Insufficient treatment of severe depression in neuromyelitis optica spectrum disorder

Neurol Neuroimmunol Neuroinflamm December 2016 vol. 3 no. 6 e286

In this just published study we investigated depressive symptoms and their current treatment in patients with neuromyelitis optica spectrum disorders in a collaboration with colleagues from Johns Hopkins University in Baltimore, MD, USA.

Abstract

Objective: To investigate depression frequency, severity, current treatment, and interactions with somatic symptoms among patients with neuromyelitis optica spectrum disorder (NMOSD).

Methods: In this dual-center observational study, we included 71 patients diagnosed with NMOSD according to the International Panel for NMO Diagnosis 2015 criteria. The Beck Depression Inventory (BDI) was classified into severe, moderate, or minimal/no depressive state category. We used the Fatigue Severity Scale to evaluate fatigue. Scores from the Brief Pain Inventory and the PainDETECT Questionnaire were normalized to estimate neuropathic pain. Psychotropic, pain, and immunosuppressant medications were tabulated by established classes.

Results: Twenty-eight percent of patients with NMOSD (n = 20) had BDI scores indicative of moderate or severe depression; 48% of patients (n = 34) endorsed significant levels of neuropathic pain. Severity of depression was moderately associated with neuropathic pain (r = 0.341, p < 0.004) but this relationship was confounded by levels of fatigue. Furthermore, only 40% of patients with moderate or severe depressive symptoms received antidepressant medical treatment. Fifty percent of those treated reported persistent moderate to severe depressive symptoms under treatment.

Conclusions: Moderate and severe depression in patients with NMOSD is associated with neuropathic pain and fatigue and is insufficiently treated. These results are consistent across 2 research centers and continents. Future research needs to address how depression can be effectively managed and treated in NMOSD.

Afferent Visual Pathway Affection in Patients with PMP22 Deletion-Related Hereditary Neuropathy with Liability to Pressure Palsies.

PLoS ONE 0.1 371/journ al.pone.0164 617

Abstract

Background: The PMP22 gene encodes a protein integral to peripheral myelin. Its deletion leads to hereditary neuropathy with liability to pressure palsies (HNPP). PMP22 is not expressed in the adult central nervous system, but previous studies suggest a role in CNS myelin development. The objective of this study was to identify potential structural and functional alterations in the afferent visual system in HNPP patients.

Methods: Twenty HNPP patients and 18 matched healthy controls (HC) were recruited in a cross-sectional study. Participants underwent neurological examination including visual acuity, visual evoked potential (VEP) examination, optical coherence tomography (OCT), and magnetic resonance imaging with calculation of brain atrophy, regarding grey and white matter, and voxel based morphometry (VBM), in addition answered the National Eye Institute’s 39-item Visual Functioning Questionnaire (NEI-VFQ). Thirteen patients and 6 HC were additionally examined with magnetic resonance spectroscopy (MRS).

Results: All patients had normal visual acuity, but reported reduced peripheral vision in comparison to HC in the NEI-VFQ (p = 0.036). VEP latency was prolonged in patients (P100 = 103.7±5.7 ms) in comparison to healthy subjects (P100 = 99.7±4.2 ms, p = 0.007). In OCT, peripapillary retinal nerve fiber layer thickness RNFL was decreased in the nasal sector (90.0±15.5 vs. 101.8±16.5, p = 0.013), and lower nasal sector RNFL correlated with prolonged VEP latency (Rho = -0.405, p = 0.012). MRS revealed reduced tNAA (731.4±45.4 vs. 814.9±62.1, p = 0.017) and tCr (373.8±22.2 vs. 418.7±31.1, p = 0.002) in the visual cortex in patients vs. HC. Whole brain volume, grey and white matter volume, VBM and metabolites in a MRS sensory cortex control voxel did not differ significantly between patients and HC.

Conclusion: PMP22 deletion leads to functional, metabolic and macro-structural alterations in the afferent visual system of HNPP patients. Our data suggest a functional relevance of these changes for peripheral vision, which warrants further investigation and confirmation.

New NIC schedule for Winter Term 2016/2017

Dear all,

our new schedule for our Neuroimmunology Colloquium (NIC) for this year’s winter term is final and available on this website.

We have put together an exciting mix from local, national and international speakers to give you a current update on topics in the context of our neuroimmunological research.

Hope to see you every Monday at 2 pm Charité Mitte Campus – Universitätsmedizin Berlin Ferdinand Sauerbruch Hörsaal 4, Hufelandweg 6.

The NIC will be part of the official teaching curriculum at Charité. Additional CME certification is pending.

NIC Winter 2016/2017 Schedule as PDF

October 17th Alexander Brandt, MD

NeuroCure Clinical Research Center, Charitè – Universitätsmedizin Berlin

Imaging Autoimmunity in the Central Nervous System

October 24th Charles Guttmann, MD

Center for Neurological Imaging, Harvard Medical School, Boston USA

International Platform for MRI Data Sharing

November 7th Tanja Schmitz-Hübsch, MD

Department of Neurology, Charitè – Universitätsmedizin Berlin

Motor Function of the Upper Limb: KINECT in Multiple Sclerosis

November 14th Martina Minnerop, MD

Institute for Neuroscience and Medicine, Jülich Germany

MR Morphometry in Cerebellar Ataxia

November 21th Doktorand Lunch Series

Julian Pohlan, Niesner Lab

Laura Pastura, Paul Lab

Bimala Malla, Infante-Duarte Lab

November 28th Klemens Ruprecht, MD

Department of Neurology, Charitè – Universitätsmedizin Berlin

Autoimmune Diseases of the CNS: Differential Diagnosis

December 5th Helena Radbruch, MD

Department of Neuropathology, Charitè – Universitätsmedizin Berlin

Role of B Cells and Antibody Producing Cells in Chronic Neuroinflammation

December 12th Michael Hoffmann, MD

University Eye Clinic, Otto von Guericke University, Madgeburg Germany

Electrophysiology of Visual Dysfunction

January 9th Velina Chavarro

NeuroCure Clinical Research Center, Charitè – Universitätsmedizin Berlin

Cognitive Function in Demyelinating Diseases

January 16th Doktorand Lunch Series

Silvina Romero, Infante-Duarte Lab

Frederike Oertel, Paul Lab

Karolin Pollok, Radbruch Lab

January 23rd Volker Siffrin, MD

Max-Delbrück-Centrum for Molecular Medicine, Berlin

Introduction to Basic Science – Neuroimmunology

January 30th Friedemann Paul, MD

Department of Neurology, Charitè – Universitätsmedizin Berlin

Pitfalls of Translational Research in Neuroimmunology – from Animal Models to Clinical Studies