S. Apóstolos-Pereira
Faculdade de Medicina, Universidade de São Paulo

Author Of 2 Presentations

 On-Demand Program
COVID-19 Late Breaking Abstracts

LB1247 - Clinical features of COVID-19 in patients with neuromyelitis optica spectrum disorders  (ID 2133)

Speakers
Authors
Presentation Number
LB1247
Presentation Topic
COVID-19

Abstract

Background

Brazil is currently considered one of the main epicenters of the coronavirus disease 2019 (COVID-19). There are many concerns related to neuromyelitis optica spectrum disorders (NMOSD) patients. In addition to the older age of onset, higher disability and the higher rate of hospitalization compared to MS, many of the commonly used preventive therapies for NMOSD are cell depleting immunosuppressants with increased risk of viral and bacterial infections.

Objectives

To describe the frequency and clinical characteristics of COVID-19 in neuromyelitis optica spectrum disorder (NMOSD) patients in Brazil.

Methods

The Brazilian Study Group NMOSD of the Brazilian Academy of Neurology has set up the registration of COVID-19 cases in NMOSD patients, using a designed web-based case report form, encompassing neuroimmunology centers and individual neurologists across the country. Data collected between March 19thand July 31th 2020 were uploaded at the REDONE.br platform. Inclusion criteria were: (i) NMOSD diagnosis according to 2015 International Panel; (ii) confirmed SARS-Cov-2 infection (RT-PCR or serology) or clinical suspicion of COVID-19 diagnosed according to CDC/CSTE case definition. Demographic data, NMOSD clinical characteristics pre and post infection, comorbidities, immunosuppressive treatment, COVID-19 clinical features and severity were described.

Results

Among the 2,061 NMOSD patients inscribed at the REDONE.br platform, 34 patients (29 women) aged 37.1 years (range 8-77), with disease onset at 31.2 years (range 4-69) and disease duration of 5.9 years (range 0.2-20.5), developed COVID-19 (18 confirmed and 16 probable cases). Most patients exhibiting mild disease was treated at home (76.5%) and 4 patients needed treatment at intensive care units (severe cases); one patient died. Four patients had NMOSD relapse during the infection; one with partial recovery.

Conclusions

The clinical features of COVID-19 in NMOSD patients were described, stressing the combination of comorbidities and immunosuppression. Mild COVID-19 was the main presentation. Collaborative studies using shared NMOSD data are needed to suitably define factors related to COVID-19 outcome.

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Imaging Poster Presentation

P0531 - 11C-PIB PET showed a distinct cerebrospinal fluid pattern in patients with progressive multiple sclerosis (ID 1913)

Speakers
Authors
Presentation Number
P0531
Presentation Topic
Imaging

Abstract

Background

Neurodegeneration attributed to axonal injury following myelin damage is present from the earliest stages of multiple sclerosis (MS), however, biomarkers to predict MS-related disability, particularly in progressive disease, are still lacking. Positron emission tomography (PET) using myelin-specific tracers has the potential to address more specific underlying in vivo pathology and broaden the understanding of heterogeneity between relapsing-remitting (RRMS) and progressive MS (PMS).

Objectives

To explore possible group differences in PET imaging with carbon-11-labeled Pittsburgh compound B (11C-PIB) among MS phenotypes and compare to healthy controls (HC).

Methods

11C-PIB PET images (40-60 min post-injection) and magnetic resonance imaging (MRI) were acquired in a hybrid PET/MRI system from 30 subjects with RRMS (21/9 women/men; mean age: 35.7, ± 7.6 years), 18 with PMS (primary, n = 11 and secondary, n = 7; 11/7 women/men; mean age: 49.9, ± 8.6 years) and 20 matched-controls (15/5 women/men; mean age: 41.4, ± 12 years ). 11C-PIB PET images were co-registered using PMODTM 4.0 to an individual 3D T1-weighted image after lesion filling (lesion segmentation tool from SPMTM 8). Voxel-based analysis with proportional scaling was performed with statistical parametric mapping (SPMTM 12), using analysis of variance model (ANOVA) among groups and t-tests between two groups. The differences were considered significant when p ≤ 0.05 corrected for multiple comparisons with family-wise error (FWE) and reported when a cluster size minimum of 200 voxels.

Results

Among MS phenotypes, there was a statistically significant difference regarding disability (p <0.001). In the RRMS group, the median EDSS was 2.5 (range, 1.0 - 6.0), while PMS had median EDSS 6.5 (range 3.5 - 7.5). ANOVA showed 11C-PIB uptake differences among groups (pFWE = 0.022) disclosing decreased 11C-PIB uptake in patients with MS relative to controls, being the lateral ventricles the only cluster region superior to 200 voxels. Decreased tracer uptake was observed in the lateral ventricles of RRMS compared to HC, but was not statistically significant (2447 voxels, z-score 4.01, pFWE = 0.219) and in the PMS group compared to HC, which was statistically significant (8245 voxels, z-score = 5.01 and pFWE = 0.004). Additional work will be performed using a supervised reference region to better understand the kinetics of the 11C-PIB PET in the ventricular system and its relationship with brain volume loss.

Conclusions

11C-PIB PET imaging showed a distinct pattern of CSF in the lateral ventricles among patients with MS and healthy controls in a voxel-based assessment, significantly in the PMS group. Similar findings were previously reported in patients with RRMS, supporting the potential role of CSF profile to distinguish phenotypes and patients at risk of disease activity or progression.

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