Neuromyelitis optica testing and treatment: Availability and affordability in 60 countries

Holroyd, Kathryn B.; Vogel, Andre C.; Lynch, Kat; Gazdag, Brittany; Voghel, Matthew; Alakel, Nicholas; Patenaude, Bryan; Chiong-Rivero, Horacio; Mateen, Farrah J.

doi:10.1016/j.msard.2019.05.013

Cited by 31 publications

(16 citation statements)

References 17 publications

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“…20,21 Since the diagnosis of NMOSD rely on the availability and affordability of both radiological and serological testing, together with the familiarity of the expanding clinical and radiological spectrum of the disease, diagnosis of NMOSD in such countries with middle to low incomes is frequently delayed with frequent misdiagnosis with MS and consequent more socio-economic burdens. 28 In the current study, although ELISA technique is less sensitive than the cell-based assay, 29 it was the only available method. Therefore, to increase the diagnostic accuracy, all patients recruited met the diagnostic criteria for the negative or unknown serostatus and were tested twice for AQP4-IgGs.…”

Section: Discussionmentioning

confidence: 83%

“…In Africa and Middle East, studies of NMOSD are infrequent and even fewer studies have focused on radiological characteristics of NMOSD mostly from Kuwait, 25 Emarat, 26 Algeria 27 and Egypt 20,21 . Since the diagnosis of NMOSD rely on the availability and affordability of both radiological and serological testing, together with the familiarity of the expanding clinical and radiological spectrum of the disease, diagnosis of NMOSD in such countries with middle to low incomes is frequently delayed with frequent misdiagnosis with MS and consequent more socio‐economic burdens 28 . In the current study, although ELISA technique is less sensitive than the cell‐based assay, 29 it was the only available method.…”

Section: Discussionmentioning

confidence: 99%

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Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

Nasreldein

Farweez

El-Fetoh

et al. 2022

Clinical & Exp Neuroim

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Background Neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune demyelinating disease of the central nervous system, which mainly affects the optic nerves and the spinal cord. Magnetic resonance imaging (MRI) plays an important role in the diagnosis of NMOSD based on the 2015 consensus criteria. Methods The objective of this study was to describe the MRI characteristics of NMOSD patients in Egypt. This were a prospective, observational study on patients fulfilling the 2015 diagnostic criteria of NMOSD. Patients were recruited consecutively from the Neurology, Psychiatry and Neurosurgery hospital, Assiut University Hospitals, Egypt from March 2019 until August 2020. Data on demographics, clinical and laboratory features were collected. MRI scan results were reviewed for each patient and compared according to Aquaporin4‐seropositivity. Results Ninety patients fulfilled NMOSD diagnostic criteria. The mean age at onset was 30.7±11.8 with a female predominance of 3:1. AQP4 antibodies were positive in 77/90 patients (85.6%). Seventy‐two patients (80%) had acute myelitis, 44 cases (61.1%) had longitudinally extensive transverse myelitis (LETM) and 61 cases (87.1%) had a central position in the cord. Bright spotty lesions (BSL) were found in 44 cases (61.1%). The most common site of cord involvement was the cervical region. Abnormal MRI brain scans were found in 81.1% of patients. No statistically significant differences could be found between the two groups. Conclusion There was a high frequency of abnormal spine and brain MRI findings in the Egyptian population. Even though no specific patterns were typical for AQP4‐specific serostatus, certain findings may suggest NMOSD diagnosis and warrant AQP4‐IgGs testing.

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

Nasreldein

Farweez

El-Fetoh

et al. 2022

Clinical & Exp Neuroim

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“…This would be more important in the Asian, African, and eastern Mediterranean populations where the prevalence of AQP4 Ab ON is greater than in the Caucasian population (2). However, less than 15% of the lower income countries (home to over 90% of the high-risk populations listed above) currently have access to AQP4 Ab serological testing (9). To enable optimal management for best visual outcomes, we recommend greater efforts to improve access to AQP4 Ab testing globally.…”

Section: Discussionmentioning

confidence: 99%

Should Aquaporin-4 Antibody Test Be Performed in all Patients With Isolated Optic Neuritis?

Siantar¹,

Ibrahim²,

Htoon³

et al. 2022

Journal of Neuro-Ophthalmology

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Background: Optic neuritis (ON) may be the initial manifestation of neuromyelitis optica spectrum disorder (NMOSD). Aquaporin-4 antibody (AQP4 Ab) is used to diagnose NMOSD. This has implications on prognosis and is important for optimal management. We aim to evaluate if clinical features can distinguish AQP4 Ab seropositive and seronegative ON patients. Methods: We reviewed patients with first episode of isolated ON from Tan Tock Seng Hospital and Singapore National Eye Centre who tested for AQP4 Ab from 2008 to 2017. Demographic and clinical data were compared between seropositive and seronegative patients. Results: Among 106 patients (120 eyes) with first episode of isolated ON, 23 (26 eyes; 22%) were AQP4 Ab positive and 83 (94 eyes; 78%) were AQP4 Ab negative. At presentation, AQP4 Ab positive patients had older mean onset age (47.9 ± 13.6 vs 36.8 ± 12.6 years, P , 0.001), worse nadir VA (OR 1.714; 95% CI, 1.36 to 2.16; P , 0.001), less optic disc swelling (OR 5.04; 95% CI, 1.682 to 15.073; p = 0.004), and higher proportions of concomitant anti-Ro antibody (17% vs 4%, p = 0.038) and anti-La antibody (17% vs 1%, p = 0.008). More AQP4 Ab positive patients received steroid-sparing immunosuppressants (74% vs 19%, p , 0.001) and plasma exchange (13% vs 0%, p = 0.009). AQP4 Ab positive patients had worse mean logMAR VA (visual acuity) at 12 months (0.70 ± 0.3 vs 0.29 ± 0.5, p = 0.051) and 36 months (0.37±0.4 vs 0.14 ± 0.2, p = 0.048) follow-up. Conclusion: Other than older onset age and retrobulbar optic neuritis, clinical features are non-discriminatory for NMOSD. We propose a low threshold for AQP4 Ab serology testing in inflammatory ON patients, particularly in high NMOSD prevalence populations, to minimize diagnostic and treatment delays.

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“…A survey of providers showed nearly half of African and Eastern Mediterranean countries lacked access to AQP4-Ab and MOG-Ab testing, and only 15% of World Health Organization defined low-income countries had access to these tests. 13 Higher prevalence of NMOSD is consistently found in women, with a female to male ratio up to 9:1. Average age of onset is between 30-40 years old.…”

Section: Epidemiology and Risk Factorsmentioning

confidence: 98%

Update on neuromyelitis optica spectrum disorder

Holroyd

Manzano

Lévy

2020

Current Opinion in Ophthalmology

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Purpose of review.-Neuromyelitis optica spectrum disorder is an autoimmune disease that caused optic neuritis and transverse myelitis. Attacks can cause severe neurological damage leading the blindness and paralysis. Understanding of the immunopathogenesis of this disease has led to major breakthroughs in diagnosis and treatment. In the past 18 months, three successful phase 3 clinical trials have been published using targeted approaches to preventing relapses.Recent findings.-Updates in epidemiology, imaging, quality of life and treatment for acute relapse and prevention have been published in the past 18 months. Epidemiology studies are distinguishing patients based on their antigen specificity for aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG), which are increasingly recognized as separate immunological conditions. Imaging by MRI and optical coherence tomography continue to be developed as tools to distinguish NMOSD from other diseases. This is especially relevant as the recent clinical trials showed differences in response between AQP4 seropositive and seronegative patients. The three drugs that were tested for prevention of NMOSD relapses were eculizumab, inebilizumab and satralizumab. All of the trials were worldwide, placebo-controlled, doublemasked studies that demonstrated a clear benefit with each approach.Summary.-Recent research in NMOSD has resulted in improved diagnosis and approved treatments.

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Neuromyelitis optica testing and treatment: Availability and affordability in 60 countries

Cited by 31 publications

References 17 publications

Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

Should Aquaporin-4 Antibody Test Be Performed in all Patients With Isolated Optic Neuritis?

Update on neuromyelitis optica spectrum disorder

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