svetlana Arkhipova
- Institute of Fundamental Medicine and Biology, Kazan (Volga Region) Federal University, 420008 Kazan, Russia
- Department of Medical Biology and Genetics, Kazan State Medical University, 420012 Kazan, Russia
| |
Collapse
|
28
|
Nakano H, Yamaguchi K, Hama N, Matsumoto Y, Shinohara M, Ide H. Relapsing Anti- MOG Antibody-associated Disease following COVID-19 Vaccination: A Rare Case Report and Review of the Literature. Intern Med 2023; 62:923-928. [PMID: 36575011 PMCID: PMC10076135 DOI: 10.2169/internalmedicine.0504-22] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Anti-myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is an autoimmune demyelinating disorder that mainly occurs post-infection or post-vaccination. MOGAD after inoculation with coronavirus disease 2019 (COVID-19) vaccines is rare, and we herein report a rare case of a patient with MOGAD after vaccination using the Pfizer-BioNTech COVID-19 vaccine (BNT162b2, Pfizer Japan, Tokyo). Our report highlights the fact that MOGAD following inoculation with COVID-19 vaccine may show clinical relapse during reduction of the oral steroid dose, and continuous treatments with immunological agents is needed to prevent disease recurrence.
Collapse
Affiliation(s)
- Hiroto Nakano
- Department of Neurology, Ishikawa Prefectural Central Hospital, Japan
| | | | - Naoyuki Hama
- Department of Neurology, Ishikawa Prefectural Central Hospital, Japan
| | - Yasuko Matsumoto
- Department of Neurology, Ishikawa Prefectural Central Hospital, Japan
| | | | - Hisashi Ide
- Department of Neurosurgery, Kaga Medical Center, Japan
| |
Collapse
|
29
|
Andrini G, Asioli GM, Spinardi L, D'Angelo R. FLAMES over an "extinguished fire": a MOG-associated disorder case report. Neurol Sci 2023; 44:1131-1134. [PMID: 36574177 DOI: 10.1007/s10072-022-06576-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022]
Affiliation(s)
| | - Gian Maria Asioli
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Luca Spinardi
- IRCCS - Azienda Ospedaliero-Universitaria di Bologna - Policlinico di Sant'Orsola-Malpighi, Bologna, Italy
| | - Roberto D'Angelo
- IRCCS - Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
| |
Collapse
|
30
|
Wu Y, Zhou H, Ci X, Lin L, Zhang D, Lu J. Clinical characteristic of myelin oligodendrocyte glycoprotein antibody associated cortical encephalitis in adults and outcomes following glucocorticoid therapy. Front Aging Neurosci 2023; 14:1076361. [PMID: 36688157 PMCID: PMC9846213 DOI: 10.3389/fnagi.2022.1076361] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 12/07/2022] [Indexed: 01/05/2023] Open
Abstract
Objective To describe the clinical and radiological features, as well as outcomes following glucocorticoid therapy and recurrence in adults suffering from cortical encephalitis associated with myelin oligodendrocyte glycoprotein (MOG) antibody. Methods The clinical information of nine adult patients suffering from cortical encephalitis associated with MOG antibody admitted to the Affiliated Brain Hospital of Nanjing Medical University from 2020 to 2022 was systematically reviewed. The clinical symptoms, laboratory data, imaging results, outcomes following glucocorticoid therapy and recurrence were evaluated. Result A total of 9 patients positive for MOG antibody and suffering from cortical encephalitis were included in our study (55.6% men, median age 29 years, 15-57 years). The most common clinical symptoms included headache (77.8%), fever (66.7%), and generalized seizures (55.6%). Some patients also experienced limb shaking (22.2%), leg numbness (22.2%), transient motor aphasia (11.1%), and vision loss (11.1%). The main features of cerebrospinal fluid () examination were increased intracranial pressure, pleocytosis, and elevated cerebrospinal fluid (CSF) protein. In addition, N-methyl-D-aspartate receptor (NMDAR) and MOG antibodies were found in the CSF of 3 patients, and NMDAR, MOG, and glial fibrillary acidic protein antibodies were found in the CSF of 1 patient. All patients were subjected to magnetic resonance imaging (MRI) and the images of eight of them showed T2 and/flair image hyperintense lesions, three showed meningeal or lesion enhancement and four showed white matter lesions, which were mostly located in the midline structures (75%). All patients received glucocorticoid therapy in the acute phase and in remission, and eight of them received an intravenous high dose of methylprednisolone, including one patient who received a simultaneous immunoglobulin therapy. One patient was treated with low-dose prednisolone tablets. Seven (77.8%) patients were wholly recovered at discharge, and 2 (22.2%) patients were left with slight symptoms. During the median 9-month follow-up (range: 2-36 months), 2 (22.2%) patients developed recurrence. Conclusion The clinical manifestations of adult MOG antibody-associated cortical encephalitis were significantly different from those of the typical MOG antibody-associated disease (MOGAD). Patients in the acute phase of the disease were prone to show signs similar to central nervous system infection, requiring clinicians to have the ability to recognize the disease to avoid misdiagnosis. In addition, seizures were common in MOG antibody-related encephalitis, and the type of seizures was age-related. Brain MRI results showed that the distribution of cerebral cortex lesions was closely related to the classification of cortical encephalitis. Based on the patient's response to the treatment, glucocorticoid therapy was effective against MOG antibody-associated cortical encephalitis, which is consistent with the treatment response and clinical prognosis of MOGAD. Therefore, our opinion was that MOG antibody might be the "responsible antibody" in MOG antibody-associated cortical encephalitis, although further studies are needed to confirm this hypothesis.
Collapse
|
31
|
Agliardi C, Guerini FR, Zanzottera M, Bolognesi E, Picciolini S, Caputo D, Rovaris M, Pasanisi MB, Clerici M. Myelin Basic Protein in Oligodendrocyte-Derived Extracellular Vesicles as a Diagnostic and Prognostic Biomarker in Multiple Sclerosis: A Pilot Study. Int J Mol Sci 2023; 24. [PMID: 36614334 DOI: 10.3390/ijms24010894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/28/2022] [Accepted: 12/30/2022] [Indexed: 01/06/2023] Open
Abstract
Approximately 15% of multiple sclerosis (MS) patients develop a progressive form of disease from onset; this condition (primary progressive-PP) MS is difficult to diagnose and treat, and is associated with a poor prognosis. Extracellular vesicles (EVs) of brain origin isolated from blood and their protein cargoes could function as a biomarker of pathological conditions. We verified whether MBP and MOG content in oligodendrocytes-derived EVs (ODEVs) could be biomarkers of MS and could help in the differential diagnosis of clinical MS phenotypes. A total of 136 individuals (7 clinically isolated syndrome (CIS), 18 PPMS, 49 relapsing remitting (RRMS)) and 70 matched healthy controls (HC) were enrolled. ODEVs were enriched from serum by immune-capture with anti-MOG antibody; MBP and MOG protein cargoes were measured by ELISA. MBP concentration in ODEVs was significantly increased in CIS (p < 0.001), RRMS (p < 0.001) and PPMS (p < 0.001) compared to HC and was correlated with disease severity measured by EDSS and MSSS. Notably, MBP concentration in ODEVs was also significantly augmented in PPMS compared to RRMS (p = 0.004) and CIS (p = 0.03). Logistic regression and ROC analyses confirmed these results. A minimally invasive blood test measuring the concentration of MBP in ODEVs is a promising tool that could facilitate MS diagnosis.
Collapse
|
32
|
Guzmán J, Vera F, Soler B, Uribe-San-Martin R, García L, Del-Canto A, Schlatter A, Salazar M, Molt F, Ramirez K, Marín J, Pelayo C, Cruz JP, Bravo-Grau S, Cárcamo C, Ciampi E. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease ( MOGAD) in Chile: lessons learned from challenging cases. Mult Scler Relat Disord 2023; 69:104442. [PMID: 36521387 DOI: 10.1016/j.msard.2022.104442] [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: 07/04/2022] [Revised: 10/16/2022] [Accepted: 12/01/2022] [Indexed: 12/07/2022]
Abstract
BACKGROUND Anti-Myelin Oligodendrocyte Glycoprotein (MOG) Antibody Associated Disease (MOGAD) is an emerging disorder recognized as a clinical entity distinct from Multiple Sclerosis and Aquaporin-4-positive Neuromyelitis Optica Spectrum Disorders (NMOSD-AQP4+), and its phenotypic spectrum continues to expand. Most information about its clinical course has emerged from retrospective studies, and treatment response both in acute and chronic-relapsing disease is still limited. We aimed to describe the clinical and paraclinical characteristics of monophasic and relapsing, paediatric and adult patients with MOGAD under regular clinical care in Chile, highlighting some challenging cases that are far from being considered benign. METHODS Observational, retrospective, and prospective longitudinal multicentre study including patients with positive serum MOG-IgG assessed by cell-based assay. RESULTS We include 35 patients, 71% women, median age at onset 30 years (range 1-68), 23% had paediatric onset, with a median disease-duration 24 months (range 12-348). In the whole cohort, the most frequent symptoms at onset were isolated optic neuritis (ON) (34%) and myelitis (22%). Encephalitis with seizures or encephalomyelitis was the most common presentation in paediatric-onset patients 75% (n = 6), compared to 11% (n = 3) of the adult-onset patients (p < 0.001). A relapsing course was observed in 34%, these patients were younger (25 vs. 34 years, p = 0.004) and with a longer disease duration (64 vs. 6 months, p = 0.004) compared to monophasic patients. Two patients developed encephalitis with seizures/status epilepticus, with concomitant positive CSF anti-NMDAR-IgG. Chronic immunotherapy was ever prescribed in 77%, the most frequent was rituximab (35%). Relapses under chronic immunotherapy occurred in 5/27 patients (18.5%), two of them under rituximab, one paediatric patient who started combined therapy with monthly IVIG and one adult patient that switched to satralizumab plus mycophenolate. The median EDSS at the last follow-up was 1.5 (range 0-6.0). CONCLUSION In Chile, patients with MOGAD exhibit a wide spectrum of clinical presentations at disease onset and during relapses. Close monitoring is needed, particularly in younger patients with short follow-up periods.
Collapse
Affiliation(s)
- Jorge Guzmán
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Francisco Vera
- Clinical Laboratory, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Bernardita Soler
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology, Hospital Sótero del Río, Santiago, Chile
| | - Reinaldo Uribe-San-Martin
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology, Hospital Sótero del Río, Santiago, Chile
| | - Lorena García
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Adolfo Del-Canto
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | | | - Fernando Molt
- Neurology, Facultad de Medicina, Universidad Católica del Norte, campus Hospital de Coquimbo, Coquimbo, Chile
| | - Karla Ramirez
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - José Marín
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Carolina Pelayo
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Juan Pablo Cruz
- Neuroradiology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Claudia Cárcamo
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ethel Ciampi
- Neurology, Pontificia Universidad Católica de Chile, Santiago, Chile; Neurology, Hospital Sótero del Río, Santiago, Chile.
| |
Collapse
|
33
|
Şekerdağ-Kılıç E, Ulusoy C, Atak D, Özkan E, Gökyüzü AB, Seyaj S, Deniz G, Uçar EA, Budan AS, Zeybel M, Öztop-Çakmak Ö, Vural A, Tuncer A, Karabudak R, Kücükali CI, Tüzün E, Gürsoy-Özdemir Y. Perivascular PDGFRB+ cells accompany lesion formation and clinical evolution differentially in two different EAE models. Mult Scler Relat Disord 2023; 69:104428. [PMID: 36450174 DOI: 10.1016/j.msard.2022.104428] [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: 08/01/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Multiple Sclerosis (MS) is a chronic inflammatory disease of the central nervous system (CNS) that may lead to progressive disability. Here, we explored the behavioral pattern and the role of vasculature especially PDGFRB+ pericytes/ perivascular cells, in MS pathogenesis. METHODS We have evaluated vascular changes in two different experimental allergic encephalomyelitis (EAE) mice models (MOG and PLP-induced). PDGFRB+ cells demonstrated distinct and different behavioral patterns. In both models, fibrosis formation was detected via collagen, fibronectin, and extracellular matrix accumulation. RESULTS The PLP-induced animal model revealed that fibrosis predominantly occurs in perivascular locations and that PDGFRB+ cells are accumulated around vessels. Also, the expression of fibrotic genes and genes coding extracellular matrix (ECM) proteins are upregulated. Moreover, the perivascular thick wall structures in affected vessels of this model presented primarily increased PDGFRB+ cells but not NG2+ cells in the transgenic NG2-DsRed transgenic animal model. On the other hand, in MOG induced model, PDGFRB+ perivascular cells were accumulated at the lesion sites. PDGFRB+ cells colocalized with ECM proteins (collagen, fibronectin, and lysyl oxidase L3). Nevertheless, both MOG and PLP-immunized mice showed increasing EAE severity, and disability parallel with enhanced perivascular cell accumulation as the disease progressed from earlier (day 15) to later (day 40). CONCLUSION As a result, we have concluded that PDGFRB+ perivascular cells may be participating in lesion progression and as well as demonstrating different responses in different EAE models.
Collapse
Affiliation(s)
- Emine Şekerdağ-Kılıç
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Canan Ulusoy
- Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Dila Atak
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Esra Özkan
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Aysu Bilge Gökyüzü
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Seddiq Seyaj
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Gülsüm Deniz
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Ege Anil Uçar
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Abdullah Salih Budan
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey
| | - Müjdat Zeybel
- Department of Gastroenterology and Hepatology, School of Medicine, Koҫ University, Istanbul, Turkey
| | - Özgür Öztop-Çakmak
- Department of Neurology, School of Medicine, Koҫ University, Istanbul, Turkey
| | - Atay Vural
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey; Department of Neurology, School of Medicine, Koҫ University, Istanbul, Turkey
| | - Asli Tuncer
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Rana Karabudak
- Department of Neurology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | | | - Erdem Tüzün
- Institute for Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Yasemin Gürsoy-Özdemir
- Research Center for Translational Medicine (KUTTAM), Koҫ University, Istanbul, Turkey; Department of Neurology, School of Medicine, Koҫ University, Istanbul, Turkey.
| |
Collapse
|
34
|
Montalvo M, Khattak JF, Redenbaugh V, Britton J, Sanchez CV, Datta A, Tillema JM, Chen J, McKeon A, Pittock SJ, Flanagan EP, Dubey D. Acute symptomatic seizures secondary to myelin oligodendrocyte glycoprotein antibody-associated disease. Epilepsia 2022; 63:3180-3191. [PMID: 36168809 PMCID: PMC10641900 DOI: 10.1111/epi.17424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/25/2022] [Accepted: 09/26/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To report the clinical presentations and outcomes of patients with seizure and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). METHODS We retrospectively reviewed the electronic medical records for clinical and paraclinical features among patients with seizures and MOG-IgG (immunoglobulin G) seropositivity. RESULTS We identified 213 patients with MOG-IgG seropositivity who fulfilled criteria for MOGAD. Seizures attributed to central nervous system (CNS) autoimmunity were observed in 10% of patients (n = 23: 19 children, 4 adults). The majority (n = 19, 83%) had pediatric disease onset. Focal motor seizures were the most common seizure semiology (16/23; 70%). Focal to bilateral tonic-clonic seizures were present in 12 patients (53%), and 3 patients (13%) developed status epilepticus. All patients had features of encephalitis at onset of seizures. Cerebral cortical encephalitis (CCE) was the most common radiological finding (10 unilateral and 5 bilateral cases). Eight of 23 patients (35%) had only CCE, six of 23 patients (26%) had only acute disseminated encephalomyelitis (ADEM), and seven of 23 patients (30%) had features of both. Fifteen patients (65%) had leptomeningeal enhancement. Three patients (13%) had coexistence of N-methyl-d-aspartate receptor (NMDAR) IgG. Only 3 of 23 patients (13%) developed drug- resistant epilepsy. Although the majority had MOGAD relapses (14/23, 60%) had only 5 of 23 patients had recurrence of episodes of encephalitis with associated seizures. Twenty-one of 23 patients (91%) had seizure freedom at last follow-up. SIGNIFICANCE MOG-IgG evaluation should be considered in patients who present with encephalitis and focal motor and/or focal to bilateral tonic-clonic seizures, especially pediatric patients with magnetic resonance imaging (MRI) brain findings consistent with CCE, ADEM, or other MOGAD presentations. The majority of these seizures are self-limited and do not require maintenance/chronic antiseizure medications. Although seizure recurrence is uncommon, many patients have MOGAD relapses in the form of encephalitis and optic neuritis.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - John Chen
- Department of Neurology, Mayo Clinic, Rochester MN
- Department of Ophthalmology, Mayo Clinic, Rochester MN
| | - Andrew McKeon
- Department of Neurology, Mayo Clinic, Rochester MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN
| | - Sean J. Pittock
- Department of Neurology, Mayo Clinic, Rochester MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN
| | - Eoin P Flanagan
- Department of Neurology, Mayo Clinic, Rochester MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN
| | - Divyanshu Dubey
- Department of Neurology, Mayo Clinic, Rochester MN
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester MN
| |
Collapse
|
35
|
Lin S, Long W, Wen J, Su Q, Liao J, Hu Z. Myelin oligodendrocyte glycoprotein antibody-associated aseptic meningitis without neurological parenchymal lesions: A novel phenotype. Mult Scler Relat Disord 2022; 68:104126. [PMID: 36115288 DOI: 10.1016/j.msard.2022.104126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 07/15/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Myelin oligodendrocyte glycoprotein (MOG) antibodies mediate inflammatory demyelinating diseases of the central nervous system. This study aimed to understand the clinical characteristics of MOG antibody-associated aseptic meningitis (MOGAM). METHODS Here, we report the cases of two children with MOGAM. A systematic literature review was conducted and included patients who had MOGAM only, without neurological parenchymal lesions. The clinical characteristics that may have affected the outcome were statistically analyzed. RESULTS We reviewed 12 cases of MOGAM; male: female = 9: 3. Prolonged fever lasting over 7 days (11/12) was the most frequent symptom, followed by headache (10/12), vomiting (5/12), and seizures (4/12). None of the patients had focal neurological manifestations or parenchymal lesions on imaging. Cerebrospinal fluid (CSF) leukocytosis was observed in all patients (12/12), and blood leukocytosis and elevated CSF pressure was observed in all patients who had corresponding results (9/9 and 4/4, respectively). Seizures occurrence was lower than that of MOG antibody-associated cortical encephalitis. Seven cases progressed to other MOG antibody-associated diseases (MOGADs) in the later phase of MOGAM. Patients who did not progress to other MOGADs had a shorter disease duration from onset to the initiation of intravenous methylprednisolone than those who did. All the patients achieved full recovery after steroid treatment. One patient had relapses. CONCLUSIONS MOGAM without inflammatory demyelination is a rare but distinct phenotype of MOGAD, with fewer clinical manifestations mimicking bacterial or viral meningitis/encephalomeningitis. Delayed diagnosis and treatment may induce the progression to other severe MOGADs. Early recognition of this unique autoimmune aseptic meningitis may contribute to early diagnosis, treatment, and better outcomes.
Collapse
Affiliation(s)
- Sufang Lin
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China.
| | - Weiwei Long
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Jialun Wen
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Qiru Su
- Department of Clinical Research, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Jianxiang Liao
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| | - Zhanqi Hu
- Department of Neurology, Shenzhen Children's Hospital, Shenzhen 518038, Guangdong, China
| |
Collapse
|
36
|
Novák J, Macháček T, Majer M, Kostelanská M, Skulinová K, Černý V, Kolářová L, Hrdý J, Horák P. Toxocara canis infection worsens the course of experimental autoimmune encephalomyelitis in mice. Parasitology 2022; 149:1720-1728. [PMID: 36050813 PMCID: PMC11010483 DOI: 10.1017/s0031182022001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 07/22/2022] [Accepted: 08/21/2022] [Indexed: 12/14/2022]
Abstract
Toxocara canis, a gastrointestinal parasite of canids, is also highly prevalent in many paratenic hosts, such as mice and humans. As with many other helminths, the infection is associated with immunomodulatory effects, which could affect other inflammatory conditions including autoimmune and allergic diseases. Here, we investigated the effect of T. canis infection on the course of experimental autoimmune encephalomyelitis (EAE), an animal model of multiple sclerosis. Mice infected with 2 doses of 100 T. canis L3 larvae 5 weeks prior to EAE induction (the Tc+EAE group) showed higher EAE clinical scores and greater weight loss compared to the non-infected group with induced EAE (the EAE group). Elevated concentrations of all measured serum cytokines (IL-1α, IL-2, IL-4, IL-6, IL-10, IL-17A, IFN-γ and TNF-α) were observed in the Tc+EAE group compared to the EAE group. In the CNS, the similar number of regulatory T cells (Tregs; CD4+FoxP3+Helios+) but their decreased proportion from total CD4+ cells was found in the Tc+EAE group compared to the EAE group. This could indicate that the group Tc+EAE harboured significantly more CD4+ T cells of non-Treg phenotype within the affected CNS. Altogether, our results demonstrate that infection of mice with T. canis worsens the course of subsequently induced EAE. Further studies are, therefore, urgently needed to reveal the underlying pathological mechanisms and to investigate possible risks for the human population, in which exposure to T. canis is frequent.
Collapse
Affiliation(s)
- Jan Novák
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
| | - Tomáš Macháček
- Department of Parasitology, Faculty of Science, Charles University, Viničná 7, 128 44, Praha 2, Czechia
| | - Martin Majer
- Department of Parasitology, Faculty of Science, Charles University, Viničná 7, 128 44, Praha 2, Czechia
| | - Marie Kostelanská
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
| | - Kateřina Skulinová
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
- Department of Parasitology, Faculty of Science, Charles University, Viničná 7, 128 44, Praha 2, Czechia
| | - Viktor Černý
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
| | - Libuše Kolářová
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
- National Reference Laboratory for Tissue Helminthoses, General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
| | - Jiří Hrdý
- Institute of Immunology and Microbiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studničkova 7, 128 00, Praha 2, Czechia
| | - Petr Horák
- Department of Parasitology, Faculty of Science, Charles University, Viničná 7, 128 44, Praha 2, Czechia
| |
Collapse
|
37
|
Sguigna PV, Tardo LM, Blackburn KM, Horton LA, Conger DL, Hogan RN, McCreary MC, Greenberg BM. Application of the International Interocular Difference Thresholds into Practice: Localising the Patient Experience. Neuroophthalmology 2022; 46:375-382. [PMID: 36544583 PMCID: PMC9762821 DOI: 10.1080/01658107.2022.2109687] [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: 08/27/2021] [Revised: 06/30/2022] [Accepted: 07/28/2022] [Indexed: 12/24/2022] Open
Abstract
Demyelinating diseases of the central nervous system (CNS) often have neuro-ophthalmological manifestations, and retinal examination can be helpful in making the diagnosis. The latest iteration of optical coherence tomography (OCT)-based criteria for optic neuritis in multiple sclerosis has been developed in the research realm, but its application to clinical practice, and to the more uncommon demyelinating diseases requires further study. The ability to use OCT data to distinguish between various CNS demyelinating disorders could provide additional paraclinical tools to accurately diagnose patients. Furthermore, neuro-ophthalmological testing can define the extent of inflammatory damage in the CNS, independent of patient-reported history. New referrals for OCT at a tertiary multiple sclerosis and neuro-immunology referral centre (n = 167) were analysed retrospectively for the self-reporting of optic neuritis, serological test results, and diagnosis. Only approximately 30% of patients with a clinical history of unilateral optic neuritis solely had a unilateral optic neuropathy, nearly 40% of those subjects actually having evidence of bilateral optic neuropathies. Roughly 30% of patients reporting a history of bilateral optic neuritis did not have any evidence of structural disease, with 20% of these patients having a separate, intervenable diagnosis noted on macular scans. OCT is a useful adjunct diagnostic tool in the evaluation of demyelinating disease and has the ability to aid in a more accurate diagnosis for patients. Application of the international interocular difference thresholds to a clinical patient population generally reproduces the original results, emphasising their appropriateness. The analysis distinguishing the demyelinating diseases needs to be replicated in a blinded, multi-centre setting.
Collapse
Affiliation(s)
- Peter V. Sguigna
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Lauren M. Tardo
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Kyle M. Blackburn
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Lindsay A. Horton
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Darrel L. Conger
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - R. Nick Hogan
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Ophthalmology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Pathology, University of Texas Southwestern, Dallas, Texas, USA
- Department of Neurosurgery, University of Texas Southwestern, Dallas, Texas, USA
| | - Morgan C. McCreary
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| | - Benjamin M. Greenberg
- Multiple Sclerosis & Neuroimmunology Division, Department of Neurology, University of Texas Southwestern, Dallas, Texas, USA
| |
Collapse
|
38
|
Agrawal M, Shankar S, Bhatta S. Neuromyelitis optica spectrum disorder with negative aquaporin-4 antibodies and positive anti-myelin oligodendrocyte glycoprotein antibodies: A case report. Med J Armed Forces India 2022; 78:S303-S307. [PMID: 36147390 PMCID: PMC9485742 DOI: 10.1016/j.mjafi.2020.10.012] [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: 03/22/2019] [Accepted: 10/12/2020] [Indexed: 10/22/2022] Open
Abstract
Neuromyelitis optica spectrum disorders (NMOSDs) are rare autoimmune-mediated chronic inflammatory disorders involving the central nervous system. The concept of NMOSDs has widened up recently. Its diagnostic criteria have broadened the knowledge of this particular disease including the atypical cases where antiaquaporin-4 antibody is negative and anti-myelin oligodendrocyte glycoprotein (MOG) antibody is positive. Myelin oligodendrocyte glycoprotein is a protein expressed on the outer surface of myelin sheath and oligodendrocytes of the central nervous system. The detection of anti-MOG-Ab is emerging evidence, and thus, research on the role of this antibody in such seronegative cases is still underway. Early diagnosis and adequate therapy is essential in such cases. Here, we report an eight-year-old girl who was diagnosed with NMOSDs and found to have anti-MOG antibodies in place of AQP-4 antibodies.
Collapse
Affiliation(s)
- Mohini Agrawal
- Resident, Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Sandeep Shankar
- Professor, Department of Ophthalmology, Armed Forces Medical College, Pune, India
| | - Sunandan Bhatta
- Resident, Department of Ophthalmology, Armed Forces Medical College, Pune, India
| |
Collapse
|
39
|
Gu D, Liu Y, Zhu H, Gan Y, Zhang B, Yang W, Hao J. Magnetic porphyrin-based metal organic gel for rapid RhB removal and enhanced antibacterial activity by heterogeneous Photo-Fenton reaction under visible light. Chemosphere 2022; 303:135114. [PMID: 35623427 DOI: 10.1016/j.chemosphere.2022.135114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
Nanomaterials with visible light-driven catalytic ability are beneficial in controlling environmental pollutants. Porphyrin-based metal organic gel (MOG) was herein synthesized in one step and magnetic metal organic gel (MMOG) was successfully prepared via in-situ reaction of MOG and Fe3O4. This MMOG was developed as a novel visible light assisted Fenton-like catalyst. The catalytic experiments showed the high photo-Fenton activity of MMOG in the degradation of Rhodamine B (RhB) in the presence of visible light and H2O2 with a RhB degradation efficiency of 94.2% within 40 min. Notably, the obtained MMOG can kill E. coli and S. aureus with high killing rate (>99.999%) under visible light. Importantly, the MMOG can be recovered simply by an external magnetic field due to the unique magnetic property. This easily synthesized MMOG with photo-Fenton activity under visible light and magnetic property makes MOG based on the photo-Fenton reaction a prospective material for the environmental and biomedical applications.
Collapse
Affiliation(s)
- Dongxu Gu
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, PR China
| | - Yu Liu
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, PR China.
| | - Hongyu Zhu
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, PR China
| | - Ying Gan
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, PR China
| | - Biao Zhang
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, PR China
| | - Weiting Yang
- School of Chemical Engineering and Technology, Hainan University, Haikou, 570228, PR China.
| | - Jianyuan Hao
- School of Materials and Energy, University of Electronic Science and Technology of China, Chengdu, 610054, PR China.
| |
Collapse
|
40
|
Colantonio MA, Nwafor DC, Jaiswal S, Shrestha AK, Elkhooly M, Rollins S, Wen S, Sriwastava S. Myelin oligodendrocyte glycoprotein antibody-associated optic neuritis and myelitis in COVID-19: a case report and a review of the literature. Egypt J Neurol Psychiatr Neurosurg 2022; 58:62. [PMID: 35668818 PMCID: PMC9152836 DOI: 10.1186/s41983-022-00496-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 05/17/2022] [Indexed: 11/16/2022] Open
Abstract
Background Our case explored the spectrum of autoimmune and infectious neurological complications of Coronavirus Disease 2019. In addition, we also reviewed and discussed clinical features, neuroimaging, CSF findings, and outcomes in patients with COVID-19-associated Myelin Oligodendrocyte Glycoprotein Antibody Disorder (MOGAD) CNS inflammatory disorder. Case presentation Here we presented a case of post-Coronavirus Disease 2019 infection Myelin Oligodendrocyte Glycoprotein Antibody Disorder in a 41-year-old male who presented with gait instability, urinary retention, and confusion. Workup done in hospital showed transverse myelitis in cervical spine region and left optic neuritis. Laboratory findings showed Myelin Oligodendrocyte Glycoprotein-IgG antibodies were positive in serum (1:100), suggestive of post-COVID Myelin Oligodendrocyte Glycoprotein Antibody Disorder. Conclusion To our knowledge, this is the first comprehensive case report and the literature review that includes the clinical features, neuroimaging, CSF findings, and outcomes in COVID-19-associated Myelin Oligodendrocyte Glycoprotein Antibody Disorder.
Collapse
Affiliation(s)
| | - Divine C. Nwafor
- School of Medicine, West Virginia University, Morgantown, WV USA
| | - Shruti Jaiswal
- West Virginia Clinical and Translational Science Institute, Morgantown, WV USA
| | | | | | - Steven Rollins
- Department of Biostatistics, West Virginia University, Morgantown, WV USA
| | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV USA
| | - Shitiz Sriwastava
- School of Medicine, West Virginia University, Morgantown, WV USA
- West Virginia Clinical and Translational Science Institute, Morgantown, WV USA
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, One Medical Center Dr., Suite 1310, Morgantown, WV 26506-9180 USA
| |
Collapse
|
41
|
Netravathi M, Dhamija K, Gupta M, Tamborska A, Nalini A, Holla V, Nitish L, Menon D, Pal P, Seena V, Yadav R, Ravindranadh M, Faheem A, Saini J, Mahadevan A, Solomon T, Singh B. COVID-19 vaccine associated demyelination & its association with MOG antibody. Mult Scler Relat Disord 2022; 60:103739. [PMID: 35306244 PMCID: PMC8917969 DOI: 10.1016/j.msard.2022.103739] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [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: 02/26/2022] [Revised: 03/05/2022] [Accepted: 03/11/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND ChAdOx1-S (Covishield™/Vaxzervria, AstraZeneca) and BBV152 (Covaxin) SARS-CoV-2 vaccines are proven to be safe and effective, but rare complications have been reported. OBJECTIVE To describe reports of central nervous system (CNS) demyelination following ChAdOx1-S and BBV152 vaccinations. METHODS & RESULTS We report 29 (17 female; mean 38 years) cases of CNS demyelination; twenty-seven occurred in temporal association with ChAdOx1-S vaccine; two in association with BBV152 vaccine. Eleven patients had presentation with myelitis, six patients developed optic neuritis, five had acute demyelinating encephalomyelitis, three presented with brainstem demyelination, and four had multiaxial involvement. Myelin oligodendrocyte glycoprotein (MOG) antibodies were positive in ten patients. One patient with ADEM and tumefactive demyelinating lesions died after a prolonged intensive care unit stay and superimposed infection. As compared to the control group (87); the postvaccinial cases were found to have a significantly higher mean age, presence of encephalopathy (p value:0.0007), CSF pleocytosis (p value: 0.0094) and raised CSF protein (p value: 0.0062). CONCLUSIONS It is difficult to establish a causal relationship between vaccination and neurological adverse events such as demyelination. The temporal association with the vaccination and the presence of MOG antibodies raises the possibility of an immunogenic process triggered by the vaccine in susceptible individuals.
Collapse
Affiliation(s)
- M. Netravathi
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India,Corresponding author
| | - Kamakshi Dhamija
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Manisha Gupta
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Arina Tamborska
- National Institute for Health Research Health Protection Unit for Emerging and Zoonotic Infections, University of Liverpool, United Kingdom,Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom,Department of Clinical Infection Microbiology and Immunology, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - A. Nalini
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - V.V. Holla
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - L.K. Nitish
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Deepak Menon
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - P.K. Pal
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - V. Seena
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Ravi Yadav
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - M. Ravindranadh
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - Arshad Faheem
- Department of Neurology, National Institute of Mental Health & Neurosciences, Bangalore, India
| | - J. Saini
- Department of Neuroimaging & Interventional Neuroradiology, National Institute of Mental Health & Neurosciences, Bangalore
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health & Neurosciences, Bangalore
| | - Tom Solomon
- National Institute for Health Research Health Protection Unit for Emerging and Zoonotic Infections, University of Liverpool, United Kingdom,Department of Neurology, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom,Department of Clinical Infection Microbiology and Immunology, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
| | - Bhagteshwar Singh
- National Institute for Health Research Health Protection Unit for Emerging and Zoonotic Infections, University of Liverpool, United Kingdom,Department of Clinical Infection Microbiology and Immunology, Institute for Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom,Department of Infectious Diseases, Christian Medical College, Vellore, India
| |
Collapse
|
42
|
von Zedtwitz K, Matteit I, Michel M, Feige B, Runge K, Denzel D, Schlump A, Nickel K, Schiele MA, Berger B, Prüss H, Urbach H, Domschke K, Tebartz van Elst L, Endres D. Anti- MOG autoantibody-associated schizophreniform psychosis. Acta Neuropsychiatr 2022; 34:47-54. [PMID: 34493350 DOI: 10.1017/neu.2021.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Autoimmune mechanisms are related to disease development in a subgroup of patients with psychosis. The contribution of immunoglobulin G (IgG) antibodies against myelin oligodendrocyte glycoprotein (MOG) is mainly unclear in this context. METHODS Therefore, two patients with psychosis and anti-MOG antibodies - detected in fixed cell-based and live cell-based assays - are presented. RESULTS Patient 1 suffered from late-onset psychosis with singular white matter lesions in magnetic resonance imaging (MRI) and intermittent electroencephalography (EEG) slowing. Patient 2 suffered from a chronic paranoid-hallucinatory disorder with intermittent confusional states, non-specific white matter alterations on MRI, a disorganised alpha rhythm on EEG, and elevated cerebrospinal fluid protein. Both patients had anti-MOG antibody titres of 1 : 320 in serum (reference < 1 : 20). CONCLUSIONS The arguments for and against a causal role for anti-MOG antibodies are discussed. The antibodies could be relevant, but due to moderate titres, they may have caused a rather 'subtle clinical picture' consisting of psychosis instead of 'classical' MOG encephalomyelitis.
Collapse
|
43
|
Kornbluh AB, Liu GT, Hopkins SE. Delayed Visual Improvement in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis. Pediatr Neurol 2022; 126:43-45. [PMID: 34736062 DOI: 10.1016/j.pediatrneurol.2021.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022]
Affiliation(s)
- Alexandra B Kornbluh
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
| | - Grant T Liu
- Division of Ophthalmology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sarah E Hopkins
- Division of Neurology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| |
Collapse
|
44
|
Netravathi M, Holla VV, Saini J, Mahadevan A. Prodromal emesis in MOG-antibody associated disorder. Mult Scler Relat Disord 2021; 58:103463. [PMID: 34933247 DOI: 10.1016/j.msard.2021.103463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 11/28/2021] [Accepted: 12/11/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Exclusive emesis has been observed in few patients of MOG-associated disorder (MOGAD). OBJECTIVES To study the occurrence of emesis in patients of Demyelinating disorders and determine their clinical and radiological features. METHODS AND RESULTS Medical records of 551 patients of CNS demyelinating disorders were reviewed. Exclusive emesis without hiccups was observed in 1 (0.1%) patient of MS, 17 (6.5%) patients of MOGAD while none were observed in patients of AQP4-ab associated disorders (p < 0.001). There were 17(M:F-8:9) patients with exclusive emesis in MOGAD in 58.8% pediatric age group, adults (35.3%) and late-onset (5.9%). ADEMON (acute demyelinating encephalomyelitis -ADEM followed by optic neuritis) was observed in 7 patients. Preceding clinical syndrome was ON (41.2%), brainstem syndrome (BS) (23.5%), involvement of both ON and BS in 23.5%, myelopathy (11.8%). MRI analysis showed combination of lesions affecting the brainstem (11), optic nerve (10), juxtacortical white matter (10) and periventricular lesions (3). Odds ratio for the presence of ADEM, lesions in medulla, pons, MCP or any of the three areas was found to be significant. CONCLUSIONS Exclusive emesis without hiccups appears to be common in MOG-antibody associated disorder and may occur as a prodromal illness or exclusive clinical episode. It is known to occur most commonly in association with ADEM and/or Optic neuritis.
Collapse
Affiliation(s)
- M Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India.
| | - Vikram Venkappayya Holla
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore 560029, Karnataka, India
| | - Jitender Saini
- Department of Neuroimaging and Interventional Neuroradiology (NIIR), National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - Anita Mahadevan
- Department of Neuropathology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
| |
Collapse
|
45
|
Amin M, Mays M, Polston D, Flanagan EP, Prayson R, Kunchok A. Myelin oligodendrocyte glycoprotein ( MOG) antibodies in a patient with glioblastoma: Red flags for false positivity. J Neuroimmunol 2021; 361:577743. [PMID: 34695769 DOI: 10.1016/j.jneuroim.2021.577743] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/05/2021] [Indexed: 11/23/2022]
Abstract
We present a patient with positive medium titer MOG-IgG and progressive neurological decline whose clinical and radiological phenotype were not consistent with a MOG-IgG associated disorder and ultimately received a diagnosis of glioblastoma after brain biopsy and died 4 weeks later. This represents an important topic with a high frequency of MOG-IgG testing in clinical practice. Due to this there are increasing reports of MOG-IgG positivity in atypical clinical phenotypes, raising the possibility of false positives, which can have important implications. It is important to highlight that judicious clinical evaluation is needed when interpreting MOG-IgG results in atypical settings.
Collapse
|
46
|
Zhang M, Du X, Zhou S, Pan G, Shen J, Li W, Yu L, Zhou Y, Zhang Y, Wang Y, Zhang L. Clinical characteristics, disease course, and outcomes of paediatric patients with myelin oligodendrocyte glycoprotein-Ab associated disease: A retrospective clinical study. J Clin Neurosci 2021; 94:1-7. [PMID: 34863421 DOI: 10.1016/j.jocn.2021.09.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 09/18/2021] [Accepted: 09/20/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To delineate the outcomes of paediatric patients with myelin oligodendrocyte glycoprotein antibody disease (MOGAD). METHODS We retrospectively analyzed the clinical characteristics, treatment, and outcomes of 34 paediatric patients with MOGAD from July 2015 to January 2020. RESULTS The median age at disease onset was 75.5 months (range: 19-170 months). The female-to-male ratio was 1:1.1. The median follow-up duration was 34.5 months (range: 14-63 months). Acute disseminated encephalomyelitis (ADEM) was the most common initial phenotype (52.9%), followed by optic neuritis (ON) (20.6%). Children with ADEM were younger than those with ON (P = 0.045). Twenty-eight (82.4%) and 18 (56.3%) children had abnormal brain and spinal magnetic resonance imaging, respectively, during the first acute attack. MOG-abs titers in children with ON were statistically higher than those in children with ADEM (P = 0.04). Thirty-two children accepted glucocorticoid treatment, while 33 (97%) children demonstrated clinical improvement within 1 week, 21 children (61.8%) achieved clinical recovery within 1 month. Eight children (23.5%) suffered a relapse, the median interval between the initial attack and recurrence was 13 (range: 3-36) months. We detected neurological sequelae in seven (20.6%) children, with visual dysfunction being the most common sequela (85.7%). CONCLUSION ADEM was the most common phenotype in both monophasic and relapsed paediatric MOGAD, followed by ON. Majority of pediatric MOGAD patients were highly responsive to glucocorticoid. Despite a benign prognosis in most patients, some patients endure neurological sequelae, mainly visual impairment. Patients with initial visual impairment should be carefully evaluated and administered individualized immunotherapy.
Collapse
Affiliation(s)
- Min Zhang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Xiaonan Du
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Shuizhen Zhou
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Gang Pan
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Jin Shen
- Department of Radiology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Wenhui Li
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Lifei Yu
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yuanfeng Zhou
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yunjian Zhang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China
| | - Yi Wang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| | - Linmei Zhang
- Department of Neurology, Children's Hospital of Fudan University, National Children's Medical Center, Shanghai, China.
| |
Collapse
|
47
|
Abstract
This article details the materials and methods required for both active induction and adoptive transfer of experimental autoimmune encephalomyelitis (EAE) in the SJL mouse strain using intact proteins or peptides from the two major myelin proteins: proteolipid protein (PLP) and myelin basic protein (MBP). Additionally, active induction of EAE in the C57BL/6 strain using myelin oligodendrocyte glycoprotein (MOG) peptide is also discussed. Detailed materials and methods required for the purification of both PLP and MBP are described, and a protocol for isolating CNS-infiltrating lymphocytes in EAE mice is included. Modifications of the specified protocols may be necessary for efficient induction of active or adoptive EAE in other mouse strains. © 2021 Wiley Periodicals LLC. Basic Protocol: Active induction of EAE with PLP, MBP, and MOG protein or peptide Alternate Protocol: Adoptive induction of EAE with PLP-, MBP-, or MOG-specific lymphocytes Support Protocol 1: Purification of proteolipid protein Support Protocol 2: Purification of myelin basic protein Support Protocol 3: Isolation of CNS-infiltrating lymphocytes.
Collapse
Affiliation(s)
- Collin Laaker
- Department of Pathology and Lab Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Martin Hsu
- Department of Pathology and Lab Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Zsuzsanna Fabry
- Department of Pathology and Lab Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephen D Miller
- Department of Microbiology-Immunology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - William J Karpus
- Department of Pathology and Lab Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| |
Collapse
|
48
|
Cirkel A, Wandinger KP, Ditz C, Leppert J, Hanker L, Cirkel C, Neumann A, Brocke J, Höftberger R, Komorowski L, Perner S, Leypoldt F, Wagner-Altendorf T, Münte TF, Royl G. Paraneoplastic encephalomyeloradiculits with multiple autoantibodies against ITPR-1, GFAP and MOG: case report and literature review. Neurol Res Pract 2021; 3:48. [PMID: 34635185 PMCID: PMC8504129 DOI: 10.1186/s42466-021-00145-w] [Citation(s) in RCA: 4] [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: 05/31/2021] [Accepted: 07/23/2021] [Indexed: 11/12/2022] Open
Abstract
Background Recently, antibodies against the alpha isoform of the glial-fibrillary-acidic-protein (GFAPα) were identified in a small series of patients with encephalomyelitis. Coexisting autoantibodies (NMDA receptor, GAD65 antibodies) have been described in a few of these patients. We describe a patient with rapidly progressive encephalomyeloradiculitis and a combination of anti-ITPR1, anti-GFAP and anti-MOG antibodies. Case presentation and literature review A 44-year old caucasian woman with a flu-like prodrome presented with meningism, progressive cerebellar signs and autonomic symptoms, areflexia, quadriplegia and respiratory insufficiency. MRI showed diffuse bilateral T2w-hyperintense brain lesions in the cortex, white matter, the corpus callosum as well as a longitudinal lesion of the medulla oblongata and the entire spinal cord. Anti-ITPR1, anti-GFAP and anti-MOG antibodies were detected in cerebrospinal fluid along with lymphocytic pleocytosis. Borderline tumor of the ovary was diagnosed. Thus, the disease of the patient was deemed to be paraneoplastic. The patient was treated by surgical removal of tumor, steroids, immunoglobulins, plasma exchange and rituximab. Four months after presentation, the patient was still tetraplegic, reacted with mimic expressions to pain or touch and could phonate solitary vowels. An extensive literature research was performed. Conclusion Our case and the literature review illustrate that multiple glial and neuronal autoantibodies can co-occur, that points to a paraneoplastic etiology, above all ovarian teratoma or thymoma. Clinical manifestation can be a mixture of typically associated syndromes, e.g. ataxia associated with anti-ITPR1 antibodies, encephalomyelitis with anti-GFAPα antibodies and longitudinal extensive myelitis with anti-MOG antibodies. Supplementary Information The online version contains supplementary material available at 10.1186/s42466-021-00145-w.
Collapse
Affiliation(s)
- Anna Cirkel
- Department of Neurology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany.
| | - Klaus-Peter Wandinger
- Department of Neurology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany.,Institute of Clinical Chemistry, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Claudia Ditz
- Department of Neurosurgery, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Jan Leppert
- Department of Neurosurgery, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Lars Hanker
- Department of Gynecology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Christoph Cirkel
- Department of Gynecology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Alexander Neumann
- Department of Neuroradiology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany
| | - Jan Brocke
- Neurological Rehabilitation Center, Segeberger Kliniken, Bad Segeberg, Germany
| | | | - Lars Komorowski
- Institute of Experimental Immunology, Euroimmun AG, Lübeck, Germany
| | - Sven Perner
- Department of Pathology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany.,Research Center Borstel, Leibniz Lung Center, 23538 Lübeck and, 23845, Borstel, Germany
| | - Frank Leypoldt
- Department of Neurosurgery, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany.,Department of Neurology, University Hospital of Schleswig-Holstein Kiel, Kiel, Germany
| | | | - Thomas F Münte
- Department of Neurology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany.,Institute of Psychology II, University Hospital of Schleswig-Holstein, Lübeck, Germany
| | - Georg Royl
- Department of Neurology, University Hospital of Schleswig-Holstein Lübeck, Lübeck, Germany
| |
Collapse
|
49
|
Gadde JA, Wolf DS, Keller S, Gombolay GY. Rate of Leptomeningeal Enhancement in Pediatric Myelin Oligodendrocyte Glycoprotein Antibody-Associated Encephalomyelitis. J Child Neurol 2021; 36:1042-1046. [PMID: 34547933 PMCID: PMC9054459 DOI: 10.1177/08830738211025867] [Citation(s) in RCA: 11] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Myelin oligodendrocyte glycoprotein antibodies (MOG-abs) are associated with demyelinating diseases. Leptomeningeal enhancement occurs in 6% of adult MOG-abs patients but rates in pediatric MOG-abs patients are unknown. METHODS Retrospective review of pediatric MOG-abs patients was performed. RESULTS Twenty-one patients (7 boys, 14 girls) were included with an average age of 8.6 years (range 2-15 years). Seven of 21 (33%) pediatric MOG-abs patients had leptomeningeal enhancement. Two patients' relapses were manifested by leptomeningeal enhancement alone and another patient presented with seizures, encephalopathy, and aseptic meningitis without demyelinating lesions. Cerebrospinal fluid pleocytosis was seen in both leptomeningeal (4/7 patients) and nonleptomeningeal enhancement (10/14 patients). Interestingly, 3 patients with leptomeningeal enhancement had normal cerebrospinal fluid white blood cell count. Cortical edema was more likely in patients with leptomeningeal enhancement (P = .0263). CONCLUSION We expand the clinical spectrum of anti-MOG antibody-associated disorder. Patients with recurrent leptomeningeal enhancement without demyelinating lesions should be tested for MOG antibodies.
Collapse
Affiliation(s)
- Judith A. Gadde
- Department of Radiology and Imaging Sciences & Pediatrics, Emory University School of Medicine, GA, USA,Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Division of Pediatric Radiology and Neuroradiology, IL, USA
| | - David S. Wolf
- Division of Pediatric Neurology, Children’s Healthcare of Atlanta: Pediatrics Institute, Emory University, GA, USA
| | - Stephanie Keller
- Division of Pediatric Neurology, Children’s Healthcare of Atlanta: Pediatrics Institute, Emory University, GA, USA
| | - Grace Y. Gombolay
- Division of Pediatric Neurology, Children’s Healthcare of Atlanta: Pediatrics Institute, Emory University, GA, USA
| |
Collapse
|
50
|
Illés Z. [Treatment and new evidences in neuromyelitis optica spectrum disorder]. Ideggyogy Sz 2021; 74:309-321. [PMID: 34657404 DOI: 10.18071/isz.74.0309] [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] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Treatment and new evidences in neuromyelitis optica spectrum disorder Illés Zs, MD, PhD Ideggyogy Sz 2021;74(9-10):309-321. Neuromyelitis optica spectrum disorder (NMOSD) is associated with antibodies against AQP4 in about 80% of the cases. In about one-fourth of seronegative cases, antibodies against the MOG protein are present in the serum (MOG-antibody associated disease, MOGAD). This article discusses off-label azathioprine and mycophenolate mofetil in the treatment of NMOSD and reviews the evidence-based clinical aspects of B/plasma cell depletion, antagonization of IL-6 signaling and blocking the complement pathway. The review also summarizes basic aspects of NMOSD pregnancy focusing on treatment, and the different therapeutic approach in MOGAD. In the recent two years, phase 3 clinical trials provided class I evidence for the efficacy and safety of rituximab (anti-CD20), inebilizumab (anti-CD19), tocilizumab (anti-IL6R), satralizumab (anti-IL6R), and eculizumab (anti-C5) in combination with other immunosuppressants or in monotherapy. The treatment approach in MOGAD is complicated by the monophasic course in about half of the cases and by the potential disappearance of MOG antibody. The necessity of maintenance treatment in MOGAD should be decided after tapered oral steroid. Immunosuppression is recommended in NMOSD during pregnancy and lactation, and this should be considered for optimal selection of treatment in fertile female patients. The new monoclonal antibodies broadened treatment options NMOSD, and the treatment strategy of MOGAD has become more straightforward.
Collapse
Affiliation(s)
- Zsolt Illés
- Pécsi Tudományegyetem, Neurológiai Klinika, Pécs.,Department of Neurology, Odense University Hospital, University of Southern Denmark, Odense, Dánia
| |
Collapse
|