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Several case studies which include a 43‑year‑old non‑diabetic non‑hypertensive gentleman with recurrent attacks of optic neuritis, hemiparesis and incoordination; and a 28‑year‑old right‑handed gentleman was diagnosed with a case of beta thalassemia major, is presented. Topics include Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) with associated non‑neurological manifestations; and Direct Immunofluorescence showed glomerular deposition and negative for any complement deposition.

The article reports that Myelin oligodendrocyte glycoprotein‑associated disorder (MOGAD) is an autoimmune oligodendrocytopathy, whereas neuromyelitis optica spectrum disorder (NMOSD) is an autoimmune astrocytopathy. Topics include Cell‑based assay shows strong immunofluorescence to aquaporin and myelin oligodendrocyte protein in the serum tested on transfected cell lines; and enhancement in the medial temporal lobe following contrast administration Coronal FLuid Attenuated Inversion Recovery.

The article presents the discussion on Multiple sclerosis (MS) being a CNS (central nervous system) demyelinating autoimmune neurodegenerative disorder. Topics include MS emphasizing on the clinical and radiological features for the diagnosis of MS with an emphasis for excluding other alternative diagnosis or MS mimic; and studying the prevalence of the autoimmune disorders, autoantibodies, and the significance.

Background: Co-occurrence of other autoimmune disorders (AID) and autoantibodies in patients with autoimmune demyelinating CNS disorders have not been studied previously in patients of Indian origin. Objective: To determine the frequency of concomitant autoimmune disorders, anti-nuclear antibody (ANA) and antithyroid antibody (ATAb) and to evaluate the impact on clinical course of disease. Materials and Methods: A total of 111 patients with MS and 152 patients with non-MS demyelinating disorders were included. Demographics, clinical course and disability were recorded. History of other autoimmune disorders (AIDs) in patients and first degree relatives was noted. Serum ANA and ATAb were tested. Results: Concomitant AIDs were seen in 21% of MS and 19% of non-MS patients. Autoimmune thyroid disease was most frequent and seen in 10.8% of MS and 6.6% of non-MS disorders. Frequency of ATAb was significantly higher among MS group (MS 25.5% vs non-MS 13.2% P = 0.04) but that of ANA was similar between the 2 groups (MS 19.8% vs non-MS 26.9% P = 0.17). A positive family history of autoimmune disorders was noted in 20% of MS and 15.1% of non-MS disorders. Clinical course was unaffected by presence of concomitant AID and autoantibodies. Conclusion: Cooccurrence of autoantibodies and AID are seen in a significant number of patients with MS and non-MS disorders and influences clinical management. [ABSTRACT FROM AUTHOR]

Background: Rituximab, an anti-CD20 monoclonal antibody, has been used worldwide as an off-label therapy in patients with multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Objective: The aim of the present study was to evaluate the efficacy and safety of rituximab in central nervous system demyelinating disorders in the Indian context. Methods: We conducted a retrospective analysis of patients with MS, NMOSD, and myelin oligodendrocyte glycoprotein antibody disease (MOGAD) who were treated with rituximab at a single tertiary care centre in Mumbai. Results: The study enrolled 102 patients (61 MS, 37 NMOSD and 4 MOGAD) from June 2008 to January 2020. Following rituximab therapy, 96.7% of MS, 67% of NMOSD, and 50% of MOGAD patients were free of relapses. The mean annualized relapse rate reduced from 2.17 to 0 for patients with relapsing remitting MS (RRMS), from 0.8 to 0 for secondary progressive MS (SPMS), from 2.5 to 0.14 for NMOSD, and from 3.43 to 1.04 for MOGAD. The median expanded disability status scale improved significantly in RRMS patients, worsened non-significantly in the SPMS group, and remained unchanged in NMOSD and MOGAD patients. On follow-up magnetic resonance imaging, there was a significant reduction in the number of MS patients developing new contrast enhancing lesions or new T2 lesions. Adverse events (infusion reactions or severe infections) occurred in 12 patients. Conclusion: Rituximab is effective and safe in Indian patients with MS and NMOSD. [ABSTRACT FROM AUTHOR]

The article presents the discussion on demyelinating diseases of the CNS and classified patients into multiple sclerosis (MS). Topics include central nervous system (CNS) autoimmune and demyelinating diseases known to be associated with systemic autoimmune diseases; and MS patients having an increased risk of rheumatoid arthritis, psoriasis, thyroid diseases, ankylosing spondylitis, dermatomyositis.

Objective: This is a retrospective chart review of consecutive children with acquired demyelinating disorders presenting to a north Indian tertiary care hospital over 4 years. The aim of this review is to describe all the patients (with single event as well as those with recurrences) with detailed description of those who recurred. Materials and Methods: Overall 35 cases were reviewed and their clinical presentations, diagnosis, management, and follow-up are being presented. Results: Out of 35 cases, 24 did not show any recurrences (seven acute disseminated encephalomyelitis (ADEM) and 17 clinically isolated syndromes). Amongst the 11 patients with recurrent demyelination, majority were multiple sclerosis (8/11, 72.7%) followed by neuromyelitisoptica (NMO; 2/11), and multiphasic ADEM (1/11). The median disease duration and follow-up since onset for those with recurrent episodes is 4 years (2.5-4.5 years). Steroids caused significant improvement in acute episodes of demyelination. However, recurrent demyelinating disorders like multiple sclerosis and NMO required long-term immunomodulation. Azathioprine currently is the most favored long-term immunomodulator used in NMO. Interferon-β and glatiramer acetate are currently recommended for multiple sclerosis. However, azathioprine may be a suitable alternative in a resource-limited setting. Conclusion: The consensus definitions for these groups of disorders need further validation in the pediatric age group. Studies with larger population size are required to characterize features that predict future recurrences. [ABSTRACT FROM AUTHOR]