Foreword: Since the beginning of the central nervous system autoimmune diseases such as multiple sclerosis (MS), optic nerve myelitis (NMO) and other demyelinating diseases have been more than 14 years, in the early days of learning with the teacher, I heard that some MS patients with DMT treatment after the effect is not good, some patients repeated recurrence, some even significantly aggravated. I was wondering, what is the reason? In the later independent diagnosis and treatment of patients has been cautious and careful, try to carefully do a good job in the diagnosis and differential diagnosis of each patient, the treatment process is also cautious medication, close follow-up, has always hoped to reduce errors as much as possible, hope to give patients the treatment plan even if ten or twenty years later to look back, should be the most optimized medical conditions at that time. After more than ten years of clinical practice-thinking-re-practice, I have more understanding and experience in the diagnosis and treatment of central nervous system immune diseases, so I opened my own WeChat public account, video number and central nervous system demyelinating lesion diagnosis and differential diagnosis live broadcast room, hoping to better convey my experience to my colleagues and patients and families, so that more people understand this rare disease, rare but not lonely!
Therefore, there is more understanding of why some MS patients have poor results after treatment with disease correction therapy (DMT) drugs, some patients have repeated relapses, and some have even significantly aggravated the problem. Today I will start with one of them, and that is the question of whether the diagnosis is correct or not.
I once met a child who was diagnosed with MS in a ** hospital many years ago and has been enrolled in the Terifluamine treatment group, and is about to prepare for medication, but because there are few MS patients in the ** hospital, the staff who manage Terifluamine recommend that the family bring the children to my outpatient clinic to see first and confirm it. After the children came to the clinic, I found that the children had seizures, obvious cognitive damage, there were indeed many lesions in the brain, some of which were demyelinating lesions, but some of the lesions were different from the classical MS, so the children drew blood to check the demyeling antibodies of the central nervous system, and the results suggested that the MOG antibodies were positive, so the diagnosis of the children was corrected to MOG antibody-related diseases, not MS, so the patient withdrew from the Terifluamine treatment group.
There have been summary reports abroad, and I have also shared in the previous public account article: MOG antibody-related diseases (MOGAD) patients with classic DMT treatment after the disease control effect is not good, and even aggravate the disease.
Recently, there are several central nervous system demyelinating lesions for the manifestation of MOGAD, there are long segment transverse myelitis, and there are 2 imaging manifestations of the same as MS, meeting the criteria for MS diagnosis of patients, just imagine, these two patients in the MOG antibody can not be detected, basically will be diagnosed with MS, according to MS treatment, using MS DMT treatment.
I'm going to share one of these examples with you today:
The patient, a 27-year-old woman, was admitted to the hospital for more than 20 days with numbness in the fingers of her right hand. The patient was confused for more than 20 days before admission, the right finger was tingled, the ulnar side of the 3 fingers was obvious, and the cervical vertebral magnetic resonance in the outer hospital suggested that the neck was 6 to 7 intramedullary, with a little peripheral edema, and the local central tube was slightly dilated. Cervical MRI enhancement after 2 days suggests a focal point of intranocular plaque in cervical 6 with significant strengthening, patchy shadow on the dorsal side of the brainstem, considering demyelinating lesions, and MS plaques in the acute phase may be. Improved Cranial MRI enhancement 11 days before admission suggests bilateral intraventricular leukoplast, bilateral frontal parietal lobe, callosum, peripal hippocampus, dorsal side of the brainstem, and left pontopid arm with multiple patchy or oval abnormal signals of varying sizes, Flair high signal, slightly enhanced signals of most DWI lesions, and poor boundaries. The imaging science is shown in the figure below:
According to the above imaging data, according to the conventional process, the patient's diagnosis first considers the demyelinating lesions of the central nervous system, and the clinical isolation syndrome (CIS) can be considered first, and the patient's future outcome may be multiple sclerosis. Special infectious diseases need to be ruled out, and of course, a special disease needs to be paid attention to, MOGAD. The patient's blood test serum central nervous system demyelinating antibody found THAT the MOG antibody 1:10 should be of diagnostic significance.
Introduction to MOG Antibody-Related Diseases (MOGAD):
Through the above examples, we should be able to easily understand why before the AQP4 antibody and MOG antibody can not be detected, some MOGAD patients were misdiagnosed as multiple sclerosis (MS), it is also easy to understand why the topic proposed, in fact, before the MOG antibody can not be detected, many MOGAD patients are misdiagnosed as optic neuromyelitis / optic nerve myelitis spectrum disease (NMO / NMOSD), with the advancement of science and technology and the general promotion of knowledge, More and more colleagues have a fuller understanding of the diagnosis and treatment of such diseases, and more patients benefit from it. I also hope that my sharing has been helpful to everyone.
Related Links:
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A "crossover" of encephalitis (2) – several cases to share
CNS Immunology Literature Review Series Ii: Unilateral Corticoencephalitis positive for MOG antibodies
The "antibody overlap case" of the central nervous system immune disease is widely discussed
Intimate lover "glucocorticoids", do you know her?
Unveiling series 2: unveiling the "ugly veil" of "cyclophosphamide"
Demystifying Series No. 3: The "Enlightened Zen Master" in Immunosuppressants
The fourth of the secret series: B-cell terminator - rituximab
One of the troikas to defeat meningitis: plasmapheresis/immunosorbent therapy
Introduction to multiple sclerosis disease and typical lesions
Typical lesions of multiple sclerosis
Inflammatory demyelinating pseudotumors
"Four diagnoses and two evaluations" of central nervous system immune diseases (latest updated version)
Dawn, not far away...
Love, let me be born again - remember the phoenix nirvana of a central nervous system vasculitis patient
One of the series: correct judgment, choose the right method, and do more with less
Series 2: Correct judgment, choose the right method, "to the point"
Series 3: Correct judgment, choose the right method, and make a quick decision
Adhere to the science of science, I hope that doctors and patients will take fewer detours, and the disease will be diagnosed and treated as soon as possible!
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Welcome to follow my WeChat public account (Dr. Zhao Guixian: cactus20150101) and video number (Dr. Zhao of Neurology) to get more popular science knowledge.
Zhao Guixian, Doctor of Clinical Medicine, graduated from the Clinical Medical College of Xi'an Jiaotong University in 2000. He graduated from Fujian Medical University in 2008 and has been working in the Department of Neurology of Huashan Hospital affiliated to Fudan University since 2008, working in the clinical frontline for a long time, specializing in "diagnosis and differential diagnosis of multiple lesions of the central nervous system", specializing in multiple sclerosis, optic nerve myelitis, central nervous system demyelinating lesions and other central nervous system immune diseases, while carrying out clinical and scientific research on multiple sclerosis (MS), and also has some of its own experience in peripheral neuropathy and neurogenetic degenerative diseases.
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