Neuromyelitis optica spectrum disorders in Arabian Gulf (NMOAG); establishment and initial characterization of a patient registry

Shosha, Eslam; Asmi, A. Al; Nasim, Eman; Inshasi, Jihad; Abdulla, Fatema; Malik, Yaser Al; Althobaiti, Ahmed; Alzawahmah, Mohamed; Alnajashi, Hind; Binfalah, Mohamed; Alharbi, Awad; Thubaiti, Ibtisam A. Al; Ahmed, Samar Farouk; Al-Hashel, Jasem; Elyas, Mortada; Nandhagopal, Ramachandiran; Gujjar, Arunodaya R.; Harbi, Talal Al; Towaijri, Ghadah Al; Alsharooqi, Isa A; AlMaawi, Ahmed; Khathaami, Ali M. Al; Alotaibi, Naser; Nahrir, Shahpar; Rasheed, A. A.; Qahtani, Mohammed Al; Alawi, Sadaga; Hundallah, Khalid; Jumah, Mohammed Al; Alroughani, Raed

doi:10.1016/j.msard.2019.101448

Cited by 10 publications

(6 citation statements)

References 55 publications

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“…The mean age at disease onset in the current study was 30.7 ± 11.8 years, it was comparable to the age at onset reported by the two previous Egyptian studies 20,21 as well as studies from Asian and African populations 13,18,19,30 . However, it is considered lower than that found in other studies from Europe and North America 31–37 .…”

Section: Discussionsupporting

confidence: 85%

“…Although patients’ EDSS scores at the last follow up visit showed a wide variation ranging from 0 to 10 with a high mean score of 5.2 ± 2.6, no statistically significant differences could be found between the two groups. Similar scores were reported in studies from Africa, Latin America and Middle East 14,19,20,43,47 . Interestingly, Kitley et al, reported lower disability scores among Asian populations compared to African and Caucasian populations suggesting role of ethnicity in disease course and disability scores 51 …”

Section: Discussionsupporting

confidence: 67%

“…The variations in clinical and radiological features have been reported among different races as well as between different serostatuses and age groups 12 . Few studies of NMOSD have been reported from Africa and Middle East, 13–19 and so far in such heavily populated African country like Egypt, only two studies of NMOSD were conducted in Egypt 20,21 …”

Section: Introductionmentioning

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: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 67%

Section: Introductionmentioning

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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“…Similar frequencies of APS were reported in a previous Egyptian case series by Salama and colleagues (5 cases, 25%) [23], in contrast to another recent Egyptian NMOSD study by Kishk and colleagues, in which only 1 case (1.4%) presented with APS [24]. In fact, the frequency of APS during the disease course varied in different studies from different nations (ranging from as low as 3% to up to 43% of NMOSD patients) [11,[21][22][23][24][25][26][27][28][29][30][31][32][33][34]. This can be partially explained by different study designs, although higher frequencies were observed among East Asians and Africans than in other populations suggesting that there may be a genetic influence [25,35].…”

Section: Discussionsupporting

confidence: 83%

Area postrema syndrome in neuromyelitis optica spectrum disorder: diagnostic challenges and descriptive patterns

Khedr

Farweez

El-Fetoh

et al. 2021

Egypt J Neurol Psychiatry Neurosurg

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Background Although area postrema syndrome (APS) is one of the core clinical features of neuromyelitis optic spectrum disorder (NMOSD), it is frequently misdiagnosed as gastrointestinal or systemic disorders. In this study, we describe the diagnostic challenges in NMOSD patients with APS and their characteristic clinical and radiological features. All patients who attended our university hospitals during the period from March 2019 to August 2020 with a diagnosis of NMOSD according to the latest diagnostic criteria were admitted and evaluated clinically, radiologically with gadolinium-enhanced brain and spinal MRI, measures of serum Anti-Aquaporin 4 (Anti-AQP4) and clinical status using the Expanded Disability Status Scale (EDSS) scores. APS was diagnosed if there was a history of intractable nausea, vomiting, or hiccups (INVH) that had lasted longer than 1 week with the exclusion of other etiologies, or less than 48 h if associated with a lesion in the dorsal medulla on MRI scan. Results Twenty out of 90 (22.2%) identified patients with a diagnosis of NMOSD had a history of unexplained intractable nausea, vomiting or hiccoughs lasting an average of 20 days. Seventeen patients were anti-Aquaporin 4 seropositive. Seven patients (35%) presented initially with isolated clinical features of APS and were diagnosed only after subsequent relapse. Patients with APS preceding other core clinical presentations (13 cases, 65%) were diagnosed after development of motor manifestations. All patients developed acute myelitis during the course of illness. Brain and spinal MRI scans showed that 13 had a linear lesion in the dorsal tegmentum of the medulla oblongata adjacent to the fourth ventricle. Otherwise, longitudinally extensive transverse myelitis was found in 80%, while 35% showed extension of the cord lesion to the AP. Conclusions APS as a core clinical characteristic of NMOSD is not a rare presentation as was previously thought and can occur in both AQP4-seropositive and seronegative NMOSD.

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“…About 10% (8-18) 24,45,[145][146][147][148][149][150][151] About 10% (4%-23%) 149,153,154 unknown Optic disc swelling About 80% (75-100) bilateral, or recurrent ON would limit this testing to fewer than half of all patients, without the risk of missing any MOG+ ON cases. 144 In pediatric ON, the E.U.…”

Section: Concomitant Myelitismentioning

confidence: 99%

Optic neuritis classification in 2021

Ducloyer¹,

Marignier

Wiertlewski³

et al. 2021

European Journal of Ophthalmology

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Optic neuritis (ON) can be associated with inflammatory disease of the central nervous system or can be isolated, with or without relapse. It can also be associated with infectious or systemic disease. These multiple associations based on a variety of clinical, radiological, and biological criteria that have changed over time have led to overlapping phenotypes: a single ON case can be classified in several ways simultaneously or over time. As early, intensive treatment is often required, its diagnosis should be rapid and precise. In this review, we present the current state of knowledge about diagnostic criteria for ON aetiologies in adults and children, we discuss overlapping phenotypes, and we propose a homogeneous classification scheme. Even if distinctions between typical and atypical ON are relevant, their phenotypes are largely overlapping, and clinical criteria are neither sensitive enough, nor specific enough, to assure a diagnosis. For initial cases of ON, clinicians should perform contrast enhanced MRI of the brain and orbits, cerebral spinal fluid analysis, and biological analyses to exclude secondary infectious or inflammatory ON. Systematic screening for MOG-IgG and AQP4-IgG IgG is recommended in children but is still a matter of debate in adults. Early recognition of neuromyelitis optica spectrum disorder, MOG-IgG-associated disorder, and chronic relapsing idiopathic optic neuritis is required, as these diagnoses require therapies for relapse prevention that are different from those used to treat multiple sclerosis.

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Neuromyelitis optica spectrum disorders in Arabian Gulf (NMOAG); establishment and initial characterization of a patient registry

Cited by 10 publications

References 55 publications

Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

Radiological characteristics of neuromyelitis optica spectrum disorder in Egypt

Area postrema syndrome in neuromyelitis optica spectrum disorder: diagnostic challenges and descriptive patterns

Optic neuritis classification in 2021

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