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Bus SRM, Wieske L, Keddie S, van Schaik IN, Eftimov F. Subcutaneous immunoglobulin for chronic inflammatory demyelinating polyradiculoneuropathy. Hippokratia 2021. [DOI: 10.1002/14651858.cd014542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sander RM Bus
- Department of Neurology, Amsterdam Neuroscience; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
| | - Luuk Wieske
- Department of Neurology, Amsterdam Neuroscience; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
| | - Stephen Keddie
- Faculty of Brain Sciences; Institute of Neurology; London UK
| | - Ivo N van Schaik
- Department of Neurology, Amsterdam Neuroscience; Amsterdam University Medical Centers, location AMC, University of Amsterdam; Amsterdam Netherlands
| | - Filip Eftimov
- Department of Neurology, Amsterdam Neuroscience; Amsterdam UMC, University of Amsterdam; Amsterdam Netherlands
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2
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Al‐Zuhairy A, Sindrup SH, Andersen H, Jakobsen J. A population‐based study of long‐term outcome in treated chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2020; 61:316-324. [DOI: 10.1002/mus.26772] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Revised: 11/26/2019] [Accepted: 11/28/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Ali Al‐Zuhairy
- Department of NeurologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Søren H. Sindrup
- Department of NeurologyOdense University Hospital Odense Denmark
| | - Henning Andersen
- Department of NeurologyAarhus University Hospital Aarhus Denmark
| | - Johannes Jakobsen
- Department of NeurologyCopenhagen University Hospital Rigshospitalet Copenhagen Denmark
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Grimm A, Oertl H, Auffenberg E, Schubert V, Ruschil C, Axer H, Winter N. Differentiation Between Guillain-Barré Syndrome and Acute-Onset Chronic Inflammatory Demyelinating Polyradiculoneuritis-a Prospective Follow-up Study Using Ultrasound and Neurophysiological Measurements. Neurotherapeutics 2019; 16:838-847. [PMID: 30756363 PMCID: PMC6694337 DOI: 10.1007/s13311-019-00716-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Differentiation of Guillain-Barré syndrome (GBS) and acute-onset chronic inflammatory demyelinating polyradiculoneuritis (CIDP) might be intricate in early stages. We compared electrodiagnostics (EDx) and nerve ultrasound (NUS) as tools for early distinction and follow-up. NUS and EDx have been performed at first visitation and after 6 months. The nerve conduction study score (NCSS), the ultrasound pattern sum score (UPSS), and clinical scores were used for comparison. Compared with the 33 GBS patients, the 34 CIDP patients (50% with symptoms < 4 weeks) revealed significant nerve enlargement in ultrasound (p < 0.001) except for the roots and vagus, which exhibited increased values in both groups. EDx has no significant differences between both groups except for the A-wave frequency and the sural sparing pattern, which is more frequent in GBS (Fisher's exact p < 0.05). In the latter, particularly, pure sensory nerves were not enlarged in contrast to CIDP, in which those were mostly enlarged (p < 0.001). This ultrasonic sensory sparing pattern (uSSP) in combination with enlarged roots/vagus is the hallmark finding in GBS with sensitivity, specificity, and positive predictive value > 85%, whereas in CIDP, enlarged sensory und multifocally enlarged sensorimotor nerves are key differentiation features to GBS. Increased echointensity of the nerves further arises only in CIDP. After 6 months, in CIDP, the significant nerve enlargement persisted, whereas in GBS, all segments almost normalized. Clinical, ultrasonic, and NCS scores correlated significantly over the time. Enlarged roots/vagus in combination with uSSP might facilitate differentiation of GBS and CIDP in the early stage, and ultrasonic 6-month normalization underlines the diagnosis of GBS in cases of uncertainty. Trial Registration: DRKS-ID 00005253.
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Affiliation(s)
- Alexander Grimm
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany.
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.
| | - Hannah Oertl
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
| | - Eva Auffenberg
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Victoria Schubert
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Christoph Ruschil
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Natalie Winter
- Center of Neurology, Tübingen University Hospital, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany
- Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
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4
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Khoo A, Frasca J, Schultz D. Measuring disease activity and predicting response to intravenous immunoglobulin in chronic inflammatory demyelinating polyneuropathy. Biomark Res 2019; 7:3. [PMID: 30805188 PMCID: PMC6373155 DOI: 10.1186/s40364-019-0154-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 01/28/2019] [Indexed: 12/13/2022] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is characterised by significant clinical heterogeneity and as such reliable biomarkers are required to measure disease activity and assess treatment response. Recent advances in our understanding of disease pathogenesis and the discovery of novel serum-based, electrophysiologic and imaging biomarkers allow clinicians to make more informed decisions regarding individualised treatment regimes. As a chronic immune-mediated process typified by relapse following withdrawal of immunomodulatory therapy, a substantial proportion of patients with CIDP require long term treatment with intravenous immunoglobulin (IVIg), a scarce and expensive donor-derived resource. The required duration and intensity of immunoglobulin treatment vary widely between individuals, highlighting both the heterogeneous nature of the underlying disease process as well as the variable pharmacologic properties of IVIg. This review outlines the use of multimodal biomarkers in the longitudinal evaluation of nerve injury and how recent developments have impacted our ability to predict both response to immunoglobulin administration and its withdrawal.
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Affiliation(s)
- Anthony Khoo
- 1Department of Neurology, Flinders Medical Centre, Bedford Park, South Australia 5042 Australia.,2College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Joseph Frasca
- 1Department of Neurology, Flinders Medical Centre, Bedford Park, South Australia 5042 Australia.,2College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - David Schultz
- 1Department of Neurology, Flinders Medical Centre, Bedford Park, South Australia 5042 Australia.,2College of Medicine and Public Health, Flinders University, Adelaide, South Australia
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Härtig F, Ross M, Dammeier NM, Fedtke N, Heiling B, Axer H, Décard BF, Auffenberg E, Koch M, Rattay TW, Krumbholz M, Bornemann A, Lerche H, Winter N, Grimm A. Nerve Ultrasound Predicts Treatment Response in Chronic Inflammatory Demyelinating Polyradiculoneuropathy-a Prospective Follow-Up. Neurotherapeutics 2018; 15:439-451. [PMID: 29435815 PMCID: PMC5935640 DOI: 10.1007/s13311-018-0609-4] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
As reliable biomarkers of disease activity are lacking, monitoring of therapeutic response in chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) remains a challenge. We sought to determine whether nerve ultrasound and electrophysiology scoring could close this gap. In CIDP patients (fulfilling EFNS/PNS criteria), we performed high-resolution nerve ultrasound to determine ultrasound pattern sum scores (UPSS) and predominant echotexture nerve conduction study scores (NCSS) as well as Medical Research Council sum scores (MRCSS) and inflammatory neuropathy cause and treatment disability scores (INCAT) at baseline and after 12 months of standard treatment. We retrospectively correlated ultrasound morphology with nerve histology when available. 72/80 CIDP patients featured multifocal nerve enlargement, and 35/80 were therapy-naïve. At baseline, clinical scores correlated with NCSS (r2 = 0.397 and r2 = 0.443, p < 0.01), but not or hardly with UPSS (Medical Research Council sum scores MRCSS r2 = 0.013, p = 0.332; inflammatory neuropathy cause and treatment disability scores INCAT r2 = 0.053, p = 0.048). Longitudinal changes in clinical scores, however, correlated significantly with changes in both UPSS and NCSS (r2 = 0.272-0.414, p < 0.0001). Combining nerve/fascicle size with echointensity and histology at baseline, we noted 3 distinct classes: 1) hypoechoic enlargement, reflecting active inflammation and onion bulbs; 2) nerve enlargement with additional hyperechogenic fascicles/perifascicular tissue in > 50% of measured segments, possibly reflecting axonal degeneration; and 3) almost no enlargement, reflecting "burned-out" or "cured" disease without active inflammation. Clinical improvement after 12 months was best in patients with pattern 1 (up to 75% vs up to 43% in pattern 2/3, Fisher's exact test p < 0.05). Nerve ultrasound has additional value not only for diagnosis, but also for classification of disease state and may predict treatment response.
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Affiliation(s)
- Florian Härtig
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Marlene Ross
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
| | - Nele Maria Dammeier
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Nadin Fedtke
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Bianka Heiling
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, 07747, Germany
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, 4031, Switzerland
| | - Eva Auffenberg
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Marilin Koch
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Tim W Rattay
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Markus Krumbholz
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Antje Bornemann
- Institute of Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Holger Lerche
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Natalie Winter
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany
| | - Alexander Grimm
- Department of Neurology, Tübingen University Hospital, University of Tübingen, Hoppe-Seyler-Str. 3, 72076, Tubingen, Germany.
- Hertie-Institute for Clinical Brain Research, University of Tübingen, 72076, Tubingen, Germany.
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Outcome in chronic inflammatory demyelinating polyneuropathy from a Malaysian centre over sixteen years. J Clin Neurosci 2018; 50:203-207. [DOI: 10.1016/j.jocn.2018.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 01/08/2018] [Indexed: 11/18/2022]
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Alabdali M, Abraham A, Alsulaiman A, Breiner A, Barnett C, Katzberg HD, Lovblom LE, Perkins BA, Bril V. Clinical characteristics, and impairment and disability scale scores for different CIDP Disease Activity Status classes. J Neurol Sci 2016; 372:223-227. [PMID: 28017218 DOI: 10.1016/j.jns.2016.11.056] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/26/2016] [Accepted: 11/22/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Selecting proper outcome measures is important for clinical practice and clinical studies assessing treatable neuropathies, such as chronic inflammatory demyelinating polyneuropathy (CIDP). OBJECTIVES To explore clinical characteristics and impairment and disability scores in CIDP patients, and assess their relationship to different CIDP Disease Activity Status (CDAS) classes. METHODS We performed a retrospective chart review of CIDP patients attending the neuromuscular clinic between January 2014 and December 2015, and explored clinical characteristics, and various impairment and disability scores for different CDAS classes. RESULTS The total cohort included 69 CIDP patients. A higher CDAS class was correlated with more frequent motor and sensory deficits, worse sensory sum score, worse scores on the disability scales, including the Rasch-built overall disability scale (RODS) and Overall Neuropathy Limitation Scale (ONLS), and lower treatment responsiveness. ONLS and RODS scales were significantly correlated (r=-0.86, p<0.0001). A change of one point or more in the ONLS score, was associated with a corresponding change of 4.1-4.5 points in the RODS score. DISCUSSION The study results show that a higher CDAS class is correlated with a more severe neuropathy. This was reflected by the sensory sum score, RODS and ONLS. These results might help profile CIDP patients at different CDAS classes for clinical practice and future clinical studies.
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Affiliation(s)
- Majed Alabdali
- Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Alon Abraham
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Abdulla Alsulaiman
- Department of Neurology, King Fahad Hospital of the University, University of Dammam, Dammam, Saudi Arabia
| | - Ari Breiner
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Hans D Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Leif E Lovblom
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai, Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, Mount Sinai, Hospital and Lunenfeld Tanenbaum Research Institute, University of Toronto, Toronto, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, Division of Neurology, Department of Medicine, University Health Network, University of Toronto, Toronto, Canada.
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8
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What is new in 2015 in dysimmune neuropathies? Rev Neurol (Paris) 2016; 172:779-784. [PMID: 27866728 DOI: 10.1016/j.neurol.2016.03.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 03/23/2016] [Indexed: 12/30/2022]
Abstract
This review discusses and summarizes the concept of nodopathies, the diagnostic features, investigations, pathophysiology, and treatment options of chronic inflammatory demyelinating polyradiculoneuropathy, and gives updates on other inflammatory and dysimmune neuropathies such as Guillain-Barré syndrome, sensory neuronopathies, small-fiber-predominant ganglionitis, POEMS syndrome, neuropathies associated with IgM monoclonal gammopathy and multifocal motor neuropathy. This field of research has contributed to the antigenic characterization of the peripheral motor and sensory functional systems, as well as helping to define immune neuropathic syndromes with widely different clinical presentation, prognosis and response to therapy.
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Disease activity in chronic inflammatory demyelinating polyneuropathy. J Neurol Sci 2016; 369:204-209. [PMID: 27653889 DOI: 10.1016/j.jns.2016.08.034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/03/2016] [Accepted: 08/15/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Evaluation of disease status in patients with chronic inflammatory demyelinating polyneuropathy (CIDP) is often done by a combination of clinical evaluation and electrodiagnostic studies. A CIDP disease activity status (CDAS) was developed to standardize outcomes in CIDP patients. We aimed to determine if the CDAS was concordant with classical evaluation and whether CDAS enables benchmarking of CIDP. METHODS We performed a retrospective chart review of 305 CIDP patients and identified 206 patients with >1 visit and applied the CDAS to this cohort. We examined relationships between the CDAS and classical evaluation as to outcomes and compared our cohort to other CIDP cohorts who had CDAS. RESULTS We found that the CDAS mirrored disease severity as measured by electrophysiology and vibration perception thresholds in that CDAS class 5 had more severe neuropathy. Our results are similar to other cohorts in the middle CDAS strata with the exception of fewer subjects in CDAS 1 and more in CDAS 5. The only demographic factor predicting CDAS 5 in our cohort was age, and the overall treatment response rate using the CDAS classification was 79.3%. CONCLUSIONS CDAS appears to have sufficient face-validity as a grading system to assess disease activity in relation to treatment status. The use of CDAS appears to allow benchmarking of patients with CIDP that may be useful in subject selection for clinical trials and also to highlight differences in practice.
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10
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Kerasnoudis A, Pitarokoili K, Gold R, Yoon MS. Nerve Ultrasound and Electrophysiology for Therapy Monitoring in Chronic Inflammatory Demyelinating Polyneuropathy. J Neuroimaging 2015; 25:931-9. [PMID: 26242571 DOI: 10.1111/jon.12279] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 05/30/2015] [Accepted: 06/07/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE We evaluated prospectively nerve ultrasound and electrophysiology as monitoring methods of intravenous immunoglobulin (IVIG) therapy in chronic inflammatory demyelinating polyneuropathy (CIDP). METHODS Overall 15 healthy subjects and 11 CIDP patients undergoing IVIG therapy were recruited in the study. All patients underwent clinical, ultrasound, and electrophysiological evaluation at the time point of first onset of symptoms (<6 weeks of symptoms) and 4, 8, and 12 months after onset. RESULTS The intranerve cross-sectional area (CSA) variability of each nerve, but not the CSA alone, correlated with the MRC Scale score during 12-month follow-up. On the other hand, none of the electrophysiological parameters correlated with the MRC Scale Score in each of the peripheral nerves. Interestingly, in ¾ of the CIDP patients, the resolution of the conduction block correlated with the improvement in the MRC Sum score. CONCLUSIONS Nerve ultrasound and in particular the intranerve CSA variability seems to be a useful method in monitoring CIDP patients. Although the sample size is small, the intranerve CSA variability seems to be more promising than neurophysiology.
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Affiliation(s)
- Antonios Kerasnoudis
- Department of Neurology, Ruhr University, St. Josef-Hospital, Gudrunstr, Bochum, Germany
| | - Kalliopi Pitarokoili
- Department of Neurology, Ruhr University, St. Josef-Hospital, Gudrunstr, Bochum, Germany
| | - Ralf Gold
- Department of Neurology, Ruhr University, St. Josef-Hospital, Gudrunstr, Bochum, Germany
| | - Min-Suk Yoon
- Department of Neurology, Ruhr University, St. Josef-Hospital, Gudrunstr, Bochum, Germany
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Rajabally YA, Cassereau J, Robbe A, Nicolas G. Disease status in chronic inflammatory demyelinating polyneuropathy: inter-centre comparative analysis and correlates. Eur J Neurol 2015; 22:1469-73. [DOI: 10.1111/ene.12767] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 05/07/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Y. A. Rajabally
- Neuromuscular Clinic; Department of Neurology; University Hospitals of Leicester; Leicester UK
| | - J. Cassereau
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
| | - A. Robbe
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
| | - G. Nicolas
- Centre de Référence Maladies Neuromusculaires de l'Enfant et de l'Adulte Nantes-Angers; Centre Hospitalier Universitaire d'Angers; Angers France
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12
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Robert F, Edan G, Nicolas G, Pouget J, Vial C, Antoine JC, Puget S. A retrospective study on the efficacy and safety of intraveinous immunoglobulin (Tegeline®) in patients with chronic inflammatory demyelinating polyneuropathy. Presse Med 2015; 44:e291-300. [DOI: 10.1016/j.lpm.2014.10.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/08/2014] [Accepted: 10/29/2014] [Indexed: 12/01/2022] Open
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Kuntzer T. [2013: what's new in inflammatory neuropathies]. Rev Neurol (Paris) 2014; 170:850-3. [PMID: 25459118 DOI: 10.1016/j.neurol.2014.05.011] [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: 03/24/2014] [Revised: 04/27/2014] [Accepted: 05/14/2014] [Indexed: 11/19/2022]
Abstract
Several high-quality publications were published in 2013 and some major trials studies were started. In Guillain-Barré syndrome, events included the launch of IGOS and a better understanding of diagnostic limits, the effect of influenza vaccination, and better care, but uncertainty remains about analgesics. A new mouse model was also described. In chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), diagnostic pitfalls can be recalled. Our knowledge of underlying pathophysiological processes has improved, and the value of monitoring with function and deficit scores has been demonstrated. IVIG can sometimes be effective longer than expected, but CIDP remains sensitive to corticosteroids, particularly with the long-term beneficial effects of megadose dexamethasone. The impact of fingolimod remains to be demonstrated in an ongoing trial. Advances concerning multifocal motor neuropathy, inflammatory plexopathy, and neuropathy with anti -MAG activity are discussed but treatments already recognized as effective should not be changed. Imaging of peripheral nerve progresses.
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Affiliation(s)
- T Kuntzer
- Département des neurosciences cliniques, université de Lausanne, CHU Vaudois (CHUV), BH07/413, rue du Bugnon 46, 1011 Lausanne, Suisse.
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Puttini S, Panaite PA, Mermod N, Renaud S, Steck AJ, Kuntzer T. Gene expression changes in chronic inflammatory demyelinating polyneuropathy skin biopsies. J Neuroimmunol 2014; 270:61-6. [PMID: 24657030 DOI: 10.1016/j.jneuroim.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/15/2014] [Accepted: 03/02/2014] [Indexed: 11/25/2022]
Abstract
Chronic-inflammatory demyelinating polyneuropathy (CIDP) is an immune-mediated disease with no known biomarkers for diagnosing the disease or assessing its prognosis. We performed transcriptional profiling microarray analysis on skin punch biopsies from 20 CIDP patients and 17 healthy controls to identify disease-associated gene expression changes. We demonstrate changes in expression of genes involved in immune and chemokine regulation, growth and repair. We also found a combination of two upregulated genes that can be proposed as a novel biomarker of the disorder.
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Affiliation(s)
- Stefania Puttini
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Lausanne University Hospital (CHUV), rue du Bugnon 46, CH-1011 Lausanne, Switzerland; Institute of Biotechnology, University of Lausanne (UNIL), chemin des Alambiques, CH-1015 Lausanne, Switzerland
| | - Petrica-Adrian Panaite
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Lausanne University Hospital (CHUV), rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Nicolas Mermod
- Institute of Biotechnology, University of Lausanne (UNIL), chemin des Alambiques, CH-1015 Lausanne, Switzerland
| | - Susanne Renaud
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Lausanne University Hospital (CHUV), rue du Bugnon 46, CH-1011 Lausanne, Switzerland; Neurology Division, Hôpital Neuchâtelois, Maladière 45, CH-2000 Neuchâtel, Switzerland
| | - Andreas J Steck
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Lausanne University Hospital (CHUV), rue du Bugnon 46, CH-1011 Lausanne, Switzerland; Department of Neurology, Basel University Hospital, Spitalstrasse 21, 4031 Basel, Switzerland
| | - Thierry Kuntzer
- Department of Clinical Neurosciences, Nerve-Muscle Unit, Lausanne University Hospital (CHUV), rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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Treatment of chronic inflammatory demyelinating polyneuropathy: from molecular bases to practical considerations. Autoimmune Dis 2014; 2014:201657. [PMID: 24527207 PMCID: PMC3914592 DOI: 10.1155/2014/201657] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Accepted: 11/13/2013] [Indexed: 02/07/2023] Open
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is an autoimmune disease of the peripheral nervous system, in which both cellular and humoral immune responses are involved. The disease is clinically heterogeneous with some patients displaying pure motor form and others also showing a variable degree of sensory dysfunction; disease evolution may also differ from patient to patient, since monophasic, progressive, and relapsing forms are reported. Underlying such clinical variability there is probably a broad spectrum of molecular dysfunctions that are and will be the target of therapeutic strategies. In this review we first explore the biological bases of current treatments and subsequently we focus on the practical management that must also take into account pharmacoeconomic issues.
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