RESUMEN
OBJECTIVE: Antibodies against Myelin Oligodendrocyte glycoprotein (MOG-Ab) have been investigated as potential biological marker for neuromyelitis optica (NMO) and high-risk syndromes (HR) negative for AQP4-Ab in populations with different ethnic background. We tested AQP4 and MOG antibodies in a Brazilian population with high African ethnic background. METHOD: The study population was composed of adult patients from Rio de Janeiro with inflammatory demyelinating diseases (new and old cases). Blood samples were sent blindly to test the AQP4 and MOG antibodies by CBA. The frequency of positive MOG-Ab was estimated in the NMOHR and the NMO spectrum disorders (NMOSD). A systematic review with meta-analysis assessed the frequency of MOG-Ab in Caucasians and non-Caucasians. RESULTS: 200 adult patients (52% Afro-Brazilian) 115 of them with NMOHR were tested. MOG antibodies were found in 5/68 negative cases of AQP4-Ab negative (7%). The criteria for NMOSD were fulfilled by 70 patients with NMOHR and none of them was positive for MOG-Ab. A low prevalence of MOG antibodies and a predominant phenotype of bilateral Optic Neuritis were found in most non-Caucasian patients. CONCLUSION: The low frequency of MOG Ab in patients from Rio de Janeiro and in other non-Caucasian populations suggests a racial/ancestral influence.
Asunto(s)
Autoanticuerpos/sangre , Enfermedades Desmielinizantes/sangre , Enfermedades Desmielinizantes/etnología , Etnicidad , Glicoproteína Mielina-Oligodendrócito/inmunología , Adolescente , Adulto , Anciano , Acuaporina 4/inmunología , Brasil/etnología , Niño , Enfermedades Desmielinizantes/diagnóstico por imagen , Enfermedades Desmielinizantes/epidemiología , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estadísticas no Paramétricas , Adulto JovenRESUMEN
UNLABELLED: Clinically isolated syndrome may reflect the first symptom of Multiple Sclerosis. Though more prevalent in Caucasians, MS can also affect Afrodescendts. Modifying disease drugs can delay convertion to clinically defined multiple sclerosis, therefore, identify patients at a higher risk of convertion is important. However data of risk factors in racially mixed population are scarce. OBJECTIVES: To analyze predictor factors to the conversion from CIS to CDMS in a mixed race Brazilian cohort. PATIENTS AND METHODS: It is a prognostic observational retrospective study, in 122 patients from MS referential center at Hospital da Lagoa, Rio de Janeiro-Brazil. Demographic and clinical features, as well as MRI and cerebrospinal fluid data were analyzed. RESULTS: After five years follow-up 87.3% converted to CDMS. Regarding to median time of conversion, there was no difference between gender, race, age at onset, mono or polysymptomatic presentation. Cerebellar CIS significantly reduced time to second event; likewise sphincter impairment. Considering DMD, patients without treatment converted earlier. CONCLUSION: Ancestry did not influence conversion risk. Cerebellar and shpincter impairment as well as MRI criteria both Barkhof/Tintoré and Swanton were important predictors. In future studies it should be also analysed the risk factors of progression in mixed race populations.
Asunto(s)
Enfermedades Desmielinizantes/epidemiología , Progresión de la Enfermedad , Esclerosis Múltiple/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Niño , Enfermedades Desmielinizantes/etnología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Esclerosis Múltiple/etnología , Factores de Riesgo , Adulto JovenRESUMEN
BACKGROUND: In 2005, the McDonald MRI criteria for dissemination in space were revised to improve diagnosis of multiple sclerosis (MS) in non-Caucasians. METHODS: We included patients with a first clinically isolated syndrome (CIS) to assess their performance in the Afro-Caribbean population. Baseline brain and spine MRI examinations were available within 3 months after onset of CIS. The development of a second clinical event was used as the main outcome indicating clinically definite MS. RESULTS: A total of 66 patients (52F/14M) were included between January 1998 and January 2008 (mean age: 34.7; median follow-up: 34 months). CIS was classified as spinal cord (30.3%), optic neuritis (28.8%), brainstem (24.2%), multiregional (10.6%), hemispheric (4.5%), or undetermined (1.5%). Overall conversion rate was 42.4% (median: 11 months). The McDonald criteria revised for dissemination in space were fulfilled in 33.3% (sensitivity: 0.39 (+/-0.18); specificity: 0.66 (+/-0.15), positive predictive value: 0.46 (+/-0.20), negative predictive value: 0.60 (+/-0.15). CONCLUSION: The Afro-Caribbean population is characterized by a strong proportion of CIS in the spinal cord and a lower burden of disease on the baseline brain MRI. This may explain the low sensitivity of the 2005 McDonald criteria for dissemination in space. Further prospective studies emphasizing MRI spinal cord features are needed to improve diagnostic criteria in a population of African descent.