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Journal: Journal of Neurology, Neurosurgery, and Psychiatry; January 1, 2023
Author(s): Gregorio Spagni, Bo Sun, Gabriele Monte, Elia Sechi, Raffaele Iorio, Amelia Evoli, Valentina Damato
How effective is rituximab in MOGAD compared to NMOSD?
This study is a systematic review and meta-analysis, that is, it reviews all previously published papers on a topic to arrive at some conclusions. This study included 315 patients and aimed to compare the efficacy and safety of rituximab in patients with MOGAD versus NMOSD. The results showed that rituximab was effective in MOGAD patients but less so than in NMOSD patients, and it caused some side effects in MOGAD patients because of which caution should be exercised in its prescription.
Related article: Long-term effectiveness and safety of Rituximab in NMOSD and MOGAD
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Journal: European Journal of Neurology; July 11, 2023
Author(s): Pietro Zara, Alessandro Dinoto, Sara Carta, Valentina Floris, Davide Turilli, Adrian Budhram, Sergio Ferrari, Stefania Milia, Paolo Solla, Sara Mariotto, Eoin P. Flanagan, A. Sebastian Lopez Chiriboga, Elia Sechi
Non-demyelinating disorders that might be misdiagnosed as NMOSD
While it is well known that multiple sclerosis and MOGAD have similar features to NMOSD, and neurologists actively try to distinguish between these three diseases, there are a range of non-demyelinating diseases that seem similar to NMOSD and might be misdiagnosed. This study reviewed cases that were misdiagnosed as NMOSD. Conditions that might have some features in common with NMOSD and can be misdiagnosed include myelopathy, optic neuropathy, or both together, genetic/metabolic disorders, neoplasms, infections, vascular disorders, spondylosis, and other immune-mediated disorders. In many cases, misdiagnosis was because the diagnostic criteria for NMOSD were applied incorrectly. This review identifies some red flags physicians should pay attention to, to avoid misdiagnosis.
Related article: Diagnostic criteria for NMOSD
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Journal: Eye; March 16, 2023
Author(s): Negar Moheb, John J. Chen
Features of optic neuritis and associated clinical signs in NMOSD and MOGAD
Optic neuritis is a common occurrence that can lead to vision loss in multiple sclerosis, NMOSD, and MOGAD. The features of optic neuritis are well described for multiple sclerosis but not for NMOSD and MOGAD. These diseases differ in severity, rate of recurrence, and overall outcomes, which is why prompt and accurate diagnosis and management is essential. This review article summarizes the characteristic neuro-ophthalmological signs in NMOSD and MOGAD, serum biomarkers and MRI findings, as well as immediate relapse management and long-term therapies used for NMOSD and MOGAD.
Related article: Optic neuritis — different forms, treatments, diagnosis, and prognosis
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Journal: Neurology and Therapy; February 24, 2023
Author(s): Marco Capobianco, Marius Ringelstein, Carly Welsh, Patricia Lobo, Gabrielle deFiebre, Marco Lana-Peixoto, Jiawei Wang, Ju-Hong Min & Dean M. Wingerchuk
NMOSD disease severity and stability in real-life settings globally
This study evaluated how NMOSD disease severity and stability is classified globally by conducting an online survey with 389 neurologists from the USA, Germany, Italy, Brazil, South Korea, and China (representing data from 1185 patients) and conducting telephonic interviews with 33 patients receiving maintenance therapy for NMOSD. The results showed wide variations, both between neurologists and patients and across geographies, in how a relapse was defined and how relapse severity was classified. Neurologists relied on clinical assessments when classifying a relapse and viewed each relapse in isolation, whereas patients subjectively evaluated relapses in terms of how their daily life was affected and how the relapse compared with prior relapses. There was a similar disconnect in the definition of disease stability, with patients placing more emphasis on zero relapses than neurologists did. A related study used the same neurologist survey and patient interviews to evaluate how NMOSD is managed in real-life settings globally.
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Journal: Neurology and Therapy; February 24, 2023
Author(s): Ju-Hong Min, Marco Capobianco, Carly Welsh, Patricia Lobo, Gabrielle deFiebre, Marco Lana-Peixoto, Dean M. Wingerchuk, Jiawei Wang, Marius Ringelstein
NMOSD management in real-life settings globally
This study evaluated treatment practices for NMOSD globally by conducting an online survey among 389 neurologists in the USA, Germany, Italy, Brazil, South Korea, and China (representing data from 1185 patients) and conducting telephonic interviews with 33 patients receiving maintenance therapy for NMOSD. Questions to neurologists captured patient demographics, diagnosis, maintenance treatment history, relapse occurrence, and disease severity. Patient interviews covered diagnosis, treatment, perceptions about relapse severity or disease stability, and switching from one treatment to another. About 25% of the patients were initially misdiagnosed, resulting in delayed treatment and more relapses compared to patients who received the correct initial diagnosis. Oral corticosteroids or immunosuppressants were typically the first treatment given in all countries, except in the USA, where monoclonal antibodies were also equally likely to be used as the first treatment. The decision to switch treatments was usually made by neurologists based on the severity of relapses. Most patients interviewed did not recall being offered a choice of treatment or understand why they were prescribed a certain treatment. A related study used the same neurologist survey and patient interviews to characterize how disease severity and stability are classified globally.
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Journal: Neurology Neuroimmunology & Neuroinflammation; October 13, 2022
Author(s): Eva Maria Wendel, Helen Sophie Thonke, Annikki Bertolini, Matthias Baumann, Astrid Blaschek, Andreas Merkenschlager, Michael Karenfort, Barbara Kornek, Christian Lechner, Daniela Pohl, Martin Pritsch, Kathrin Schanda, Mareike Schimmel, Charlotte Thiels, Stephan Waltz, Gert Wiegand, Banu Anlar, Nina Barisic, Christian Blank, Markus Breu, Philip Broser, Adela Della Marina, Katharina Diepold, Matthias Eckenweiler, Astrid Eisenkölbl, Michael Freilinger, Ursula Gruber-Sedlmayr, Annette Hackenberg, Tobias Iff, Ellen Knierim, Johannes Koch, Georg Kutschke, Steffen Leiz, Grischa Lischetzki, Margherita Nosadini, Alexander Pschibul, Edith Reiter-Fink, Doris Rohrbach, Michela Salandin, Stefano Sartori, Jan-Ulrich Schlump, Johannes Stoffels, Jurgis Strautmanis, Daniel Tibussek, Victoria Tüngler, Norbert Utzig, Markus Reindl, Kevin Rostásy; BIOMARKER Study Group
Fluctuating anti-MOG antibody levels in children and what they could mean
MOGAD patients who have persistent high levels of anti-MOG antibodies tend to have a more aggressive, relapsing disease course. This study involved 116 children with MOGAD and aimed to evaluate whether certain clinical characteristics and serum biomarkers might predict the risk of relapse and how anti-MOG antibody levels may fluctuate in these children. The children were followed up for 3 years on average if they had no relapse and for 5 years if they had a relapse. The results showed that when anti-MOG levels declined over time, and especially when the antibody tests went from positive (detected) to negative (not detected) over time, the children were less likely to have a relapse.
Related article: Can anti-MOG-antibody levels predict relapses in MOGAD?
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Journal: Current Opinion in Neurology; March 19, 2024
Author(s): Elisabeth Maillart, Kumaran Deiva, Romain Marignier
Clinical features of patients with MOGAD
This study is a review of previously published studies, aiming to summarize the clinical features of MOGAD. Over the last two decades, improvements in antibody testing methods have improved the accuracy of MOGAD diagnosis. Additionally, international criteria for MOGAD have been proposed for the first time. This study evaluates and explains each of the clinical features mentioned in the international criteria for MOGAD and also discusses potential challenges for the criteria to be applied in varied clinical settings. This study could be helpful for neurologists and patients looking to arrive at a treatment plan.
Related article: Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD): current understanding and challenges
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Journal: Multiple Sclerosis and Related Disorders; July 8, 2023
Author(s): Jie Wang, Keyu Yang, Fang Zhang, Yujie Yi, Jing Wang
Could certain clinical factors predict relapses in MOGAD?
About 50% of patients with MOGAD tend to have relapses. This study, conducted on 24 MOGAD patients in China, aimed to determine if any specific clinical features might predict relapses in MOGAD. The results showed that the most common clinical features of MOGAD are loss of vision, numbness in the limbs or face, and eye pain. Patients who have optic neuritis, a history of immune disease, high levels of anti-MOG antibodies (≥1:100), and/or high levels of leukocytes in the cerebrospinal fluid (above 50/mm3) may be more likely to have relapses.
Related article: Can anti-MOG-antibody levels predict relapses in MOGAD?
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Journal: Journal of Neurology, Neurosurgery, and Psychiatry; March 1, 2023
Author(s): Matteo Gastaldi, Thomas Foiadelli, Giacomo Greco, Silvia Scaranzin, Eleonora Rigoni, Stefano Masciocchi, Sergio Ferrari, Chiara Mancinelli, Laura Brambilla, Margherita Mancardi, Thea Giacomini, Diana Ferraro, Marida Della Corte, Antonio Gallo, Massimiliano Di Filippo, Luana Benedetti, Giovanni Novi, Maurizio Versino, Paola Banfi, Raffaele Iorio, Lucia Moiola, Emanuela Turco, Stefano Sartori, Margherita Nosadini, Martino Ruggieri, Salvatore Savasta, Elena Colombo, Elena Ballante, Sven Jarius, Sara Mariotto, Diego Franciotta; NINA study group
Can anti-MOG-antibody levels predict relapses in MOGAD?
Testing for anti- MOG antibodies is an important diagnostic tool for patients with MOGAD. But little is known about how often the antibody tests should be repeated and what persistent high antibody levels might mean for the disease course. This study was conducted on 102 MOGAD patients in Italy. The results showed that patients with persistent positive anti-MOG-antibody tests and high levels antibodies over time are more likely to have relapses.
Related article: What predicts a relapsing disease course after the first demyelination event in MOGAD patients?
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Journal: Multiple Sclerosis and Related Disorders; December 28, 2023
Author(s): Haifen Liao, Ping Fan, Hengfang Ruan, Wei Qiu, Meifen Zhang, Huijuan L
How do NMOSD patients perceive and deal with their risk of relapses?
Recurrent relapses in NMOSD lead to increasing disability. To some extent, this can be avoided if patients accurately perceive and respond to their risk of having a relapse. This study used face-to-face, semi-structured interviews with 15 NMOSD patients to assess how patients perceive their risk of having a relapse and associated coping strategies. The themes that came up in the interviews included patients’ perceptions of the possibility and warning signs of a relapse, understanding and misconceptions about relapse triggers, consequences of a relapse, and coping strategies. The findings showed that the chances of a relapse tend to be underestimated by patients until they have had two or more relapses and overestimated after two or more relapses. A potential trigger for relapses, which can be easily managed, is non-compliance to recommended medication protocols. Relapses have significant negative effects on patients, and patients are therefore eager to discuss treatment planning and relapse management with their doctors.
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