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ObjectiveWe characterised the clinical course, treatment and outcomes in 59 patients with relapsing myelin oligodendrocyte glycoprotein (MOG) antibody-associated demyelination.MethodsWe evaluated clinical phenotypes, annualised relapse rates (ARR) prior and on immunotherapy and Expanded Disability Status Scale (EDSS), in 218 demyelinating episodes from 33 paediatric and 26 adult patients.ResultsThe most common initial presentation in the cohort was optic neuritis (ON) in 54% (bilateral (BON) 32%, unilateral (UON) 22%), followed by acute disseminated encephalomyelitis (ADEM) (20%), which occurred exclusively in children. ON was the dominant phenotype (UON 35%, BON 19%) of all clinical episodes. 109/226 (48%) MRIs had no brain lesions. Patients were steroid responsive, but 70% of episodes treated with oral prednisone relapsed, particularly at doses <10 mg daily or within 2 months of cessation. Immunotherapy, including maintenance prednisone (P=0.0004), intravenous immunoglobulin, rituximab and mycophenolate, all reduced median ARRs on-treatment. Treatment failure rates were lower in patients on maintenance steroids (5%) compared with non-steroidal maintenance immunotherapy (38%) (P=0.016). 58% of patients experienced residual disability (average follow-up 61 months, visual loss in 24%). Patients with ON were less likely to have sustained disability defined by a final EDSS of ≥2 (OR 0.15, P=0.032), while those who had any myelitis were more likely to have sustained residual deficits (OR 3.56, P=0.077).ConclusionRelapsing MOG antibody-associated demyelination is strongly associated with ON across all age groups and ADEM in children. Patients are highly responsive to steroids, but vulnerable to relapse on steroid reduction and cessation.

Fingolimod ist ein oral einzunehmender Modulator des Sphingosin-1-Phosphat-(S1P-)Rezeptors und die erste orale Therapie für schubförmige multiple Sklerose. Als Komplikation tritt bei einem geringen Anteil der Patienten ein zystoides Makulaödem auf, meist in den ersten 3 Monaten nach Therapiebeginn. Wir berichten hier über den Fall eines 34-jährigen männlichen Patienten mit schubförmiger multipler Sklerose, bei dem an Tag 5 der Behandlung mit Fingolimod eine akute Uveitis anterior auftrat. Entsprechende Behandlungsmaßnahmen und Absetzen des Arzneimittels zeigten zunächst Wirkung, im weiteren Verlauf entwickelte sich jedoch eine geringgradige chronische Uveitis anterior ohne zystoides Makulaödem. Wir diskutieren mögliche Entstehungsmechanismen der Uveitis in dieser Patientengruppe. Bei Patienten, die mit Fingolimod behandelt werden und bei denen innerhalb von 5 Tagen nach Behandlungsbeginn Schmerzen und Rötung des Auges auftreten, wird eine sofortige augenärztliche Untersuchung empfohlen. Übersetzung aus Case Rep Ophthalmol 2016;7:284-288 (DOI: 10.1159/000453392)

There is neither lake nor river in Columbus, New Mexico, now nor was there on March 9, 1916, when it was raided by Mexican bandits. The muddied waters are those of history as the events that took place over 59 years ago are almost as cloudy today as the day they occurred. Many questions about the raid remain unanswered: Was Pancho Villa at Columbus? If so, did he enter the town? How many Mexicans took part in the raid? However, the question that has concerned the amateur and professional historian of Mexico, the United States, and Germany is why did the raid take place? What was the greater importance of the raid? Most of these questions cannot be adequately answered without an examination of the political and military career of Francisco Villa, the recent and contemporary American viewpoint of Villa, and some salient events that preceded March 9, 1916.