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Ubogu EE. Animal models of immune-mediated demyelinating polyneuropathies. Autoimmunity 2024; 57:2361745. [PMID: 38850571 DOI: 10.1080/08916934.2024.2361745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/26/2024] [Indexed: 06/10/2024]
Abstract
Immune-mediated demyelinating polyneuropathies (IMDPs) are rare disorders in which dysregulated adaptive immune responses cause peripheral nerve demyelinating inflammation and axonal injury in susceptible individuals. Despite significant advances in understanding IMDP pathogenesis guided by patient data and representative mammalian models, specific therapies are lacking. Significant knowledge gaps in IMDP pathogenesis still exist, e.g. precise antigen(s) and mechanisms that initially trigger immune system activation and identification of large population disease susceptibility factors. The initial directional cues for antigen-specific effector or autoreactive leukocyte trafficking into peripheral nerves are also unknown. An overview of current animal models, with emphasis on the experimental autoimmune neuritis and spontaneous autoimmune peripheral polyneuropathy models, is provided. Insights on the initial directional cues for peripheral nerve tissue specific autoimmunity using a novel Major Histocompatibility Complex class II conditional knockout mouse strain are also discussed, suggesting an essential research tool to study cell- and time-dependent adaptive immunity in autoimmune diseases.
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Affiliation(s)
- Eroboghene E Ubogu
- Neuromuscular Immunopathology Research Laboratory, Division of Neuromuscular Disease, Department of Neurology, University of Alabama at Birmingham, Birmingham, AL, USA
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2
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Li Y, Yi JS, Guptill JT, Juel VC, Hobson-Webb L, Raja SM, Karatz T, Gable KL. Immune dysregulation in chronic inflammatory demyelinating polyneuropathy. J Neuroimmunol 2024; 391:578360. [PMID: 38723578 DOI: 10.1016/j.jneuroim.2024.578360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 04/22/2024] [Accepted: 04/29/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disorder of the peripheral nerves with an incompletely understood underlying pathophysiology. This investigation focused on defining B and T cell frequencies, T cell functional capacity and innate immune system analysis in patients with CIDP. METHODS By using multi-parameter flow cytometry, we examined the phenotype and function of PBMCs in 25 CIDP patients who were relatively clinically stable on treatment who met EFNS/PNS criteria, 21 patients with genetically confirmed hereditary neuropathy and 25 healthy controls. We also evaluated the regulatory T cell (Treg) inhibitory capacity by co-culturing Treg and effector T cells. RESULTS Proinflammatory CD4 T cells, especially type 1 helper T cell (Th1) and CD8 T cells in patients with CIDP were found to have an enhanced capacity to produce inflammatory cytokines. There was no difference in frequency of Th17 regulatory cells in CIDP patients versus healthy controls, however, Treg function was impaired in CIDP patients. There was no remarkable difference in innate immune system measures. Within B cell subsets, transitional cell frequency was decreased in CIDP patients. INTERPRETATION Patients with CIDP clinically stable on treatment continued to show evidence of a proinflammatory state with impaired Treg function. This potentially implies an inadequate suppression of ongoing inflammation not addressed by standard of care therapies as well as persistent activity of disease while on treatment. Targeting T cells, especially inhibiting Th1 and polyfunctional CD8 T cells or improving Treg cell function could be potential targets for future therapeutic research.
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Affiliation(s)
- Yingkai Li
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | - John S Yi
- Division of Surgical Sciences, Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA
| | - Jeffrey T Guptill
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | - Vern C Juel
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | - Lisa Hobson-Webb
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | - Shruti M Raja
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | - Tabitha Karatz
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA
| | - Karissa L Gable
- Neuromuscular Division, Department of Neurology, Duke University Medical Center, Durham, NC 27710, USA.
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3
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Kokubun N, Funakoshi K, Yuki N. Do corticosteroids aggravate pure motor chronic inflammatory demyelinating polyneuropathy? J Peripher Nerv Syst 2024. [PMID: 38853616 DOI: 10.1111/jns.12639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 05/28/2024] [Indexed: 06/11/2024]
Affiliation(s)
- Norito Kokubun
- Department of Neurology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Kei Funakoshi
- Department of Neurology, Dokkyo Medical University, Shimotsuga-gun, Tochigi, Japan
| | - Nobuhiro Yuki
- Department of Neurology, Takai Hospital, Tenri, Nara, Japan
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Hearn SL, Stino AM, Howard IM, Malhotra G, Robinson L. Serial electrodiagnostic testing: Utility and indications in adult neurological disorders. Muscle Nerve 2024; 69:670-681. [PMID: 38549195 DOI: 10.1002/mus.28083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Accepted: 03/07/2024] [Indexed: 05/08/2024]
Abstract
Although existing guidelines address electrodiagnostic (EDX) testing in identifying neuromuscular conditions, guidance regarding the uses and limitations of serial (or repeat) EDX testing is limited. By assessing neurophysiological change longitudinally across time, serial electrodiagnosis can clarify a diagnosis and potentially provide valuable prognostic information. This monograph presents four broad indications for serial electrodiagnosis in adult peripheral neurological disorders. First, where clinical change has raised suspicion for a new or ongoing lesion, EDX reassessment for spatial spread of abnormality, involvement of previously normal muscle or nerve, and/or evolving pathophysiology can clarify a diagnosis. Second, where diagnosis of a progressive neuromuscular condition is uncertain, electrophysiological data from a second time point can confirm or refute suspicion. Third, to establish prognosis after a static nerve injury, a repeat study can assess the presence and extent of reinnervation. Finally, faced with a limited initial study (as when complicated by patient or environmental factors), a repeat EDX study can supplement missing or limited data to provide needed clarity. Repeat EDX studies carry certain limitations, however, such as with prognostication in the setting of remote or chronic lesions, sensory predominant fascicular injury, or mild axonal injury. Nevertheless, serial electrodiagnosis remains a valuable and underused tool in the diagnostic and prognostic evaluation of neuromuscular conditions.
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Affiliation(s)
- Sandra L Hearn
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Amro Maher Stino
- Division of Neuromuscular Medicine, Department of Neurology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Ileana M Howard
- Department of Rehabilitation Medicine, University of Washington, Washington, USA
| | - Gautam Malhotra
- Altair Health, Morristown, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Lawrence Robinson
- Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
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5
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Kuwabara S. [Cutting edge of diagnosis and treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) based on the EAN/PNS guideline 2021]. Rinsho Shinkeigaku 2024; 64:321-325. [PMID: 38644208 DOI: 10.5692/clinicalneurol.cn-001937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a most common chronic immune-mediated demyelinating neuropathy, and includes a number of clinical subtypes. The major phenotype is "typical CIDP", which is characterized by symmetric polyneuropathy and "proximal and distal" muscle weakness. During the historical changes in the concept of CIDP, multifocal motor neuropathy, anti-myelin-associated glycoprotein (MAG) neuropathy, and autoimmune nodopathy have been excluded. Currently CIDP is considered as a syndrome including typical CIDP and CIDP variant such as distal CIDP and multifocal CIDP. In 2021, the international guideline of diagnosis and treatment for CIDP, European Academy of Neurology (EAN)/Peripheral Nerve Society (PNS) Guideline, was published. This review article introduces the putline of the guideline with medical-social situation in Japan. The diagnosis of CIDP is based on (1) phenotype of typical CIDP or variant, (2) electrophysiologic evidence of peripheral nerve demyelination, and (3) exclusion criteria. The first-line treatments are corticosteroids or immunoglobulin therapy, and plasma exchange should be considered if the 2 treatments were not effective sufficiently. This guideline recommends intravenous or subcutaneous immunoglobulin as a maintenance therapy, and suggests other immune-suppressive agents. In the near future, new treatment with biologics, such as monoclonal antibodies against neonatal Fc receptors, complements, and CD19/20 will be approved.
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Affiliation(s)
- Satoshi Kuwabara
- Department of Neurology, Graduate School of Medicine, Chiba University
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Zhao M, Chen G, Li S, Li X, Chen H, Lou Z, Ouyang H, Zhan Y, Du C, Zhao Y. Recurrent CNTN1 antibody-positive nodopathy: a case report and literature review. Front Immunol 2024; 15:1368487. [PMID: 38846936 PMCID: PMC11153691 DOI: 10.3389/fimmu.2024.1368487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024] Open
Abstract
Background Contactin-1 (CNTN1) antibody-positive nodopathy is rare and exhibits distinct clinical symptoms such as tremors and ataxia. However, the mechanisms of these symptoms and the characteristics of the cerebral spinal fluid (CSF) remain unknown. Case presentation Here, we report a case of recurrent CNTN1 antibody-positive nodopathy. Initially, a 45-year-old woman experiencing numbness in the upper limbs and weakness in the lower limbs was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Eleven years later, her symptoms worsened, and she began to experience tremors and ataxia. Tests for serum CNTN1, GT1a, and GQ1b antibodies returned positive. Subsequently, she was diagnosed with CNTN1 antibody-positive nodopathy and underwent plasmapheresis therapy, although the treatment's efficacy was limited. To gain a deeper understanding of the disease, we conducted a comprehensive literature review, identifying 52 cases of CNTN1 antibody-positive nodopathy to date, with a tremor prevalence of 26.9%. Additionally, we found that the average CSF protein level in CNTN1 antibody-positive nodopathy was 2.57 g/L, with 87% of patients exhibiting a CSF protein level above 1.5 g/L. Conclusion We present a rare case of recurrent CNTN1 antibody-positive nodopathy. Our findings indicate a high prevalence of tremor (26.9%) and elevated CSF protein levels among patients with CNTN1 antibody-positive nodopathy.
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Affiliation(s)
- Min Zhao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Guixian Chen
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Shuguang Li
- School of International Relations, National University of Defense Technology, Nanjing, China
| | - Xiaojun Li
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Haoxuan Chen
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zhenzhen Lou
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Huiying Ouyang
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yibo Zhan
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Chenghao Du
- The Second School of Clinical Medicine, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Yuanqi Zhao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, Guangdong, China
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
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Zhang L, Zhang Y, Li R, Zhu J, Lin A, Yan Y, Zhang Z, Wang N, Xu G, Fu Y. Anti-neurofascin-155 antibody mediated a distinct phenotype of chronic inflammatory demyelinating polyradiculoneuropathy. J Neurol 2024:10.1007/s00415-024-12443-9. [PMID: 38771386 DOI: 10.1007/s00415-024-12443-9] [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: 04/11/2024] [Revised: 05/07/2024] [Accepted: 05/13/2024] [Indexed: 05/22/2024]
Abstract
BACKGROUND To investigate Ranvier's autoantibodies prevalence and isotypes in various peripheral neuropathy variants, compare clinical features between seronegative and seropositive patients, and elucidate immune mechanisms underlying antibody generation. METHODS Antibodies against anti-neurofascin-155 (NF155), NF186, contactin-1 (CNTN1), CNTN2, contactin-associated protein 1 (CASPR1), and CASPR2 were identified through cell-based assays. Plasma cytokines were analyzed in anti-NF155 antibody-positive chronic inflammatory demyelinating polyneuropathy (NF155+ CIDP) and Ranvier's antibodies-negative CIDP (Ab- CIDP) patients using a multiplexed fluorescent immunoassay, validated in vitro in a cell culture model. RESULTS In 368 plasma samples, 50 Ranvier's autoantibodies were found in 45 individuals, primarily in CIDP cases (25 out of 69 patients) and in 10 out of 122 Guillain-Barré syndrome patients. Anti-NF155 and CNTN1-IgG were exclusive to CIDP. Fourteen samples were NF155-IgG, primarily IgG4 subclass, linked to CIDP features including early onset, tremor, sensory disturbance, elevated CSF protein, prolonged motor latency, conduction block, and poor treatment response. NF155-IgG had low sensitivity (20.28%) but high specificity (100%) for CIDP, rising to 88.88% with tremor and prolonged motor latency. Cytokine profiling in NF155+ CIDP revealed distinct immune responses involving helper T cells, toll-like receptor pathways. Some NF155+ CIDP patients had circulating NF155-specific B cells producing NF155-IgG without antigen presence, suggesting therapeutic potential. CONCLUSION The study emphasizes the high specificity and sensitivity of NF155-IgG for diagnosing CIDP characterized by distinctive features. Further investigation into circulating NF155-specific B cell phenotypes may pave the way for B cell directed therapy.
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Affiliation(s)
- Lijie Zhang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yuanyuan Zhang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Runyun Li
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Jiting Zhu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Aiyu Lin
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
| | - Yaping Yan
- Key Laboratory of the Ministry of Education for Medicinal Resources and Natural Pharmaceutical Chemistry, National Engineering Laboratory for Resource Development of Endangered Crude Drugs in Northwest of China, College of Life Sciences, Shaanxi Normal University, Xi'an, 710119, China
| | - Zaiqiang Zhang
- Department of Neurology, China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100050, China
| | - Ning Wang
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China.
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| | - Guorong Xu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China.
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
| | - Ying Fu
- Department of Neurology and Institute of Neurology of First Affiliated Hospital, Institute of Neuroscience, and Fujian Key Laboratory of Molecular Neurology, Fujian Medical University, Fuzhou, 350005, China.
- Department of Neurology, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
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Naito H, Sugimoto T, Hironaka A, Nakamori M, Yamazaki Y, Ochi K, Maruyama H. Diagnostic value of lower extremity ultrasonographic nerve enlargement for differentiating demyelinating Charcot-Marie-Tooth disease from chronic inflammatory demyelinating polyneuropathy. J Neurol Sci 2024; 460:122995. [PMID: 38583391 DOI: 10.1016/j.jns.2024.122995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/01/2024] [Accepted: 03/31/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND PURPOSE We previously reported that nerve enlargement assessment by nerve ultrasonography of the intermediate upper limb is applicable for distinguishing demyelinating Charcot-Marie-Tooth disease (CMT) from chronic inflammatory demyelinating polyneuropathy (CIDP). However, differences in the severity and distribution patterns of lower extremity nerve enlargement have not been established for either disease. Therefore, we examined the utility of lower extremity nerve ultrasonography for differentiating between CMT and CIDP. METHODS Twelve patients with demyelinating CMT and 17 patients with CIDP were evaluated. The median, ulnar, tibial, and fibular nerves were evaluated in three regions: the distal upper extremity, intermediate upper extremity, and lower extremity. Of the 14 selected screening sites, the number of sites that exhibited nerve enlargement (enlargement site number, ESN) in each region was determined. RESULTS The screening ESNs in the intermediate region and lower extremities were greater in patients with demyelinating CMT than in patients with CIDP and greater than the ESN in the distal region (p = 0.010, p = 0.001, and p = 0.101, respectively). The ESNs in the intermediate region and lower extremities significantly differed among patients with typical CIDP, CIDP variants, and demyelinating CMT (p = 0.084 and p < 0.001). Among the 14 selected screening sites, the combined upper and lower extremity ESNs exhibited the highest AUC (0.92; p < 0.001). CONCLUSIONS Combining the upper and lower extremities for ultrasonographic nerve measurement more accurately distinguishes CIDP from demyelinating CMT.
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Affiliation(s)
- Hiroyuki Naito
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Takamichi Sugimoto
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan.
| | - Akemi Hironaka
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Masahiro Nakamori
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Yu Yamazaki
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Kazuhide Ochi
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
| | - Hirofumi Maruyama
- Department of Clinical Neuroscience and Therapeutics, Hiroshima University, Hiroshima, Japan
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Querol L, De Sèze J, Dysgaard T, Levine T, Rao TH, Rivner M, Hartung HP, Kiessling P, Shimizu S, Marmol D, Bozorg A, Colson AO, Massow U, Eftimov F. Efficacy, safety and tolerability of rozanolixizumab in patients with chronic inflammatory demyelinating polyradiculoneuropathy: a randomised, subject-blind, investigator-blind, placebo-controlled, phase 2a trial and open-label extension study. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-333112. [PMID: 38729747 DOI: 10.1136/jnnp-2023-333112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a peripheral nerve disorder characterised by weakness and sensory loss. We assessed the neonatal Fc receptor inhibitor rozanolixizumab for CIDP management. METHODS CIDP01 (NCT03861481) was a randomised, subject-blind, investigator-blind, placebo-controlled, phase 2a study. Adults with definite or probable CIDP receiving subcutaneous or intravenous immunoglobulin maintenance therapy were randomised 1:1 to 12 once-weekly subcutaneous infusions of rozanolixizumab 10 mg/kg or placebo, stratified according to previous immunoglobulin administration route. Investigators administering treatment and assessing efficacy, and patients, were blinded. The primary outcome was a change from baseline (CFB) to day 85 in inflammatory Rasch-built Overall Disability Scale (iRODS) score. Eligible patients who completed CIDP01 entered the open-label extension CIDP04 (NCT04051944). RESULTS In CIDP01, between 26 March 2019 and 31 March 2021, 34 patients were randomised to rozanolixizumab or placebo (17 (50%) each). No significant difference in CFB to day 85 in iRODS centile score was observed between rozanolixizumab (least squares mean 2.0 (SE 3.2)) and placebo (3.4 (2.6); difference -1.5 (90% CI -7.5 to 4.5)). Overall, 14 (82%) patients receiving rozanolixizumab and 13 (76%) receiving placebo experienced a treatment-emergent adverse event during the treatment period. Across CIDP01 and CIDP04, rozanolixizumab was well tolerated over up to 614 days; no clinically meaningful efficacy results were seen. No deaths occurred. CONCLUSIONS Rozanolixizumab did not show efficacy in patients with CIDP in this study, although this could be due to a relatively high placebo stability rate. Rozanolixizumab was well tolerated over medium-to-long-term weekly use, with an acceptable safety profile.
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Affiliation(s)
- Luis Querol
- Neuromuscular Diseases Unit - Neurology Department, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain
- Center for Network Research in Rare Diseases - CIBERER, Madrid, Spain
| | - Jérôme De Sèze
- Department of Neurology, Clinical Investigation Centre, University Hospital of Strasbourg, Strasbourg, France
| | - Tina Dysgaard
- Department of Neurology, Copenhagen Neuromuscular Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Todd Levine
- Honor Health Neurology, Bob Bové Neuroscience Institute, Scottsdale, Arizona, USA
| | - T Hemanth Rao
- The Neurological Institute, PA, Charlotte, North Carolina, USA
| | - Michael Rivner
- Department of Neurology, Augusta University, Augusta, Atlanta, Georgia, USA
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Brain and Mind Center, Medical Faculty, University of Sydney, Sydney, New South Wales, Australia
- Department of Neurology, Palacký University, Olomouc, Czech Republic
| | | | | | | | - Ali Bozorg
- UCB Pharma, Morrisville, North Carolina, USA
| | | | | | - Filip Eftimov
- Department of Neurology, Amsterdam Neuroscience, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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10
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Doneddu PE, Cocito D, Fazio R, Benedetti L, Peci E, Liberatore G, Falzone YM, Germano F, Gallia F, Giannotta C, Lleixà C, Bianchi E, Nobile-Orazio E. Prospective open-label trial with rituximab in patients with chronic inflammatory demyelinating polyradiculoneuropathy not responding to conventional immune therapies. J Neurol Neurosurg Psychiatry 2024:jnnp-2023-332844. [PMID: 38729746 DOI: 10.1136/jnnp-2023-332844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 02/13/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND To evaluate the efficacy of rituximab in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) patients not responding to conventional immune therapies. METHODS An open-label, prospective exploratory study was conducted with intravenous rituximab on 17 CIDP patients who had not responded to at least two first-line therapies. The primary endpoint was to determine the proportion of patients who showed improvement 6 months after rituximab therapy. The percentage of responders to rituximab, along with a 95% CI, was reported and compared with the 30% response rate after other immunosuppressive drugs previously documented in the literature. RESULTS 13 of the 17 treated patients (76.5%) showed improvement at 6 months (95% CI 50.1 to 93.2). Among the 14 patients who completed the 12-month follow-up (2 were lost to follow-up after showing improvement at months 8 and 10, and 1 deteriorated at 6 months), 13 (92.9%) demonstrated improvement at 12 months (95% CI 66.1 to 99.8). Nerve conduction parameters improved by at least 20% in two nerves in 6 out of 15 (40%) patients at 6 months and in 7 out of 13 (53.9%) at 12 months. None of the treated patients withdrew from the study due to side effects. There was a significant reduction of circulating CD19+ cells 15 days, 2, 6 and 12 months after treatment. CONCLUSION Rituximab seems to be a safe therapy in most patients with CIDP not responding to conventional immune therapies. The high percentage of patients who improved in this study suggests a possible positive effect of rituximab which is worth investigating in future randomised controlled clinical trials. TRIAL REGISTRATION NUMBER NCT05877040.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Dario Cocito
- Dipartimento Scienze Cliniche e Biologiche, Università di Torino, Torino, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Erdita Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Yuri Matteo Falzone
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Germano
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Infantile Science (DINOGMI), Genoa University, Genova, Italy
| | - Francesca Gallia
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Claudia Giannotta
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Cinta Lleixà
- Department of Neurology, Neuromuscular Diseases Unit, Hospital de La Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Elisa Bianchi
- Laboratorio di Malattie Neurologiche, Istituto di ricerche farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, University of Milan, Milano, Italy
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Barkhaus PE, Nandedkar SD, de Carvalho M, Swash M, Stålberg EV. Revisiting the compound muscle action potential (CMAP). Clin Neurophysiol Pract 2024; 9:176-200. [PMID: 38807704 PMCID: PMC11131082 DOI: 10.1016/j.cnp.2024.04.002] [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: 12/07/2023] [Revised: 04/15/2024] [Accepted: 04/21/2024] [Indexed: 05/30/2024] Open
Abstract
The compound muscle action potential (CMAP) is among the first recorded waveforms in clinical neurography and one of the most common in clinical use. It is derived from the summated muscle fiber action potentials recorded from a surface electrode overlying the studied muscle following stimulation of the relevant motor nerve fibres innervating the muscle. Surface recorded motor unit potentials (SMUPs) are the fundamental units comprising the CMAP. Because it is considered a basic, if not banal signal, what it represents is often underappreciated. In this review we discuss current concepts in the anatomy and physiology of the CMAP. These have evolved with advances in instrumentation and digitization of signals, affecting its quantitation and measurement. It is important to understand the basic technical and biological factors influencing the CMAP. If these influences are not recognized, then a suboptimal recording may result. The object is to obtain a high quality CMAP recording that is reproducible, whether the study is done for clinical or research purposes. The initial sections cover the relevant CMAP anatomy and physiology, followed by how these principles are applied to CMAP changes in neuromuscular disorders. The concluding section is a brief overview of CMAP research where advances in recording systems and computer-based analysis programs have opened new research applications. One such example is motor unit number estimation (MUNE) that is now being used as a surrogate marker in monitoring chronic neurogenic processes such as motor neuron diseases.
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Affiliation(s)
- Paul E. Barkhaus
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI USA
| | - Sanjeev D. Nandedkar
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI USA
- Natus Medical Inc., Hopewell Junction, NY, USA
| | - Mamede de Carvalho
- Instituto de Medicina Molecular and Institute of Physiology, Centro de Estudos Egas Moniz, Faculty of Medicine, University of Lisbon, Portugal
- Department of Neurosciences and Mental Health, CHULN-Hospital de Santa Maria, Lisbon, Portugal
| | - Michael Swash
- Barts and the London School of Medicine, Queen Mary University of London, London UK
| | - Erik V. Stålberg
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Caballero-Ávila M, Lleixà C, Pascual-Goñi E, Martín-Aguilar L, Vidal-Fernandez N, Tejada-Illa C, Collet-Vidiella R, Rojas-Garcia R, Cortés-Vicente E, Turon-Sans J, Gallardo E, Olivé M, Vesperinas A, Carbayo Á, Llansó L, Martinez-Martinez L, Shock A, Christodoulou L, Dizier B, Freeth J, Soden J, Dawson S, Querol L. Membrane Proteome-Wide Screening of Autoantibodies in CIDP Using Human Cell Microarray Technology. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2024; 11:e200216. [PMID: 38484217 PMCID: PMC11078148 DOI: 10.1212/nxi.0000000000200216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/19/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND AND OBJECTIVES Autoantibody discovery in complex autoimmune diseases is challenging. Diverse successful antigen identification strategies are available, but, so far, have often been unsuccessful, especially in the discovery of protein antigens in which conformational and post-translational modification are critical. Our study assesses the utility of a human membrane and secreted protein microarray technology to detect autoantibodies in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). METHODS A cell microarray consisting of human embryonic kidney-293 cells expressing >5,000 human proteins was used. First, a validation step was performed with 4 serum samples from patients with autoimmune nodopathy (AN) to assess the ability of this technology to detect circulating known autoantibodies. The ability of the cell microarray technology to discover novel IgG autoantibodies was assessed incubating the array with 8 CIDP serum samples. Identified autoantibodies were subsequently validated using cell-based assays (CBAs), ELISA, and/or tissue immunohistochemistry and analyzed in a cohort of CIDP and AN (n = 96) and control (n = 100) samples. RESULTS Serum anti-contactin-1 and anti-neurofascin-155 were detected by the human cell microarray technology. Nine potentially relevant antigens were found in patients with CIDP without other detectable antibodies; confirmation was possible in six of them: ephrin type-A receptor 7 (EPHA7); potassium-transporting ATPase alpha chain 1 and subunit beta (ATP4A/4B); leukemia-inhibitory factor (LIF); and interferon lambda 1, 2, and 3 (IFNL1, IFNL2, IFNL3). Anti-ATP4A/4B and anti-EPHA7 antibodies were detected in patients and controls and considered unrelated to CIDP. Both anti-LIF and anti-IFNL antibodies were found in the same 2 patients and were not detected in any control. Both patients showed the same staining pattern against myelinating fibers of peripheral nerve tissue and of myelinating neuron-Schwann cell cocultures. Clinically relevant correlations could not be established for anti-LIF and anti-IFNL3 antibodies. DISCUSSION Our work demonstrates the utility of human cell microarray technology to detect known and discover unknown autoantibodies in human serum samples. Despite potential CIDP-associated autoantibodies (anti-LIF and anti-IFNL3) being identified, their clinical and pathogenic relevance needs to be elucidated in bigger cohorts.
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Affiliation(s)
- Marta Caballero-Ávila
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Cinta Lleixà
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Elba Pascual-Goñi
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Lorena Martín-Aguilar
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Núria Vidal-Fernandez
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Clara Tejada-Illa
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Roger Collet-Vidiella
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Ricardo Rojas-Garcia
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Elena Cortés-Vicente
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Janina Turon-Sans
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Eduard Gallardo
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Montse Olivé
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Ana Vesperinas
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Álvaro Carbayo
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Laura Llansó
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Laura Martinez-Martinez
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Anthony Shock
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Louis Christodoulou
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Benjamin Dizier
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Jim Freeth
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Jo Soden
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Sarah Dawson
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
| | - Luis Querol
- From the Neuromuscular Diseases Unit (M.C.-Á., C.L., E.P.-G., L.M.-A., N.V.-F., C.T.-I., R.C.-V., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., A.V., Á.C., L.L., L.Q.), Department of Neurology, Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona; Neuromuscular Diseases (C.L., R.R.-G., E.C.-V., J.T.-S., E.G., M.O., L.Q.), Centro para la Investigación Biomédica en Red en Enfermedades Raras (CIBERER), Madrid; Department of Immunology (L.M.-M.), Hospital de la Santa Creu i Sant Pau, Institut d'Investigació Biomèdica Sant Pau, Universitat Autònoma de Barcelona, Spain; UCB Pharma (A.S., L.C., B.D.), Slough; and Retrogenix (Charles River's company) (J.F., J.S., S.D.), United Kingdom
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13
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Guttikonda A, Ahmad G, Goyal P, Xiang Y, Johnson LM, Gillespie S, Carvell KT, Butera R, Verma S. Outcome measures in pediatric chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2024; 69:580-587. [PMID: 38436500 DOI: 10.1002/mus.28071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION/AIMS Objective outcome measures in children undergoing treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are lacking. The aim of the study was to record serial grip strength and motor nerve conduction studies to assess interval change. METHODS This was a retrospective review of 16 children (8 females and 8 males; median age, 9.7 years; interquartile range, 6-13 years) with CIDP followed at a tertiary children's hospital from 2013 to 2021. Subjects were treated with intravenous immunoglobulin (IVIG). Right and left grip strength measurements were obtained at each clinic visit using a handheld dynamometer. Annual right median motor nerve conduction study data were recorded during the study period. RESULTS Mean duration of follow-up was 2.9 years. Grip strength (right: 0.19 kg/month, p < 0.001; left 0.23 kg/month, p < 0.001) and median F-wave latencies (-0.23/month, p = 0.015) showed significant improvement over time. Akaike information criterion showed time + IVIG frequency <21 days as best fit for grip strength and distal compound muscle action potential amplitude. DISCUSSION Our study results indicate serial grip strength measurements are a feasible and objective way to assess motor strength improvement in children with CIDP receiving immunotherapy.
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Affiliation(s)
- Apoorva Guttikonda
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ghazal Ahmad
- Department of Neurology, Medical College of Georgia, Augusta, Georgia, USA
| | - Parul Goyal
- Department of Neurology, Mercy Clinic, Springfield, Missouri, USA
| | - Yijin Xiang
- Epidemiology section, University of Southern California, Los Angeles, California, USA
| | - Laura Michelle Johnson
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Kimberly T Carvell
- Division of Physical Therapy, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Robert Butera
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia, USA
| | - Sumit Verma
- Departments of Pediatrics and Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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14
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Doneddu PE, Gentile L, Cocito D, Fazio R, Luigetti M, Briani C, Filosto M, Siciliano G, Benedetti L, Antonini G, Matà S, Marfia GA, Inghilleri M, Manganelli F, Cosentino G, Brighina F, Carpo M, Carta F, Mazzeo A, Peci E, Strano C, Romano A, Campagnolo M, Cotti-Piccinelli S, Viola DV, Germano F, Leonardi L, Sperti M, Mataluni G, Ceccanti M, Spina E, Vegezzi E, Di Stefano V, Nobile-Orazio E. Assessment of diagnostic criteria for multifocal motor neuropathy in patients included in the Italian database. Eur J Neurol 2024; 31:e16248. [PMID: 38376074 DOI: 10.1111/ene.16248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE This study aimed to assess the diagnostic criteria, ancillary investigations and treatment response using real-life data in multifocal motor neuropathy (MMN) patients. METHODS Clinical and laboratory data were collected from 110 patients enrolled in the Italian MMN database through a structured questionnaire. Twenty-six patients were excluded due to the unavailability of nerve conduction studies or the presence of clinical signs and symptoms and electrodiagnostic abnormalities inconsistent with the MMN diagnosis. Analyses were conducted on 73 patients with a confirmed MMN diagnosis and 11 patients who did not meet the diagnostic criteria. RESULTS The European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria were variably applied. AUTHOR When applying the American Association of Electrodiagnostic Medicine criteria, an additional 17% of patients fulfilled the criteria for probable/definite diagnosis whilst a further 9.5% missed the diagnosis. In 17% of the patients only compound muscle action potential amplitude, but not area, was measured and subsequently recorded in the database by the treating physician. Additional investigations, including anti-GM1 immunoglobulin M antibodies, cerebrospinal fluid analysis, nerve ultrasound and magnetic resonance imaging, supported the diagnosis in 46%-83% of the patients. Anti-GM1 immunoglobulin M antibodies and nerve ultrasound demonstrated the highest sensitivity. Additional tests were frequently performed outside the EFNS/PNS guideline recommendations. CONCLUSIONS This study provides insights into the real-world diagnostic and management strategies for MMN, highlighting the challenges in applying diagnostic criteria.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Dario Cocito
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Sede di Roma, Roma, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical center for Neuromuscular Diseases, Brescia, Italy
| | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giovanni Antonini
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza' University of Rome, Roma, Italy
| | - Sabrina Matà
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Girolama Alessandra Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Maurizio Inghilleri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Filippo Brighina
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | | | - Francesca Carta
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Erdita Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Camilla Strano
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Sede di Roma, Roma, Italy
| | - Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Stefano Cotti-Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical center for Neuromuscular Diseases, Brescia, Italy
| | - Divina Valeria Viola
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Luca Leonardi
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza' University of Rome, Roma, Italy
| | - Martina Sperti
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Giorgia Mataluni
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Vincenzo Di Stefano
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
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15
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Moret F, Spada E, Ceccanti M, Libonati L, D'Andrea E, Villano U, Madonna E, Chionne P, Carocci A, Pisani G, Fionda L, Antonini G, Petrucci A, Bruni R, Ciccaglione AR, Taliani G, Rivano Capparuccia M, Nobile-Orazio E, Inghilleri M, Cambieri C. Chronic inflammatory demyelinating polyneuropathy and HEV antibody status: A case-control study from Lazio, Italy. J Neurol Sci 2024; 459:122959. [PMID: 38490091 DOI: 10.1016/j.jns.2024.122959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 02/28/2024] [Accepted: 03/10/2024] [Indexed: 03/17/2024]
Abstract
INTRODUCTION Few studies have pointed to the possible role of infectious diseases in triggering Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP). Given the association of Hepatitis E Virus (HEV) with Guillain Barrè syndrome, we conducted a case-control study to determine the possible association of HEV infection with CIDP, analyzing possible risk factors for acquiring HEV infection in both CIDP patients and controls. MATERIALS AND METHODS 82 CIDP and 260 from the general population have provided some personal information (demographics, anamnestic data and recognized risk factors for HEV infection) and underwent venipuncture blood sampling for virological assays testing for anti-HEV IgG and IgM with ELISA and RNA-HEV performing RT-PCR. RESULTS Anti-HEV IgG seropositivity resulted in 32 CIDP patients (39.0%) and in 45 controls (17.3%), indicating a significant association between anti-HEV IgG positivity and CIDP (OR 3.04; 95% CI 1.70-5.43, p-value <0.001), but in multivariate logistic regression the only significant associations with anti-HEV positivity were eating pork liver sausages (OR 10.443, 95% CI 2.268-60.12, p-value 0.004) and IVIg/SCIg administration (OR 31.32, 95% CI 7.914-171.7, p-value <0.001). DISCUSSION The higher prevalence of anti-HEV IgG in CIDP patients than in controls could be justified by chronically administering IVIg/SCIg with a passive acquisition of anti-HEV antibodies. Furthermore, all the 20 CIDP patients who underwent IVIg/SCIg administration reported HEV risk factors, so that they could have acquired the infection. CONCLUSIONS Further studies in a larger CIDP patient sample in treatment with therapy other than IVIg/SCIg are necessary to rule out the possible confounding effect of IVIg/SCIg.
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Affiliation(s)
- Federica Moret
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy.
| | - Enea Spada
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Marco Ceccanti
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Laura Libonati
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Edoardo D'Andrea
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
| | - Umbertina Villano
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta Madonna
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Chionne
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Alberto Carocci
- National Center for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Giulio Pisani
- National Center for the Control and Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Laura Fionda
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Giovanni Antonini
- Department of Neurosciences, Mental Health and Sensory Organs (NESMOS), Sapienza University of Rome, Rome, Italy
| | - Antonio Petrucci
- Center for Neuromuscular and Neurological Rare Diseases, AO San Camillo Forlanini Hospital, C.ne Gianicolense 87, 00152 Rome, Italy
| | - Roberto Bruni
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Anna Rita Ciccaglione
- Department of Infectious Diseases, Viral Hepatitis and Oncovirus and Retrovirus Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gloria Taliani
- Department of Public Health and Infectious Diseases, Infectious and Tropical Medicine Unit, 'Policlinico Umberto I' Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Rivano Capparuccia
- Department of Public Health and Infectious Diseases, Infectious and Tropical Medicine Unit, 'Policlinico Umberto I' Hospital, Sapienza University of Rome, Rome, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy; Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
| | - Maurizio Inghilleri
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed Pozzilli, IS, Italy
| | - Chiara Cambieri
- Department of Human Neuroscience, Centre for Rare Neuromuscular Disease, Sapienza University of Rome, Rome, Italy
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16
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Leone E, Pandyan A, Rogers A, Kulshrestha R, Hill J, Philp F. Effectiveness of conservative non-pharmacological interventions in people with muscular dystrophies: a systematic review and meta-analysis. J Neurol Neurosurg Psychiatry 2024; 95:442-453. [PMID: 38124127 DOI: 10.1136/jnnp-2023-331988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 11/28/2023] [Indexed: 12/23/2023]
Abstract
INTRODUCTION Management of muscular dystrophies (MD) relies on conservative non-pharmacological treatments, but evidence of their effectiveness is limited and inconclusive. OBJECTIVE To investigate the effectiveness of conservative non-pharmacological interventions for MD physical management. METHODS This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and searched Medline, CINHAL, Embase, AMED and Cochrane Central Register of Controlled Trial (inception to August 2022). Effect size (ES) and 95% Confidence Interval (CI) quantified treatment effect. RESULTS Of 31,285 identified articles, 39 studies (957 participants), mostly at high risk of bias, were included. For children with Duchenne muscular dystrophy (DMD), trunk-oriented strength exercises and usual care were more effective than usual care alone in improving distal upper-limb function, sitting and dynamic reaching balance (ES range: 0.87 to 2.29). For adults with Facioscapulohumeral dystrophy (FSHD), vibratory proprioceptive assistance and neuromuscular electrical stimulation respectively improved maximum voluntary isometric contraction and reduced pain intensity (ES range: 1.58 to 2.33). For adults with FSHD, Limb-girdle muscular dystrophy (LGMD) and Becker muscular dystrophy (BMD), strength-training improved dynamic balance (sit-to-stand ability) and self-perceived physical condition (ES range: 0.83 to 1.00). A multicomponent programme improved perceived exertion rate and gait in adults with Myotonic dystrophy type 1 (DM1) (ES range: 0.92 to 3.83). CONCLUSIONS Low-quality evidence suggests that strength training, with or without other exercise interventions, may improve perceived exertion, distal upper limb function, static and dynamic balance, gait and well-being in MD. Although more robust and larger studies are needed, current evidence supports the inclusion of strength training in MD treatment, as it was found to be safe.
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Affiliation(s)
- Enza Leone
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK
| | - Anand Pandyan
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Alison Rogers
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK
| | - Richa Kulshrestha
- Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, Shropshire, UK
| | - Jonathan Hill
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Fraser Philp
- School of Health Sciences, University of Liverpool, Liverpool, UK
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17
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Cutellè C, De Lorenzo A, Doneddu PE, Creta MF, Selmi C, Liberatore G, Giordano A, Gentile F, Erre GL, Nobile-Orazio E. Cytokines and chemokines in patients with chronic inflammatory demyelinating polyradiculoneuropathy and multifocal motor neuropathy: A systematic review. J Peripher Nerv Syst 2024. [PMID: 38600685 DOI: 10.1111/jns.12622] [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: 12/02/2023] [Revised: 02/18/2024] [Accepted: 03/12/2024] [Indexed: 04/12/2024]
Abstract
Advances in the understanding of cytokines have revolutionized mechanistic treatments for chronic inflammatory and autoimmune diseases, as exemplified by rheumatoid arthritis. We conducted a systematic literature review on the role of cytokines and chemokines in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and multifocal motor neuropathy (MMN). Ovid Medline, EMBASE and Web of Science were searched until August 31, 2022 for human studies investigating cytokines levels in CIDP or MMN. Fifty-five articles on 1061 CIDP patients and 86 MMN patients were included, with a median of 18 patients per study (range 3-71). Studies differed in the inclusion criteria, type of assay, manufacturer, control subjects, and tested biological material. Only a minority of studies reported data on disease activity. Interleukin (IL)-6, IL-17, CXCL10, and tumor necrosis factor alpha (TNF-α), were elevated in CIDP compared to controls in most of the studies. IL-6 and TNF-α levels are also correlated with disability. In MMN patients, IL-1Ra was elevated in the majority of the reports. While acknowledging the challenges in comparing studies and the various limitations of the studies, including small patient numbers, particularly in MMN, our review suggests that IL-6, IL-17, CXCL10, and TNF-α might play a role in CIDP pathogenesis. Larger studies are needed in MMN.
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Affiliation(s)
- Claudia Cutellè
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | | | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Giuseppe Liberatore
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
| | | | | | - Gian Luca Erre
- Department of Medicine, Surgery and Pharmacy, Sassari University, Sassari, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Milan, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
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18
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Schmitz F, Klimas R, Spenner M, Schumacher A, Hieke A, Greiner T, Enax-Krumova E, Sgodzai M, Fels M, Brünger J, Huckemann S, Stude P, Tegenthoff M, Gold R, Philipps J, Fisse AL, Grüter T, Pitarokoili K, Motte J, Sturm D. Morphological Differentiation of Corneal Inflammatory Cells: Proposal of Pragmatic Protocol. Cornea 2024:00003226-990000000-00534. [PMID: 38588437 DOI: 10.1097/ico.0000000000003543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 02/18/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE Corneal confocal microscopy is a noninvasive imaging technique to analyze corneal nerve fibers and corneal inflammatory cells (CICs). The amount of CICs is a potential biomarker of disease activity in chronic autoinflammatory diseases. To date, there are no standardized criteria for the morphological characterization of CICs. The aim was to establish a protocol for a standardized morphological classification of CICs based on a literature search and to test this protocol for applicability and reliability. METHODS A systematic review of the literature about definitions of CICs was conducted. Existing morphological descriptions were translated into a structured algorithm and applied by raters. Subsequently, the protocol was optimized by reducing and defining the criteria of the cell types. The optimized algorithm was applied by 4 raters. The interrater reliability was calculated using Fleiss kappa (K). RESULTS A systematic review of the literature revealed no uniform morphological criteria for the differentiation of the individual cell types in CICs. Our first protocol achieved only a low level of agreement between 3 raters (K = 0.09; 1062 rated cells). Our revised protocol was able to achieve a higher interrater reliability with 3 (K = 0.64; 471 rated cells) and 4 (K = 0.61; 628 rated cells) raters. CONCLUSIONS The indirect use of criteria from the literature leads to a high error rate. By clearly defining the individual cell types and standardizing the protocol, reproducible results were obtained, allowing the introduction of this protocol for the future evaluation of CICs in the corneal confocal microscopy.
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Affiliation(s)
- Fynn Schmitz
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Marie Spenner
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Tineke Greiner
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Elena Enax-Krumova
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Miriam Fels
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Philipp Stude
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Martin Tegenthoff
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jörg Philipps
- Department of Neurology and Neurogeriatrics, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Dietrich Sturm
- Immune-mediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
- Department of Neurology, BG University Hospital Bergmannsheil, Ruhr-University Bochum, Germany
- Department of Neurology, Agaplesion Bethesda Krankenhaus, Wuppertal, Germany; and
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19
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van Alfen N. Diagnosing CIDP: Can we look forward by looking back? Muscle Nerve 2024; 69:387-388. [PMID: 38366749 DOI: 10.1002/mus.28067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 01/29/2024] [Accepted: 02/03/2024] [Indexed: 02/18/2024]
Abstract
See article on pages 397–402 in this issue.
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Affiliation(s)
- Nens van Alfen
- Department of Neurology, Clinical Neurophysiology Laboratory 652, Clinical Neuromuscular Imaging Group, Donders Center for Neuroscience, Radboudumc, Nijmegen, The Netherlands
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Fisse AL, Schäfer E, Hieke A, Schröder M, Klimas R, Brünger J, Huckemann S, Grüter T, Sgodzai M, Schneider-Gold C, Gold R, Nguyen HP, Pitarokoili K, Motte J, Arning L. Association of the neonatal Fc receptor promoter variable number of tandem repeat polymorphism with immunoglobulin response in patients with chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16205. [PMID: 38205888 DOI: 10.1111/ene.16205] [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: 09/14/2023] [Revised: 12/04/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND AND PURPOSE Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease with humoral and cellular autoimmunity causing demyelination of peripheral nerves, commonly treated with intravenous immunoglobulins (IVIg). The neonatal Fc receptor (FcRn), encoded by the FCGRT gene, prevents the degradation of immunoglobulin G (IgG) by recycling circulating IgG. A variable number of tandem repeat (VNTR) polymorphism in the promoter region of the FCGRT gene is associated with different expression levels of mRNA and protein. Thus, patients with genotypes associated with relatively low FcRn expression may show a poorer treatment response to IVIg due to increased IVIg degradation. METHODS VNTR genotypes were analyzed in 144 patients with CIDP. Patients' clinical data, including neurological scores and treatment data, were collected as part of the Immune-Mediated Neuropathies Biobank registry. RESULTS Most patients (n = 124, 86%) were VNTR 3/3 homozygotes, and 20 patients (14%) were VNTR 2/3 heterozygotes. Both VNTR 3/3 and VNTR 2/3 genotype groups showed no difference in clinical disability and immunoglobulin dosage. However, patients with a VNTR 2 allele were more likely to receive subcutaneous immunoglobulins (SCIg) than patients homozygous for the VNTR 3 allele (25% vs. 9.7%, p = 0.02) and were more likely to receive second-line therapy (75% vs. 54%, p = 0.05). CONCLUSIONS The VNTR 2/3 genotype is associated with the administration of SCIg, possibly reflecting a greater benefit from SCIg due to more constant immunoglobulin levels without lower IVIg levels between the treatment circles. Also, the greater need for second-line treatment in VNTR 2/3 patients could be an indirect sign of a lower response to immunoglobulins.
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Affiliation(s)
- Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Emelie Schäfer
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Maximilian Schröder
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Rafael Klimas
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Jil Brünger
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Sophie Huckemann
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | | | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Huu Phuc Nguyen
- Department of Human Genetics, Ruhr University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
- Immune-Mediated Neuropathies Biobank, Ruhr University Bochum, Bochum, Germany
| | - Larissa Arning
- Department of Human Genetics, Ruhr University Bochum, Bochum, Germany
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Tozza S, Palumbo G, Severi D, Iovino A, Spina E, Aruta F, Cassano E, Iodice R, Dubbioso R, Ruggiero L, Nolano M, Santoro L, Manganelli F. Heterogenous electrophysiological features in early stage of hereditary transthyretin amyloidosis neuropathy. Neurol Sci 2024; 45:1685-1689. [PMID: 37870643 PMCID: PMC10942904 DOI: 10.1007/s10072-023-07140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Hereditary transthyretin-mediated amyloidosis (ATTRv, v for variant) is a progressive disease caused by mutations in the TTR gene, leading to sensory-motor, axonal and length-dependent neuropathy. However, some patients may show variable electrophysiological pattern. The aim of this study was to evaluate the electrophysiological features of TTR amyloid neuropathy at the time of the first nerve conduction study (NCS) to assess whether there were distinguishing features useful for early diagnosis. METHODS We retrospectively revised the first electrophysiological findings of ATTRv patients, and we categorized the neuropathy based on nerve conduction slowing, type of involved fibres and distribution pattern of PNS involvement. Cluster analysis was performed to evaluate the prevalence of neuropathy features between the early and late stage of disease, based on disease duration and disability burden assessed by NIS. RESULTS We recruited 33 patients (27 males) with mean age 63.9 ± 10.8 years, mean disease duration 2.8 ± 2.4 years and mean NIS 47.6 ± 41.8. Overall, the frequency analysis showed that the most common features of ATTRv neuropathy included the categories of axonal, sensory-motor and neuronopathic-like pattern. This electrophysiological pattern of PNS involvement was constant in patients in late stage of disease, whereas ATTRv patients in early stage of disease displayed variable electrophysiological pattern of PNS involvement. DISCUSSION Our findings demonstrated that ATTRv neuropathy may present at first NCS in a variable way, and it changes over the course of disease. Such heterogeneity makes the suspicion of ATTRv even more challenging at the time of first electrophysiological examination.
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Affiliation(s)
- Stefano Tozza
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy.
| | - Giovanni Palumbo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Daniele Severi
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Aniello Iovino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Emanuele Spina
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Francesco Aruta
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Emanuele Cassano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Rosa Iodice
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Raffaele Dubbioso
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Lucia Ruggiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Maria Nolano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Lucio Santoro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
| | - Fiore Manganelli
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Via Sergio Pansini, 5, 80131, Naples, Italy
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Giesche N, Böhm-Gonzalez ST, Kleiser B, Kowarik MC, Dubois E, Stransky E, Armbruster M, Grimm A, Marquetand J. Antiganglioside antibody frequency in routine clinical care settings. Eur J Neurol 2024:e16290. [PMID: 38556758 DOI: 10.1111/ene.16290] [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: 12/19/2023] [Revised: 02/23/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND AND PURPOSE Antiganglioside antibodies (AGAs) might be involved in the etiopathogenesis of many neurological diseases, such as Miller-Fisher syndrome (MFS) and Guillain-Barré syndrome (GBS). Available comprehensive reference data regarding AGA positivity rates and cross-responsiveness among AGAs (where one line immunoblot is positive for ≥1 AGA) during routine clinical care are scant. METHODS In this 10-year monocentric retrospective study, 3560 immunoglobulin (Ig) G and IgM line blots (GA Generic Assays' Anti-Ganglioside Dot kit) obtained using cerebrospinal fluid (CSF) and serum samples from 1342 patients were analyzed for AGA positivity in terms of 14 diagnosis categories and AGA cross-responsiveness. RESULTS Of all 3560 line blots 158 (4.4%) and of all CSF samples 0.4% (4/924) CSF line blots were AGA positive. For serum IgG, blots with positivity rates higher than the standard deviation of 15.6% were associated with MFS (GD3, GD1a, GT1a and GQ1b) and acute motor axonal neuropathy (AMAN) (GM1, GD1a and GT1a). For serum IgM, blots with positivity rates higher than the standard deviation of 8.1% were associated with AMAN (GM2, GT1a and GQ1b), MFS (GM1, GT1a and GQ1b), multifocal motor neuropathy (MMN) (GM1, GM2 and GQ1b) and chronic inflammatory demyelinating polyneuropathy (CIDP) (GM1). Cross-responsiveness was observed in 39.6% of all positive serum AGA. CONCLUSIONS Testing for AGAs during routine clinical care rarely led to positive findings, both in serum and even less in CSF, except for the diagnoses AMAN, MFS, MMN and CIDP. Nonspecific findings found as cross-responsiveness between different AGA samples occur frequently, impacting the positivity of most AGA subtypes.
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Affiliation(s)
- Niklas Giesche
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Samuel Tobias Böhm-Gonzalez
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Benedict Kleiser
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Markus C Kowarik
- Department of Neurology and Stroke, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Evelyn Dubois
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Elke Stransky
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Marcel Armbruster
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Alexander Grimm
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Justus Marquetand
- Department of Epileptology, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- Department of Neural Dynamics and Magnetoencephalography, Hertie-Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
- MEG-Center, University of Tübingen, Tübingen, Germany
- Institute for Modelling and Simulation of Biomechanical Systems, Stuttgart, Germany
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Aotsuka Y, Misawa S, Suichi T, Shibuya K, Nakamura K, Kano H, Otani R, Morooka M, Ogushi M, Nagashima K, Sato Y, Kuriyama N, Kuwabara S. Prevalence, Clinical Profiles, and Prognosis of CIDP in Japanese Nationwide Survey: Analyses of 1,257 Diagnosis-Confirmed Patients. Neurology 2024; 102:e209130. [PMID: 38408295 DOI: 10.1212/wnl.0000000000209130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 11/20/2023] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To investigate the current epidemiology, clinical profile, and treatment of chronic inflammatory demyelinating polyneuropathy (CIDP) using a nationwide survey in Japan. METHODS We conducted a nationwide survey using an epidemiologic method established in 2021. Questionnaire sheets were sent to the hospital departments of neurology and pediatric neurology throughout Japan. A primary questionnaire was used to determine the number of patients and their prevalence, and a second questionnaire was used to collect detailed clinical information. RESULTS The primary survey showed that the estimated number of patients with CIDP was 4,180, with a prevalence of 3.3 per 100,000 persons. In the secondary survey, detailed clinical data were available for 1,257 patients. The male-to-female ratio was 1.5:1, and the median age at onset was 52 years. Typical CIDP was the most frequent subtype (52%), followed by distal (17%) and multifocal/focal CIDP (17%). Initial treatments included immunoglobulin therapy (72%), corticosteroids (15%), and others (13%). Among patients with CIDP, 78% had a progressive/relapsing course, 14% did not respond to first-line treatments, and 18% could not walk independently at the last visit. Among the subtypes, typical CIDP had the most severe disability before treatment (44% of patients could not walk independently). However, they showed a more favorable response to treatment than those with distal or multifocal CIDP. In the subgroup analyses, logistic regression analyses showed that younger age at onset, no muscle atrophy, and abnormal median-normal sural sensory nerve responses were associated with a higher probability of independent walking. DISCUSSION Our study represents the largest cohort study on CIDP to demonstrate the current epidemiologic and clinical status of CIDP in Japan. Clinical subtypes seem to be associated with different treatment responses and outcomes; therefore, an appropriate treatment strategy according to the pathophysiology of each subtype is required to improve the prognosis of CIDP.
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Affiliation(s)
- Yuya Aotsuka
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Sonoko Misawa
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Tomoki Suichi
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Kazumoto Shibuya
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Keigo Nakamura
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Hiroki Kano
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Ryo Otani
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Marie Morooka
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Moeko Ogushi
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Kengo Nagashima
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Yasunori Sato
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Nagato Kuriyama
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
| | - Satoshi Kuwabara
- From the Department of Neurology (Y.A., S.M., T.S., K.S., K. Nakamura, H.K., R.O., M.M., M.O., S.K.), Graduate School of Medicine, Chiba University; School of Medicine (K. Nagashima, Y.S.), Keio University, Tokyo; and Shizuoka Graduate University of Public Health and Kyoto Prefectural University of Medicine (N.K.), Japan
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24
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Matthys A, Bardel B, Le Bras F, Créange A, Nordine T, Gounot R, Ingen-Housz-Oro S, Carvalho M, Lefaucheur JP, Haioun C, Planté-Bordeneuve V, Gendre T. Rate and characteristics of inflammatory neuropathies associated with brentuximab vedotin therapy. Eur J Neurol 2024:e16285. [PMID: 38511878 DOI: 10.1111/ene.16285] [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: 11/15/2023] [Revised: 03/05/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND AND PURPOSE Peripheral neuropathy is a frequent complication of brentuximab vedotin (BV), used in CD30+ lymphoma treatment. Classic BV-induced neuropathy (BV-CN) is a mild distal sensory axonal polyneuropathy. Severe BV-induced inflammatory neuropathies (BV-IN) have been described. BV-IN contribute to lymphoma-associated morbidity but might be immunotherapy-responsive. Our primary objective was to evaluate the rate of BV-IN. Our secondary objectives were to determine risk factors and warning signs. METHODS We conducted a retrospective cohort study on all patients treated with BV at our center between April 2014 and September 2021. Clinical, biological, and electrophysiological data were collected. BV-induced neuropathy was defined as the occurrence of neuropathy up to 3 months after BV discontinuation. BV-IN was defined with criteria adapted from European Academy of Neurology/Peripheral Nerve Society 2021 electrodiagnostic criteria for chronic inflammatory demyelinating polyradiculoneuropathy. Other neuropathies were classified as BV-CN. RESULTS Among 83 patients, 41 (49%) developed neuropathy: 35 BV-CN and 6 BV-IN. Thus, the rate of BV-IN was 7.2%. Compared to patients with BV-CN, no predisposing factor was identified. However, patients with BV-IN more frequently presented muscle weakness (67% vs. 5.7%, p < 0.05), gait disorders (83% vs. 20%, p < 0.05), or acute or subacute onset (67% vs. 14%, p < 0.05). BV-IN was frequently more severe (Common Terminology Criteria for Adverse Events grade ≥3; 50% vs. 0%, p < 0.05). Four patients were treated with immunotherapy. CONCLUSIONS Brentuximab vedotin-induced neuropathy is an overlooked complication. Based on four easily identifiable "red flags", we provide an algorithm to help non-neurologist physicians that care for BV-treated patients to detect BV-IN. The aim of the algorithm is to decrease the diagnostic and management delay of this disabling neuropathy.
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Affiliation(s)
- Arthur Matthys
- Department of Neurology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Center for Interdisciplinary Research in Biology, Collège de France, CNRS UMR 7241, INSERM U1050, Labex Memolife, PSL Research University, Paris, France
| | - Benjamin Bardel
- Unit of Clinical Neurophysiology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Reference Center for Neuromuscular Diseases Nord/Est/Ile-de-France, Paris, France
| | - Fabien Le Bras
- Lymphoid Malignancies Unit, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Alain Créange
- Department of Neurology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Reference Center for Neuromuscular Diseases Nord/Est/Ile-de-France, Paris, France
| | - Tarik Nordine
- Unit of Clinical Neurophysiology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Reference Center for Neuromuscular Diseases Nord/Est/Ile-de-France, Paris, France
| | - Romain Gounot
- Lymphoid Malignancies Unit, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Saskia Ingen-Housz-Oro
- Department of Dermatology, Paris-Est Créteil University EpiDermE, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Muriel Carvalho
- Department of Pharmacy, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Jean-Pascal Lefaucheur
- Unit of Clinical Neurophysiology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Reference Center for Neuromuscular Diseases Nord/Est/Ile-de-France, Paris, France
| | - Corinne Haioun
- Lymphoid Malignancies Unit, AP-HP, Henri Mondor University Hospital, Créteil, France
| | - Violaine Planté-Bordeneuve
- Department of Neurology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Reference Center for Neuromuscular Diseases Nord/Est/Ile-de-France, Paris, France
| | - Thierry Gendre
- Department of Neurology, AP-HP, Henri Mondor University Hospital, Créteil, France
- Reference Center for Neuromuscular Diseases Nord/Est/Ile-de-France, Paris, France
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Kodal LS, Witt AM, Pedersen BS, Aagaard MM, Dysgaard T. Prognostic value of neurofilament light in blood in patients with polyneuropathy: A systematic review. J Peripher Nerv Syst 2024; 29:17-27. [PMID: 38066727 DOI: 10.1111/jns.12608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023]
Abstract
Neurofilament light protein (NfL) is a part of the neuronal skeleton, primarily expressed in axons, and is released when nerves are damaged. NfL has been found to be a potential diagnostic biomarker in different types of polyneuropathies. However, whether NfL levels can be used as a predictor for the risk of disease progression is currently less understood. We searched MEDLINE (PubMed), Embase, Cochrane Library, and Web of Science Searches and included longitudinal studies with a baseline and follow-up examination of adult patients with polyneuropathy and NfL measured in blood. Twenty studies investigating NfL as a predictor of disease progression were identified, examining eight polyneuropathy subtypes. The results from studies in Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) patients were divergent, with two out of five studies finding a significant association between NfL levels and clinical outcomes. Meta-analysis of the three Guillian-Barré Syndrome (GBS) studies found higher odds for the inability to run after 1 year in patients with high levels of NfL (odds ratio 2.18, 95% confidence interval 1.04-4.56). Results from studies examining other subacute or chronic polyneuropathies like Charcot-Marie-Tooth (CMT) varied in study design and results. Our findings suggest NfL can be used as a predictor of disease progression, particularly in polyneuropathies such as CIDP and GBS. However, NfL may not serve as a reliable and cost-effective biomarker for slowly progressive polyneuropathies like CMT. Future standardized studies considering NfL as a prognostic blood biomarker in patients with different types of polyneuropathies are warranted.
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Affiliation(s)
- Louise Sloth Kodal
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne Møller Witt
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Britt Staevnsbo Pedersen
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Müller Aagaard
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Tina Dysgaard
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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Murakami T, Kishi M, Tokuda N, Honda M, Hanajima R. Repeated Acute Exacerbations of Chronic Inflammatory Demyelinating Polyradiculoneuropathy Accompanied by Pain and Swelling in Distal Extremities. Intern Med 2024; 63:733-737. [PMID: 37468246 PMCID: PMC10982018 DOI: 10.2169/internalmedicine.2021-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/06/2023] [Indexed: 07/21/2023] Open
Abstract
An 81-year-old man experienced acute progression of weakness in the extremities accompanied by a fever, tenderness, and swelling in distal parts of the extremities. He had flaccid tetraparesis with fasciculations and general hyporeflexia. Nerve conduction studies indicated demyelinating sensorimotor neuropathy. A cerebrospinal fluid examination revealed elevated proteins without pleocytosis. Immunological treatments were effective, but his symptoms exhibited repeated relapse and remission phases. He was diagnosed with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) with an acute onset. The highlight of this case is pain with inflammatory reaction recognized as red flags of CIDP, with the clinical course and electrophysiological findings compatible with CIDP.
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Affiliation(s)
- Takenobu Murakami
- Department of Neurology, Tottori Prefectural Kousei Hospital, Japan
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Masafumi Kishi
- Department of Neurology, Tottori Prefectural Kousei Hospital, Japan
- Department of Neurology, Tottori Red Cross Hospital, Japan
| | - Naoki Tokuda
- Department of Neurology, Tottori Prefectural Kousei Hospital, Japan
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
| | - Makoto Honda
- Department of Neurology, Tottori Prefectural Kousei Hospital, Japan
| | - Ritsuko Hanajima
- Division of Neurology, Department of Brain and Neurosciences, Faculty of Medicine, Tottori University, Japan
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Afanasiev V, Tsouni P, Kuntzer T, Cairoli A, Delmont E, Vallat JM, Devaux J, Théaudin M. Successful autologous hematopoietic stem cell transplantation in a refractory anti-Caspr1 antibody nodopathy. J Peripher Nerv Syst 2024; 29:116-119. [PMID: 38123899 DOI: 10.1111/jns.12610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
AIM Autoimmune nodopathies have specific clinicopathologic features, antibodies directed against nodal proteins (neurofascin 186) or paranodal proteins (neurofascin 155, contactin 1, contactin-associated protein 1 (Caspr1)), and usually have a poor response to first-line therapies for chronic inflammatory demyelinating polyradiculoneuropathy. Anti-Caspr1 nodopathy treated with autologous hematopoietic stem cell transplantation (AHSCT) has not been previously reported. METHODS We report the first case of an anti-Caspr1 antibody-positive nodopathy refractory to high-intensity immunosuppressive treatment, including rituximab, that responded dramatically to AHSCT. RESULTS A 53-year-old woman presented with a rapidly progressive generalized ataxic, painful motor, and inflammatory neuropathy supported by neurophysiologic and MRI studies. Initial tests for antibodies to nodal/paranodal proteins were negative. She was treated with multiple courses of intravenous immunoglobulin and methylprednisolone, plasma exchange, rituximab, and cyclophosphamide without significant clinical benefit. Repeated testing for antibodies to nodal/paranodal proteins yielded a positive result for anti-Caspr1/IgG4 isotype antibodies. Given the poor response to multiple high intensity treatments and the relatively young age of the patient, we decided to perform AHSCT at 30 months post-onset. Immediately after AHSCT, she stopped all immunomodulatory or immunosuppressive therapy. The Overall Neuropathy Limitation Score improved from 8/12 to 4/12 at 6 months post-AHSCT. At 3 months post-AHSCT, IgG4 against Caspr1 was negative and no reactivity against paranodes could be detected. CONCLUSION We report a particularly severe anti-Caspr1 antibody autoimmune nodopathy that responded dramatically to AHSCT. Although the rarity of the disease limits the possibility of larger studies, AHSCT may be a valuable therapy in treatment-refractory cases.
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Affiliation(s)
- Vadim Afanasiev
- Department of Neurology, Neurocentre, Hôpital du Valais, Sion, Switzerland
| | - Pinelopi Tsouni
- Department of Neurology, Neurocentre, Hôpital du Valais, Sion, Switzerland
| | - Thierry Kuntzer
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Anne Cairoli
- Department of Hematology, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
| | - Emilien Delmont
- Referral Centre for Neuromuscular Diseases and ALS, La Timone Hospital, Marseille, France
| | - Jean-Michel Vallat
- Department and Laboratory of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges (CHU Limoges), Limoges, France
| | - Jérôme Devaux
- Institut de Génomique Fonctionnelle, Université de Montpellier, CNRS, INSERM, Montpellier, France
| | - Marie Théaudin
- Department of Clinical Neuroscience, University Hospital of Lausanne (CHUV), and University of Lausanne, Lausanne, Switzerland
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Oh SJ. Nodal Conduction Block and Internodal Conduction Block in Nodopathy. J Clin Neuromuscul Dis 2024; 25:163-170. [PMID: 38441938 DOI: 10.1097/cnd.0000000000000477] [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: 03/07/2024]
Abstract
OBJECTIVES In 2015, a new term "nodopathy" was introduced to represent a group of neuropathy because of autoantibodies at the node of Ranvier and paranodal area. This review was conducted to highlight the electrophysiologic characteristics of acute and chronic nodopathies by the newly introduced term: "nodal conduction block (CB); CB without temporal dispersion or slow nerve conduction velocity" and by introducing a new term: "internodal CB; CB with temporal dispersion or/and slow nerve conduction velocity". METHODS Through PubMed searches, 23 cases of acute (<4 weeks of neuropathy) nodopathy and 12 cases of chronic (>4 weeks of neuropathy) nodopathy are identified. Two other required inclusion criteria are positive nodal antibody test and detailed nerve conduction data with or without figure. All existing data were analyzed to see whether these cases had nodal or internodal CB. RESULTS Among 23 cases of acute nodopathy, 11 had nodal CB, 9 internodal CB, and 3 mixed CB. Thus, nodal CB was observed in 61% of acute nodopathy cases and internodal CB in 52% of acute nodopathy cases. Among 12 cases of chronic nodopathy, all 12 had internodal CB. CONCLUSIONS Nodal CB is the nerve conduction characteristic of acute nodopathy, but internodal CB does not rule out acute nodopathy. Internodal CB is the nerve conduction characteristic of chronic nodopathy.
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Affiliation(s)
- Shin J Oh
- Department of Neurology, University of Alabama at Birmingham, Birmingham, AL
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29
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Stino AM, Bumma N, Smith R, Davalos L, Allen J, Ye JC, Pianko M, Campagnaro E, Fierro C, Awad A, Murdock B, Pietrzak M, Loszanski G, Kline DM, Efebera Y, Elsheikh B. Lenalidomide in the treatment of anti-myelin-associated glycoprotein neuropathy: A phase 1 study to identify the maximum tolerated dose. Eur J Neurol 2024; 31:e16164. [PMID: 38015467 DOI: 10.1111/ene.16164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 10/12/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Anti-myelin-associated glycoprotein (MAG) neuropathy is a debilitating demyelinating polyneuropathy with no approved therapies. Our primary objective was to ascertain lenalidomide safety and maximum tolerated dose (MTD) in anti-MAG neuropathy. METHODS This phase 1b, open-label, single-arm, dose-finding trial was conducted from 2019 through 2022. The original design included a dose-escalation/extension phase followed by a dose-expansion phase. Three doses of lenalidomide were evaluated: 10, 15, and 25 mg. The main outcome was the MTD. RESULTS Eleven patients enrolled (10 men), with a mean age of 67.6 years (SD = 6.18, range 58-77 years) and mean disease duration of 8.5 years (SD = 10.9, range 1-40 years). The study terminated early due to higher-than-expected non-dose-limiting toxicity venous thromboembolism (VTE) events. The calculated MTD was 25 mg (posterior mean of toxicity probability was 0.01 with a 95% credible interval of 0.00, 0.06), but a recommended phase 2 dose of 15 mg was advised. For secondary exploratory outcomes, only EQ-5D (-0.95, 95% CI -1.81 to -0.09) and total IgM (-162 mg/dL, 95% CI -298 to -26) showed signs of improvement by month 12. CONCLUSIONS Lenalidomide was associated with higher-than-expected VTE events in anti-MAG neuropathy patients, despite a calculated MTD of 25 mg. A recommended phase 2 dose of 15 mg was advised. Lenalidomide did not improve disability or impairment at 12 months, although this study was not powered for efficacy. The risks of long term lenalidomide may outweigh benefit for patients with anti-MAG neuropathy. Any future efficacy study should address VTE risk, as current myeloma guidelines appear inadequate. TRIAL REGISTRATION Lenalidomide in Anti-MAG Neuropathy: Phase 1b Study, ClinicalTrials.gov Identifier: NCT03701711, https://clinicaltrials.gov/ct2/show/NCT03701711. First submitted October 10, 2018. First patient enrolled in January 2019.
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Affiliation(s)
- Amro M Stino
- Department of Neurology, Division of Neuromuscular Medicine, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Naresh Bumma
- Department of Internal Medicine, Division of Hematology-Oncology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Rachel Smith
- Center for Biostatistics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Long Davalos
- Department of Neurology, Division of Neuromuscular Medicine, The University of Cincinnati Medical Center, Cincinnati, Ohio, USA
| | - Jeff Allen
- Department of Neurology, Division of Neuromuscular Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jing Christine Ye
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Matthew Pianko
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Erica Campagnaro
- Department of Internal Medicine, Division of Hematology-Oncology, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Cassandra Fierro
- Department of Neurology, Division of Neuromuscular Medicine, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Abdelrahman Awad
- Department of Neurology, Division of Neuromuscular Medicine, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Ben Murdock
- Department of Neurology, Division of Neuromuscular Medicine, The University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Maciej Pietrzak
- Department of Biomedical Informatics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Gerard Loszanski
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David M Kline
- Department of Biostatistics and Data Science, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
| | - Yvonne Efebera
- Department of Oncology, Ohio Health, Columbus, Ohio, USA
| | - Bakri Elsheikh
- Department of Neurology, Division of Neuromuscular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Puma A, Grecu N, Badea RȘ, Morisot A, Zugravu R, Ioncea MB, Cavalli M, Lăcătuș O, Ezaru A, Hacina C, Villa L, Raffaelli C, Azulay N, Sacconi S. Typical CIDP, distal variant CIDP, and anti-MAG antibody neuropathy: An ultra-high frequency ultrasound comparison of nerve structure. Sci Rep 2024; 14:4643. [PMID: 38409319 PMCID: PMC10897478 DOI: 10.1038/s41598-024-54452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
To date, little is known about the usefulness of ultra-high frequency ultrasound (UHF-US, 50-70 MHz) in clinical practice for the diagnosis of dysimmune neuropathies. We present a prospective study aimed at comparing UHF-US alterations of nerves and fascicles in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), distal CIDP (d-CIDP) and anti-MAG neuropathy and their relationships with clinical and electrodiagnostic (EDX) features. 28 patients were included (twelve CIDP, 6 d-CIDP and 10 anti-MAG) and ten healthy controls. Each patient underwent neurological examination, EDX and UHF-US study of median and ulnar nerves bilaterally. UHF-US was reliable in differentiating immune neuropathies from controls when using mean and/or segmental nerve and/or fascicle cross-sectional area (CSA); furthermore, fascicle ratio (fascicle/nerve CSA) was a reliable factor for differentiating d-CIDP from other types of polyneuropathies. The fascicle CSA appears to be more increased in CIDP and its variant than in anti-MAG neuropathy. UHF-US offers information beyond simple nerve CSA and allows for a better characterization of the different forms of dysimmune neuropathies.
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Affiliation(s)
- Angela Puma
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France.
- Faculty of Medicine, UMR7370 CNRS, LP2M, Labex ICST, Université Nice Côte d'Azur, Nice, France.
| | - Nicolae Grecu
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Raluca Ș Badea
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
- Carol Davila University of Medicine and Pharmacy, 8 Bulevardul Eroii Sanitari, 050474, Bucharest, Romania
| | - Adeline Morisot
- Department of Public Health, University Hospital of Nice, Nice, France
| | - Roxana Zugravu
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Mihai B Ioncea
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Michele Cavalli
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Oana Lăcătuș
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Neurology Department, University Emergency Hospital Bucharest, 169 Splaiul Independentei, 050098, Bucharest, Romania
| | - Andra Ezaru
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
- Service Médicine Polyvalente, Pôle Spécialités Médicales, CH Grasse, 28 Chemin de Clavary, 06180, Grasse, France
| | - Chorfa Hacina
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Luisa Villa
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Charles Raffaelli
- Ultrasound Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Nicolas Azulay
- Ultrasound Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
| | - Sabrina Sacconi
- Peripheral Nervous System and Muscle Department, Université Côte d'Azur, CHU Nice, 30 Voie Romaine, 06000, Nice, France
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Zheng Y, Hu J, Sun C, Qiao K, Zhao Y, Liu B, Sun J, Xi J, Luo S, Lu J, Zhao C, Lin J. Insights into refractory chronic inflammatory demyelinating polyneuropathy: a comprehensive real-world study. Front Neurol 2024; 15:1326874. [PMID: 38356878 PMCID: PMC10865491 DOI: 10.3389/fneur.2024.1326874] [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: 11/24/2023] [Accepted: 01/15/2024] [Indexed: 02/16/2024] Open
Abstract
Background Refractory chronic inflammatory demyelinating polyneuropathy (CIDP) is a challenging subset of CIDP. It does not respond well to immune therapy and causes substantial disability. A comprehensive understanding of its clinical profile, electrophysiological characteristics and potential risk factors associated with refractoriness remains to be further elucidated. Methods Data in this cross-sectional study was collected and reviewed from the Huashan Peripheral Neuropathy Database (HSPN). Included patients were categorized into refractory CIDP and non-refractory CIDP groups based on treatment response. The clinical and electrophysiological characteristics were compared between refractory and non-refractory CIDP groups. Potential risk factors associated with refractory CIDP were explored with a multivariate logistic regression model. Results Fifty-eight patients with CIDP were included. Four disease course patterns of refractory CIDP are described: a relapsing-remitting form, a stable form, a secondary progressive form and a primary progressive form. Compared to non-refractory CIDP patients, refractory CIDP exhibited a longer disease duration (48.96 ± 33.72 vs. 28.33 ± 13.72 months, p = 0.038) and worse functional impairment (MRC sum score, 46.08 ± 12.69 vs. 52.81 ± 7.34, p = 0.018; mRS, 2.76 ± 0.93 vs. 2.33 ± 0.99, p = 0.082; INCAT, 3.68 ± 1.76 vs. 3.03 ± 2.28, p = 0.056, respectively). Electrophysiological studies further revealed greater axonal impairment (4.15 ± 2.0 vs. 5.94 ± 2.77 mv, p = 0.011, ulnar CMAP) and more severe demyelination (5.56 ± 2.86 vs. 4.18 ± 3.71 ms, p = 0.008, ulnar distal latency, 7.94 ± 5.62 vs. 6.52 ± 6.64 ms, p = 0.035, median distal latency; 30.21 ± 12.59 vs. 37.48 ± 12.44 m/s, p = 0.035, median conduction velocity; 58.66 ± 25.73 vs. 42.30 ± 13.77 ms, p = 0.033, median F-wave latency), compared to non-refractory CIDP. Disease duration was shown to be an independent risk factor for refractory CIDP (p < 0.05, 95%CI [0.007, 0.076]). Conclusion This study provided a comprehensive description of refractory CIDP, addressing its clinical features, classification of clinical course, electrophysiological characteristics, and prognostic factors, effectively elucidating its various aspects. These findings contribute to a better understanding of this challenging subset of CIDP and might be informative for management and treatment strategies.
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Affiliation(s)
- Yongsheng Zheng
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Jianian Hu
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Chong Sun
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Kai Qiao
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Yanyin Zhao
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Bingyou Liu
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Jian Sun
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Jianying Xi
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Sushan Luo
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Jiahong Lu
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
| | - Chongbo Zhao
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
| | - Jie Lin
- Department of Neurology, Huashan Hospital of Fudan University, Shanghai, China
- National Center for Neurological Disorders (NCND), Shanghai, China
- Huashan Rare Disease Center, Huashan Hospital Fudan University, Shanghai, China
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Dziadkowiak E, Koszewicz M, Podgórski P, Wieczorek M, Budrewicz S, Zimny A. Central nervous system involvement in chronic inflammatory demyelinating polyradiculoneuropathy-MRS and DTI study. Front Neurol 2024; 15:1301405. [PMID: 38333607 PMCID: PMC10850251 DOI: 10.3389/fneur.2024.1301405] [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: 09/24/2023] [Accepted: 01/04/2024] [Indexed: 02/10/2024] Open
Abstract
Objective The current research aimed to analyze the alterations within the motor cortex and pyramidal pathways and their association with the degree of damage within the peripheral nerve fibers in patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). To achieve that goal, we investigated the microstructural changes within the pyramidal white matter tracts using diffusion tensor imaging (DTI) parameters, evaluated metabolic alterations in both precentral gyri using magnetic resonance spectroscopy (MRS) ratios, and correlated them with the neurographic findings in patients with CIDP. Methods The spectroscopic ratios of NAA/Cr, Cho/Cr, and mI/Cr from both precentral gyri and the values of fractional anisotropy (FA), axial diffusivity (AD), and mean diffusivity (MD) from both of the corticospinal tracts were correlated with the results of neurological and neurographic findings. The comparison of DTI parameters between the patients and controls was performed using Student's t-test or the Mann-Whitney U test. Due to the lack of normal distribution of most variables, Spearman's Rho rank coefficient was used to test all correlations. All analyses were performed at a significant level of alpha = 0.05 using STATISTICA 13.3. Results Compared to the control group (CG), the patient group showed significantly lower ratios of NAA/Cr (1.66 ± 0.11 vs. 1.61 ± 0.15; p = 0.022), higher ratios of ml/Cr in the right precentral gyrus (0.57 ± 0.15 vs. 0.61 ± 0.08; p = 0.005), and higher levels of Cho/Cr within the left precentral gyrus (0.83 ± 0.09 vs. 0.88 ± 0.14, p = 0.012). The DTI parameters of MD from the right CST and AD from the right and left CSTs showed a strong positive correlation (0.52-0.53) with the sural sensory nerve action potential (SNAP) latency of the right sural nerve. There were no other significant correlations between other DTI and MRS parameters and neurographic results. Significance In our study, significant metabolic alterations were found in the precentral gyri in patients with CIDP without clinical symptoms of central nervous system involvement. The revealed changes reflected neuronal loss or dysfunction, myelin degradation, and increased gliosis. Our results suggest coexisting CNS damage in these patients and may provide a new insight into the still unknown pathomechanism of CIDP.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Przemysław Podgórski
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Małgorzata Wieczorek
- Faculty of Earth Sciences and Environmental Management, University of Wroclaw, Uniwersytecki, Wrocław, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska, Wrocław, Poland
| | - Anna Zimny
- Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska, Wrocław, Poland
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Luigetti M, Primiano G, Basile V, Vitali F, Pignalosa S, Romano A, Sabino A, Marino M, Di Santo R, Ciasca G, Basile U. Serum Neurofilament and Free Light Chain Levels in Patients Undergoing Treatment for Chronic Inflammatory Demyelinating Polyneuropathy. Int J Mol Sci 2024; 25:1254. [PMID: 38279256 PMCID: PMC10816730 DOI: 10.3390/ijms25021254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/28/2024] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an immune-mediated disorder affecting the peripheral nervous system. Despite the established diagnostic criteria, monitoring disease activity and treatment remains challenging. To address this limitation, we investigated serum neurofilament light chain (sNfL) and serum free light chains (sFLCs) as potential biomarkers. A total of 32 CIDP patients undergoing immunoglobulin therapy and 32 healthy controls enrolled in the present study, and agreed to have their blood plasma sNfL and sFLCs analyzed, while CIDP severity was assessed through the modified Rankin Scale (mRS) and the Overall Neuropathy Limitations Scale (ONLS). In line with the immunoglobulin treatment aimed at limiting neuronal damage administered to the majority of patients, sNfL levels did not exhibit significant differences between the two groups. However, CIDP patients showed significantly elevated sFLC and sFLC ratios, while the marker levels did not correlate with the clinical scores. The study confirms the potential of sFLCs as a sensitive biomarker of inflammatory processes in CIDP. Additionally, the present study results regarding neurofilaments strengthen the role of sNfL in monitoring CIDP treatments, confirming the effectiveness of immunoglobulin therapy. Overall, our results demonstrate how combining these markers can lead to better patient characterization for improved treatment.
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Affiliation(s)
- Marco Luigetti
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.L.); (A.R.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
| | - Guido Primiano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.L.); (A.R.)
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
- Fondazione UILDM Lazio Onlus, 00167 Rome, Italy
| | - Valerio Basile
- Clinical Pathology Unit and Cancer Biobank, Department of Research and Advanced Technologies, I.R.C.C.S. Regina Elena National Cancer Institute, 00144 Rome, Italy;
| | - Francesca Vitali
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
| | - Stefano Pignalosa
- Dipartimento di Patologia Clinica, Ospedale Santa Maria Goretti, A.U.S.L. Latina, 04100 Latina, Italy; (S.P.); (U.B.)
| | - Angela Romano
- Dipartimento di Neuroscienze, Organi di Senso e Torace, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy; (M.L.); (A.R.)
| | - Andrea Sabino
- Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (F.V.); (A.S.)
| | - Mariapaola Marino
- Sezione di Patologia Generale, Dipartimento di Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy;
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (R.D.S.); (G.C.)
| | - Riccardo Di Santo
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (R.D.S.); (G.C.)
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gabriele Ciasca
- Fondazione Policlinico Universitario “A. Gemelli” I.R.C.C.S., 00168 Rome, Italy; (R.D.S.); (G.C.)
- Sezione di Fisica, Dipartimento di Neuroscienze, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Umberto Basile
- Dipartimento di Patologia Clinica, Ospedale Santa Maria Goretti, A.U.S.L. Latina, 04100 Latina, Italy; (S.P.); (U.B.)
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Hassing LT, Jiang FY, Zutt R, Arends S. Nitrous-oxide-induced polyneuropathy and subacute combined degeneration of the spine: clinical and diagnostic characteristics in 70 patients, with focus on electrodiagnostic studies. Eur J Neurol 2024; 31:e16076. [PMID: 37754673 DOI: 10.1111/ene.16076] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 09/04/2023] [Accepted: 09/11/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND AND PURPOSE Nitrous oxide (N2 O) induced neurological symptoms are increasingly encountered. Our aim is to provide clinical and diagnostic characteristics with a focus on electrodiagnostic studies. METHODS Patients with neurological sequelae due to N2 O presenting in our hospital between November 2018 and December 2021 reporting clinical and diagnostic data were retrospectively reviewed. RESULTS Seventy patients (median 22 years) were included. Median N2 O usage was 4 kg/week during 12 months. Patients' history revealed a higher rate of sensory symptoms compared to motor (97% vs. 57%) and 77% walking difficulties. Clinical diagnosis was polyneuropathy (PNP) in 44%, subacute combined degeneration (SCD) of the spine in 19%, both in 37%. Median vitamin B12 level was low (159 pmol/L), normal in 16%. The median methylmalonic acid was increased (2.66 μmol/L). Electrodiagnostic abnormalities were observed in 91%, with 72% fulfilling axonal PNP criteria, 20% showing mild to intermediate slowing. One patient fulfilled demyelinating PNP criteria not related to N2 O abuse (Charcot-Marie-Tooth type 1a). More prominent motor nerve conduction abnormalities were found; lower limbs were more affected. In 64% with normal conduction, myography showed signs of axonal loss. Magnetic resonance imaging showed cervical myelopathy in 58% involving generally five to six segments. CONCLUSIONS Nitrous oxide (N2 O) leads to neurological symptoms by causing PNP and/or SCD primarily involving the legs. Distinguishing PNP and SCD clinically was shown to be insufficient. Electrodiagnostic studies showed axonal PNP. Demyelinating PNP due to N2 O abuse was not present in our cohort. Therefore, further diagnostic work-up is warranted if demyelinating features are present.
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Affiliation(s)
- L T Hassing
- HagaZiekenhuis, Department of Neurology, The Hague, The Netherlands
| | - F Y Jiang
- HagaZiekenhuis, Department of Radiology, The Hague, The Netherlands
| | - R Zutt
- HagaZiekenhuis, Department of Neurology, The Hague, The Netherlands
| | - S Arends
- HagaZiekenhuis, Department of Neurology, The Hague, The Netherlands
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Rubin DI, Lamb CJ. The role of electrodiagnosis in focal neuropathies. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:43-59. [PMID: 38697746 DOI: 10.1016/b978-0-323-90108-6.00010-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
Electrodiagnostic (EDX) testing plays an important role in confirming a mononeuropathy, localizing the site of nerve injury, defining the pathophysiology, and assessing the severity and prognosis. The combination of nerve conduction studies (NCS) and needle electromyography findings provides the necessary information to fully assess a nerve. The pattern of NCS abnormalities reflects the underlying pathophysiology, with focal slowing or conduction block in neuropraxic injuries and reduced amplitudes in axonotmetic injuries. Needle electromyography findings, including spontaneous activity and voluntary motor unit potential changes, complement the NCS findings and further characterize chronicity and degree of axon loss and reinnervation. EDX is used as an objective marker to follow the progression of a mononeuropathy over time.
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Affiliation(s)
- Devon I Rubin
- Department of Neurology, Mayo Clinic, Jacksonville, FL, United States.
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Poser PL, Sajid GS, Beyer L, Hieke A, Schumacher A, Horstkemper L, Karl AS, Grüter T, Sgodzai M, Pitarokoili K, Gerwert K, Gold R, Fisse AL, Gisevius B, Motte J. Serum neurofilament light chain does not detect self-reported treatment-related fluctuations in chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16023. [PMID: 37539836 DOI: 10.1111/ene.16023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/09/2023] [Accepted: 07/31/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Serum neurofilament light chain (sNfL) is a marker for axonal degeneration. Patients with chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) often report a fluctuation of symptoms throughout one treatment cycle with intravenous immunoglobulins (IVIG). The aim of this study was to determine whether sNfL is suitable to quantify patient-reported symptom fluctuations. METHODS Twenty-nine patients with the diagnosis of CIDP or a CIDP-variant under treatment with IVIG were recruited in this study and underwent examination before IVIG infusion, in the middle of the treatment interval, and before their next IVIG infusion. Patients were surveyed regarding symptom fluctuations at the last visit and divided into two groups: those with and without fluctuations of symptoms. At the first visit, sociodemographic and disease-specific data were collected. Clinical scores were assessed at every examination. sNfL values were compared between both groups at the different time points after conversion into Z-scores-adjusted for age and body mass index. RESULTS Patients with CIDP show elevated sNfL Z-scores (median at baseline: 2.14, IQR: 1.0). There was no significant change in sNfL Z-scores or questionnaire scores within the treatment cycle in either group. There was no significant difference in sNfL levels between the patients with and without symptom fluctuations. CONCLUSIONS CIDP patients show elevated sNfL levels. However, sNfL is not suitable to reflect patient-reported fluctuations of symptoms. This indicates that symptom fluctuations during treatment with IVIG in patients with CIDP are not caused by a neuroaxonal injury. Furthermore, repeated sNfL measurements within one treatment cycle with IVIG seem to have no benefit for symptom monitoring.
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Affiliation(s)
- Philip Lennart Poser
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Gulchan Shazadi Sajid
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Léon Beyer
- Department of Biophysics, Faculty of Biology and Biophysics, Ruhr-University Bochum, Bochum, Germany
- Center for Protein Diagnostics (Prodi), Ruhr-University Bochum, Bochum, Germany
| | - Alina Hieke
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Aurelian Schumacher
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Lea Horstkemper
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna-Sophia Karl
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Thomas Grüter
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Melissa Sgodzai
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Klaus Gerwert
- Department of Biophysics, Faculty of Biology and Biophysics, Ruhr-University Bochum, Bochum, Germany
- Center for Protein Diagnostics (Prodi), Ruhr-University Bochum, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Anna Lena Fisse
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
| | - Barbara Gisevius
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
- Immunmediated Neuropathies Biobank (INHIBIT), Ruhr-University Bochum, Bochum, Germany
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van Doorn PA, Van den Bergh PYK, Hadden RDM, Avau B, Vankrunkelsven P, Attarian S, Blomkwist-Markens PH, Cornblath DR, Goedee HS, Harbo T, Jacobs BC, Kusunoki S, Lehmann HC, Lewis RA, Lunn MP, Nobile-Orazio E, Querol L, Rajabally YA, Umapathi T, Topaloglu HA, Willison HJ. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. Eur J Neurol 2023; 30:3646-3674. [PMID: 37814552 DOI: 10.1111/ene.16073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.
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Affiliation(s)
- Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter Y K Van den Bergh
- Neuromuscular Reference Centre, Department of Neurology, University Hospital Saint-Luc, Brussels, Belgium
| | | | - Bert Avau
- Cochrane Belgium, CEBAM, Leuven, Belgium
- CEBaP, Belgian Red Cross, Mechelen, Belgium
| | - Patrik Vankrunkelsven
- Department of Public Health and Primary Care KU Leuven, Cochrane Belgium, CEBAM, Leuven, Belgium
| | - Shahram Attarian
- Centre de Référence des Maladies Neuromusculaires et de la SLA, APHM, CHU Timone, Marseille, France
| | | | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Stephan Goedee
- Department of Neurology, University Medical Center Utrecht, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty Köln, University Hospital Köln, Cologne, Germany
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael P Lunn
- Department of Neurology and MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Institute, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Luis Querol
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yusuf A Rajabally
- Neuromuscular Service, Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Hugh J Willison
- Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
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Sommer C. Differentiating Charcot-Marie-Tooth disease from chronic inflammatory demyelinating polyradiculoneuropathy: neurophysiology is not the only clue. Eur J Neurol 2023; 30:3642. [PMID: 37410578 DOI: 10.1111/ene.15966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 07/04/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Claudia Sommer
- Neurologische Klinik, Universitätsklinikum Würzburg, Würzburg, Germany
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Mendoza M, Tran C, Bril V, Katzberg HD, Barnett-Tapia C. Symptom and Treatment Satisfaction in Members of the US and Canadian GBS/CIDP Foundations with a Diagnosis of Chronic Inflammatory Demyelinating Polyneuropathy. Adv Ther 2023; 40:5188-5203. [PMID: 37751023 DOI: 10.1007/s12325-023-02661-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/21/2023] [Indexed: 09/27/2023]
Abstract
INTRODUCTION Current guidelines for defining good outcomes in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) are predominately defined by experts. At present, we do not have a patient-anchored definition of what constitutes a "good" outcome. Our study aimed to assess the symptom burden of people living with CIDP, as well as satisfaction with treatments and clinical outcomes. METHODS We conducted an online-survey in CIDP patients registered with the US and Canadian GBS/CIDP foundations. Respondents answered general demographic and clinical questions, as well as satisfaction with current symptom burden and treatments, plus validated outcome measures. RESULTS A total of 318 individuals with self-reported CIDP completed the online survey, of whom 128 (40%) considered their current disease burden as satisfactory while 190 (60%) did not. Of 305 patients who answered the treatment satisfaction question, 222(74%) were satisfied with their treatments. Patients who were satisfied with their current symptoms had, on average, better scores in quality of life and disease severity scales, although regression modeling showed that only ability to walk, stable symptoms, and health utility scores were associated with symptom satisfaction. Treatment satisfaction was associated with stable symptoms, use of IVIG, and use of one versus no medication. CONCLUSIONS A high proportion of members of the US and Canadian GBS/CIDP Foundations reporting a diagnosis of CIDP were unsatisfied with current symptoms, despite a high level of overall satisfaction with treatments. There is an unmet need for improving long-term outcomes in people with a diagnosis of CIDP, and for studying patient-centered long-term treatment goals.
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Affiliation(s)
- Meg Mendoza
- Toronto General Hospital, Ellen and Martin Prosserman Centre for Neuromuscular Disease, 200 Elizabeth Street 5ECW-334, Toronto, ON, M5G2C4, Canada
| | - Christopher Tran
- Division of Neurology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Vera Bril
- Toronto General Hospital, Ellen and Martin Prosserman Centre for Neuromuscular Disease, 200 Elizabeth Street 5ECW-334, Toronto, ON, M5G2C4, Canada
- Division of Neurology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Hans D Katzberg
- Toronto General Hospital, Ellen and Martin Prosserman Centre for Neuromuscular Disease, 200 Elizabeth Street 5ECW-334, Toronto, ON, M5G2C4, Canada
- Division of Neurology, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Carolina Barnett-Tapia
- Toronto General Hospital, Ellen and Martin Prosserman Centre for Neuromuscular Disease, 200 Elizabeth Street 5ECW-334, Toronto, ON, M5G2C4, Canada.
- Division of Neurology, University Health Network and University of Toronto, Toronto, ON, Canada.
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Montes-Robles MA, Gallardo-Pérez MM, Hernández-Flores EJ, Pastelín-Martínez MDL, Sánchez-Bonilla D, Robles-Nasta M, Ocaña-Ramm G, Olivares-Gazca JC, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. In persons with CIDP, auto-HSCT can be conducted fully on an outpatient basis and induces significant clinical responses: A prospective study in a single center. Transpl Immunol 2023; 81:101944. [PMID: 37866669 DOI: 10.1016/j.trim.2023.101944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/09/2023] [Accepted: 10/19/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyneuropathy (CIDP) is one of the world's most common treatable neuropathy which usually responds to immunosuppressive treatment. Autologous hematopoietic stem cell transplantation (aHSCT) is an intense way of inducing immunosuppression. OBJECTIVE We analyze the evolution of CIDP patients treated with aHSCT in our center. METHODS Between 2018 and 2023, persons with CIDP were prospectively autografted employing the "Mexican method" to conduct grafts on an outpatient basis, employing cyclophosphamide 200 mg/Kg and rituximab 1000 mg. The protocol is registered in ClinicalTrials.gov identifier NCT02674217. RESULTS In our center 21 autologous transplant cases were completed in 2018-2023. Seven patients provided data to assess the efficacy of the procedure. Positive responses (stabilization and/or improvement) were observed in all seven patients: Five reported improvements in the Inflammatory Neuropathy Cause and Treatment (INCAT) score and one reported stabilization. In the Inflammatory Rasch-Built Overall Disability Scale (I-RODS) score. Median INCAT score was 5 (range 1-9), whereas median I-RODS score was 24 (range 11-29). Five patients (71%) reported improvement in the INCAT score, one reported stabilization and one informed worsening; concerning the I-RODS score 5 (71%) informed improvement, whereas two reported stabilization. CONCLUSION aHSCT conducted fully in an outpatient basis, employing the conditioning regimen of the "Mexican method" appears to be a feasible therapeutic option for persons with CIDP. Additional studies are needed to confirm these observations.
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Affiliation(s)
| | - Moisés Manuel Gallardo-Pérez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Edgar J Hernández-Flores
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | | | - Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Max Robles-Nasta
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Guillermo Ocaña-Ramm
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, Mexico.; Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico..
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van Doorn PA, Van den Bergh PYK, Hadden RDM, Avau B, Vankrunkelsven P, Attarian S, Blomkwist-Markens PH, Cornblath DR, Goedee HS, Harbo T, Jacobs BC, Kusunoki S, Lehmann HC, Lewis RA, Lunn MP, Nobile-Orazio E, Querol L, Rajabally YA, Umapathi T, Topaloglu HA, Willison HJ. European Academy of Neurology/Peripheral Nerve Society Guideline on diagnosis and treatment of Guillain-Barré syndrome. J Peripher Nerv Syst 2023; 28:535-563. [PMID: 37814551 DOI: 10.1111/jns.12594] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/25/2023] [Accepted: 08/28/2023] [Indexed: 10/11/2023]
Abstract
Guillain-Barré syndrome (GBS) is an acute polyradiculoneuropathy. Symptoms may vary greatly in presentation and severity. Besides weakness and sensory disturbances, patients may have cranial nerve involvement, respiratory insufficiency, autonomic dysfunction and pain. To develop an evidence-based guideline for the diagnosis and treatment of GBS, using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, a Task Force (TF) of the European Academy of Neurology (EAN) and the Peripheral Nerve Society (PNS) constructed 14 Population/Intervention/Comparison/Outcome questions (PICOs) covering diagnosis, treatment and prognosis of GBS, which guided the literature search. Data were extracted and summarised in GRADE Summaries of Findings (for treatment PICOs) or Evidence Tables (for diagnostic and prognostic PICOs). Statements were prepared according to GRADE Evidence-to-Decision (EtD) frameworks. For the six intervention PICOs, evidence-based recommendations are made. For other PICOs, good practice points (GPPs) are formulated. For diagnosis, the principal GPPs are: GBS is more likely if there is a history of recent diarrhoea or respiratory infection; CSF examination is valuable, particularly when the diagnosis is less certain; electrodiagnostic testing is advised to support the diagnosis; testing for anti-ganglioside antibodies is of limited clinical value in most patients with typical motor-sensory GBS, but anti-GQ1b antibody testing should be considered when Miller Fisher syndrome (MFS) is suspected; nodal-paranodal antibodies should be tested when autoimmune nodopathy is suspected; MRI or ultrasound imaging should be considered in atypical cases; and changing the diagnosis to acute-onset chronic inflammatory demyelinating polyradiculoneuropathy (A-CIDP) should be considered if progression continues after 8 weeks from onset, which occurs in around 5% of patients initially diagnosed with GBS. For treatment, the TF recommends intravenous immunoglobulin (IVIg) 0.4 g/kg for 5 days, in patients within 2 weeks (GPP also within 2-4 weeks) after onset of weakness if unable to walk unaided, or a course of plasma exchange (PE) 12-15 L in four to five exchanges over 1-2 weeks, in patients within 4 weeks after onset of weakness if unable to walk unaided. The TF recommends against a second IVIg course in GBS patients with a poor prognosis; recommends against using oral corticosteroids, and weakly recommends against using IV corticosteroids; does not recommend PE followed immediately by IVIg; weakly recommends gabapentinoids, tricyclic antidepressants or carbamazepine for treatment of pain; does not recommend a specific treatment for fatigue. To estimate the prognosis of individual patients, the TF advises using the modified Erasmus GBS outcome score (mEGOS) to assess outcome, and the modified Erasmus GBS Respiratory Insufficiency Score (mEGRIS) to assess the risk of requiring artificial ventilation. Based on the PICOs, available literature and additional discussions, we provide flow charts to assist making clinical decisions on diagnosis, treatment and the need for intensive care unit admission.
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Affiliation(s)
- Pieter A van Doorn
- Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Peter Y K Van den Bergh
- Neuromuscular Reference Centre, Department of Neurology, University Hospital Saint-Luc, Brussels, Belgium
| | | | - Bert Avau
- Cochrane Belgium, CEBAM, Leuven, Belgium
- CEBaP, Belgian Red Cross, Mechelen, Belgium
| | - Patrik Vankrunkelsven
- Department of Public Health and Primary Care KU Leuven, Cochrane Belgium, CEBAM, Leuven, Belgium
| | - Shahram Attarian
- Centre de Référence des Maladies Neuromusculaires et de la SLA, APHM, CHU Timone, Marseille, France
| | | | - David R Cornblath
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - H Stephan Goedee
- Department of Neurology, University Medical Center Utrecht, Brain Center UMC Utrecht, Utrecht, The Netherlands
| | - Thomas Harbo
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Bart C Jacobs
- Department of Neurology and Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Susumu Kusunoki
- Department of Neurology, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Helmar C Lehmann
- Department of Neurology, Medical Faculty Köln, University Hospital Köln, Cologne, Germany
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael P Lunn
- Department of Neurology and MRC Centre for Neuromuscular Diseases, National Hospital for Neurology and Neurosurgery, London, UK
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Service, IRCCS Humanitas Research Institute, Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
| | - Luis Querol
- Neuromuscular Diseases Unit, Neurology Department, Hospital de la Santa Creu I Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Yusuf A Rajabally
- Neuromuscular Service, Neurology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | | | | | - Hugh J Willison
- Glasgow Biomedical Research Centre, University of Glasgow, Glasgow, UK
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Ogata H. [The significance of autoantibodies against nodal and paranodal proteins in autoimmune nodopathies]. Rinsho Shinkeigaku 2023; 63:715-724. [PMID: 37880115 DOI: 10.5692/clinicalneurol.cn-001878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is recognized as a syndrome caused by multiple pathologies. Since the 2010s, it has been clarified that autoantibodies against membranous proteins localized in the nodes of Ranvier and paranodes are positive in subsets of CIDP patients, leading to proposing a new disease concept called autoimmune nodopathies, which is independent of CIDP, in the revised international CIDP guidelines. This article reviews the significance of these autoantibodies, especially anti-neurofascin 155 and anti-contactin 1 antibodies, which have been the most prevalent and achieved a higher degree of consensus.
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Kmezic I, Gustafsson R, Fink K, Svenningsson A, Samuelsson K, Ingre C, Olsson T, Hansson M, Kockum I, Adzemovic MZ, Press R. Validation of elevated levels of interleukin-8 in the cerebrospinal fluid, and discovery of new biomarkers in patients with GBS and CIDP using a proximity extension assay. Front Immunol 2023; 14:1241199. [PMID: 38077366 PMCID: PMC10702497 DOI: 10.3389/fimmu.2023.1241199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 11/01/2023] [Indexed: 12/18/2023] Open
Abstract
Background Biomarkers for diagnosis of inflammatory neuropathies, assessment of prognosis, and treatment response are lacking. Methods CSF and EDTA plasma from patients with Guillain-Barré syndrome (GBS), chronic inflammatory demyelinating polyneuropathy (CIDP), healthy controls (HC) and disease controls were analyzed with Olink multiplex proximity extension assay (PEA) from two independent cohorts. Levels of interleukin-8 (IL8) were further analyzed with ELISA in patients with GBS, CIDP, paraproteinemia-related demyelinating polyneuropathy (PDN), multifocal motor neuropathy (MMN), HC and disease controls. ROC analysis was performed. Outcome was measured with the GBS-disability score (GBS-ds) or Inflammatory Neuropathy Cause and Treatment (INCAT) score. Results In CSF, multiplex PEA analysis revealed up-regulation of IL8 in GBS compared to CIDP and HC respectively, and CIDP compared to HC. In addition, levels of IL2RA were upregulated in GBS compared to both HC and CIDP, SELE in GBS compared to HC, and ITGAM, IL6, and NRP1 in GBS compared to CIDP. In plasma, levels of MMP3, THBD and ITGAM were upregulated in CIDP compared to HC. Validation of multiplex IL8 results using ELISA, revealed increased levels of IL8 in CSF in patients with GBS and CIDP versus HC and non-inflammatory polyneuropathies (NIP) respectively, as well as in PDN versus NIP and HC. Levels of IL8 in CSF correlated with impairment in the acute phase of GBS as well as outcome at 6-months follow up. Conclusion IL8 in CSF is validated as a diagnostic biomarker in GBS and CIDP, and a prognostic biomarker in GBS. Multiplex PEA hereby identifies several potential biomarkers in GBS and CIDP.
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Affiliation(s)
- Ivan Kmezic
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rasmus Gustafsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Fink
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anders Svenningsson
- Department of Clinical Sciences, Karolinska Institutet Danderyd Hospital, Stockholm, Sweden
| | - Kristin Samuelsson
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Caroline Ingre
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Tomas Olsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Hansson
- Department of Clinical Chemistry, Karolinska University Hospital, Stockholm, Sweden
- Department of Laboratory Medicine H5, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Kockum
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Milena Z. Adzemovic
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Centre for Neurology, Academic Specialist Centre, Stockholm Health Services, Stockholm, Sweden
| | - Rayomand Press
- Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Yoshikawa M, Sekiguchi K, Suehiro H, Watanabe S, Noda Y, Hara H, Matsumoto R. Nerve enlargement differs among chronic inflammatory demyelinating polyradiculoneuropathy subtypes and multifocal motor neuropathy. Clin Neurophysiol Pract 2023; 8:228-234. [PMID: 38152246 PMCID: PMC10751816 DOI: 10.1016/j.cnp.2023.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/06/2023] [Accepted: 10/22/2023] [Indexed: 12/29/2023] Open
Abstract
Objective We aimed to evaluate differences in ultrasonographic nerve enlargement sites among typical chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), distal CIDP, multifocal CIDP and multifocal motor neuropathy (MMN) in a Japanese population. Methods We retrospectively reviewed medical records and selected 39 patients (14 with typical CIDP, 7 with multifocal CIDP, 4 with distal CIDP, and 14 with MMN) who underwent ultrasonography. Median and ulnar nerve cross-sectional areas (CSAs) were measured at the wrist, forearm, elbow, and upper arm. CSA ratios for each nerve were calculated as: wrist-to-forearm index (WFI) = wrist CSA/forearm CSA; elbow-to-upper arm index (EUI) = elbow CSA/upper arm CSA; and intranerve CSA variability (INCV) = maximal CSA/minimal CSA. Results Significant differences were observed among typical CIDP, multifocal CIDP, distal CIDP, and MMN in CSA at the forearm and upper arm in the median nerves (p < 0.05). Patients with multifocal CIDP had lower WFI and EUI and higher INCV than the other groups (p < 0.05). Conclusions Regardless of the untreated period, compared with other CIDP subtypes and MMN, multifocal CIDP showed a focal and marked nerve enlargement in the Japanese population. Significance Differences in nerve enlargement site may be an underlying feature of multifocal CIDP.
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Affiliation(s)
- Masaaki Yoshikawa
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima-cho, Saga 849-8501, Japan
| | - Kenji Sekiguchi
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Hirotomo Suehiro
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Shunsuke Watanabe
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Yoshikatsu Noda
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
| | - Hideo Hara
- Division of Neurology, Department of Internal Medicine, Saga University Faculty of Medicine, 5-1-1 Nabeshima-cho, Saga 849-8501, Japan
- Fukuoka International University of Health and Welfare, 3-6-40 Momochihama, Sawara-ku, Fukuoka 814-0001, Japan
| | - Riki Matsumoto
- Division of Neurology, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe, Hyogo 650-0017, Japan
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Cocito D, Peci E, Torrieri MC, Clerico M. Subcutaneous Immunoglobulin in Chronic Inflammatory Demyelinating Polyneuropathy: A Historical Perspective. J Clin Med 2023; 12:6961. [PMID: 38002576 PMCID: PMC10671960 DOI: 10.3390/jcm12226961] [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: 10/16/2023] [Revised: 10/30/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023] Open
Abstract
The therapeutic administration of subcutaneous immunoglobulin (SCIg) offers various advantages over intravenous immunoglobulin (IVIg). This narrative review examines and compares SCIg versus IVIg in chronic inflammatory demyelinating polyneuropathy (CIDP). SCIg is as effective as IVIg but is better tolerated and easier to administer, as intravenous access is not required. Furthermore, SCIg administration is more convenient and cost-effective than IVIg, enabling flexible treatment scheduling at home and improving patients' overall quality of life. The availability of highly concentrated immunoglobulin G (IgG) subcutaneous solutions, such as IgPro20, a 20% IgG solution stabilized with L-proline, allows for the administration of larger volumes in a single session, while the parallel development of new technological devices enables the delivery of higher doses over a shorter time. Based on the results of the PATH study, SCIg has become a well-established therapy in CIDP. In addition to discussing the advantages of SCIg, this review summarizes the evolution of SCIg by discussing all the relevant clinical studies which have considered its use in the treatment of CIDP.
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Affiliation(s)
- Dario Cocito
- Clinical and Biological Sciences Department, University of Turin, 10043 Orbassano, Italy
| | - Erdita Peci
- Clinical and Biological Sciences Department, University of Turin, 10043 Orbassano, Italy
| | | | - Marinella Clerico
- Academic Neurology Unit, San Luigi Gonzaga University Hospital, Clinical and Biological Sciences Department, University of Turin, 10043 Orbassano, Italy;
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Collins MP, Hadden RDM, Shahnoor N. Primary perineuritis, a rare but treatable neuropathy: Review of perineurial anatomy, clinicopathological features, and differential diagnosis. Muscle Nerve 2023; 68:696-713. [PMID: 37602939 DOI: 10.1002/mus.27949] [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: 04/02/2023] [Revised: 07/10/2023] [Accepted: 07/16/2023] [Indexed: 08/22/2023]
Abstract
The perineurium surrounds each fascicle in peripheral nerves, forming part of the blood-nerve barrier. We describe its normal anatomy and function. "Perineuritis" refers to both a nonspecific histopathological finding and more specific clinicopathological entity, primary perineuritis (PP). Patients with PP are often assumed to have nonsystemic vasculitic neuropathy until nerve biopsy is performed. We systematically reviewed the literature on PP and developed a differential diagnosis for histopathologically defined perineuritis. We searched PubMed, Embase, Scopus, and Web of Science for "perineuritis." We identified 20 cases (11 M/9F) of PP: progressive, unexplained neuropathy with biopsy showing perineuritis without vasculitis or other known predisposing condition. Patients ranged in age from 18 to 75 (mean 53.7) y and had symptoms 2-24 (median 4.5) mo before diagnosis. Neuropathy was usually sensory-motor (15/20), painful (18/19), multifocal (16/20), and distal-predominant (16/17) with legs more affected than arms. Truncal numbness occurred in 6/17; 10/18 had elevated cerebrospinal fluid (CSF) protein. Electromyography (EMG) and nerve conduction studies (NCS) demonstrated primarily axonal changes. Nerve biopsies showed T-cell-predominant inflammation, widening, and fibrosis of perineurium; infiltrates in epineurium in 10/20 and endoneurium in 7/20; and non-uniform axonal degeneration. Six had epithelioid cells. 19/20 received corticosteroids, 8 with additional immunomodulators; 18/19 improved. Two patients did not respond to intravenous immunoglobulin (IVIg). At final follow-up, 13/16 patients had mild and 2/16 moderate disability; 1/16 died. Secondary causes of perineuritis include leprosy, vasculitis, neurosarcoidosis, neuroborreliosis, neurolymphomatosis, toxic oil syndrome, eosinophilia-myalgia syndrome, and rarer conditions. PP appears to be an immune-mediated, corticosteroid-responsive disorder. It mimics nonsystemic vasculitic neuropathy. Cases with epithelioid cells might represent peripheral nervous system (PNS)-restricted forms of sarcoidosis.
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Affiliation(s)
- Michael P Collins
- Department of Neurology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | | | - Nazima Shahnoor
- Neuromuscular Pathology Laboratory, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Ren Y, Chen S, Yang H. Case Report: Telitacicept in treating a patient with NF155+ autoimmune nodopathy: a successful attempt to manage recurrent elevated sero-anti-NF155 antibodies. Front Immunol 2023; 14:1279808. [PMID: 37965304 PMCID: PMC10642300 DOI: 10.3389/fimmu.2023.1279808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
This report presents a case of a neurofascin-155 (NF155)+ autoimmune nodopathy (AN) patient who exhibited resistance to conventional treatments but responded positively to telitacicept therapy. Telitacicept, a dual inhibitor of B lymphocyte stimulator (BLyS) and A proliferation-inducing ligand (APRIL), suppressed the development and survival of plasma cells and mature B cells. The patient's unique clinical features were consistent with NF155+ AN, showing limited response to standard treatments like rituximab and a recurrent significant increase in anti-NF155 antibody titers. Administering telitacicept (160mg, ih) led to an improvement in clinical symptoms, inflammatory neuropathy cause and treatment (INCAT) scale and inflammatory Rasch-built overall disability scale (I-RODS), and stabilized anti-NF155 antibody levels without a rebound. This case demonstrates telitacicept as a potential novel therapy for NF155+ AN, particularly when conventional treatments fail. Further investigation into its safety, efficacy, dosage, and treatment cycle in NF155+ AN is warranted.
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Affiliation(s)
| | | | - Huan Yang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, China
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Appeltshauser L, Doppler K. Pan-Neurofascin autoimmune nodopathy - a life-threatening, but reversible neuropathy. Curr Opin Neurol 2023; 36:394-401. [PMID: 37639464 DOI: 10.1097/wco.0000000000001195] [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: 08/31/2023]
Abstract
PURPOSE OF REVIEW Autoimmune nodopathies are immune-mediated neuropathies associated with antibodies targeting the peripheral node of Ranvier. Recently, antibodies against all neurofascin-isoforms (pan-neurofascin) have been linked to a clinical phenotype distinct from previously described autoimmune nodopathies. Here, we aim at highlighting the molecular background and the red flags for diagnostic assessment and provide treatment and surveillance approaches for this new disease. RECENT FINDINGS Neurofascin-isoforms are located at different compartments of the node of Ranvier: Neurofascin-186 at the axonal nodal gap, and Neurofascin-155 at the terminal Schwann cell loops at the paranode. Pan-neurofascin antibodies recognize a common epitope on both isoforms and can access the node of Ranvier directly. Depending on their subclass profile, antibodies can induce direct structural disorganization and complement activation. Affected patients present with acute and immobilizing sensorimotor neuropathy, with cranial nerve involvement and long-term respiratory insufficiency. Early antibody-depleting therapy is crucial to avoid axonal damage, and remission is possible despite extended disease and high mortality. The antibody titer and serum neurofilament light chain levels can serve as biomarkers for diagnosis and therapy monitoring. SUMMARY Pan-neurofascin-associated autoimmune nodopathies has unique molecular and clinical features. Testing should be considered in severe and prolonged Guillain-Barré-like phenotype.
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Affiliation(s)
- Luise Appeltshauser
- Department of Neurology, University Hospital Würzburg (UKW), Würzburg, Germany
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Cintas P, Bouhour F, Cauquil C, Masingue M, Tard C, Sacconi S, Delmont E, Choumert A, Chanson JB, Michaud M, Solé G, Cassereau J, Noury JB, Nicolas G, Bellance R, Péréon Y, Camdessanché JP, Magy L, Attarian S. Current clinical management of CIDP with immunoglobulins in France: An expert opinion. Rev Neurol (Paris) 2023; 179:914-922. [PMID: 37019741 DOI: 10.1016/j.neurol.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 01/05/2023] [Accepted: 03/13/2023] [Indexed: 04/05/2023]
Abstract
Treatment strategies in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) must be adapted on a case-to-case basis. Validated and reproducible tools for monitoring treatment response are required at diagnosis, when initiating treatment and throughout follow-up. A task force of French neurologists, experts in neuromuscular disease reference centers, was assembled to provide expert advice on the management of typical CIDP with intravenous immunoglobulins (Ig), and to harmonize treatment practices in public and private hospitals. The task force also referred to the practical experience of treating CIDP with Ig at the diagnostic, induction and follow-up stages, including the assessment and management of Ig dependence, and following the recommendations of the French health agency.
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Affiliation(s)
- P Cintas
- Service de neurologie, CHU de Toulouse Purpan, centre de référence de pathologies neuromusculaires, Toulouse, France
| | - F Bouhour
- Service d'ENMG et de pathologies neuromusculaires, hospices civils de Lyon, hôpital neurologique, Lyon, France
| | - C Cauquil
- Service de neurologie, AP-HP Kremlin-Bicêtre, Paris, France
| | - M Masingue
- Service de neuromyologie, centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, AP-HP Pitié-Salpêtrière, Paris, France
| | - C Tard
- Unité d'expertise cognitivo-motrice, U1172, service de neurologie, CHU de Lille, centre de référence des maladies neuromusculaires Nord/Est/Île-de-France, Lille, France
| | - S Sacconi
- Système nerveux périphérique et muscle, CHU de Nice, université Côte d'Azur, Nice, France
| | - E Delmont
- Service de neurologie, centre de référence des maladies neuromusculaires et SLA, hôpital de la Timone, Marseille, France
| | - A Choumert
- Service des maladies neurologiques rares, CHU de la Réunion, groupe hospitalier Sud Réunion, Saint-Pierre, France
| | - J-B Chanson
- Service de neurologie, CHRU Strasbourg, centre de référence neuromusculaire Nord/Est/Île-de-France, Strasbourg, France
| | - M Michaud
- Service de neurologie, CHU de Nancy, hôpital Central, Nancy, France
| | - G Solé
- Service de neurologie et maladies neuromusculaires, CHU de Bordeaux, centre de référence des maladies neuromusculaires AOC, hôpital Pellegrin, Bordeaux, France
| | - J Cassereau
- CHU d'Angers, centre de référence des maladies neuromusculaires AOC, Angers, France
| | - J-B Noury
- Inserm, LBAI, UMR1227, centre de référence des maladies neuromusculaires AOC, CHRU de Brest, Brest, France
| | - G Nicolas
- Service de neurologie, centre de référence neuromusculaire Nord-Est/Île-de-France , Université UVSQ Paris-Saclay, hôpital Raymond-Poincaré, Garches, France
| | - R Bellance
- CeRCa, site constitutif de centre de référence caribéen des maladies neuromusculaires rares, CHU de Martinique, hôpital P. Zobda-Quitman, Fort-de-France, France
| | - Y Péréon
- Explorations fonctionnelles, Filnemus, Euro-NMD, Nantes université, CHU de Nantes, centre de référence AOC, Nantes, France
| | - J-P Camdessanché
- Service de neurologie, CHU de Saint-Étienne, hôpital Nord, Saint-Étienne, France
| | - L Magy
- Service et laboratoire de neurologie, centre de référence neuropathies périphériques rares, NNerf, UR 20218 NeurIT, CHU de Limoges, hôpital Dupuytren, Limoges, France
| | - S Attarian
- Service de neurologie, centre de référence des maladies neuromusculaires et SLA, hôpital de la Timone, Marseille, France.
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Chen L, Zhang Y, Qin N, Han R, Li Y. Atypical chronic inflammatory demyelinating polyradiculoneuropathy with ophthalmoplegia and anti-sulfatide IgM positivity. J Int Med Res 2023; 51:3000605231193575. [PMID: 37812511 PMCID: PMC10563483 DOI: 10.1177/03000605231193575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 07/17/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a heterogeneous group of chronic immune-mediated polyradiculoneuropathies. The clinical presentation of CIDP is mainly characterized by a classic peripheral demyelinating sensory-motor type and persists for a minimum of 2 months. However, CIDP may also present with atypical symptoms.Case presentation: This report presents the case of a patient with CIDP with ophthalmoplegia and anti-sulfatide IgM antibodies. Maintenance intravenous immunoglobulin and glucocorticoid therapies were administered to the patient in accordance with the clinical, laboratory, and electrophysiological findings, which were indicative of CIDP. The treatment partially improved the symptoms, and no recurrence was detected throughout the 3-month monitoring phase. CONCLUSIONS This study combines a retrospective analysis and a literature review to explore the possible mechanism of CIDP.
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Affiliation(s)
- Li Chen
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Yanjun Zhang
- Department of Neurology, Tianjin Academy of Traditional Chinese Medicine Affiliated Hospital, Tianjin, China
| | - Nan Qin
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
| | - Ranran Han
- Department of Neurology and Tianjin Neurological Institute, Tianjin Medical University General Hospital, Tianjin, China
| | - Yuwang Li
- Department of Neurology, Tianjin Huanhu Hospital, Tianjin, China
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