Marco Lana-peixoto - Academia.edu (original) (raw)

Papers by Marco Lana-peixoto

Research paper thumbnail of International consensus diagnostic criteria for neuromyelitis optica spectrum disorders

Neurology, 2015

Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) ... more Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The new nomenclature defines the unifying term NMO spectrum disorders (NMOSD), which is stratified further by serologic testing (NMOSD with or without AQP4-IgG). The core clinical characteristics required for patients with NMOSD with AQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable. The IPND also proposed validation strategies and achieved consensus on pediatric NMOSD diagnosis and the concepts of monophasic NMOSD and opticospinal MS.

Research paper thumbnail of Use of Advanced Magnetic Resonance Imaging Techniques in Neuromyelitis Optica Spectrum Disorder

JAMA neurology, Jan 26, 2015

Brain parenchymal lesions are frequently observed on conventional magnetic resonance imaging (MRI... more Brain parenchymal lesions are frequently observed on conventional magnetic resonance imaging (MRI) scans of patients with neuromyelitis optica (NMO) spectrum disorder, but the specific morphological and temporal patterns distinguishing them unequivocally from lesions caused by other disorders have not been identified. This literature review summarizes the literature on advanced quantitative imaging measures reported for patients with NMO spectrum disorder, including proton MR spectroscopy, diffusion tensor imaging, magnetization transfer imaging, quantitative MR volumetry, and ultrahigh-field strength MRI. It was undertaken to consider the advanced MRI techniques used for patients with NMO by different specialists in the field. Although quantitative measures such as proton MR spectroscopy or magnetization transfer imaging have not reproducibly revealed diffuse brain injury, preliminary data from diffusion-weighted imaging and brain tissue volumetry indicate greater white matter than...

Research paper thumbnail of Seronegative Neuromyelitis Optica Spectrum--the challenges on disease definition and pathogenesis

Arquivos de neuro-psiquiatria, 2014

Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or... more Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or longitudinally extensive transverse myelitis, and some brain lesions are also unique to NMOSD. Serum autoantibodies against aquaporin-4 (AQP4) are detected in most cases of NMOSD. However, some patients with NMOSD remain seronegative despite repetitive testing during attacks with highly sensitive cell-based assays. The differential diagnosis of NMOSD is not restricted to multiple sclerosis and it includes many diseases that can produce longitudinally extensive myelitis and/or optic neuritis. We review the clinical features, imaging, and laboratory findings that can be helpful on the diagnostic work-up, discuss the differences between AQP4 antibody positive and negative patients with NMOSD, including features of NMOSD with antibodies against myelin oligodendrocyte glycoprotein.

Research paper thumbnail of Seronegative Neuromyelitis Optica Spectrum - The challenges on disease definition and pathogenesis

Arquivos de Neuro-Psiquiatria, 2014

Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or... more Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or longitudinally extensive transverse myelitis, and some brain lesions are also unique to NMOSD. Serum autoantibodies against aquaporin-4 (AQP4) are detected in most cases of NMOSD. However, some patients with NMOSD remain seronegative despite repetitive testing during attacks with highly sensitive cellbased assays. The differential diagnosis of NMOSD is not restricted to multiple sclerosis and it includes many diseases that can produce longitudinally extensive myelitis and/or optic neuritis. We review the clinical features, imaging, and laboratory findings that can be helpful on the diagnostic work-up, discuss the differences between AQP4 antibody positive and negative patients with NMOSD, including features of NMOSD with antibodies against myelin oligodendrocyte glycoprotein.

Research paper thumbnail of Treatment of Neuromyelitis Optica: Review and Recommendations

Multiple sclerosis and related disorders, 2012

Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the op... more Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.

Research paper thumbnail of MRI characteristics of neuromyelitis optica spectrum disorder: An international update

Neurology, Jan 18, 2015

Since its initial reports in the 19th century, neuromyelitis optica (NMO) had been thought to inv... more Since its initial reports in the 19th century, neuromyelitis optica (NMO) had been thought to involve only the optic nerves and spinal cord. However, the discovery of highly specific anti-aquaporin-4 antibody diagnostic biomarker for NMO enabled recognition of more diverse clinical spectrum of manifestations. Brain MRI abnormalities in patients seropositive for anti-aquaporin-4 antibody are common and some may be relatively unique by virtue of localization and configuration. Some seropositive patients present with brain involvement during their first attack and/or continue to relapse in the same location without optic nerve and spinal cord involvement. Thus, characteristics of brain abnormalities in such patients have become of increased interest. In this regard, MRI has an increasingly important role in the differential diagnosis of NMO and its spectrum disorder (NMOSD), particularly from multiple sclerosis. Differentiating these conditions is of prime importance because early init...

Research paper thumbnail of Mismatch negativity contribution in multiple sclerosis patients

Brazilian journal of otorhinolaryngology

Mismatch Negativity is a functional index of the supratemporal auditory cortex. The aim of the pr... more Mismatch Negativity is a functional index of the supratemporal auditory cortex. The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task--PASAT. a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequency MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when co...

Research paper thumbnail of Profile of the Brazilian scientific production in multiple sclerosis

Brazilian Journal of Medical and Biological Research, 2006

Research paper thumbnail of Tonic pupil in leprosy

Arquivos brasileiros de oftalmologia, 2014

Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosi... more Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosis, a sluggish reaction to light, and poor dilation in response to anticholinergic mydriatics. We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. In both cases, instillation of dilute 0.1% pilocarpine caused miosis in the affected eyes. Tonic pupil occurs in many conditions, but its association with leprosy had not been previously reported.

Research paper thumbnail of Unusual presentation of cat scratch disease in HIV+ patient

British Journal of Ophthalmology, 2003

Research paper thumbnail of Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: II. As evidências para o uso de glicocorticóides e imunomoduladores

Arquivos De Neuro-psiquiatria, 2002

Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important... more Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important role in causing demyelinating lesions in the central nervous system. A number of drugs acting in different stages of these mechanisms have been tested for its treatment. This paper analyses the most important clinical trials with glucocorticoids and immunomodulatory treatments, including human immunoglobulin, using the classes of

Research paper thumbnail of Bipolar disorder and multiple sclerosis

Arquivos De Neuro-psiquiatria, 2007

Bipolar disorder may be overrepresented in multiple sclerosis (MS) patients. Although research in... more Bipolar disorder may be overrepresented in multiple sclerosis (MS) patients. Although research in this area is limited, studies assessing the nature of this association have focused on genetic aspects, ad- verse reaction to drugs and brain demyelinating lesions. Herein we report three patients with MS that also presented bipolar disorder. The coexistence of neurological and psychiatric symptoms in most MS

Research paper thumbnail of Treatment of neuromyelitis optica: Review and recommendations

Multiple Sclerosis and Related Disorders, 2012

Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the op... more Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.

Research paper thumbnail of Sjögren syndrome and neuromyelitis optica spectrum disorder co-exist in a common autoimmune milieu

Arquivos de Neuro-Psiquiatria, 2014

The relationship between Sjögren&... more The relationship between Sjögren's syndrome (SS) and neuromyelitis optica spectrum disorder (NMOSD) is not completely understood. We report two patients with both conditions and review 47 other previously reported cases meeting currently accepted diagnostic criteria, from 17 articles extracted from PubMed. Out of 44 patients whose gender was informed, 42 were females. Mean age at onset of neurological manifestation was 36.2 years (10-74). Serum anti-AQP4-IgG was positive in 32 patients, borderline in 1, and negative in 4. Our Case 1 was seronegative for AQP4-IgG and had no non-organ-specific autoantibodies other than anti-SSB antibodies. Our Case 2 had serum anti-AQP4, anti-SSA/SSB, anti-thyreoglobulin and anti-acethylcholine-receptor antibodies, as well as clinical hypothyreoidism, but no evidence of myasthenia gravis. Our Cases and others, as previously reported in literature, with similar heterogeneous autoimmune response to aquaporin-4, suggest that SS and NMO co-exist in a common autoimmune milieu which is not dependent on aquaporin-4 autoimmunity.

Research paper thumbnail of Anterior ischaemic optic neuropathy in a child with AS haemoglobinopathy and migraine

British Journal of Ophthalmology - BRIT J OPHTHALMOL, 1998

Editor,—Anterior ischaemic optic neuropathy (AION) is a disease that occurs most frequently in mi... more Editor,—Anterior ischaemic optic neuropathy (AION) is a disease that occurs most frequently in middle aged and elderly people resulting from vascular occlusive disorders or transient decreased blood flow in the territory of the short posterior ciliary arteries. Although rare in the young, ...

Research paper thumbnail of Asymptomatic Intracranial Gumma in a Patient with Syphilitic Uveitis and Human Immunodeficiency Virus Infection

Scandinavian Journal of Infectious Diseases, 2003

In conclusion, brucella peritonitis is a rare clinical form of brucellosis. It should be consider... more In conclusion, brucella peritonitis is a rare clinical form of brucellosis. It should be considered as a cause of spontaneous bacterial peritonitis in a patient with ascites or cirrhosis, especially in endemic regions, and appropriate serological and microbiological tests should be performed to confirm the diagnosis.

Research paper thumbnail of Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders

Neurology, 2014

Objective: To evaluate clinical features among patients with neuromyelitis optica spectrum disord... more Objective: To evaluate clinical features among patients with neuromyelitis optica spectrum disorders (NMOSD) who have myelin oligodendrocyte glycoprotein (MOG) antibodies, aquaporin-4 (AQP4) antibodies, or seronegativity for both antibodies.

Research paper thumbnail of Aquaporin-4 antibody-positive myelitis initially biopsied for suspected spinal cord tumors: Diagnostic considerations

Multiple Sclerosis Journal, 2014

Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spina... more Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spinal cord tumors. Both patients were later diagnosed with neuromyelitis optica spectrum disorders (NMOSD) supported by their AQP4seropositivity. Pathological review of both biopsies revealed demyelinated lesions with thickened vessel walls and tissue rarefaction. Immunohistochemical staining demonstrated findings compatible with acute NMOSD lesions in one case while the other case exhibited findings consistent with chronic NMOSD lesions. A pre-biopsy differential diagnosis of longitudinally extensive spinal cord tumors should include NMOSD. Specific biopsy features, such as cystic changes with vascular wall thickening and astrocyte injury, should raise suspicion for NMOSD.

Research paper thumbnail of Simple phonic tic in multiple sclerosis

Multiple Sclerosis, 2002

Movement disorders occurring in association with multiple sclerosis (MS) are rare. Among them par... more Movement disorders occurring in association with multiple sclerosis (MS) are rare. Among them paroxysmal dystonia is the most common, although chorea, ballism, palatal myoclonia, spasmodic torticollis, writer's cramp and generalized dystonia have been reported. We describe a 34-year old woman with MS who developed simple phonic tic characterized by throat-clearing sounds. Magnetic resonance imaging showed demyelinating lesions involving the thalamus and basal ganglia. This is the first report of tic disorder occurring as a manifestation of MS.

Research paper thumbnail of 5-21-17 Migraine-associated anterior ischemic optic neuropathy in sickle-cell trait

Journal of the Neurological Sciences, 1997

Research paper thumbnail of International consensus diagnostic criteria for neuromyelitis optica spectrum disorders

Neurology, 2015

Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) ... more Neuromyelitis optica (NMO) is an inflammatory CNS syndrome distinct from multiple sclerosis (MS) that is associated with serum aquaporin-4 immunoglobulin G antibodies (AQP4-IgG). Prior NMO diagnostic criteria required optic nerve and spinal cord involvement but more restricted or more extensive CNS involvement may occur. The International Panel for NMO Diagnosis (IPND) was convened to develop revised diagnostic criteria using systematic literature reviews and electronic surveys to facilitate consensus. The new nomenclature defines the unifying term NMO spectrum disorders (NMOSD), which is stratified further by serologic testing (NMOSD with or without AQP4-IgG). The core clinical characteristics required for patients with NMOSD with AQP4-IgG include clinical syndromes or MRI findings related to optic nerve, spinal cord, area postrema, other brainstem, diencephalic, or cerebral presentations. More stringent clinical criteria, with additional neuroimaging findings, are required for diagnosis of NMOSD without AQP4-IgG or when serologic testing is unavailable. The IPND also proposed validation strategies and achieved consensus on pediatric NMOSD diagnosis and the concepts of monophasic NMOSD and opticospinal MS.

Research paper thumbnail of Use of Advanced Magnetic Resonance Imaging Techniques in Neuromyelitis Optica Spectrum Disorder

JAMA neurology, Jan 26, 2015

Brain parenchymal lesions are frequently observed on conventional magnetic resonance imaging (MRI... more Brain parenchymal lesions are frequently observed on conventional magnetic resonance imaging (MRI) scans of patients with neuromyelitis optica (NMO) spectrum disorder, but the specific morphological and temporal patterns distinguishing them unequivocally from lesions caused by other disorders have not been identified. This literature review summarizes the literature on advanced quantitative imaging measures reported for patients with NMO spectrum disorder, including proton MR spectroscopy, diffusion tensor imaging, magnetization transfer imaging, quantitative MR volumetry, and ultrahigh-field strength MRI. It was undertaken to consider the advanced MRI techniques used for patients with NMO by different specialists in the field. Although quantitative measures such as proton MR spectroscopy or magnetization transfer imaging have not reproducibly revealed diffuse brain injury, preliminary data from diffusion-weighted imaging and brain tissue volumetry indicate greater white matter than...

Research paper thumbnail of Seronegative Neuromyelitis Optica Spectrum--the challenges on disease definition and pathogenesis

Arquivos de neuro-psiquiatria, 2014

Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or... more Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or longitudinally extensive transverse myelitis, and some brain lesions are also unique to NMOSD. Serum autoantibodies against aquaporin-4 (AQP4) are detected in most cases of NMOSD. However, some patients with NMOSD remain seronegative despite repetitive testing during attacks with highly sensitive cell-based assays. The differential diagnosis of NMOSD is not restricted to multiple sclerosis and it includes many diseases that can produce longitudinally extensive myelitis and/or optic neuritis. We review the clinical features, imaging, and laboratory findings that can be helpful on the diagnostic work-up, discuss the differences between AQP4 antibody positive and negative patients with NMOSD, including features of NMOSD with antibodies against myelin oligodendrocyte glycoprotein.

Research paper thumbnail of Seronegative Neuromyelitis Optica Spectrum - The challenges on disease definition and pathogenesis

Arquivos de Neuro-Psiquiatria, 2014

Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or... more Neuromyelitis optica spectrum disorders (NMOSD) are characterized by severe optic neuritis and/or longitudinally extensive transverse myelitis, and some brain lesions are also unique to NMOSD. Serum autoantibodies against aquaporin-4 (AQP4) are detected in most cases of NMOSD. However, some patients with NMOSD remain seronegative despite repetitive testing during attacks with highly sensitive cellbased assays. The differential diagnosis of NMOSD is not restricted to multiple sclerosis and it includes many diseases that can produce longitudinally extensive myelitis and/or optic neuritis. We review the clinical features, imaging, and laboratory findings that can be helpful on the diagnostic work-up, discuss the differences between AQP4 antibody positive and negative patients with NMOSD, including features of NMOSD with antibodies against myelin oligodendrocyte glycoprotein.

Research paper thumbnail of Treatment of Neuromyelitis Optica: Review and Recommendations

Multiple sclerosis and related disorders, 2012

Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the op... more Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.

Research paper thumbnail of MRI characteristics of neuromyelitis optica spectrum disorder: An international update

Neurology, Jan 18, 2015

Since its initial reports in the 19th century, neuromyelitis optica (NMO) had been thought to inv... more Since its initial reports in the 19th century, neuromyelitis optica (NMO) had been thought to involve only the optic nerves and spinal cord. However, the discovery of highly specific anti-aquaporin-4 antibody diagnostic biomarker for NMO enabled recognition of more diverse clinical spectrum of manifestations. Brain MRI abnormalities in patients seropositive for anti-aquaporin-4 antibody are common and some may be relatively unique by virtue of localization and configuration. Some seropositive patients present with brain involvement during their first attack and/or continue to relapse in the same location without optic nerve and spinal cord involvement. Thus, characteristics of brain abnormalities in such patients have become of increased interest. In this regard, MRI has an increasingly important role in the differential diagnosis of NMO and its spectrum disorder (NMOSD), particularly from multiple sclerosis. Differentiating these conditions is of prime importance because early init...

Research paper thumbnail of Mismatch negativity contribution in multiple sclerosis patients

Brazilian journal of otorhinolaryngology

Mismatch Negativity is a functional index of the supratemporal auditory cortex. The aim of the pr... more Mismatch Negativity is a functional index of the supratemporal auditory cortex. The aim of the present study on Mismatch Negativity (MMN) in multiple sclerosis (MS) patients was to evaluate if the MMN can be correlated with cognitive deficits assessed by the Paced Auditory Addition Task--PASAT. a clinical study in forty females and 20 males separated in two groups: control individuals and those with a definite diagnosis of MS underwent a duration and frequency MMN. The MMN latencies and negative amplitudes obtained from the MS group were compared to the ones from the control group. The scores from the Paced Auditory Addition Task were correlated either with the presence or the absence of MMN. MMN was found in 60% of the individuals with multiple sclerosis within the auditory stimulation protocol with varied durations, and in 45 % within the auditory stimulation protocol with frequency variations. There were no statistically significant differences in latencies and amplitudes when co...

Research paper thumbnail of Profile of the Brazilian scientific production in multiple sclerosis

Brazilian Journal of Medical and Biological Research, 2006

Research paper thumbnail of Tonic pupil in leprosy

Arquivos brasileiros de oftalmologia, 2014

Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosi... more Pupil abnormalities in leprosy usually result from chronic iritis with loss of stroma, iris miosis, a sluggish reaction to light, and poor dilation in response to anticholinergic mydriatics. We report two patients with long-standing lepromatous leprosy who developed tonic pupils characterized by mydriasis, absence of reaction to light and hypersensitivity to weak cholinergic solution. Examination revealed iritis and iris atrophy. In both cases, instillation of dilute 0.1% pilocarpine caused miosis in the affected eyes. Tonic pupil occurs in many conditions, but its association with leprosy had not been previously reported.

Research paper thumbnail of Unusual presentation of cat scratch disease in HIV+ patient

British Journal of Ophthalmology, 2003

Research paper thumbnail of Consenso expandido do BCTRIMS para o tratamento da esclerose múltipla: II. As evidências para o uso de glicocorticóides e imunomoduladores

Arquivos De Neuro-psiquiatria, 2002

Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important... more Multiple sclerosis is an inflammatory disease in which immunological mechanisms play an important role in causing demyelinating lesions in the central nervous system. A number of drugs acting in different stages of these mechanisms have been tested for its treatment. This paper analyses the most important clinical trials with glucocorticoids and immunomodulatory treatments, including human immunoglobulin, using the classes of

Research paper thumbnail of Bipolar disorder and multiple sclerosis

Arquivos De Neuro-psiquiatria, 2007

Bipolar disorder may be overrepresented in multiple sclerosis (MS) patients. Although research in... more Bipolar disorder may be overrepresented in multiple sclerosis (MS) patients. Although research in this area is limited, studies assessing the nature of this association have focused on genetic aspects, ad- verse reaction to drugs and brain demyelinating lesions. Herein we report three patients with MS that also presented bipolar disorder. The coexistence of neurological and psychiatric symptoms in most MS

Research paper thumbnail of Treatment of neuromyelitis optica: Review and recommendations

Multiple Sclerosis and Related Disorders, 2012

Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the op... more Neuromyelitis optica (NMO) is an autoimmune demyelinating disease preferentially targeting the optic nerves and spinal cord. Once regarded as a variant of multiple sclerosis (MS), NMO is now recognized to be a different disease with unique pathology and immunopathogenesis that does not respond to traditional MS immunomodulators such as interferons. Preventive therapy in NMO has focused on a range of immunosuppressive medications, none of which have been validated in a rigorous randomized trial. However, multiple retrospective and a few recent prospective studies have provided evidence for the use of six medications for the prevention of NMO exacerbations: azathioprine, rituximab, mycophenolate mofetil, prednisone, methotrexate and mitoxantrone. This review provides a comprehensive analysis of each of these medications in NMO and concludes with a set of recommended consensus practices.

Research paper thumbnail of Sjögren syndrome and neuromyelitis optica spectrum disorder co-exist in a common autoimmune milieu

Arquivos de Neuro-Psiquiatria, 2014

The relationship between Sjögren&... more The relationship between Sjögren's syndrome (SS) and neuromyelitis optica spectrum disorder (NMOSD) is not completely understood. We report two patients with both conditions and review 47 other previously reported cases meeting currently accepted diagnostic criteria, from 17 articles extracted from PubMed. Out of 44 patients whose gender was informed, 42 were females. Mean age at onset of neurological manifestation was 36.2 years (10-74). Serum anti-AQP4-IgG was positive in 32 patients, borderline in 1, and negative in 4. Our Case 1 was seronegative for AQP4-IgG and had no non-organ-specific autoantibodies other than anti-SSB antibodies. Our Case 2 had serum anti-AQP4, anti-SSA/SSB, anti-thyreoglobulin and anti-acethylcholine-receptor antibodies, as well as clinical hypothyreoidism, but no evidence of myasthenia gravis. Our Cases and others, as previously reported in literature, with similar heterogeneous autoimmune response to aquaporin-4, suggest that SS and NMO co-exist in a common autoimmune milieu which is not dependent on aquaporin-4 autoimmunity.

Research paper thumbnail of Anterior ischaemic optic neuropathy in a child with AS haemoglobinopathy and migraine

British Journal of Ophthalmology - BRIT J OPHTHALMOL, 1998

Editor,—Anterior ischaemic optic neuropathy (AION) is a disease that occurs most frequently in mi... more Editor,—Anterior ischaemic optic neuropathy (AION) is a disease that occurs most frequently in middle aged and elderly people resulting from vascular occlusive disorders or transient decreased blood flow in the territory of the short posterior ciliary arteries. Although rare in the young, ...

Research paper thumbnail of Asymptomatic Intracranial Gumma in a Patient with Syphilitic Uveitis and Human Immunodeficiency Virus Infection

Scandinavian Journal of Infectious Diseases, 2003

In conclusion, brucella peritonitis is a rare clinical form of brucellosis. It should be consider... more In conclusion, brucella peritonitis is a rare clinical form of brucellosis. It should be considered as a cause of spontaneous bacterial peritonitis in a patient with ascites or cirrhosis, especially in endemic regions, and appropriate serological and microbiological tests should be performed to confirm the diagnosis.

Research paper thumbnail of Distinction between MOG antibody-positive and AQP4 antibody-positive NMO spectrum disorders

Neurology, 2014

Objective: To evaluate clinical features among patients with neuromyelitis optica spectrum disord... more Objective: To evaluate clinical features among patients with neuromyelitis optica spectrum disorders (NMOSD) who have myelin oligodendrocyte glycoprotein (MOG) antibodies, aquaporin-4 (AQP4) antibodies, or seronegativity for both antibodies.

Research paper thumbnail of Aquaporin-4 antibody-positive myelitis initially biopsied for suspected spinal cord tumors: Diagnostic considerations

Multiple Sclerosis Journal, 2014

Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spina... more Two patients with longitudinally extensive myelopathy were initially biopsied for suspected spinal cord tumors. Both patients were later diagnosed with neuromyelitis optica spectrum disorders (NMOSD) supported by their AQP4seropositivity. Pathological review of both biopsies revealed demyelinated lesions with thickened vessel walls and tissue rarefaction. Immunohistochemical staining demonstrated findings compatible with acute NMOSD lesions in one case while the other case exhibited findings consistent with chronic NMOSD lesions. A pre-biopsy differential diagnosis of longitudinally extensive spinal cord tumors should include NMOSD. Specific biopsy features, such as cystic changes with vascular wall thickening and astrocyte injury, should raise suspicion for NMOSD.

Research paper thumbnail of Simple phonic tic in multiple sclerosis

Multiple Sclerosis, 2002

Movement disorders occurring in association with multiple sclerosis (MS) are rare. Among them par... more Movement disorders occurring in association with multiple sclerosis (MS) are rare. Among them paroxysmal dystonia is the most common, although chorea, ballism, palatal myoclonia, spasmodic torticollis, writer's cramp and generalized dystonia have been reported. We describe a 34-year old woman with MS who developed simple phonic tic characterized by throat-clearing sounds. Magnetic resonance imaging showed demyelinating lesions involving the thalamus and basal ganglia. This is the first report of tic disorder occurring as a manifestation of MS.

Research paper thumbnail of 5-21-17 Migraine-associated anterior ischemic optic neuropathy in sickle-cell trait

Journal of the Neurological Sciences, 1997