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Interferon-β-related tumefactive brain lesion in a Caucasian patient with neuromyelitis optica and clinical stabilization with tocilizumab

Overview of attention for article published in BMC Neurology, December 2014
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  • Good Attention Score compared to outputs of the same age (76th percentile)
  • Above-average Attention Score compared to outputs of the same age and source (64th percentile)

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1 X user
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1 Facebook page
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3 Wikipedia pages

Citations

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23 Dimensions

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126 Mendeley
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Title
Interferon-β-related tumefactive brain lesion in a Caucasian patient with neuromyelitis optica and clinical stabilization with tocilizumab
Published in
BMC Neurology, December 2014
DOI 10.1186/s12883-014-0247-3
Pubmed ID
Authors

Jens Harmel, Marius Ringelstein, Jens Ingwersen, Christian Mathys, Norbert Goebels, Hans-Peter Hartung, Sven Jarius, Orhan Aktas

Abstract

BackgroundNeuromyelitis optica (NMO) is a severely disabling inflammatory disorder of the central nervous system and is often misdiagnosed as multiple sclerosis (MS). There is increasing evidence that treatment options shown to be beneficial in MS, including interferon-ß (IFN-ß), are detrimental in NMO.Case presentationWe here report the first Caucasian patient with aquaporin 4 (AQP4)-seropositive NMO presenting with a tumefactive brain lesion on treatment with IFN-ß. Disease started with relapsing optic neuritis and an episode of longitudinally extensive transverse myelitis (LETM) in the absence of any brain MRI lesions or cerebrospinal fluid-restricted oligoclonal bands. After initial misdiagnosis of multiple sclerosis (MS) the patient received subcutaneous IFN-ß1b and, subsequently, subcutaneous IFN-ß1a therapy for several years. Under this treatment, the patient showed persisting relapse activity and finally presented with a severe episode of subacute aphasia and right-sided hemiparesis due to a large T2 hyperintensive tumefactive lesion of the left brain hemisphere and a smaller T2 lesion on the right side. Despite rituximab therapy two further LETM episodes occurred, resulting in severe neurological deficits. Therapeutic blockade of the interleukin (IL)-6 signalling pathway by tocilizumab was initiated, leading to clinical and radiological stabilization.ConclusionOur case (i) illustrates the relevance of correctly distinguishing NMO and MS since these disorders differ markedly in their responsiveness to immunomodulatory and -suppressive therapies; (ii) confirms and extends a previous report describing the development of tumefactive brain lesions under IFN-ß therapy of two Asian NMO patients; and (iii) suggests tocilizumab as a promising therapeutic alternative in highly active NMO disease courses.Interferon-ß (IFN-ß) is one of the established first-line therapies for patients with relapsing-remitting multiple sclerosis (MS). While the efficacy of IFN-ß in MS is widely accepted, the possible benefit in non-classical MS variants has been disputed. This is the case for neuromyelitis optica (NMO/Devic¿s syndrome), considered an MS subtype until the discovery of the anti-aquaporin 4 (AQP4) antibodies (AQP4-Ab) [1,2]. In both Asian and European NMO patients, IFN-ß failed to show therapeutic efficacy [3-5]. Of note, Shimizu and colleagues recently reported two Asian patients with NMO spectrum disease (NMOSD) who developed extensive brain lesions following IFN-ß therapy [6]. Here we report the case of an AQP4-seropositive NMO patient of Caucasian descent presenting with a tumefactive lesion on IFN-ß treatment. Of note, our patient did not respond to B cell depletion by the monoclonal anti-CD20 antibody rituximab but improved upon blockade of the IL-6 pathway using tocilizumab.

X Demographics

X Demographics

The data shown below were collected from the profile of 1 X user who shared this research output. Click here to find out more about how the information was compiled.
Mendeley readers

Mendeley readers

The data shown below were compiled from readership statistics for 126 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Spain 1 <1%
Unknown 125 99%

Demographic breakdown

Readers by professional status Count As %
Student > Bachelor 43 34%
Student > Postgraduate 10 8%
Student > Master 10 8%
Student > Ph. D. Student 7 6%
Student > Doctoral Student 5 4%
Other 17 13%
Unknown 34 27%
Readers by discipline Count As %
Psychology 48 38%
Medicine and Dentistry 24 19%
Neuroscience 9 7%
Nursing and Health Professions 3 2%
Agricultural and Biological Sciences 2 2%
Other 4 3%
Unknown 36 29%
Attention Score in Context

Attention Score in Context

This research output has an Altmetric Attention Score of 5. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 29 May 2019.
All research outputs
#6,391,095
of 23,577,654 outputs
Outputs from BMC Neurology
#727
of 2,523 outputs
Outputs of similar age
#78,448
of 334,528 outputs
Outputs of similar age from BMC Neurology
#9
of 25 outputs
Altmetric has tracked 23,577,654 research outputs across all sources so far. This one has received more attention than most of these and is in the 72nd percentile.
So far Altmetric has tracked 2,523 research outputs from this source. They typically receive a little more attention than average, with a mean Attention Score of 6.9. This one has gotten more attention than average, scoring higher than 70% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 334,528 tracked outputs that were published within six weeks on either side of this one in any source. This one has done well, scoring higher than 76% of its contemporaries.
We're also able to compare this research output to 25 others from the same source and published within six weeks on either side of this one. This one has gotten more attention than average, scoring higher than 64% of its contemporaries.