Clinical, Demographic, and Radiological Characteristics of Patients Demonstrating Antibodies Against Myelin Oligodendrocyte Glycoprotein

Background: Optic neuritis, myelitis, and neuromyelitis optica spectrum disorder (NMOSD) have been associated with antibodies against myelin oligodendrocyte glycoprotein-immunoglobulin G (anti-MOG-IgG). Furthermore, patients with radiological and demographic features atypical for multiple sclerosis (MS) with optic neuritis and myelitis also demonstrate antibodies against aquaporin-4 and anti-MOG-IgG. However, data on the diagnosis, treatment, follow-up, and prognosis in patients with anti-MOG-IgG are limited. Aims: To evaluate the clinical, radiological, and demographic characteristics of patients with anti-MOG-IgG. Study Design: Multicenter, retrospective, observational study. Methods: Patients with blood samples demonstrating anti-MOG-IgG that had been evaluated at the Neuroimmunology laboratory at Ondokuz Mayis University's Faculty of Medicine were included in the study. Results: Of the 104 patients with anti-MOG-IgG, 56.7% were women and 43.3% were men. Approximately 2.4% of the patients were diagnosed with MS, 15.8% with acute disseminated encephalomyelitis (ADEM), 39.4% with NMOSD, 31.3% with isolated optic neuritis, and 11.1% with isolated myelitis. Approximately 53.1% of patients with spinal involvement at clinical onset demonstrated a clinical course of NMOSD. Thereafter, 8.8% of these patients demonstrated a clinical course similar to MS and ADEM, and 28.1% demonstrated a clinical course of isolated myelitis. The response to acute attack treatment was lower and the disability was higher in patients aged > 40 years than patients aged < 40 years at clinical onset. Oligoclonal band was detected in 15.5% of the patients. Conclusion: For patients with NMOSD and without anti-NMO antibodies, the diagnosis is supported by the presence of anti-MOG-IgG. Furthermore, advanced age at clinical onset, Expanded Disability Status Scale (EDSS) score at clinical onset, spinal cord involvement, and number of attacks may be negative prognostic factors in patients with anti-MOG-IgG.

The role of oligoclonal band count and IgG index in treatment response and disease activity in multiple sclerosis.

BACKGROUND/AIM: Multiple sclerosis (MS) is an inflammatory demyelinating central nervous system (CNS) disease. Among the paraclinical tests, brain and spinal Magnetic Resonance Imaging (MRI) is primarily involved in the diagnosis process, and cerebrospinal fluid (CSF) analysis is fundamental in diagnosing MS and the differential diagnosis. A positive relationship was demonstrated between oligoclonal band (OCB) positivity, CSF band number and immunoglobulin G(IgG) index. The study aimed to evaluate whether the number of OCB can predict disease activity and determine a correlation with the IgG index. METHODS: Our study included 401 MS patients who had relapsing-remitting multiple sclerosis (RRMS), primary progressive multiple sclerosis (PPMS), secondary progressive multiple sclerosis (SPMS), clinic isolated syndrome (CIS), radiologic isolated syndrome (RIS), Neuromyelitis optica spectrum disorder (NMOSD) and Acute disseminated encephalomyelitis (ADEM) with OCB number groups of 2-4, 4-8, 8-12, and 12 and above. RESULTS: No significant correlation was observed between IgG index, pre-and post-treatment EDSS (Expanded Disability Status Scale Scores) and disease-modifying therapies (DMT). Drug response was better in the patient group with band number between 2 and 8 and post-treatment EDSS scores were lower (1.62±0.44). CONCLUSION: The study results suggested that band number may be as valuable as the IgG index and a predictive biomarker for disease activity.

Ocular Flutter-Myoclonus-Ataxia Syndrome After mRNA BNT162b2 COVID-19 Vaccine: A Case Report.

Ocular flutter (OF) is a rare oculomotor syndrome. The most common etiologies are paraneoplastic, postinfectious and toxic-metabolic. However post-vaccinal etiology was rarely reported in OF. Here, we reported a post-vaccinal clinical syndrome characterized by OF-myoclonus and ataxia associated with oligoclonal bands (OCBs). A 60-year-old male who presented with dizziness, unsteady gait, involuntary movements, involuntary conjugate eye oscillations and extremity jerks that started 3 days after the second dose of mRNA BNT162b2 Covid-19 vaccine. Routine biochemical and serological analysis were within normal limits. No pathological finding was detected in brain MRI. Paraneoplastic and autoimmune encephalitis tests were unremarkable in cerebrospinal fluid (CSF). Oligoclonal bands were positive in CSF. This is the first description of the relationship between vaccines against SARS-CoV-2 and the clinical syndrome of OF, Myoclonus and Ataxia (OFMAS). Humoral immune mechanisms seem to play an important role in OFMAS. Presence of OCBs in CSF may also be associated with this condition.

Blood biomarkers in acute ischemic stroke: The prognostic value of neutrophil-to-lymphocyte ratio and mean platelet volume.

BACKGROUND: The neutrophil-to-lymphocyte ratio (NLR) and mean platelet volume (MPV) reflect systemic inflammation, which plays an important role in the process of treating ischemic strokes. Few studies have evaluated the association between blood biomarkers and clinical outcomes in ischemic strokes in intensive care units (ICUs). OBJECTIVES: This retrospective study aims to explore the relationship between blood biomarkers and the clinical outcomes of acute ischemic stroke (AIS) patients. MATERIAL AND METHODS: Basic descriptive statistics of the patients admitted to the ICU with the diagnosis of AIS according to sociodemographic, clinical and laboratory findings were collected. Receiver operating characteristic (ROC) curve analysis was used to determine the cutoff point for NLR and MPV variables based on the diagnosis in statistical analyses and crosstab analyses of variables. The χ2 and Fisher's exact tests were used to assess the statistical relationship between categorical variables. In addition, the odds ratio (OR) was utilized to show the strength of the relationship between the categorical NLR, MPV and modified Rankin Scale (mRS) variables. Finally, the Mann-Whitney U test was used to compare the medians of 2 independent groups. RESULTS: A total of 1,379 records were identified in the database search. Eighty-seven patients who met the inclusion criteria and were hospitalized in the ICU were included in the study. The optimal cutoff point was determined to be 4.0 for NLR and 9.0 for the MPV. A statistically significant relationship was found between high medians of the NLR and the MPV and unfavorable functional outcomes using a 5% significance level (p < 0.001 and p < 0.001, respectively). CONCLUSIONS: We showed that the NLR and MPV are associated with stroke severity, unfavorable functional outcomes and mortality in AIS. These findings provide new insights into the mechanisms and treatment strategies of AIS. The results show that these accessible values can be used as independent predictive biomarkers.

Miller Fisher Syndrome Associated With COVID-19: A History of Molecular Mimicry and an Up-to-Date Review of the Literature.

Miller Fisher syndrome (MFS) was first recognized by Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the SARS-CoV-2 pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 24 cases, including four children associated with MFS, had been reported. This current review aimed to present the basic clinical and laboratory characteristics of patients with MFS and coronavirus disease-2019 (COVID-19). Since 2020, cases with different age and gender characteristics have been reported from eight different countries. Most cases were reported from Europe. SARS-CoV-2 infection was confirmed in seven of the cases. The youngest case reported was a 6-year-old boy from Turkey, while the oldest case was a 70-year-old female from Spain. All these reported cases and our past medical knowledge of MFS suggest that molecular mimicry is the main immunological mechanism. Despite all these data, more case reports, cohorts, and case-control studies will be needed to clarify the relationship between MFS and COVID-19.

Miller Fisher Syndrome Associated With COVID-19: A Child Case Report and an Up-to-Date Review of the Literature.

Miller Fisher Syndrome (MFS) was first recognized by James Collier in 1932 as a clinical triad of ataxia, areflexia, and ophthalmoplegia. In 1956, three cases with this triad were published by Charles Miller Fisher as a limited variant of Guillian-Barré syndrome (GBS), and the disease started to be called by his name. Since the beginning of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, there have been many reports of peripheral and central nervous system involvement. Until December 2022, a total of 23 cases including two children associated with MFS had been reported. In this article, we present a case of SARS-CoV-2 with classic triad clinical findings, which started with the atypical clinic at an early age. Electrophysiological studies of the case were found to be consistent with sensory axonal polyneuropathy. AntiGQ1b antibody IgG and IgM were negative. The case was spontaneously remitted without IV immunoglobulin (IVIg) or plasma exchange (PE) treatment. A current review of the literature is presented with the smallest pediatric case reported. Based on this case, it was planned to emphasize the targets and highlights in the diagnostic parameters.

The cooling effect on proinflammatory cytokines interferon-gamma, tumor necrosis factor-alpha, and nitric oxide in patients with multiple sclerosis.

Multiple sclerosis (MS) is the most common inflammatory demyelinating disease of the central nervous system (CNS) in young adults. The proinflammatory cytokines such as interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), and nitric oxide (NO) which are known to be produced by inflammatory cells play a key role in the pathogenesis of MS. Some metabolic changes may have an effect on axonal transmission, and white blood cells NO and other inflammatory mediators such as cytokines may be affected from cooling process. In this study, we evaluated the effects of body cooling procedure on proinflammatory cytokines such as TNF-α, IFN-γ, and NO levels. Twenty patients with MS were evaluated. Thirteen of the patients were women, 7 were men (mean age: 33.6 ± 7.5 yrs.). Body temperature was reduced by an average of 1°C approximately in 1 hour with using the "Medivance Arctic Sun Temperature Management System" device. In our study, the decrease in TNF-α, IFN-γ levels after the cooling procedure has no statistical significance, whereas the decrease in the mean level of NO level after the cooling procedure is 4.63 ± 7.4 µmol/L which has statistical significance (P = 0.002). These results suggested that the decrease in NO level improves conduction block in demyelinated axonal segments after cooling procedure in multiple sclerosis.