1
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Lyou HJ, Chung YH, Kim MJ, Kim M, Jeon MY, Kim SW, Shin HY, Kim BJ. Clinical Features of Autoimmune Nodopathy With Anti-Neurofascin-155 Antibodies in South Koreans. J Clin Neurol 2024; 20:186-193. [PMID: 38171501 PMCID: PMC10921045 DOI: 10.3988/jcn.2023.0055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/02/2023] [Accepted: 06/14/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND AND PURPOSE Anti-neurofascin-155 (NF155) antibody is one of the autoantibodies associated with autoimmune nodopathy. We aimed to determine the clinical features of South Korean patients with anti-NF155-antibody-positive autoimmune nodopathy. METHODS The sera of 68 patients who fulfilled the diagnostic criteria for chronic inflammatory demyelinating polyneuropathy (CIDP) were tested for anti-NF155 antibodies using a cell-based assay (CBA) and enzyme-linked immunosorbent assay (ELISA). The anti-NF155-positive sera were also assayed for NF155 immunoglobulin G (IgG) subclasses, and for anti-NF186 and NF140 antibodies. The clinical features of the patients were reviewed retrospectively. RESULTS Among the 68 patients, 6 (8.8%) were positive for anti-NF155 antibodies in both the CBA and ELISA. One of those six patients was also positive for anti-NF186 and anti-NF140 antibodies. IgG4 was the predominant subclass in four patients. The mean age at onset was 32.2 years. All six positive patients presented with progressive sensory ataxia. Five patients treated using corticosteroids presented a partial or no response. All six patients were treated using intravenous immunoglobulin (IVIg). Among them, five exhibited a partial or poor response and the other exhibited a good response. All three patients treated using rituximab showed a good response. CONCLUSIONS The clinical characteristics of the patients were consistent with those in previous studies. Anti-NF155 antibody assay is necessary for diagnosing autoimmune nodopathy and its appropriate treatment, especially in young patients with CIDP who present with sensory ataxia and poor therapeutic responses to corticosteroids and IVIg.
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Affiliation(s)
- Hyun Ji Lyou
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yeon Hak Chung
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min Ju Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - MinGi Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Mi Young Jeon
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea.
| | - Byoung Joon Kim
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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2
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Krishnan G, Chandrasekar KK, Natarajan GK. Hepatitis B Precipitating Neurological Complications: A Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) Conundrum. Cureus 2024; 16:e53551. [PMID: 38445132 PMCID: PMC10913701 DOI: 10.7759/cureus.53551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2024] [Indexed: 03/07/2024] Open
Abstract
Hepatitis B virus stands as a prominent contributor to cirrhosis, hepatocellular carcinoma, and other liver-related fatalities. On the other hand, neurological manifestations in HBV-infected individuals are infrequently observed. Chronic inflammatory demyelinating polyneuropathy (CIDP) represents an immune-mediated neuropathy, known for its distinctive pattern of symmetrical involvement and weakness in both proximal and distal muscles. In this study, we present a noteworthy instance of chronic inflammatory demyelinating polyneuropathy (CIDP) occurring in a patient with chronic inactive hepatitis B infection.
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3
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Miller D, Walsh L, Smith L, Supakul N, Ho C, Onishi T. Magnetic resonance imaging enhancement of spinal nerve roots in a boy with X-linked adrenoleukodystrophy before diagnosis of chronic inflammatory demyelinating polyneuropathy. Radiol Case Rep 2024; 19:493-498. [PMID: 38046924 PMCID: PMC10692474 DOI: 10.1016/j.radcr.2023.10.065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/22/2023] [Accepted: 10/26/2023] [Indexed: 12/05/2023] Open
Abstract
We present a boy with X-linked adrenoleukodystrophy (X-ALD) who was found to have lumbar nerve root enhancement on a screening MRI of the spine. The MRI was performed for lower extremity predominant symptoms. Several weeks after this MRI, he developed leg pain and was averse to walking long distances. He was diagnosed with Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) with electromyography, nerve conduction studies, and serial imaging. His case is consistent with CIDP in association with X-ALD based on improvement with intravenous immunoglobulin (IVIG) with continued contrast enhancement and lower extremity symptoms 8 weeks after his initial scans. Contrast enhancement of nerve roots has not been previously described in X-ALD. Nerve root enhancement has been seen in other leukodystrophies such as globoid cell leukodystrophy and metachromatic leukodystrophy. This case also demonstrates comorbid X-ALD with CIDP and highlights possible mechanisms from the literature for this association. We also review the broad differential of cauda equina nerve root enhancement.
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Affiliation(s)
- Derryl Miller
- Department of Clinical Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Laurence Walsh
- Department of Clinical Neurology, Genetics, and Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Lisa Smith
- Department of Clinical Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Nucharin Supakul
- Department of Clinical Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chang Ho
- Department of Clinical Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Toshihiro Onishi
- Department of Pediatrics Hematology/Oncology, Indiana University School of Medicine, Indianapolis, IN, USA
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4
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Pace M, Cannella R, Di Stefano V, Lupica A, Alonge P, Morici G, Brighina F, Brancato F, Midiri F, Galia M. Usefulness and Clinical Impact of Whole-Body MRI in Detecting Autoimmune Neuromuscular Disorders. Brain Sci 2023; 13:1500. [PMID: 37891867 PMCID: PMC10605918 DOI: 10.3390/brainsci13101500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/28/2023] [Accepted: 10/04/2023] [Indexed: 10/29/2023] Open
Abstract
Autoimmune neuromuscular diseases are a group of heterogenous pathologies secondary to the activation of the immune system that damage the structures of the peripheric nerve, the neuromuscular junction, or the skeleton muscle. The diagnosis of autoimmune neuromuscular disorders comprises a combination of data from clinical, laboratory, electromyography, imaging exam, and biopsy. Particularly, the whole-body MRI examination in the last two decades has been of great use in the assessment of neuromuscular disorders. MRI provides information about the structures involved and the status of activity of the disease. It can also be used as a biomarker, detect the pattern of specific muscle involvement, and is a useful tool for targeting the optimal muscle site for biopsy. In this work, we summarized the most used technical protocol of whole-body MRI and the role of this imaging technique in autoimmune neuromuscular disorders.
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Affiliation(s)
- Mario Pace
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Vincenzo Di Stefano
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Antonino Lupica
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Paolo Alonge
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Giulio Morici
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
| | - Filippo Brighina
- Section of Neurology, Department of Biomedicine, Neuroscience and Advanced Diagnostic (BIND), University of Palermo, 90127 Palermo, Italy; (V.D.S.); (A.L.); (P.A.); (F.B.)
| | - Federica Brancato
- Department of Surgical, Oncological and Oral Science (Di.Chir.On.S.), University of Palermo, 90133 Palermo, Italy;
| | - Federico Midiri
- IRCCS Ospedale Galeazzi-Sant’Ambrogio, Via Cristina Belgioioso 173, 20161 Milano, Italy;
| | - Massimo Galia
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University Hospital “Paolo Giaccone”, Via del Vespro 129, 90127 Palermo, Italy; (M.P.); (R.C.); (G.M.)
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5
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Welborn BL, Benjamin J. Development of Lewis-Sumner Syndrome or Multifocal Acquired Demyelinating Sensory and Motor Neuropathy (MADSAM) Following COVID-19 Infection. Cureus 2023; 15:e46643. [PMID: 37818123 PMCID: PMC10561901 DOI: 10.7759/cureus.46643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/07/2023] [Indexed: 10/12/2023] Open
Abstract
Multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), also known as asymmetrical or multifocal chronic inflammatory demyelinating polyneuropathy (CIDP) or Lewis-Sumner syndrome, is a painless asymmetric demyelinating sensorimotor mononeuropathy multiplex and is an atypical and rare variant of CIDP. We report a case of a 48-year-old female who presented with complaints of shortness of breath, fatigue, difficulty walking and speaking, and primarily right unilateral symptoms involving multiple peripheral nerves, the right phrenic nerve, and the facial nerve following a coronavirus disease 2019 (COVID-19) infection. She was diagnosed with MADSAM after an extensive physical examination, electromyography (EMG), nerve conduction tests, and laboratory testing. She improved following the initiation of long-term treatment with intravenous immunoglobulin (IVIG). To the best of our knowledge, this is the second reported case of MADSAM following a COVID-19 infection. There have been reports of demyelinating diseases of the central and peripheral nervous systems related to COVID-19; however, it remains unclear whether COVID-19 is the causative agent or only a correlative.
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Affiliation(s)
- Brandon L Welborn
- Neurology, Edward Via College of Osteopathic Medicine, Spartanburg, USA
| | - Jeff Benjamin
- Neurology, Bon Secours Diane Collins Neuroscience Institute, Greenville, USA
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6
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Gül S, Siraj I, Meyer JA. Idiopathic Intracranial Hypertension Secondary to Chronic Inflammatory Demyelinating Polyradiculoneuropathy. Cureus 2023; 15:e43648. [PMID: 37719616 PMCID: PMC10505048 DOI: 10.7759/cureus.43648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/19/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is the most common immune-mediated inflammatory polyneuropathy, defined as progressive or relapsing symptoms for over two months with pathological or electrophysiological evidence of peripheral nerve demyelination. Papilledema is optic nerve head edema secondary to increased intracranial pressure or infiltrative/infectious etiologies. Regardless of the cause, visual loss is one of the feared manifestations due to optic nerve damage. We present a 50-year-old female patient with CIDP who developed papilledema that was secondary to increased intracranial pressure from high protein content in the cerebrospinal fluid (CSF) and elevated body mass index (BMI) secondary to prednisone use. Treatment with acetazolamide completely resolved the papilledema and headaches, and the patient was later maintained on mycophenolate, intravenous immunoglobulin (IVIG), rituximab, and prednisone. To the best of our knowledge, this is the first case that describes successful medical management of increased intracranial pressure in the setting of CIDP.
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Affiliation(s)
- Sedat Gül
- Neurology, State University of New York Upstate Medical University, Syracuse, USA
| | | | - Jenny A Meyer
- Neurology, State University of New York Upstate Medical University, Syracuse, USA
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7
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Sher AA, Lao YT, Coombs KM. HLA-A, HSPA5, IGFBP5 and PSMA2 Are Restriction Factors for Zika Virus Growth in Astrocytic Cells. Viruses 2022; 15:97. [PMID: 36680137 PMCID: PMC9863221 DOI: 10.3390/v15010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 12/31/2022] Open
Abstract
(1) Background: Zika virus (ZIKV), an arbo-flavivirus, is transmitted via Aeges aegyptii mosquitoes Following its major outbreaks in 2013, 2014 and 2016, WHO declared it a Public Health Emergency of International Concern. Symptoms of ZIKV infection include acute fever, conjunctivitis, headache, muscle & joint pain and malaise. Cases of its transmission also have been reported via perinatal, sexual and transfusion transmission. ZIKV pathologies include meningo-encephalitis and myelitis in the central nervous system (CNS) and Guillain-Barré syndrome and acute transient polyneuritis in the peripheral nervous system (PNS). Drugs like azithromycin have been tested as inhibitors of ZIKV infection but no vaccines or treatments are currently available. Astrocytes are the most abundant cells in the CNS and among the first cells in CNS infected by ZIKV; (2) Methods: We previously used SOMAScan proteomics to study ZIKV-infected astrocytic cells. Here, we use mass spectrometric analyses to further explain dysregulations in the cellular expression profile of glioblastoma astrocytoma U251 cells. We also knocked down (KD) some of the U251 cellular proteins using siRNAs and observed the impact on ZIKV replication and infectivity; (3) Results & Conclusions: The top ZIKV dysregulated cellular networks were antimicrobial response, cell death, and energy production while top dysregulated functions were antigen presentation, viral replication and cytopathic impact. Th1 and interferon signaling pathways were among the top dysregulated canonical pathways. siRNA-mediated KD of HLA-A, IGFBP5, PSMA2 and HSPA5 increased ZIKV titers and protein synthesis, indicating they are ZIKV restriction factors. ZIKV infection also restored HLA-A expression in HLA-A KD cells by 48 h post-infection, suggesting interactions between this gene product and ZIKV.
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Affiliation(s)
- Affan A. Sher
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Ying Tenny Lao
- Manitoba Centre for Proteomics & Systems Biology, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
| | - Kevin M. Coombs
- Department of Medical Microbiology & Infectious Diseases, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Manitoba Centre for Proteomics & Systems Biology, University of Manitoba, Winnipeg, MB R3E 3P4, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB R3E 3P4, Canada
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8
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Sizemore G, Lucke-Wold B, Small C. Review of SARS-COV-2 Systemic Impact: Building the Case for Sepsis via Virus in the Circulatory System. SM JOURNAL OF NEUROLOGICAL DISORDERS AND STROKE 2022; 6:7. [PMID: 36780255 PMCID: PMC9910055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
SARS-COV-2 can contribute to long term consequences associated with sepsis and circulatory dysfunction. In this insightful paper, we highlight the emerging pathophysiology utilizing two case examples. Both systemic and organ specific features are discussed. In addition, a novel laboratory assay is presented that identified SARS-COV-2 in the circulation using conserved SARS ion channels rather than the spike protein. The presentation is linked to the pathophysiology with the emphasis for early recognition and continued research. This paper will serve as a catalyst for continued discovery.
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Affiliation(s)
- Gina Sizemore
- West Virginia University School of Medicine Morgantown, WV
| | | | - Coulter Small
- Department of Neurosurgery, University of Florida, Gainesville, FL
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9
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Roth SP, Gemma T, Dovich T, Candella A. Anesthetic Management of a Patient With Distal Acquired Demyelinating Symmetric (DADS) Neuropathy Under General Anesthesia. Cureus 2022; 14:e27417. [PMID: 36051732 PMCID: PMC9419994 DOI: 10.7759/cureus.27417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 11/05/2022] Open
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10
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Keh RYS, Shah S, Lilleker JB, Lavin T, Morrow J, Carr AS, Lunn MP. Pragmatic guide to peripheral nerve disease and the role of clinical biomarkers. Pract Neurol 2022; 22:pn-2022-003438. [PMID: 35850979 DOI: 10.1136/pn-2022-003438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/03/2022]
Abstract
In clinical neurology practice, there are few sensitive, specific and responsive serological biomarkers reflecting pathological processes affecting the peripheral nervous system. Instead, we rely on surrogate multimodality biomarkers for diagnosis and management. Correct use and interpretation of the available tests is essential to ensure that appropriate treatments are used and adjusted in a timely fashion. The incorrect application or interpretation of biomarkers can result in misdiagnosis and delays in appropriate treatment. Here, we discuss the uses and limitations of such biomarkers and discuss possible future developments.
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Affiliation(s)
- Ryan Yann Shern Keh
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Sachit Shah
- Lysholm Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - James B Lilleker
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
- Division of Musculoskeletal and Dermatological, Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK
| | - Tim Lavin
- Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Northern Care Alliance NHS Foundation Trust, Manchester, UK
| | - Jasper Morrow
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Lysholm Department of Neuroradiology, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling S Carr
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Neurology, University College London, London, UK
| | - Michael P Lunn
- Centre for Neuromuscular Diseases, National Hospital of Neurology and Neurosurgery, Queen Square, University College London Hospitals NHS Foundation Trust, London, UK
- Institute of Neurology, University College London, London, UK
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11
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Rumsey JW, Lorance C, Jackson M, Sasserath T, McAleer CW, Long CJ, Goswami A, Russo MA, Raja SM, Gable KL, Emmett D, Hobson-Webb LD, Chopra M, Howard JF, Guptill JT, Storek MJ, Alonso-Alonso M, Atassi N, Panicker S, Parry G, Hammond T, Hickman JJ. Classical Complement Pathway Inhibition in a "Human-On-A-Chip" Model of Autoimmune Demyelinating Neuropathies. ADVANCED THERAPEUTICS 2022; 5:2200030. [PMID: 36211621 PMCID: PMC9540753 DOI: 10.1002/adtp.202200030] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Indexed: 07/21/2023]
Abstract
Chronic autoimmune demyelinating neuropathies are a group of rare neuromuscular disorders with complex, poorly characterized etiology. Here we describe a phenotypic, human-on-a-chip (HoaC) electrical conduction model of two rare autoimmune demyelinating neuropathies, chronic inflammatory demyelinating polyneuropathy (CIDP) and multifocal motor neuropathy (MMN), and explore the efficacy of TNT005, a monoclonal antibody inhibitor of the classical complement pathway. Patient sera was shown to contain anti-GM1 IgM and IgG antibodies capable of binding to human primary Schwann cells and induced pluripotent stem cell derived motoneurons. Patient autoantibody binding was sufficient to activate the classical complement pathway resulting in detection of C3b and C5b-9 deposits. A HoaC model, using a microelectrode array with directed axonal outgrowth over the electrodes treated with patient sera, exhibited reductions in motoneuron action potential frequency and conduction velocity. TNT005 rescued the serum-induced complement deposition and functional deficits while treatment with an isotype control antibody had no rescue effect. These data indicate that complement activation by CIDP and MMN patient serum is sufficient to mimic neurophysiological features of each disease and that complement inhibition with TNT005 was sufficient to rescue these pathological effects and provide efficacy data included in an investigational new drug application, demonstrating the model's translational potential.
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Affiliation(s)
- John W Rumsey
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | - Case Lorance
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | - Max Jackson
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | - Trevor Sasserath
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
| | | | | | - Arindom Goswami
- NanoScience Technology Center, University of Central Florida, Orlando, Florida, USA
| | - Melissa A Russo
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Shruti M Raja
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Karissa L Gable
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Doug Emmett
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Lisa D Hobson-Webb
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Manisha Chopra
- Department of Neurology, The University of North Carolina - Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - James F Howard
- Department of Neurology, The University of North Carolina - Chapel Hill, School of Medicine, Chapel Hill, NC, USA
| | - Jeffrey T Guptill
- Division of Neuromuscular Disease, Department of Neurology, Duke University Medical Center, Box 3403, Durham, NC, USA
| | - Michael J Storek
- Sanofi, Immunology and Inflammation, 225 2 Ave, Waltham, MA, 02451 USA
| | | | - Nazem Atassi
- Sanofi, Neurology Early Development, 50 Binney Street, Cambridge, MA, 02142 USA
| | - Sandip Panicker
- Bioverativ, a Sanofi company, 225 2 Ave, Waltham, MA, 02451 USA
| | - Graham Parry
- Bioverativ, a Sanofi company, 225 2 Ave, Waltham, MA, 02451 USA
| | - Timothy Hammond
- Sanofi, Neurological Diseases, 49 New York Ave, Framingham, MA, 01701 USA
| | - James J Hickman
- Hesperos, Inc., 12501 Research Parkway, Suite 100, Orlando, FL 32826
- NanoScience Technology Center, University of Central Florida, Orlando, Florida, USA
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12
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Koszewicz M, Mulak A, Dziadkowiak E, Budrewicz S. Is Fecal Calprotectin an Applicable Biomarker of Gut Immune System Activation in Chronic Inflammatory Demyelinating Polyneuropathy? - A Pilot Study. Front Hum Neurosci 2021; 15:733070. [PMID: 34867240 PMCID: PMC8636096 DOI: 10.3389/fnhum.2021.733070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a complex autoimmune disease caused by dysregulated response to not fully recognized antigens. Some association between CIDP and inflammatory bowel disease (IBD) has been reported, but the exact pathophysiological links of these disorders are not well understood. Aim of the Study: To evaluate fecal calprotectin as a biomarker of gut inflammation in CIDP patients without IBD. Methods: Fifteen patients with CIDP and 15 healthy controls were included in the study. The CIDP diagnosis was based on the EFNS/PNS criteria. The occurrence of bowel symptoms was assessed based on a questionnaire. The quantitative evaluation of fecal calprotectin level was performed by the ELISA test. Results: The fecal calprotectin level (μg/g) expressed as median along with the lower and upper quartiles [25Q–75Q] was significantly higher in CIDP patients compared to the controls: 26.6 [17.5–109.0] vs 15.6 [7.1–24.1], p = 0.0066. Abnormal fecal calprotectin level (>50 μg/g) was found in 33% of all CIDP patients and in none of the control subjects. The patients with abnormal fecal calprotectin level did not differ from the rest of the study group regarding the neurological status. The most common bowel symptoms reported by CIDP patients included constipation (33%), feeling of incomplete evacuation (33%), bloating (27%), and alternating bowel movement pattern (27%). Conclusion: In one-third of CIDP patients the signs of gut immune system activation have been observed. This finding may be associated with CIDP pathogenesis and induction of autoimmune response as well as concomitant dysautonomia with gastrointestinal symptoms.
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Affiliation(s)
| | - Agata Mulak
- Department of Gastroenterology and Hepatology, Wrocław Medical University, Wrocław, Poland
| | - Edyta Dziadkowiak
- Department of Neurology, Wrocław Medical University, Wrocław, Poland
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13
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Goyal NA, Karam C, Sheikh KA, Dimachkie MM. Subcutaneous immunoglobulin treatment for chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2021; 64:243-254. [PMID: 34260074 PMCID: PMC8457117 DOI: 10.1002/mus.27356] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 12/15/2022]
Abstract
Immunoglobulin G (IgG) therapy is an established long‐term treatment in chronic inflammatory demyelinating polyneuropathy (CIDP) that is commonly administered intravenously (IVIg). The subcutaneous immunoglobulin (SCIg) administration route is a safe and effective alternative option, approved by the United States Food and Drug Administration (FDA) in 2018, for maintenance treatment of adults with CIDP. Physicians and patients alike need to be aware of all their treatment options in order to make informed decisions and plan long‐term treatment strategies. In this review, we collate the evidence for SCIg in CIDP from all published studies and discuss their implications and translation to clinical practice. We also provide guidance on the practicalities of how and when to transition patients from IVIg to SCIg and ongoing patient support. Evidence suggests that IVIg and SCIg have comparable long‐term efficacy in CIDP. However, SCIg can provide additional benefits for some patients, including no requirement for venous access or premedication, and reduced frequency of systemic adverse events. Local‐site reactions are more common with SCIg than IVIg, but these are mostly well‐tolerated and abate with subsequent infusions. Data suggest that many patients prefer SCIg following transition from IVIg. SCIg preference may be a result of the independence and flexibility associated with self‐infusion, whereas IVIg preference may be a result of familiarity and reliance on a healthcare professional for infusions. In practice, individualizing maintenance dosing based on disease behavior and determining the minimally effective IgG dose for individuals are key considerations irrespective of the administration route chosen.
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Affiliation(s)
- Namita A Goyal
- Department of Neurology, MDA ALS and Neuromuscular Center, University of California, Irvine, California, USA
| | - Chafic Karam
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kazim A Sheikh
- Department of Neurology, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Mazen M Dimachkie
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, USA
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14
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Pająk R, Mendela E, Będkowska N, Paprocka J. Update on Neuropathies in Inborn Errors of Metabolism. Brain Sci 2021; 11:brainsci11060763. [PMID: 34201281 PMCID: PMC8227217 DOI: 10.3390/brainsci11060763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 11/16/2022] Open
Abstract
Neuropathies are relatively common in inborn errors of metabolism (IEMs); however, due to the early onset and severe, progressive course of many IEMs, they have not been very well researched yet. This article aims to review and compare neuropathies in inborn errors of metabolism, mostly with childhood and juvenile onset. Some of these diseases are treatable if diagnosed early and in many cases, the therapy can not only slow down disease progression, but can also reverse the changes already made by the condition.
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Affiliation(s)
- Renata Pająk
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (R.P.); (E.M.); (N.B.)
| | - Ewelina Mendela
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (R.P.); (E.M.); (N.B.)
| | - Natalia Będkowska
- Students’ Scientific Society, Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland; (R.P.); (E.M.); (N.B.)
| | - Justyna Paprocka
- Department of Pediatric Neurology, Faculty of Medical Sciences in Katowice, Medical University of Silesia, 40-752 Katowice, Poland
- Correspondence:
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15
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Tanitame K. A middle-aged woman with numbness and weakness of the extremities. Eur J Intern Med 2021; 83:78-79. [PMID: 32980220 DOI: 10.1016/j.ejim.2020.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/20/2020] [Indexed: 11/23/2022]
Affiliation(s)
- Keizo Tanitame
- Department of Diagnostic Radiology, Hiroshima Prefectural Hospital, 1-5-54 Ujinakanda, Hiroshima, 734-8530, Japan.
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16
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Chkheidze R, Pytel P. What Every Neuropathologist Needs to Know: Peripheral Nerve Biopsy. J Neuropathol Exp Neurol 2020; 79:355-364. [PMID: 32167544 DOI: 10.1093/jnen/nlaa012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Peripheral neuropathy is a common disorder with many possible etiologies including metabolic diseases, inflammatory conditions, infections, malignancy, inherited diseases, drugs, and toxins. In most instances, diagnosis and treatment plan can be established based on clinical presentation, family history, laboratory results, genetic testing, and electrophysiological studies. But in some situations, a peripheral nerve biopsy remains a valuable tool. This is especially true in patients with rapidly progressive disease, with atypical presentation or for whom other approaches fail to yield a definitive diagnosis. The pathologic examination starts with basic decisions about specimen triage. A few basic questions help to provide an initial framework for the assessment of a nerve biopsy-is the specimen adequate; are there inflammatory changes; are there vascular changes; is there amyloid; are there changes to axonal density and the Schwann cell-myelin-axon unit. In the appropriate context and with such an approach peripheral nerve biopsies can still represent a clinically helpful test.
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Affiliation(s)
- Rati Chkheidze
- From the Department of Pathology, UT Southwestern Medical Center, Dallas, Texas
| | - Peter Pytel
- Department of Pathology, University of Chicago, Chicago, Illinois
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17
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Malik A, Berry R, Fung BM, Tabibian JH. Association between chronic inflammatory demyelinating polyneuropathy and gastrointestinal malignancies. Clin J Gastroenterol 2020; 14:1-13. [PMID: 33146871 DOI: 10.1007/s12328-020-01281-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/20/2020] [Indexed: 11/29/2022]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an uncommon and under-recognized immune-mediated disorder of the peripheral nervous system. It is associated with both infectious and non-infectious etiologies and presents in several variant forms. In rare instances, CIDP has been reported in association with gastrointestinal (esophageal, hepatic, colorectal, and pancreatic) malignancies. The diagnosis of malignancy is typically preceded by weeks to months by that of CIDP, though the inverse may also be seen. As with other etiologies of CIDP, cases associated with gastrointestinal malignancies are often treated with corticosteroids, intravenous immunoglobulins, and/or plasma exchange, with improvement or resolution of neurological symptoms in the majority of cases. In this review, we provide a practical overview of CIDP, with an emphasis on recognizing the clinical association between CIDP and gastrointestinal malignancies.
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Affiliation(s)
- Adnan Malik
- Division of Hepatology, Loyola University Medical Center, Maywood, IL, USA
| | - Rani Berry
- Department of Internal Medicine, UCLA Ronald Reagan Medical Center, Los Angeles, CA, USA
| | - Brian M Fung
- Department of Medicine, Olive View-UCLA Medical Center, Sylmar, CA, USA
| | - James H Tabibian
- Division of Gastroenterology, Olive View-UCLA Medical Center, 14445 Olive View Dr, Sylmar, CA, 2B-182, USA. .,David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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18
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Abu-Rumeileh S, Garibashvili T, Ruf W, Fangerau T, Kassubek J, Althaus K, Otto M, Senel M. Exacerbation of chronic inflammatory demyelinating polyneuropathy in concomitance with COVID-19. J Neurol Sci 2020; 418:117106. [PMID: 32911389 PMCID: PMC7462872 DOI: 10.1016/j.jns.2020.117106] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/30/2022]
Abstract
A clinical worsening in CIDP may occur in concomitance with COVID-19. Cytokine hyperactivation triggered by SARS-CoV-2 infection might be a possible mechanism. The management of these patients is particularly challenging.
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Affiliation(s)
| | | | - Wolfgang Ruf
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Tanja Fangerau
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Jan Kassubek
- Department of Neurology, University of Ulm, Ulm, Germany
| | | | - Markus Otto
- Department of Neurology, University of Ulm, Ulm, Germany
| | - Makbule Senel
- Department of Neurology, University of Ulm, Ulm, Germany.
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Rozłucka L, Semik-Grabarczyk E, Pietrukaniec M, Żak-Gołąb A, Grabarczyk M, Grosicki S, Holecki M. Demyelinating polyneuropathy and lymphoplasmacytic lymphoma coexisting in 36-year-old man: A case report. World J Clin Cases 2020; 8:2566-2573. [PMID: 32607333 PMCID: PMC7322434 DOI: 10.12998/wjcc.v8.i12.2566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 05/20/2020] [Accepted: 05/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lymphoplasmacytic lymphoma is a rare non-Hodgkin’s lymphoma, occurring mostly in the elderly. It develops slowly and leads to malignant proliferation of lymphoid line cells in the bone marrow, lymph nodes and spleen. It may also affect nerve roots and meninges; some patients develop sensorimotor polyneuropathy which may precede general symptoms of lymphoma.
CASE SUMMARY We present a case of a 36-year-old man diagnosed in 2012 with chronic inflammatory demyelinating polyneuropathy (CIDP), then he was hospitalized in 2019 due to progressive symptoms of heart failure and significant weight loss over the previous four months. Based on clinical and laboratory findings a diagnosis of lymphoplasmacytic lymphoma was suspected and confirmed by bone marrow flow cytometry. There was no improvement in the results of laboratory tests and the patient's condition after immediate implementation of chemotherapy. Patient died on the fifth day of treatment.
CONCLUSION While CIDP and malignant disease co-occurrence is rare, it should be suspected and investigated in patients with atypical neuropathy symptoms.
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Affiliation(s)
- Lesia Rozłucka
- Department of Internal Medicine, Allergology and Clinical Immunology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice 40-752, Poland
| | - Elżbieta Semik-Grabarczyk
- Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice 40-752, Poland
| | - Marta Pietrukaniec
- Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice 40-752, Poland
| | - Agnieszka Żak-Gołąb
- Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice 40-752, Poland
| | - Małgorzata Grabarczyk
- Student Scientific Society at the Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice 40-752, Poland
| | - Sebastian Grosicki
- Department of Hematology and Cancer Prevention, Faculty of Health Sciences in Bytom, Medical University of Silesia, Bytom, 41-902, Poland
| | - Michał Holecki
- Department of Internal Medicine, Autoimmune and Metabolic Diseases, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice 40-752, Poland
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20
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Druzhinina ES, Nikitin SS, Bembeeva RT, Druzhinin DS. [Chronic dysimmune hypertrophic plexopathy as a variant of atypical chronic inflammatory demyelinating polyneuropathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 119:94-99. [PMID: 31994521 DOI: 10.17116/jnevro201911912194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The authors report the clinical case of a 7-year-old child with gradual development in left leg weakness considering by the neurologist as the unknown lesion of the sciatic nerve. According to the results of clinical and instrumental examinations, the diagnosis was established as a focal form of chronic inflammatory demyelinating polyneuropathy (CIDP). The dysimmune cause of the disease was confirmed by MRI of the lumbosacral plexus with contrast enhancement of neural structures and response to therapy with high-dose intravenous immunoglobulin in combination with corticosteroids.
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Affiliation(s)
- E S Druzhinina
- Pirogov Russian National Research Medical University, Moscow, Russia; Medical Center 'Practical Neurology', Moscow, Russia
| | - S S Nikitin
- Medical Center 'Practical Neurology', Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - D S Druzhinin
- Yaroslavl State Medical University, Yaroslavl, Russia
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21
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Hamdan F, Towman F. Electrodiagnostic patterns of demyelination and hughes functional grading in typical chronic inflammatory demyelinating polyneuropathy. NEUROL SCI NEUROPHYS 2020. [DOI: 10.4103/nsn.nsn_8_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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22
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Abstract
Nerve conduction studies (NCSs) are an essential tool in the evaluation of the peripheral nervous system. The sensory nerve action potential (SNAP) provides information on the sensory nerve axon and its pathway from the distal receptors in the skin to the dorsal root ganglia, while the compound muscle action potential (CMAP) is an assessment of the motor nerve fibers from their origins in the anterior horn cell to their termination along muscle fibers. Various parameters of the SNAP and CMAP waveforms are used to determine the number of functioning nerve fibers and the speed of conduction. Similarly, specific electrodiagnostic patterns involving SNAP and CMAP amplitudes, latencies and other measurements can help discern the underlying nerve pathophysiology as either axon loss or demyelinating in nature. Numerous technical and environmental factors can affect the NCS and should be recognized and corrected if possible. Finally, while basic NCSs are a noninvasive and low-risk procedure, safety issues for patients with implanted electrical devices should be considered.
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Affiliation(s)
- Jinny Tavee
- Neuromuscular Division, Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, IL, United States.
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23
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Kim SW, Kim EH, Lee J, Choi YC, Kim SM, Shin HY. Risk of osteoporosis in patients with chronic inflammatory neuropathy- a population-based cohort study. Sci Rep 2019; 9:9131. [PMID: 31235735 PMCID: PMC6591220 DOI: 10.1038/s41598-019-45591-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 05/30/2019] [Indexed: 12/16/2022] Open
Abstract
The risk of osteoporosis in patients with chronic inflammatory neuropathy (CIN) has not been evaluated in detail. We conducted a population-based case-control study nested in a retrospective cohort to analyze osteoporosis risk among patients with CIN using a nationwide database. Patients with CIN based on the Korean Classification of Disease diagnostic code were included and were matched to controls. A Cox proportional hazards regression model was used to evaluate the effect of CIN on osteoporosis. After propensity score matching, 585 CIN patients and 585 controls were selected. Patients with CIN had an increased osteoporosis risk (hazard ratio [HR] = 2.293, 95% confidence interval [CI] 1.460-3.601) compared with controls. The osteoporosis risk was higher among male patients with CIN than among male controls (HR = 5.404, 95% CI 2.252-12.969), while there were no significant differences among women. Among the CIN patients, the average daily dose of corticosteroids was higher in those who developed osteoporosis (19.6 mg [10.8-49.3]) than those who did not (16.2 mg [7.2-29.1], p = 0.001). The osteoporosis risk among CIN patients is higher than among controls. High risk of osteoporosis in male patients may indicate that osteoporosis in CIN patients results from the disease itself or related treatments.
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Affiliation(s)
- Seung Woo Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Eun Hwa Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinae Lee
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, South Korea
| | - Young-Chul Choi
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Min Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ha Young Shin
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
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24
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Camargo CRSD, Schoueri JHM, Alves BDCA, Veiga GRLD, Fonseca FLA, Bacci MR. Uremic neuropathy: an overview of the current literature. ACTA ACUST UNITED AC 2019; 65:469-474. [PMID: 30994849 DOI: 10.1590/1806-9282.65.3.469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy (UN) is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
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Affiliation(s)
| | | | | | | | - Fernando L A Fonseca
- Laboratory of Clinical Analysis, ABC Medical School, Santo André, SP, Brasil.,Pharmaceutical Sciences Department, Federal University of São Paulo, Diadema, SP, Brasil
| | - Marcelo R Bacci
- Department of Integrated Clinical Discussions, ABC Medical School, Santo André, SP, Brasil
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25
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Camargo CRD, Schoueri JHM, Alves BDCA, Veiga GRLD, Fonseca FLA, Bacci MR. Uremic neuropathy: an overview of the current literature. ACTA ACUST UNITED AC 2019; 65:281-286. [PMID: 30892456 DOI: 10.1590/1806-9282.65.2.281] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Peripheral neuropathy is a disorder that affects the cell body, axon or myelin of motor or peripheral sensory neurons and occurs in 60-100% of patients who are submitted to dialysis due to chronic kidney disease. Uremic neuropathy is attributed to the accumulation of organic waste, evident in patients with reduced glomerular filtration rate. OBJECTIVES This review aims to make clinical characteristics of uremic neuropathy evident enabling early diagnosis and treatment. METHODS This is a literature review of articles published on PubMed over the last 10 years using "Uremic Neuropathy" as "Title/Abstract". RESULTS A total of nine articles that met the inclusion criteria were included. UN is a distal symmetric sensorimotor polyneuropathy that occurs due to the accumulation of uremic toxins associated with an oxidative stress-related free radical activity. Hyperkalemia is thought to play an important role in its pathophysiology. Diagnosis depends on nerve conduction studies, and treatment includes dialysis or renal transplant. CONCLUSION Clinical presentations of UN are broad and non-specific; nonetheless, it is important to detect early changes in order to avoid its progression. The earlier UN is diagnosed and treated, the more successful are the clinical outcomes.
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Affiliation(s)
- Celeste R de Camargo
- Department of Integrated Clinical Discussions, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Jean H M Schoueri
- Department of Integrated Clinical Discussions, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Beatriz da Costa Aguiar Alves
- Laboratory of Clinical Analysis, ABC Medical School, Av. Principe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Glaucia R L da Veiga
- Laboratory of Clinical Analysis, ABC Medical School, Av. Principe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
| | - Fernando L A Fonseca
- Laboratory of Clinical Analysis, ABC Medical School, Av. Principe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil.,Pharmaceutical Sciences Department, Federal University of São Paulo, R. Prof. Arthur Riedel, 275, CEP 09972-270 Diadema, São Paulo, Brasil
| | - Marcelo R Bacci
- Department of Integrated Clinical Discussions, ABC Medical School, Av. Príncipe de Gales, 821, CEP 09060-650, Santo André, SP, Brasil
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26
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Thammongkolchai T, Suhaib O, Termsarasab P, Li Y, Katirji B. Chronic immune sensorimotor polyradiculopathy: Report of a case series. Muscle Nerve 2019; 59:658-664. [PMID: 30697760 DOI: 10.1002/mus.26436] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 01/11/2019] [Accepted: 01/20/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Chronic immune sensorimotor polyradiculopathy (CISMP) is a chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) variant affecting both sensory and motor nerve roots without evidence of peripheral nerve demyelination. METHODS We report a case series of 9 patients with CISMP, identified from 2 tertiary centers. Clinical, electrodiagnostic, and neuroradiologic features, and treatment responses, were retrospectively reviewed. RESULTS Patients presented with sensorimotor deficits and hypo-/areflexia, predominantly involving lower extremities. Three had cranial nerve involvement. Electrodiagnostic findings in all patients localized to roots proximal to dorsal root ganglia, without evidence of peripheral nerve demyelination. Cerebrospinal fluid examination revealed an albuminocytologic association. Eight patients exhibited gadolinium enhancement and thickening of multiple spinal nerve roots and/or cranial nerves. All patients demonstrated good responses to immunotherapies. DISCUSSION CISMP is similar to CIDP in many aspects, but lacks typical electrodiagnostic findings of peripheral nerve demyelination. It is important to recognize this unusual and treatable entity. Muscle Nerve 59:658-664, 2019.
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Affiliation(s)
- Thananan Thammongkolchai
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA
| | - Omer Suhaib
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Pichet Termsarasab
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Yuebing Li
- Department of Neurology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Bashar Katirji
- Department of Neurology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, 44106, USA
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27
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Hughes R, Dalakas MC, Merkies I, Latov N, Léger JM, Nobile-Orazio E, Sobue G, Genge A, Cornblath D, Merschhemke M, Ervin CM, Agoropoulou C, Hartung HP, Day T, Spies J, Roberts L, Van Damme P, Van den Bergh PYK, Maertens de Noordhout A, Dionne A, Larue S, Massie R, Melanson M, Camu W, De Seze J, Le Masson G, Pouget J, Schmidt J, Kimiskidis VK, Chapman J, Drory VE, Fazio R, Gallia F, Kusunoki S, Mori M, Iijima M, Okamoto T, Baba M, Faber CG, van Schaik IN, Fryze W, Motta E, Selmaj K, Casasnovas C, Sola AG, Illa I, Holt J, Miller JAL, Lunn MP, Brannagan TH, Brown M, Kelemen J, Iyadurai S, Rezania K, Sharma KR, Tandan R, Gudesblatt M, Lawson V, Amato AA. Oral fingolimod for chronic inflammatory demyelinating polyradiculoneuropathy (FORCIDP Trial): a double-blind, multicentre, randomised controlled trial. Lancet Neurol 2018; 17:689-698. [DOI: 10.1016/s1474-4422(18)30202-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 05/01/2018] [Accepted: 05/14/2018] [Indexed: 12/17/2022]
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28
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Keddie S, D'Sa S, Foldes D, Carr AS, Reilly MM, Lunn MPT. POEMS neuropathy: optimising diagnosis and management. Pract Neurol 2018; 18:278-290. [PMID: 29511110 DOI: 10.1136/practneurol-2017-001792] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2018] [Indexed: 02/06/2023]
Abstract
POEMS syndrome is a rare and disabling autoinflammatory condition characterised by a typical peripheral neuropathy and the presence of a monoclonal plasma cell disorder. The acronym 'POEMS' represents the complex and multisystem features of the disease, including polyneuropathy, organomegaly, endocrinopathy, a monoclonal plasma cell disorder and skin disease. The diagnosis of POEMS is a significant challenge because of the heterogeneity of clinical presentations and variation of POEMS features. Patients are often misdiagnosed with another cause of inflammatory neuropathy and receive one or more ineffective immunomodulatory medications, resulting in delayed diagnosis and further clinical deterioration before a diagnosis is made. University College London Hospitals sees one of the largest reported POEMS cohorts in Europe, and runs a multispecialist clinic to assist with diagnosis, treatment and ongoing support. This review draws upon our experience to present the typical features of POEMS syndrome and highlight diagnostic conundrums commonly experienced, supplemented with clinical cases. We provide an investigative guide for clinicians when considering POEMS as the diagnosis, and propose a treatment algorithm that centres on the site and degree of monoclonal cell proliferation.
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Affiliation(s)
- Stephen Keddie
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK.,Neuroimmunology & CSF Laboratory, Institute of Neurology, National Hospital for Neurology and Neurosurgery, London, UK
| | - Shirley D'Sa
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - David Foldes
- Cancer Division, University College London Hospitals NHS Foundation Trust, London, UK
| | - Aisling S Carr
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Mary M Reilly
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
| | - Michael P T Lunn
- MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK.,Department of Molecular Neuroscience, UCL Institute of Neurology, London, UK
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Lovett A, McKee K, Prasad S. Clinical Reasoning: A 49-year-old man with progressive numbness, weakness, and evidence of leptomeningeal enhancement. Neurology 2018; 90:e90-e93. [PMID: 29284657 DOI: 10.1212/wnl.0000000000004770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Alexandra Lovett
- From the Department of Neurology (A.L., K.M.), Massachusetts General Hospital; and Department of Neurology (A.L., K.M., S.P.), Brigham and Women's Hospital, Boston, MA.
| | - Kathleen McKee
- From the Department of Neurology (A.L., K.M.), Massachusetts General Hospital; and Department of Neurology (A.L., K.M., S.P.), Brigham and Women's Hospital, Boston, MA
| | - Sashank Prasad
- From the Department of Neurology (A.L., K.M.), Massachusetts General Hospital; and Department of Neurology (A.L., K.M., S.P.), Brigham and Women's Hospital, Boston, MA
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Yoon D, Biswal S, Rutt B, Lutz A, Hargreaves B. Feasibility of 7T MRI for imaging fascicular structures of peripheral nerves. Muscle Nerve 2017; 57:494-498. [PMID: 29211916 DOI: 10.1002/mus.26035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2017] [Indexed: 12/12/2022]
Abstract
INTRODUCTION Evaluation of the nerve fascicular structure can be useful in diagnosing nerve damage, but it is a very challenging task with 3T MRI because of limited resolution. In this pilot study, we present the feasibility of high-resolution 7T MRI for examining the nerve fascicular structure. METHODS A 3-dimensional (3D) gradient-spoiled sequence was used for imaging peripheral nerves in extremities. Images acquired with different in-plane resolutions (0.42 × 0.42 mm vs. 0.12 × 0.12 mm), and different main field strengths (7T vs. 3T) were compared. RESULTS The individual nerve fascicles were identified at 0.12 × 0.12 mm resolution in both field strengths but not at 0.42 × 0.42 mm resolution. The fascicular structure was more sharply depicted in 7T images than in 3T images. DISCUSSION High-resolution 3D imaging with 7T MRI demonstrated feasibility for imaging nerve fascicular structures. Muscle Nerve 57: 494-498, 2018.
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Affiliation(s)
- Daehyun Yoon
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Road Stanford, California, 94305, USA
| | - Sandip Biswal
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Road Stanford, California, 94305, USA
| | - Brian Rutt
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Road Stanford, California, 94305, USA
| | - Amelie Lutz
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Road Stanford, California, 94305, USA
| | - Brian Hargreaves
- Department of Radiology, Stanford University School of Medicine, 1201 Welch Road Stanford, California, 94305, USA
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31
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Lichtenstein T, Sprenger A, Weiss K, Slebocki K, Cervantes B, Karampinos D, Maintz D, Fink GR, Henning TD, Lehmann HC. MRI biomarkers of proximal nerve injury in CIDP. Ann Clin Transl Neurol 2017; 5:19-28. [PMID: 29376089 PMCID: PMC5771316 DOI: 10.1002/acn3.502] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/17/2017] [Accepted: 10/17/2017] [Indexed: 12/30/2022] Open
Abstract
Objective To evaluate the utility of nerve diffusion tensor imaging (DTI), nerve cross‐sectional area, and muscle magnetic resonance imaging (MRI) multiecho Dixon for assessing proximal nerve injury in chronic inflammatory demyelinating polyneuropathy (CIDP). Methods In this prospective observational cohort study, 11 patients with CIDP and 11 healthy controls underwent a multiparametric MRI protocol with DTI of the sciatic nerve and assessment of muscle proton‐density fat fraction of the biceps femoris and the quadriceps femoris muscles by multiecho Dixon MRI. Patients were longitudinally evaluated by MRI, clinical examination, and nerve conduction studies at baseline and after 6 months. Results In sciatic nerves of CIDP patients, mean cross‐sectional area was significantly higher and fractional anisotropy value was significantly lower, compared to controls. In contrast, muscle proton‐density fat fraction was significantly higher in thigh muscles of patients with CIDP, compared to controls. MRI parameters showed high reproducibility at baseline and 6 months. Interpretation Advanced MRI parameters demonstrate subclinical proximal nerve damage and intramuscular fat accumulation in CIDP. Data suggest DTI and multiecho Dixon MRI might be useful in estimating axonal damage and neurogenic muscle changes in CIDP.
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Affiliation(s)
- Thorsten Lichtenstein
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Alina Sprenger
- Department of Neurology University Hospital of Cologne Cologne Germany
| | - Kilian Weiss
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany.,Philips Healthcare Germany Hamburg Germany
| | - Karin Slebocki
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Barbara Cervantes
- Cognitive Neuroscience Institute of Diagnostic and Interventional Radiology Technical University Munich Munich Germany
| | - Dimitrios Karampinos
- Cognitive Neuroscience Institute of Diagnostic and Interventional Radiology Technical University Munich Munich Germany
| | - David Maintz
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany
| | - Gereon R Fink
- Department of Neurology University Hospital of Cologne Cologne Germany.,Institute of Neuroscience and Medicine (INM-3) Research Centre Juelich Jülich Germany
| | - Tobias D Henning
- Institute of Diagnostic and Interventional Radiology University Hospital of Cologne Cologne Germany.,Department of Neuroradiology Krankenhaus der Barmherzigen Brüder Trier Germany
| | - Helmar C Lehmann
- Department of Neurology University Hospital of Cologne Cologne Germany
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Lupescu IC, Dulamea AO. Predominant Upper Limb Chronic Demyelinating Polyneuropathy Associated with HBV Infection. MAEDICA 2017; 12:286-288. [PMID: 29610592 PMCID: PMC5879587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Chronic inflammatory demyelinating polyneuropathy is an acquired, presumably immune-mediated peripheral neuropathy, characterized by symmetric sensory-motor involvement. Although most often idiopathic, it has been described in association with several disorders, sometimes improving under treatment. We present the case of a 57-year-old male who was admitted to hospital for paresthesias and muscle weakness affecting both upper limbs, initially only the hands, but with worsening and ascending progression during the last three years. The lower limbs were also involved but to a lesser extent. Electromyography indicated multifocal chronic demyelinating polyneuropathy with predominant upper limb involvement. Lumbar puncture showed a raised cerebrospinal fluid protein level. Laboratory samples revealed positive serology for HBV. Based on these, the diagnosis of chronic inflammatory demyelinating polyneuropathy with chronic hepatitis B was made. The patient received IVIG therapy and has since been coming periodically for IVIG sessions, with clinical and electromyographic improvement.
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Otto M, Markvardsen L, Tankisi H, Jakobsen J, Fuglsang-Frederiksen A. The electrophysiological response to immunoglobulin therapy in chronic inflammatory demyelinating polyneuropathy. Acta Neurol Scand 2017; 135:656-662. [PMID: 27546708 DOI: 10.1111/ane.12663] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/01/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize changes in motor nerve conduction studies (MNCS) and motor unit number index (MUNIX) following treatment with subcutaneous immunoglobulin and to assess whether these changes are related to muscle strength. METHODS Data from 23 patients participating in a randomized, controlled trial were analyzed. MNCS and MUNIX were performed before and after 12 weeks of treatment. Isokinetic strength (IMS) was measured in various muscles together with grip strength (GS). RESULTS Proximally evoked compound muscle action potential (CMAP) amplitudes and MUNIX tended to be better preserved in treated patients (P=.049 and .045). Changes in other parameters did not differ between groups. There was no correlation between changes in electrophysiological parameters and IMS. Changes in GS were related to median nerve motor conduction velocity, distal motor latency, CMAP amplitudes, and distally evoked CMAP duration (P=.013-.035). CONCLUSION Proximally evoked CMAP amplitudes appear to be the best MNCS parameter to assess treatment outcome in chronic inflammatory demyelinating polyneuropathy.
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Affiliation(s)
- M. Otto
- Department of Clinical Neurophysiology; Aarhus University Hospital; Aarhus Denmark
| | - L. Markvardsen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
| | - H. Tankisi
- Department of Clinical Neurophysiology; Aarhus University Hospital; Aarhus Denmark
| | - J. Jakobsen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
- Neuroscience Center; Rigshospitalet; Copenhagen Denmark
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Katzberg HD, Latov N, Walker FO. Measuring disease activity and clinical response during maintenance therapy in CIDP: from ICE trial outcome measures to future clinical biomarkers. Neurodegener Dis Manag 2017; 7:147-156. [DOI: 10.2217/nmt-2016-0058] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Some patients with chronic inflammatory demyelinating polyradiculoneuropathy who respond to initial intravenous immunoglobulin require repeated courses over prolonged periods of time; however, evidence to guide dosage and interval of intravenous immunoglobulin during maintenance therapy is limited. Optimizing treatment requires assessment of underlying disease activity and clinical outcome. Electrophysiological measures of demyelination, and clinical measures using handgrip strength and walking velocity promise to be particularly informative. Major advances in resolution and image processing have expanded clinical applications for ultrasound to include the study of peripheral nerves. Ultrasonography shows promise in diagnosing chronic inflammatory demyelinating polyradiculoneuropathy and distinguishing it from other conditions, providing first ever insight into gross pathology of peripheral nerves. Ultrasonography may also have a role in monitoring disease activity and treatment response.
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Affiliation(s)
- Hans D Katzberg
- University of Toronto, Toronto General Hospital/UHN, Toronto, ON, Canada
| | | | - Francis O Walker
- Wake Forest University School of Medicine, Winston-Salem, NC, USA
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35
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Kumar A, Patwa HS, Nowak RJ. Immunoglobulin therapy in the treatment of multifocal motor neuropathy. J Neurol Sci 2017; 375:190-197. [DOI: 10.1016/j.jns.2017.01.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 12/30/2016] [Accepted: 01/23/2017] [Indexed: 12/21/2022]
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36
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Gilmore KJ, Allen MD, Doherty TJ, Kimpinski K, Rice CL. Electrophysiological and neuromuscular stability of persons with chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2017; 56:413-420. [DOI: 10.1002/mus.25516] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 12/07/2016] [Accepted: 12/09/2016] [Indexed: 12/14/2022]
Affiliation(s)
- Kevin J. Gilmore
- School of Kinesiology; The University of Western Ontario; London ON Canada
| | - Matti D. Allen
- School of Medicine Queen's University Kingston ON Canada
| | - Timothy J. Doherty
- Department of Clinical Neurological Sciences; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
- Department of Physical Medicine and Rehabilitation; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| | - Kurt Kimpinski
- School of Kinesiology; The University of Western Ontario; London ON Canada
- Department of Clinical Neurological Sciences; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
| | - Charles L. Rice
- School of Kinesiology; The University of Western Ontario; London ON Canada
- Department of Anatomy and Cell Biology; Schulich School of Medicine and Dentistry, The University of Western Ontario; London ON Canada
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Moodley K, Bill PLA, Patel VB. A comparative study of CIDP in a cohort of HIV-infected and HIV-uninfected patients. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2016; 4:e315. [PMID: 28054000 PMCID: PMC5182055 DOI: 10.1212/nxi.0000000000000315] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/21/2016] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate differences in clinical presentation, electrodiagnostic measures, CSF changes, and treatment outcome measures in HIV-infected and HIV-uninfected patients with chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS A retrospective analysis of medical records of all patients meeting the European Federation of Neurology diagnostic criteria for idiopathic CIDP was performed in 2 neuromuscular units in Kwa-Zulu Natal between 2003 and 2015. RESULTS Eighty-four patients were included in the study; 39 were HIV-infected and 45 were HIV-uninfected. Among the HIV-infected patients, the majority were younger, were female, and had a monophasic progressive illness. Eighty-six percent (86%) were corticosteroid-responsive and 76% were in remission within 6-12 months requiring no further treatment. Among the HIV- uninfected patients, the majority were older, were male, and had a relapsing-remitting course. Twenty-seven percent (27%) were corticosteroid-responsive, 95% required combination therapy, and 33% were not in remission by 18 months on therapy. CONCLUSION This study shows that HIV-infected patients with CIDP were younger, were more often female, displayed a monophasic progressive course, were highly steroid-responsive, and went into remission within 12 months of corticosteroid initiation.
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Affiliation(s)
- Kaminie Moodley
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Pierre L A Bill
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
| | - Vinod Bhagu Patel
- Department of Neurology, University of KwaZulu-Natal, Durban, South Africa
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Lim JY, Lim YH, Choi EH. Acute-onset chronic inflammatory demyelinating polyneuropathy in hantavirus and hepatitis B virus coinfection: A case report. Medicine (Baltimore) 2016; 95:e5580. [PMID: 27930572 PMCID: PMC5266044 DOI: 10.1097/md.0000000000005580] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Chronic inflammatory demyelinating polyneuropathy (CIDP) is an acquired autoimmune disorder with progressive weakness. Acute-onset CIDP resembles Guillain-Barre syndrome (GBS), a rapidly progressive disorder, and follows a chronic course. To our knowledge, no case of acute-onset CIDP in hantavirus and hepatitis B virus (HBV) coinfection has been reported previously. CLINICAL FINDINGS We report a case of acute-onset CIDP that was initially diagnosed as GBS. DIAGNOSES A 44-year-old male logger complained of acute quadriplegia and dyspnea. Mechanical ventilation was initiated. He was an HBV carrier with mild elevation of hepatic enzyme, and positive for hantavirus antibody. He was diagnosed with GBS and immunoglobulin therapy was administered. INTERVENTIONS After 8 months, quadriplegia and hypesthesia recurred. Immunoglobulin therapy at this time had no effect, but steroid therapy had some effect. OUTCOMES A diagnosis of CIDP was made. After 2 months, severe extremity pain and dyspnea developed again, and steroid pulse therapy was initiated. CONCLUSION Besides GBS, acute-onset CIDP can occur with hantavirus and HBV coinfection. Patients with this coinfection in whom GBS has been initially diagnosed should be followed up for a long time, because of the possibility of relapse or deterioration, and acute-onset CIDP should always be considered.
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Affiliation(s)
- Jong Youb Lim
- Department of Rehabilitation Medicine, Eulji University Hospital, Daejeon
- Department of Rehabilitation Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Young-Ho Lim
- Department of Rehabilitation Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
| | - Eun-Hi Choi
- Department of Rehabilitation Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, South Korea
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Chhabra A, Carrino JA, Farahani SJ, Thawait GK, Sumner CJ, Wadhwa V, Chaudhary V, Lloyd TE. Whole-body MR neurography: Prospective feasibility study in polyneuropathy and Charcot-Marie-Tooth disease. J Magn Reson Imaging 2016; 44:1513-1521. [PMID: 27126998 DOI: 10.1002/jmri.25293] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Accepted: 04/08/2016] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate the feasibility of whole-body magnetic resonance neurography (WBMRN) in polyneuropathy for technical feasibility, distribution of nerve abnormalities, and differentiation. MATERIALS AND METHODS Twenty WBMRN examinations were performed on a 3T scanner over 2 years. Patient demographics including history of hereditary and acquired neuropathy were recorded. The images were evaluated by two independent readers with nerve imaging experience for quality. The nerve signal and size alterations were measured in the brachial plexus, lumbosacral plexus, and femoral and sciatic nerves; diffusion tensor imaging parameters (fractional anisotropy [FA] and apparent diffusion coefficient [ADC]) were determined in plexuses, and tractography was performed. Nonparametric Wilcoxon rank sum test, receiver operating characteristic (ROC) analysis, and intraclass correlation coefficients (ICCs) were obtained. RESULTS Excellent image quality was obtained for the majority of lumbosacral (LS) plexus (18/20) and 50% of brachial plexus (10/20) regions. Qualitatively among cases, the nerve hyperintensity and/or thickening involved the brachial plexus (11/11), LS plexus (7/11), and both plexuses (7/11), with most nerve thickenings observed in Charcot-Marie-Tooth disease type 1. The nerve signal intensity alterations were significantly different for both brachial (P < 0.05) and LS (P < 0.05) plexuses in cases versus controls. The femoral and sciatic nerve size alterations were different (P < 0.05), while signal intensity differences were not significant (P = 0.1-0.97). Transverse dimensions of C8 (4 mm), L5 (6.2 mm) and S1 (5.1 mm) nerve roots, and sciatic nerves (10.2 mm) were the most accurate diagnostic performance measures in distinguishing cases from controls. CONCLUSION WBMRN is feasible for use in the clinical practice for the identification and potential characterization of polyneuropathy. J. Magn. Reson. Imaging 2016;44:1513-1521.
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Affiliation(s)
- Avneesh Chhabra
- Musculoskeletal Radiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.,Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - John A Carrino
- Musculoskeletal Radiology, Hospital of Special Surgery, New York, New York, USA
| | - Sahar J Farahani
- Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gaurav K Thawait
- Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Vibhor Wadhwa
- Musculoskeletal Radiology, Russell H Morgan Department of Radiology & Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Vinay Chaudhary
- Neurology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Thomas E Lloyd
- Neurology, Johns Hopkins University, Baltimore, Maryland, USA
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Viala K. Diagnosis of atypical forms of chronic inflammatory demyelinating polyradiculoneuropathy: a practical overview based on some case studies. Int J Neurosci 2015; 126:777-85. [DOI: 10.3109/00207454.2015.1096786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Rajabally YA, Blomkwist-Markens PH, Katzberg HD. New insights into the management of chronic inflammatory demyelinating polyradiculoneuropathy. Neurodegener Dis Manag 2015; 5:257-68. [PMID: 26107324 DOI: 10.2217/nmt.15.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and its variants can be challenging to diagnose and treat. A combination of clinical, electrophysiological and laboratory features is often required to reach a diagnosis. New data are emerging about potential biomarkers and factors that may indicate treatment needs in individual patients. High-quality evidence exists for the efficacy of intravenous immunoglobulin (IVIG) in the treatment of CIDP, including quality of life (QoL) benefits. Besides pharmacological treatment, psychological factors must also be addressed to improve patients' QoL. Home-based IVIG infusion therapy is currently a well-established approach in some countries. A 6-month pilot study conducted in Ontario, Canada, provided proof of safety and patient acceptance of home-based IVIG therapy, although some logistical issues emerged.
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Affiliation(s)
- Yusuf A Rajabally
- Regional Neuromuscular Clinic, Queen Elizabeth Neuroscience Centre, University Hospitals of Birmingham, Birmingham, B15 2TH, UK
| | | | - Hans D Katzberg
- Neuromuscular Medicine, University of Toronto, Toronto General Hospital/UHN, Toronto, Canada
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42
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Gilbee ES. Lightning can strike twice: an unlucky patient of neurological interest. BMJ Case Rep 2013; 2013:bcr2013009475. [PMID: 23814000 PMCID: PMC3703035 DOI: 10.1136/bcr-2013-009475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Poliomyelitis, once a worldwide epidemic, is becoming increasingly rare owing to the introduction of the polio vaccine in the 1950s. It is estimated that the number of cases of polio has reduced by 99% since the Global Polio Eradication Initiative (GPEI) started in 1988. Amyotrophic lateral sclerosis (ALS) is another relatively uncommon condition which also affects anterior horn cells with debilitating neurological, and deadly, consequences. An unusual case of an aggressive form of ALS developing in a 72-year-old patient with paralytic poliomyelitis in childhood is presented. Her initial presentation was puzzling, and our approach to the diagnostic dilemma is discussed.
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