Publications by authors named "Ringelstein M"

Introduction: Very rarely, adult NMDAR antibody-associated encephalitis (NMDAR-E) leads to persistent cerebellar atrophy and ataxia. Transient cerebellar ataxia is common in pediatric NMDAR-E. Immune-mediated cerebellar ataxia may be associated with myelin oligodendrocyte glycoprotein (MOG), aquaporin-4 (AQP-4), kelch-like family member 11 (KLHL11), and glutamate kainate receptor subunit 2 (GluK2) antibodies, all of which may co-occur in NMDAR-E.

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Background: Recurrent attacks in neuromyelitis optica spectrum disorders (NMOSDs) or myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) can lead to severe disability. We aimed to analyse the real-world use of immunotherapies in patients with NMOSD and MOGAD, focusing on changes in treatment strategies, effects on attack rates (ARR) and risk factors for attacks.

Methods: This longitudinal registry-based cohort study included 493 patients (320 with aquaporin-4 immunoglobulin G (AQP4-IgG) seropositive NMOSD (65%), 44 with AQP4-IgG seronegative NMOSD (9%) and 129 MOGAD (26%)) with 1247 treatments from 19 German and one Austrian centre from the registry of the neuromyelitis optica study group (NEMOS).

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Objective: In this multicentric study, we were interested in the vision-related quality of life and its association with visual impairment in neuromyelitis optica spectrum disorders (NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) in comparison to multiple sclerosis (MS) and healthy controls.

Methods: We analysed extracted data from the German NEMOS registry including National Eye Institute Visual Function Questionnaire (NEI-VFQ) scores, high and low contrast visual acuity (HCVA, LCVA), visually evoked potentials (VEP) and the scores for the expanded disability status scale (EDSS) and other neurological tests which assessed their disease-related impairment. The mean follow-up time of our patients was 1.

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  • Patients with neuromyelitis optica spectrum disorder (NMOSD) often have antibodies against aquaporin-4 (AQP4), making MRI monitoring critical for understanding the disease's progression.
  • A retrospective study involved MRI data from 525 AQP4-IgG-seropositive NMOSD patients across 11 countries, focusing on the types and locations of lesions in the central nervous system.
  • Results showed a high prevalence of hyperintense lesions in the brain and significant patterns of myelitis in the spinal cord, emphasizing the importance of MRI in tracking this condition.
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Background: Incomplete attack remission is the main cause of disability in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). Apheresis therapies such as plasma exchange and immunoadsorption are widely used in neuroimmunology. Data on apheresis outcomes in MOGAD attacks remain limited.

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  • Cognitive impairment is a significant issue in myelin oligodendrocyte glycoprotein-IgG-associated disease (MOGAD), with a study showing that about 21.9% of patients experience cognitive deficits, particularly in mental flexibility and attention.
  • The study involved 32 MOGAD patients and analyzed clinical factors like age and previous relapses, finding that the overall number of relapses and past episodes of acute disseminated encephalomyelitis (ADEM) were linked to increased cognitive impairment risk.
  • MRI results indicated that patients with MOGAD had reduced white and deep gray matter volumes compared to healthy controls, highlighting potential neurological damage in this condition.
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  • Eculizumab (ECU) has shown effectiveness in preventing attacks in patients with aquaporin-4 (AQP4)-IgG seropositive neuromyelitis optica spectrum disorders (NMOSDs) during a retrospective analysis in clinical settings between 2014 and 2022.
  • A total of 52 patients were studied, with 88% being attack-free during treatment, and the annualized attack rate significantly decreased from 1.0 to 0.
  • While common side effects included serious infections, five patients died from various complications, indicating a need for careful monitoring during long-term ECU therapy.
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Background: Optic neuritis (ON) is a common manifestation of multiple sclerosis (MS) and myelin-oligodendrocyte-glycoprotein IgG-associated disease (MOGAD). This study evaluated the applicability of optical coherence tomography (OCT) for differentiating between both diseases in two independent cohorts.

Methods: One hundred sixty two patients from seven sites underwent standard OCT and high-contrast visual acuity (HCVA) testing at least 6 months after first ON.

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Background: Data on cognition in patients with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) are limited to studies with small sample sizes. Therefore, we aimed to analyse the extent, characteristics and the longitudinal course of potential cognitive deficits in patients with MOGAD.

Methods: The CogniMOG-Study is a prospective, longitudinal and multicentre observational study of 113 patients with MOGAD.

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Epstein-Barr virus (EBV) infection has long been associated with the development of multiple sclerosis (MS). MS patients have elevated titers of EBV-specific antibodies in serum and show signs of CNS damage only after EBV infection. Regarding CD8+ T-cells, an elevated but ineffective response to EBV was suggested in MS patients, who present with a broader MHC-I-restricted EBV-specific T-cell receptor beta chain (TRB) repertoire compared to controls.

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  • The study aimed to describe the clinical features of double-antibody seronegative neuromyelitis optica spectrum disorders (DN-NMOSD), focusing on how these disorders affect the retina.
  • Researchers analyzed data from 25 individuals with DN-NMOSD and compared it to those with aquaporin-4 antibody positive neuromyelitis optica (AQP4-NMOSD) and healthy controls, using optical coherence tomography (OCT) to assess retinal damage.
  • The findings revealed significant thinning of the retinal nerve fiber layer and ganglion cell layers in DN-NMOSD patients, even after just one optic neuritis episode, indicating severe retinal damage and neurodegeneration regardless of an ON history.
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  • Retinal optical coherence tomography (OCT) serves as a biomarker for tracking disease progression in relapsing-remitting multiple sclerosis (RRMS), although the changes in retinal layers for progressive MS remain uncertain.
  • Analyzing data from 195 RRMS, 87 secondary progressive MS (SPMS), 125 primary progressive MS (PPMS), and 98 control patients, researchers found that certain retinal layer thicknesses could predict relapses and MRI activity in various MS types.
  • However, the variability in measuring retinal thickness limits the effectiveness of longitudinal assessments for individual patients.
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  • Myelin oligodendrocyte glycoprotein antibody-associated encephalomyelitis (MOG-EM) is an important condition to differentiate from multiple sclerosis and neuromyelitis optica, with new diagnostic criteria emphasizing specific antibody testing.
  • This study evaluated the effectiveness of using MOG-IgG3-specific testing in addition to standard tests for detecting MOG antibodies in patients previously identified as having MOG-EM.
  • Results showed that MOG-IgG3 could improve the sensitivity of tests, as 52% of patients still displayed positive MOG-IgG3 results, indicating it may be a crucial subclass in diagnosing MOG-EM, despite its absence in healthy controls or
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Background: Susac syndrome (SuS) is a rare autoimmune disease that leads to hearing impairment, visual field deficits, and encephalopathy due to an occlusion of precapillary arterioles in the brain, retina, and inner ear. Given the potentially disastrous outcome and difficulties in distinguishing SuS from its differential diagnoses, such as multiple sclerosis (MS), our exploratory study aimed at identifying potential new SuS-specific neuroimaging markers.

Methods: Seven patients with a definite diagnosis of SuS underwent magnetic resonance imaging (MRI) at 7 Tesla (7T), including T2* weighted and quantitative susceptibility mapping (QSM) sequences.

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  • The study focused on understanding how disability accumulates in patients with neuromyelitis optica spectrum disorder (NMOSD) and myelin oligodendrocyte glycoprotein-antibody-associated disease (MOGAD), examining factors like disease duration, attack frequency, and age.* -
  • Data from 483 patients indicated that NMOSD patients reached significant disability milestones much sooner than MOGAD patients, despite similar attack rates; older age at symptom onset was linked to higher disability risk.* -
  • Overall, NMOSD and MOGAD exhibit different patterns of disability progression, with MOGAD being less severe, and recent research has enhanced awareness and treatment strategies, positively impacting patient outcomes.*
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Background And Objectives: Optical coherence tomography angiography (OCTA) is a noninvasive high-resolution imaging technique for assessing the retinal vasculature and is increasingly used in various ophthalmologic, neuro-ophthalmologic, and neurologic diseases. To date, there are no validated consensus criteria for quality control (QC) of OCTA. Our study aimed to develop criteria for OCTA quality assessment.

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Article Synopsis
  • - This manuscript offers practical advice for treating acute attacks and preventing future episodes of neuromyelitis optica spectrum disorders (NMOSD), an autoimmune disease that severely impacts the central nervous system, primarily affecting vision and mobility.
  • - The study highlights the importance of Aquaporin-4 immunoglobulin G antibodies (AQP4-IgG) as a key diagnostic marker and contributor to NMOSD, with recent advancements leading to four new approved preventive therapies: eculizumab, ravulizumab, inebilizumab, and satralizumab, which may replace older treatments.
  • - The Neuromyelitis Optica Study Group (NEMOS) presents a consensus on current NMOSD therapies and practical
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Importance: Differential diagnosis of patients with seronegative demyelinating central nervous system (CNS) disease is challenging. In this regard, evidence suggests that immunoglobulin (Ig) A plays a role in the pathogenesis of different autoimmune diseases. Yet little is known about the presence and clinical relevance of IgA antibodies against myelin oligodendrocyte glycoprotein (MOG) in CNS demyelination.

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Article Synopsis
  • The term 'neuromyelitis optica spectrum disorders' (NMOSD) encompasses several related conditions, including aquaporin-4 immunoglobulin G (AQP4-IgG)-positive neuromyelitis optica (NMO) and other syndromes lacking AQP4-IgG.
  • NMOSD is now recognized as a distinct disorder, separate from multiple sclerosis (MS), due to differences in their causes, clinical presentation, treatments, and outcomes.
  • The article series includes updated guidelines for diagnosing NMOSD and differentiating it from similar conditions, such as MOG antibody-associated diseases, as well as recommendations for the latest treatment options available.
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Introduction: We sought insights into neuromyelitis optica spectrum disorder (NMOSD) treatment practices worldwide.

Methods: Neurologists from the USA, Germany, Italy, Brazil, South Korea, and China completed an online survey, contributing clinical records for aquaporin-4 (AQP4) immunoglobulin G (IgG)-seropositive adults with NMOSD, which included patient demographics, diagnosis, maintenance treatment history, relapse occurrence, and severity. Interviewed patients receiving NMOSD maintenance therapy provided information about their diagnosis, treatment, perceptions about relapse severity or disease stability, and treatment switches.

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Introduction: We sought insights into the classification of and factors associated with relapse severity and disease stability in neuromyelitis optica spectrum disorder (NMOSD) clinical practice worldwide.

Methods: Neurologists recruited from six countries (the USA, Germany, Italy, Brazil, South Korea, and China) participated in a 30-60 minute online survey and submitted two to four clinical records for aquaporin-4-immunoglobulin G (AQP4-IgG)-seropositive adults with NMOSD, which included patient demographics, diagnosis, maintenance treatment history, relapse occurrence, and severity. Separately, patients with NMOSD receiving maintenance therapy were interviewed over the telephone about their treatment journey, as well as perceptions of relapse severity and disease stability, and their potential influence on treatment decisions.

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Article Synopsis
  • The study investigates the effectiveness of intereye differences (IED) in optical coherence tomography (OCT) parameters to diagnose optic neuritis (ON) in patients with aquaporin-4 antibody seropositive neuromyelitis optica spectrum disorders (AQP4+NMOSD).
  • It compares OCT data from AQP4+NMOSD patients who had unilateral ON more than six months prior with healthy controls and other AQP4+NMOSD patients without ON, measuring both absolute and percentage differences in retinal thickness.
  • The findings show high accuracy for using IED metrics in diagnosing ON in AQP4+NMOSD, indicating that these OCT parameters could improve diagnostic criteria for this condition.
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