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Abstract Details

Lesion Evolution on MRI in Myelitis Associated with MS, Aquaporin-4-IgG and Myelin Oligodendrocyte Glycoprotein-IgG
Autoimmune Neurology
S16 - Autoimmune Neurological Disorders: Diagnosis, Biomarkers, and Epidemiology (1:24 PM-1:36 PM)
003

To investigate the temporal evolution on MRI of myelitis lesions in multiple sclerosis (MS), aquaporin-4 (AQP4)-IgG autoimmunity, and myelin oligodendrocyte glycoprotein (MOG)-IgG-associated disorders (MOGAD).
The MRI evolution of myelitis lesions in MS, AQP4-IgG autoimmunity, and MOGAD is not well characterized.
We retrospectively identified Mayo Clinic patients with: 1) AQP4/MOG-IgG serum positivity (live cell-based assay) or MS (2017 McDonald criteria) at first clinical myelitis; and 2) spine MRI performed within 6 weeks of nadir and at ≥6 months follow-up. Patients with myelitis relapses before the follow-up MRI were excluded. The initial MRI was compared to the last available follow-up MRI before the second myelitis (if any) to determine lesion evolution/resolution.
Eighty-eight patients were included: AQP4-IgG, 35; MOGAD, 28; and MS, 25. Median age (range) at myelitis onset (AQP4-IgG, 55 [10-78]; MOGAD, 26 [5-74]; MS, 39 [28-60]) and female gender frequency (AQP4-IgG, 24/35 [69%]; MOGAD, 11/28 [39%]; MS, 20/25 [80%]) were lower among MOGAD patients; p<0.01. Median EDSS (range) at myelitis nadir was: AQP4-IgG, 6.5 [2-8]; MOGAD, 6.5 [3-8]; MS, 3 [0-7]; and at last follow-up was: AQP4-IgG, 3 [0-8]; MOGAD, 1 [0-7]; MS, 2 [0-7]. Follow-up MRI to assess for resolution was undertaken at a median of 22 (range, 6-201) months from initial myelitis. Complete resolution of T2-parenchymal abnormalities at that time was noted in 3/35 (9%) AQP4-IgG-positive, 20/28 (71%) MOGAD, and 2/25 (8%) MS patients (p<0.0001); and none of those with enhancing MRI lesions acutely (AQP4-IgG, 32/34 [94%]; MOGAD, 14/28 [50%]; MS, 19/23 [83%]; p=0.0002) showed persistent enhancement. Spinal cord atrophy occurred in 14/35 (40%) AQP4-IgG-positive, 3/28 (11%) MOGAD, and 6/25 (24%) MS patients (p=0.03), and was associated with need for a gait aid at last follow-up (p=0.03).

MOGAD myelitis lesions resolve to undetectable more frequently than MS and AQP4-IgG myelitis. These findings may have diagnostic and prognostic value.  
Authors/Disclosures
Elia Sechi, MD (University of Sassari)
PRESENTER 		Dr. Sechi has nothing to disclose.
Karl Krecke Karl Krecke has nothing to disclose.
Marina Buciuc, MD (MUSC) Dr. Buciuc has nothing to disclose.
Sean J. Pittock, MD, FAAN (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Arialys. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from NIH. The institution of Dr. Pittock has received research support from Alexion/AstraZeneka. The institution of Dr. Pittock has received research support from F. Hoffman/LaRoche/Genentech. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received publishing royalties from a publication relating to health care.
Brian G. Weinshenker, MD, FAAN (University of Virginia Health System) Dr. Weinshenker has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CANbridge Pharmaceuticals. Dr. Weinshenker has received personal compensation in the range of $0-$499 for serving as a Consultant for CALIBR. Dr. Weinshenker has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Horizon. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Group (Chugai, Genentech, Roche). Dr. Weinshenker has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB Pharmaceuticals. Dr. Weinshenker has received research support from Guthy Jackson Charitable Foundation. Dr. Weinshenker has received intellectual property interests from a discovery or technology relating to health care.
No disclosure on file
Nicholas L. Zalewski, MD (Mayo Clinic) Dr. Zalewski has nothing to disclose.
Eoin P. Flanagan, MBBCh, FAAN (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from Viela Bio. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities.