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Medscape
3 days ago
- Health
- Medscape
Comorbidities Intensify Rare Neurologic Diseases
Comorbidities, especially cardiovascular and autoimmune diseases, were frequent in aquaporin-4 antibody-positive neuromyelitis optica spectrum disorder (AQP4-NMOSD) and myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD), correlating with worse clinical outcomes, including more frequent optic neuritis relapses, greater disability, and retinal layer thinning. METHODOLOGY: The CROCTINO study was a retrospective, multicentre cohort study that analysed data of 442 patients with AQP4-NMOSD, MOGAD, and double seronegative NMOSD (DN-NMOSD) across 22 centres worldwide between 2000 and 2018, focusing on retinal pathology using optical coherence tomography (OCT). Researchers assessed comorbidities (classified into 14 categories) and their impact on disease severity, optic neuritis relapse rates, Expanded Disability Status Scale (EDSS) scores, and retinal integrity using OCT. They compared the prevalence and types of comorbidities across disease groups, evaluated associations with clinical outcomes, and analysed changes in retinal layer thickness. TAKEAWAY: Comorbidities were present in 43.5% of patients with AQP4-NMOSD, 40.8% of those with MOGAD, and 36.4% of those with DN-NMOSD. Those with AQP4-NMOSD had more multiple comorbidities than those with MOGAD (50% vs 25%; P = .03). = .03). EDSS scores were higher in patients with MOGAD and comorbidities than in those without (3.0 vs 2.0; P = .006) and in those with DN-NMOSD and comorbidities than in those without (5.0 vs 2.0; P = .008), but not significantly different between those with AQP4-NMOSD and those without. = .006) and in those with DN-NMOSD and comorbidities than in those without (5.0 vs 2.0; = .008), but not significantly different between those with AQP4-NMOSD and those without. Among patients with AQP4-NMOSD, those with cardiovascular comorbidities exhibited higher annual optic neuritis relapses than those with autoimmune comorbidities (mean, 1.06 ± 3.33 vs 0.49 ± 0.98; P < .001). < .001). Retinal changes showed reduced inner nuclear layer thickness in patients with AQP4-NMOSD having comorbidities, especially cardiovascular conditions ( P = .009). IN PRACTICE: "Comorbidities are frequent in AQP4-NMOSD and MOGAD and are associated with ON [optic neuritis] frequency and disability. These findings highlight the need for proactive comorbidity management to improve patient care," the authors wrote. SOURCE: This study, led by Sara Samadzadeh, Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark, was published online on June 09, 2025, in the European Journal of Neurology . LIMITATIONS: This study's retrospective design may have led to inaccuracies in comorbidity documentation, including unrecorded risk factors (eg, smoking) and inconsistent data recorded. Some comorbidities could independently affect OCT or EDSS outcomes, potentially confounding the results. DISCLOSURES: This study was supported by the Lundbeck Foundation; the University of Southern Denmark, Slagelse Hospital Research Fund, and Region Zealand Health Sciences Research Fund; and the Guthy-Jackson Charitable Foundation. Some authors reported receiving support from several other organisations.
Time of India
5 days ago
- Health
- Time of India
Nair hospital's neuro-immunology OPD in Mumbai becomes haven for hundreds of patients
Mumbai: Nair Hospital's neuro-immunology outpatient department (OPD) has become a long-term haven for hundreds of patients. Sparked by improved diagnosis of neuro-immune disorders after the Covid-19 pandemic, the OPD celebrated its third anniversary this month. It is the only dedicated OPD in civic hospitals for such conditions, with 906 patient consultations since its launch, including 186 new diagnoses. The rest are follow-ups, as most conditions require lifelong care. For 29-year-old Mohammed Naaz Quershi, symptoms began in 2023 with a drooping eyelid, progressing to difficulty chewing and hand weakness. "Doctors told me this usually affects older people. I was confused," said the Mazgaon resident. After visiting several hospitals without answers, he was diagnosed at Mumbai Central's Nair Hospital with myasthenia gravis, a rare autoimmune disorder that disrupts nerve-muscle communication. While the public hospital saved him costly specialist visits, he still spends around Rs 10,000 monthly on medication. Quershi is one amongst many who rely on the department for ongoing care. So far, patients have presented with 29 different neuro-immunological conditions, all involving the immune system attacking the body. The most commonly treated include Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (MOGAD), myasthenia gravis, and IgG4-related pachymeningitis. MOGAD accounts for 139 cases — 35 new cases — involving immune attacks on the spinal cord that can cause partial vision loss, seizures, and muscle weakness. Myasthenia gravis was diagnosed in 119 patients — 26 new cases — while 76 were treated for IgG4-related pachymeningitis, which causes chronic headaches, seizures, and neurological deficits. "These diseases were once considered mysterious because of a lack of diagnostic tools," said Dr Rahul Chakor, HOD at Nair Hospital's neurology department. Another neurologist from the department said, "They are relatively rare, so diagnostic tests and medications are not prioritised in public healthcare. Most tests aren't available in BMC hospitals, so we refer patients to private labs offering discounted rates. " Dr Chakor added that even as challenges persist, Nair Hospital has retained the majority of its patients. Only 20 out of 186 new patients discontinued follow-ups. "Most require lifelong treatment, but some achieve remission in two years," he said. Former KEM assistant professor Dr Parthvi Ravat's study found that PET scans can reveal brain inflammation from autoimmune causes, even when MRI and antibody tests fail. Dr Sangeeta Ravat, dean of KEM Hospital, added, "But patients often go undiagnosed for years and visit multiple hospitals. We send samples to NIMHANS in Bengaluru when tests are not available locally. NIMHANS offers testing at heavily subsidised rates. "
