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Background: Outcomes of coronavirus disease 2019 (COVID‐19) in patients with neuromyelitis optica spectrum disorders (NMOSD) or myelin oligodendrocyte glycoprotein antibody‐associated disease (MOGAD), often treated with immunosuppressive therapies, are still unknown. Methods: We conducted a multicenter, retrospective, observational cohort study among all French expert centers for neuromyelitis optica and related disorders. Patients with NMOSD or MOGAD included in the study received a confirmed or highly suspected diagnosis of COVID‐19 between 1 March 2020 and 30 June 2020. Main outcome was COVID‐19 severity score assessed on a seven‐point ordinal scale ranging from 1 (not hospitalized with no limitations on activities) to 7 (death). Results: Fifteen cases (mean [SD] age: 39.3 [14.3] years, 11 female) were included. Five patients (33.3%) were hospitalized, all receiving rituximab. A 24‐year‐old patient with positive aquaporine‐4 antibody, with obesity as comorbidity, needed mechanical ventilation. Outpatients were receiving anti‐CD20 (5), mycophenolate mofetil (3) or azathioprine (3). They were younger (mean [SD] age: 37.0 [13.4] years), with a longer disease duration (mean [SD]: 8.3 [6.3] years) and had a lower expanded disability severity score (EDSS) score (median [range] EDSS: 2.5 [0–4]) relative to patients requiring hospitalization (mean [SD] age: 44.0 [16.4] years, mean [SD] disease duration: 5.8 [5.5] years, median [range] EDSS: 4 [0–6.5]). Conclusions: COVID‐19 outcome was overall favorable in this cohort. Larger international studies are needed to identify risk factors of severe COVID‐19; however, we recommend personal protective measures to reduce risk of SARS‐CoV‐2 infection in this immunocompromised population. [ABSTRACT FROM AUTHOR]

Background: The kappa free light chains index (κ‐index) is increasing in importance as a fast, easy, cost‐effective, and quantitative biomarker in multiple sclerosis (MS), which can replace cerebrospinal fluid (CSF)‐restricted oligoclonal bands (OCB) detection. In previous studies, controls often included mixed patients with several inflammatory central nervous system disorders. The aim of the present study was to assess the κ‐index in patients with serum aquaporin‐4 (AQP4)‐IgG or myelin‐oligodendrocyte‐glycoprotein (MOG)‐IgG. Methods: We analyzed CSF/serum samples of patients with AQP4‐IgG or MOG‐Ig and evaluated distinct κ‐index cut‐offs. We described clinical and magnetic resonance imaging (MRI) features of patients with the highest κ‐index values. Results: In 11 patients with AQP4‐IgG, median κ‐index was 16.8 (range 0.2; 63) and 6/11 (54.5%) had κ‐index >12. Among 42 patients with MOG‐IgG, 2 had low positive MOG‐IgG titers, were ultimately diagnosed with MS, and had a markedly increased κ‐index (54.1 and 102.5 respectively). For the remaining 40 MOG‐IgG‐positive patients the median κ‐index was 0.3 (range 0.1; 15.5). Some 6/40 (15%) and 1/40 (2.5%) patients had a κ‐index >6 and >12, respectively. None fulfilled MRI dissemination in space and dissemination in time (DIS/DIT) criteria and the final diagnosis was MOG‐IgG‐associated disease (MOGAD) for these 40 patients. Four of the 40 (10%) MOG‐IgG‐positive patients had OCB. Conclusion: While a marked increase in κ‐index could discriminate MS from MOGAD, a low κ‐index threshold could lead to confusion between MS and MOGAD or AQP4 antibody‐positive neuromyelitis optica spectrum disorder. [ABSTRACT FROM AUTHOR]

Background and purpose: Lesion remyelination preserves axonal integrity in animal models of multiple sclerosis (MS), but an in vivo demonstration of its protective effect on surrounding tissues in humans is lacking. Methods: Nineteen persons with MS were enrolled in a cohort study and underwent two positron emission tomography (PET)/magnetic resonance imaging (MRI) scans 1–4 months apart. Voxelwise maps of Pittsburgh compound B distribution volume ratio, reflecting myelin content, were used to calculate an index of baseline demyelination, and of dynamic demyelination and remyelination over the follow‐up in 549 single white matter lesions. Changes in fractional anisotropy and mean diffusivity, reflecting microstructural damage, were calculated in the proximal and distal 3‐mm‐thick rings surrounding each lesion, and used to classify perilesional microstructure as "preserved" or "worsening" over the follow‐up. Mixed‐effect linear models and logistic regressions were employed to investigate whether PET‐derived lesional indices were associated with changes in MRI metrics in perilesions, and to identify which of them best predicted the microstructural evolution of perilesions over time. Results: A higher index of remyelination, and a lower index of baseline and dynamic demyelination in lesions were associated with a less severe microstructural deterioration of the corresponding proximal and distal perilesions over time (p‐value range: <0.001–0.012), but the index of remyelination was the best predicting variable of perilesional fate. For every extra 1% of remyelination within each lesion, the probability of the corresponding perilesional microstructure remaining preserved over time increased by 39% (odds ratio = 6.62, 95% confidence interval = 2.16–20.32, p < 0.001). Conclusions: Intralesional remyelination is associated with the microstructural preservation of surrounding tissues, possibly preventing neuroaxonal damage resulting from Wallerian degeneration. [ABSTRACT FROM AUTHOR]