脊髓炎
医学
横贯性脊髓炎
急性播散性脑脊髓炎
多发性硬化
视神经脊髓炎
髓鞘少突胶质细胞糖蛋白
急性横贯性脊髓炎
视神经炎
血浆置换术
内科学
病理
胃肠病学
免疫学
脊髓
抗体
实验性自身免疫性脑脊髓炎
精神科
作者
Divyanshu Dubey,Sean J. Pittock,Karl N. Krecke,Padraig P. Morris,Elia Sechi,Nicholas L. Zalewski,Brian G. Weinshenker,Eslam Shosha,Claudia F. Lucchinetti,James P. Fryer,A. Sebastian López‐Chiriboga,John C. Chen,Jiraporn Jitprapaikulsan,Andrew McKeon,Avi Gadoth,B. Mark Keegan,Jan‐Mendelt Tillema,Elie Naddaf,Marc C. Patterson,Kevin Messacar,Kenneth L. Tyler,Eoin P. Flanagan
出处
期刊:JAMA Neurology
[American Medical Association]
日期:2019-03-01
卷期号:76 (3): 301-301
被引量:285
标识
DOI:10.1001/jamaneurol.2018.4053
摘要
Importance
Recognizing the characteristics of myelin oligodendrocyte glycoprotein autoantibody (MOG-IgG) myelitis is essential for early accurate diagnosis and treatment. Objective
To evaluate the clinical, radiologic, and prognostic features of MOG-IgG myelitis and compare with myelitis with aquaporin-4–IgG (AQP4-IgG) and multiple sclerosis (MS). Design, Setting, and Participants
We retrospectively identified 199 MOG-IgG–positive Mayo Clinic patients from January 1, 2000, through December 31, 2017, through our neuroimmunology laboratory. Fifty-four patients met inclusion criteria of (1) clinical myelitis; (2) MOG-IgG positivity; and (3) medical records available. We excluded 145 patients without documented myelitis. Myelitis of AQP4-IgG (n = 46) and MS (n = 26) were used for comparison. Main Outcomes and Measures
Outcome variables included modified Rankin score and need for gait aid. A neuroradiologist analyzed spine magnetic resonance imaging of patients with MOG-IgG and control patients blinded to diagnosis. Results
Of 54 included patients with MOG-IgG myelitis, the median age was 25 years (range, 3-73 years) and 24 were women (44%). Isolated transverse myelitis was the initial manifestation in 29 patients (54%), and 10 (19%) were initially diagnosed as having viral/postviral acute flaccid myelitis. Cerebrospinal fluid–elevated oligoclonal bands occurred in 1 of 38 (3%). At final follow-up (median, 24 months; range, 2-120 months), 32 patients (59%) had developed 1 or more relapses of optic neuritis (n = 31); transverse myelitis (n = 7); or acute disseminated encephalomyelitis (n = 1). Clinical features favoring MOG-IgG myelitis vs AQP4-IgG or MS myelitis included prodromal symptoms and concurrent acute disseminated encephalomyelitis. Magnetic resonance imaging features favoring MOG-IgG over AQP4-IgG or MS myelitis were T2-signal abnormality confined to gray matter (sagittal line and axial H sign) and lack of enhancement. Longitudinally extensive T2 lesions were of similar frequency in MOG-IgG and AQP4-IgG myelitis (37 of 47 [79%] vs 28 of 34 [82%];P = .52) but not found in MS. Multiple spinal cord lesions and conus involvement were more frequent with MOG-IgG than AQP4-IgG but not different from MS. Wheelchair dependence at myelitis nadir occurred in one-third of patients with MOG-IgG and AQP4-IgG but never with MS, although patients with MOG-IgG myelitis recovered better than those with AQP4-IgG. Conclusions and Relevance
Myelitis is an early manifestation of MOG-IgG–related disease and may have a clinical phenotype of acute flaccid myelitis. We identified a variety of clinical and magnetic resonance imaging features that may help clinicians identify those at risk in whom MOG-IgG should be tested.
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