Novel Glial Targets and Recurrent Longitudinally Extensive Transverse Myelitis

Jitprapaikulsan, Jiraporn; Chiriboga, A. Sebastian López; Flanagan, Eoin P.; Fryer, James P.; McKeon, Andrew; Weinshenker, Brian G.; Pittock, Sean J.

doi:10.1001/jamaneurol.2018.0805

Cited by 21 publications

(10 citation statements)

References 6 publications

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“…Both AQP4-IgG-seropositive NMOSD and MOG-IgG-seropositive encephalomyelitis follow a mostly relapsing-remitting disease course and - as humorally mediated autoimmune diseases - should be distinguished from MS in terms of pathogenesis, prognosis, and therapy. Rarely, antibodies targeting the astrocytic structural protein glial fibrillary astrocyte protein (GFAP) can be detected in the CSF of some patients presenting with symptoms of meningoencephalomyelitis [ 49 , 92 ].…”

Section: Non-infectious Inflammatory Diseasesmentioning

confidence: 99%

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Tumani

Petereit²,

Gerritzen³

et al. 2020

Neurol. Res. Pract.

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Introduction: Cerebrospinal fluid (CSF) analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits. Recommendations (most important 3-5 recommendations on a glimpse): 1. The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient. 2. Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult. 3. In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF analysis program can be carried out within 2 h. 4. The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy. 5. As a quality assurance measure in CSF analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF analysis.

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Section: Non-infectious Inflammatory Diseasesmentioning

confidence: 99%

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Tumani

Petereit²,

Gerritzen³

et al. 2020

Neurol. Res. Pract.

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“…In a cohort study on 276 subjects with MOGAD, the presence of myelitis at onset, alone or in combination with other presentations, was associated with decreased risk of relapse compared to other non-myelitis phenotypes (HR, 0.41; 95% CI, 0.20–0.88; P = 0.01) ( 114 ). The most common phenotype of MOGAD relapses is ON, regardless of the initial clinical presentation, and recurrent episodes of myelitis as the sole clinical phenotype of MOGAD are uncommon ( 115 , 116 ). Although evidence is still limited, a relapse-independent disease progression is considered extremely rare in MOGAD, and a gradually progressive disease course should prompt careful consideration of alternative diagnoses ( 117 ).…”

Section: Discussionmentioning

confidence: 99%

Myelitis features and outcomes in CNS demyelinating disorders: Comparison between multiple sclerosis, MOGAD, and AQP4-IgG-positive NMOSD

et al. 2022

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Inflammatory myelopathies can manifest with a combination of motor, sensory and autonomic dysfunction of variable severity. Depending on the underlying etiology, the episodes of myelitis can recur, often leading to irreversible spinal cord damage and major long-term disability. Three main demyelinating disorders of the central nervous system, namely multiple sclerosis (MS), aquaporin-4-IgG-positive neuromyelitis optica spectrum disorders (AQP4+NMOSD) and myelin oligodendrocyte glycoprotein-IgG associated disease (MOGAD), can induce spinal cord inflammation through different pathogenic mechanisms, resulting in a more or less profound disruption of spinal cord integrity. This ultimately translates into distinctive clinical-MRI features, as well as distinct patterns of disability accrual, with a step-wise worsening of neurological function in MOGAD and AQP4+NMOSD, and progressive disability accrual in MS. Early recognition of the specific etiologies of demyelinating myelitis and initiation of the appropriate treatment is crucial to improve outcome. In this review article we summarize and compare the clinical and imaging features of spinal cord involvement in these three demyelinating disorders, both during the acute phase and over time, and outline the current knowledge on the expected patterns of disability accrual and outcomes. We also discuss the potential implications of these observations for patient management and counseling.

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“…Often a watchful waiting approach is pursued at initial presentation as a monophasic course is commonly encountered. [12][13][14][15] Applicable Guidelines and Areas of Uncertainty…”

Section: Prognosismentioning

confidence: 99%

Challenging Myelopathy Cases

et al. 2022

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Misdiagnosis of myelopathies is common and can lead to irreversible disability when diagnosis-and disease-specific treatment are delayed.Therefore, quickly determining the etiology of myelopathy is crucial.Clinical evaluation and MRI spine are paramount in establishing the correct diagnosis and subsequently an appropriate treatment plan. Herein, we review an approach to myelopathy diagnosis focused on the time course of neurologic symptom progression and neuroimaging pearls, and apply them to a variety of inflammatory, structural, and vascular myelopathy cases.

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Novel Glial Targets and Recurrent Longitudinally Extensive Transverse Myelitis

Cited by 21 publications

References 6 publications

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

S1 guidelines “lumbar puncture and cerebrospinal fluid analysis” (abridged and translated version)

Myelitis features and outcomes in CNS demyelinating disorders: Comparison between multiple sclerosis, MOGAD, and AQP4-IgG-positive NMOSD

Challenging Myelopathy Cases

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