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Dziadkowiak E, Nowakowska-Kotas M, Rałowska-Gmoch W, Budrewicz S, Koszewicz M. Molecular, Electrophysiological, and Ultrasonographic Differences in Selected Immune-Mediated Neuropathies with Therapeutic Implications. Int J Mol Sci 2023; 24:ijms24119180. [PMID: 37298132 DOI: 10.3390/ijms24119180] [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: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
The spectrum of immune-mediated neuropathies is broad and the different subtypes are still being researched. With the numerous subtypes of immune-mediated neuropathies, establishing the appropriate diagnosis in normal clinical practice is challenging. The treatment of these disorders is also troublesome. The authors have undertaken a literature review of chronic inflammatory demyelinating polyradiculoneuropathy (CIDP), Guillain-Barre syndrome (GBS) and multifocal motor neuropathy (MMN). The molecular, electrophysiological and ultrasound features of these autoimmune polyneuropathies are analyzed, highlighting the differences in diagnosis and ultimately treatment. The immune dysfunction can lead to damage to the peripheral nervous system. In practice, it is suspected that these disorders are caused by autoimmunity to proteins located in the node of Ranvier or myelin components of peripheral nerves, although disease-associated autoantibodies have not been identified for all disorders. The electrophysiological presence of conduction blocks is another important factor characterizing separate subgroups of treatment-naive motor neuropathies, including multifocal CIDP (synonyms: multifocal demyelinating neuropathy with persistent conduction block), which differs from multifocal motor neuropathy with conduction block (MMN) in both responses to treatment modalities and electrophysiological features. Ultrasound is a reliable method for diagnosing immune-mediated neuropathies, particularly when alternative diagnostic examinations yield inconclusive results. In overall terms, the management of these disorders includes immunotherapy such as corticosteroids, intravenous immunoglobulin or plasma exchange. Improvements in clinical criteria and the development of more disease-specific immunotherapies should expand the therapeutic possibilities for these debilitating diseases.
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Affiliation(s)
- Edyta Dziadkowiak
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Marta Nowakowska-Kotas
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Wiktoria Rałowska-Gmoch
- Department of Neurology, The St. Jadwiga's Regional Specialist Neuropsychiatric Centre, Wodociągowa 4, 45-221 Opole, Poland
| | - Sławomir Budrewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
| | - Magdalena Koszewicz
- Department of Neurology, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
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Jurczyszyn A, Olszewska-Szopa M, Vesole D. POEMS Syndrome-Clinical Picture and Management. Current Knowledge. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2023:S2152-2650(23)00136-2. [PMID: 37210272 DOI: 10.1016/j.clml.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 04/17/2023] [Accepted: 04/20/2023] [Indexed: 05/22/2023]
Abstract
POEMS syndrome is a rare form of plasma cell dyscrasia. Difficulties arise already at the stage of making the diagnosis (complex and heterogeneous clinical picture) and continue during the course of treatment (lack of guidelines for therapy, data coming mainly from reports and short series of patients). In this article we review the current state of knowledge on POEMS syndrome diagnostics, clinical characteristics, prognosis, reported treatment outcomes and the emergence of the new therapeutic strategies.
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Affiliation(s)
- Artur Jurczyszyn
- Department of Hematology, Jagiellonian University Medical College, Kraków, Poland.
| | - Magdalena Olszewska-Szopa
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation, Wroclaw Medical University, Wroclaw, Poland
| | - David Vesole
- Hackensack University Medical Center, New Jersey Medical School, Rutgers University, Hackensack, NJ
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Peillet C, Adams D, Attarian S, Bouhour F, Cauquil C, Cassereau J, Chanson JB, Cintas P, Creange A, Delmont E, Fargeot G, Genestet S, Gueguen A, Kaminsky AL, Kuntzer T, Labeyrie C, Michaud M, Pereon Y, Puma A, Viala K, Chretien P, Adam C, Echaniz-Laguna A. Anti-disialosyl-IgM chronic autoimmune neuropathies: a nationwide multicenter retrospective study. Eur J Neurol 2022; 29:3547-3555. [PMID: 35969369 DOI: 10.1111/ene.15523] [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: 06/02/2022] [Revised: 07/30/2022] [Accepted: 08/11/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND & PURPOSE In this retrospective study involving 14 University Hospitals from France and Switzerland, we aimed at defining the clinicopathologic features of chronic neuropathies with anti-disialosyl ganglioside IgM antibodies (CNDA). RESULTS Fifty-five patients with a polyneuropathy evolving for more than 2 months and with at least one anti-disialosyl ganglioside IgM antibody, i.e., anti-GD1b, -GT1b, -GQ1b, -GT1a, -GD2 and -GD3 were identified. Seventy-eight percent of patients were male, mean age at disease onset was 55 years (30-76), and disease onset was progressive (82%) or acute (18%). Patients presented with limb sensory symptoms (94% of cases), sensory ataxia (85%), oculomotor weakness (36%), limb motor symptoms (31%), and bulbar muscles weakness (18%). Sixty-five percent of patients had a demyelinating polyradiculoneuropathy electrodiagnostic profile, and 24% a sensory neuronopathy profile. Anti-GD1b antibodies were found in 78% of cases, while other anti-disialosyl antibodies were each observed in less than 51% of patients. Other features included nerve biopsy demyelination (100% of cases), increased cerebrospinal fluid protein content (75%), IgM paraprotein (50%), and malignant hemopathy (8%). Eighty six percent of CNDA patients were intravenous immunoglobulins (IVIg)-responsive, and rituximab was successfully used as second-line treatment in 50% of cases. Fifteen percent of patients had mild symptoms and were not treated. CNDA course was progressive (55%) or relapsing (45%), and 93% of patients still walked after a mean disease duration of 11 years. CONCLUSION CNDA have a recognizable phenotype, are mostly IgIV-responsive, and present with a good outcome in a majority of cases.
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Affiliation(s)
- Claire Peillet
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France
| | - David Adams
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Shahram Attarian
- Neurology Department, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Françoise Bouhour
- Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, 69500, Bron, France
| | - Cécile Cauquil
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Julien Cassereau
- Reference Centre for Neuromuscular Disorders, Department of Neurology, Angers University Hospital, 49933 Angers, France, Service de Neurologie, CHU Angers, Angers, France
| | - Jean-Baptiste Chanson
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, University Hospital of Strasbourg, France
| | | | - Alain Creange
- Service de Neurologie, CHU Henri Mondor, APHP, UPEC, Créteil, France
| | - Emilien Delmont
- Neurology Department, CHU Timone, 264 Rue Saint Pierre, 13005, Marseille, France
| | - Guillaume Fargeot
- Department of Clinical Neurophysiology, APHP, CHU Pitié-Salpêtrière, Paris, France
| | - Steeve Genestet
- Department of Clinical Neurophysiology, University Hospital Brest, France
| | - Antoine Gueguen
- Department of Neurology, Fondation Ophtalmologique A. de Rothschild, Paris, France
| | - Anne Laure Kaminsky
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, University Hospital of Nancy, France
| | - Thierry Kuntzer
- Nerve-muscle unit, Department of clinical neurosciences, Lausanne University Hospital (CHUV) and University of Lausanne, Lausanne, Switzerland, Switzerland
| | - Céline Labeyrie
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
| | - Maud Michaud
- Department of Neurology, Reference Center for Neuromuscular Disorders NEIDF, University Hospital of Nancy, France
| | - Yann Pereon
- Reference Centre for Neuromuscular Disorders AOC Filnemus, Euro-NMD, Hôtel-Dieu, Nantes University Hospital, Nantes, France
| | - Angela Puma
- Peripheral Nervous System and Muscle Department, Côte d'Azur University, Nice University Hospital, Nice, France
| | - Karine Viala
- Department of Clinical Neurophysiology, APHP, CHU Pitié-Salpêtrière, Paris, France
| | - Pascale Chretien
- Clinical Immunology Laboratory, APHP, CHU Bicêtre, 94276, France.,Université de Paris, CNRS, INSERM, UTCBS, Unité des technologies Chimiques et Biologiques pour la Santé, Paris, France
| | - Clovis Adam
- Pathology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France
| | - Andoni Echaniz-Laguna
- Neurology Department, APHP, CHU de Bicêtre, Le Kremlin-Bicêtre, France.,French National Reference Center for Rare Neuropathies (NNERF), Le Kremlin-Bicêtre, 94276, France.,INSERM U1195, Paris-Saclay University, Le Kremlin-Bicêtre, France
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Karam C. Chronic Inflammatory Demyelinating Polyradiculoneuropathy: Five New Things. Neurol Clin Pract 2022; 12:258-262. [DOI: 10.1212/cpj.0000000000001150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 12/10/2021] [Indexed: 11/15/2022]
Abstract
Chronic Inflammatory Demyelinating Polyradiculoneuropathy (CIDP), while rare and heterogeneous, is one of the most common immune mediated neuropathies. CIDP, however, especially CIDP variants, can be difficult to diagnose. (1) There is no gold standard testing for CIDP, and, while a few specific disease-associated antibodies have been described, these are absent in the majority of patients. Furthermore, many experts consider the presence of these antibodies to be indicative of a separate disease. (2) Ultimately, CIDP remains a diagnosis of exclusion. Mimics are ruled out either by history or additional ancillary testing. Following experts’ guidelines on the diagnosis of CIDP increases significantly the accuracy of diagnosis. On a different note, while most patients with CIDP respond well to treatment, some may not tolerate therapy, and other may be refractory to first line treatments. In this review, we discuss 5 new things related to CIDP: 1) the updated European Academy of Neurology/Peripheral Nerve Society (EAN/PNS) CIDP guidelines, 2) the expansion of the Chronic Immune Sensory Polyradiculopathy (CISP) spectrum, 3) updates in therapy for CIDP, 4) antibodies testing, serum neurofilament light chain and their role, and 5) disorders that can mimic CIDP.
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