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Abstract Details

Etiologies of Myelopathy in Uganda Based on Neuroimaging, Autoantibodies, and Next Generation Sequencing
Autoimmune Neurology
S4 - Autoimmune Neurology: Autoimmune Encephalitis and Neuronal Autoantibodies (2:24 PM-2:36 PM)
008

Non-traumatic myelopathy etiologies have not been well characterized in Sub-Saharan Africa.

To assess the utility of glial antibody testing and metagenomic next-generation sequencing (mNGS) of serum and cerebrospinal fluid (CSF) in the diagnostic work-up of myelopathy in Ugandan patients.

Adults presenting with clinical features localizing to the spinal cord were prospectively enrolled in a research study at Mulago and Kiruddu National Referral Hospitals in Kampala, Uganda from 2018-2022. 1.5 Tesla magnetic resonance imaging (MRI) was performed on the spinal cord. Serum and CSF were tested for antibodies to aquaporin-4 (AQP4) and myelin oligodendrocyte glycoprotein (MOG) by live cell-based flow cytometry at Mayo Clinic. mNGS was performed on RNA extracted from CSF at UCSF.

134 patients were enrolled. The median age was 32 years (range, 18-85) with 55% male and 25% HIV positive. Most (n=88 [66%]) had intradural abnormalities on MRI. Ten participants had MOG-IgG detected with a median MOG-IgG-binding-index of 2.53 (range, 1.22-3.8), of whom 8 had intramedullary lesions and 2 a normal MRIs. AQP4-IgG was detected in 10 patients with median AQP4-IgG-binding-index 20.33 (range, 2.25-63.51). Six had intramedullary lesions and four patients with normal MRIs. CSF mNGS detected Schistosoma mansoni in 10 patients and varicella-zoster virus in one patient and all 11 had MRI abnormalities. Cytomegalovirus (CMV) sequences were detected in 35 patients, though in only 2 HIV-infected patients was the CMV copy number likely high enough to be associated with the clinical presentation. Vitamin B12 deficiency was diagnosed in 5 patients.

AQP4/MOG-IgG and mNGS identified the underlying etiology in a quarter of the non-traumatic myelopathy cohort, with AQP4-IgG positive NMOSD and MOGAD accounting for up to 15% of cases. S. mansoni, a treatable parasitic infection, was the most common infectious etiology. Making these studies available to developing countries should be a priority.

Authors/Disclosures
Kisekka Musubire (Mulago National Referal Hospital)
PRESENTER
Dr. Musubire has nothing to disclose.
Kristoffer Leon (University of California, San Francisco) Dr. Leon has nothing to disclose.
Eoin Flanagan (Mayo Clinic) The institution of Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genentech. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Horizon Therapeutics. The institution of Dr. Flanagan has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche. Dr. Flanagan has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Pharmacy times. The institution of Dr. Flanagan has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for UCB. The institution of Dr. Flanagan has received research support from Viela Bio. The institution of Dr. Flanagan has received research support from UCB. The institution of Dr. Flanagan has received research support from Roche. Dr. Flanagan has received publishing royalties from a publication relating to health care. Dr. Flanagan has a non-compensated relationship as a Member of medical Advisory Board with The MOG Project that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Journal of The Neurologic Sciences that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial board member with Neuroimmunology Reports that is relevant to AAN interests or activities. Dr. Flanagan has a non-compensated relationship as a Editorial Board Member with Neurology, Neuroimmunology Neuroinflammation (N2) Journal that is relevant to AAN interests or activities.
No disclosure on file
David Boulware (University of Minnesota) The institution of David R. Boulware, MD, MPH has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Sfunga. David R. Boulware, MD, MPH has received publishing royalties from a publication relating to health care. David R. Boulware, MD, MPH has received personal compensation in the range of $0-$499 for serving as a Study Section with NIH.
No disclosure on file
Patrick Cras (University of Antwerp) The institution of Dr. Cras has received research support from Belgian Fund for Scientific Research. Dr. Cras has received personal compensation in the range of $0-$499 for serving as a member with National Bioethics Committee.
Barbara Willekens (Antwerp University Hospital) The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Janssen. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sanofi. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sandoz. The institution of Dr. Willekens has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Almirall . The institution of Dr. Willekens has received research support from Roche. The institution of Dr. Willekens has received research support from Janssen. Dr. Willekens has a non-compensated relationship as a Co-chair scientific panel of neuroimmunology with European Academy of Neurology that is relevant to AAN interests or activities.
Sean Pittock (Mayo Clinic Dept of Neurology) Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genentech, Inc.. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Sage Therapeutics, Inc.. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astellas. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Prime Therapeutics. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for UCB. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche/Genentech. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MedImmune/Viela Bio. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arialys Therapeutics. The institution of Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Roche/Genentech. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for UCB, Inc. Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Hoffman/LaRoche AG. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech. Dr. Pittock has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for F. Hofman/LaRoche. The institution of Dr. Pittock has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion. The institution of Dr. Pittock has received research support from Grifols. The institution of Dr. Pittock has received research support from NIH. The institution of Dr. Pittock has received research support from Viela Bio/MedImmune/Horizon. The institution of Dr. Pittock has received research support from Alexion Pharmaceuticals. The institution of Dr. Pittock has received research support from F. Hoffman/LaRoche/Genentech. The institution of Dr. Pittock has received research support from NovelMed. The institution of Dr. Pittock has received research support from AstaZeneca. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care. Dr. Pittock has received intellectual property interests from a discovery or technology relating to health care.
Michael Wilson (University of California San Francisco) Dr. Wilson has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Delve Bio. Dr. Wilson has stock in Delve Bio. The institution of Dr. Wilson has received research support from Genentech / Roche. The institution of Dr. Wilson has received research support from NIH. The institution of Dr. Wilson has received research support from UCSF Weill Institute for Neurosciences. The institution of Dr. Wilson has received research support from Novartis. The institution of Dr. Wilson has received research support from National Multiple Sclerosis Society. The institution of Dr. Wilson has received research support from Fanconi Anemia Research Foundation. The institution of Dr. Wilson has received research support from Department of Defense. Dr. Wilson has received intellectual property interests from a discovery or technology relating to health care. Dr. Wilson has received intellectual property interests from a discovery or technology relating to health care. Dr. Wilson has received personal compensation in the range of $10,000-$49,999 for serving as a Expert Witness with US Dept of Justice.