Optical coherence tomography in central nervous system demyelinating diseases related optic neuritis

AIM: To compare the thickness of the peripapillary retinal nerve fiber layer (RNFL) and ganglion cell-inner plexiform layer (GCIPL) among patients with various forms of optic neuritis (ON) and to identify whether any particular parameters or their thinning pattern can be used to distinguish the type of ON. METHODS: This prospective study was conducted at the Department of Ophthalmology, Faculty of Medicine, Siriraj Hospital, Thailand, between January, 2015 and December, 2016. We enlisted patients over 18 years of age with history of ON and categorized patients into 4 groups: 1) aquaporin 4 antibodies (AQP4-IgG) positive; 2) multiple sclerosis (MS); 3) myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) positive; 4) idiopathic-ON patients. Healthy controls were also included during the same study period. All patients underwent complete ophthalmological examination and spectral domain optical coherence tomography (OCT) imaging to analyze RNFL and GCIPL thickness after at least 3mo since the last episode of acute ON. The generalized estimating equation (GEE) models were used to compare the data amongst ON groups. RESULTS: Among 87 previous ON eyes from 57 patients (43 AQP4-IgG+ON, 17 MS-ON, 8 MOG-IgG+ON, and 19 idiopathic-ON), mean logMAR visual acuity of AQP4-IgG+ON, MS-ON, MOG-IgG+ON, and idiopathic-ON groups was 0.76±0.88, 0.12±0.25, 0.39±0.31, and 0.75±1.08, respectively. Average, superior, and inferior RNFL were significantly reduced in AQP4-IgG+ON, MOG-IgG+ON and idiopathic-ON eyes, relative to those of MS-ON. Differences were not statistically significant for RNFL or GCIPL between the AQP4-IgG+ON and MOG-IgG+ON groups, whereas visual acuity in MOG-IgG+ON was slightly, but not significantly, better (0.39 vs 0.76). Although RNFL thickness in MOG-IgG+ON was significantly reduced as compared to MS-ON, mean visual acuity and GCIPL were not different. CONCLUSION: Thinning of superior and inferior quadrants of RNFL are more commonly seen in MOG-IgG+ON and AQP4-IgG+ON. Long term visual acuity in MOG-IgG+ON is often better than AQP4-IgG+ON, whereas the structural change from OCT is comparable

Real-world data on the Immunity Response to the COVID-19 Vaccine among Patients with Central Nervous System Immunological Diseases

Objective: The effects of immunotherapies on the immune response to various regimens of SARS-CoV-2 vaccines in patients with autoimmune neurological disease have been demonstrated in limited data. Thus, we evaluated the immune responses in each platform of COVID-19 vaccination between patients with autoimmune neurological disease and a healthy population. Materials and Methods: We conducted a prospective observational study. We collected serum from patients with autoimmune neurological diseases to perform serological methods using anti-RBD IgG assay, neutralizing antibodies assay, and interferon SARS-CoV-2 immunoassay. Serological response level was analyzed by platforms of vaccines and types of immune modifying therapy. Results: Fifty-eight patients had tested for an anti-RBD IgG response, and those receiving no immunotherapy/ healthy controls had the highest median anti-RBD IgG levels amongst immunotherapy statuses. Rituximab in those who received inactivated or mRNA vaccine regimens had the lowest antibody level compared with other immunotherapies. In vector-based vaccine regimens, significant reductions of anti-RBD IgG response were observed in all other immunotherapy groups except for azathioprine, with the greatest difference seen compared to rituximab. Thirty-five patients with positive anti-RBD responses were further tested for neutralizing antibodies. The mRNA vaccine regimen demonstrated the highest inhibition percentage among the Delta and Omicron variants. Twentytwo patients were tested for T cell responses, with no significant difference in T-cell activity across all groups. Conclusion: We have demonstrated a significant decrease in antibody response against SARS-CoV-2 in patients with autoimmune neurological diseases receiving immunotherapies compared to a healthy population, especially for patients taking rituximab

Hemifacial Spasm Treated with Botulinum Toxin Injection : A Ten-Year Experience at Siriraj Hospital

Background : Hemifacial spasm is a common movement disorder in Thailand. Botulinum toxin has been introduced as an advanced treatment for this condition recently. Objective: To evaluate the efficacy and complication of botulinum toxin in the treatment of hemifacial spasm. Methods: We reviewed all files of patients with hemifacial spasm in the Movement Disorders Clinic at Siriraj Hospital, Mahidol University, who were treated with botulinum toxin injection from January 1989 until September 1999. Sex, age, duration of treatment, times of injection, treatment outcome, and complications were analyzed. Results: There were 913 patients of which 38 patients were excluded because they were lost to follow up. 875 patients were analyzed, (269 males, 606 females sex ratio 1:2.25). The mean age of all patients was 50.86 ± 12.53 years with a range of 18 to 81 years. The follow-up period ranged from 1-130 months (mean = 32.5 ± 35.05 months). The outcome were classified as excellent (improvement >50%) in 58.9%, good (improvement >25%) in 37.3%, fair (improvement 25%) was 96.2 percent. There were complications of mild facial paresis in 80 patients (9.1%), ptosis in 39 patients (4.5%), excessive lacrimation in 7 patients (0.8%), and others (including pain and itching at the injection sites and double vision) in 7 patients (0.8%). All of the complications ere transient. Conclusion: Botulinum toxin A injection is a safe and effective way with no long term systemic complications (of treating patients with hemifacial spasm)

Efficacy and safety of rituximab in multiple sclerosis and neuromyelitis optica spectrum disorder

Abstract In Thailand, resource limitations lead many multiple sclerosis (MS) and neuromyelitis optica spectrum disorder (NMOSD) patients to use off-label immunosuppressants. This study assesses the efficacy and safety of rituximab (RTX) with a CD19-based reinfusion regimen among Thai MS and NMOSD patients. A retrospective review of patients at the Faculty of Medicine Siriraj Hospital from January 1994 to April 2023 was conducted. The primary outcome assessed was the change in annualized relapse rate (ARR) for patients using RTX for over a year. Secondary outcomes included changes in the Expanded Disability Status Scale (EDSS) scores, time to the first relapse after RTX initiation for patients using RTX for over a year, and an evaluation of the safety of RTX. The study encompassed 36 MS and 39 NMOSD patients. A majority of patients (91.7% of MS and 79.5% of NMOSD) experienced no relapses during a median follow-up of 30 months (Interquartile range [IQR] 20–46) and 31 months (IQR 23–41), respectively. The median ARR significantly decreased in both MS (from 0.77 [IQR 0.42–1.83] to 0 [IQR 0–0], p < 0.001) and NMOSD (from 0.92 [IQR 0.68–1.78] to 0 [IQR 0–0.17], p < 0.001) patients after switching to RTX, with no difference between those following a fixed 6-month time point regimen and a CD19-based reinfusion regimen. Median EDSS scores improved significantly at the last follow-up visit in both groups. The mean time to the first subsequent relapse was 8.3 ± 3.0 months in MS and 6.8 ± 1.7 months in NMOSD. Mild adverse drug reactions occurred in 44% of patients. RTX effectively prevents relapses in Thai MS and NMOSD patients, with no observed serious adverse drug reactions

Fördert Atrazin den Fusarienbefall an Maiskolben?

In zweijährigen Feldversuchen an zwei Standorten wurde überprüft, ob Atrazin den Befall von Maiskolben mit Fusarien fördert. Das Herbizid wurde in einer Aufwandmenge von 1,4 kg/ha (reiner Witkstoff) eingesetzt. Eine Erhöhung des Befalls konnte nicht festgestellt werden. An Fusarienarten wurden von den Kolben am häufigsten isoliert: F. poae, F. moniliforme, F. graminearum, F. oxysporum und F. culmorum. Does atracine promote attack of corn-cobs by Fusaria? In two years of field trials at two localities it was investigated if atracine influences attack of corn-cobs by Fusaria. The herbicide was applied in a concentration of 1,4 kg/ha (active substance). No increase of attack was ascertained. The species of Fusaria most frequently isolates from cobs were: F. poae, F. moniliforme, F. graminearum, F. oxysporum and F. culmorum