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Li J, Chen S, Shi J, Yang F, Zhang G, Zhou Y, Kong Y, Luo X, Liu Y, Xu Y, Wang Y. VX-509 (Decernotinib)-modified tolerogenic dendritic cells alleviate experimental autoimmune neuritis by promoting Th17/Treg rebalance. Int Immunopharmacol 2024; 138:112597. [PMID: 38955025 DOI: 10.1016/j.intimp.2024.112597] [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: 02/20/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an auto-inflammatory peripheral nerve disease. Dendritic cell-mediated T cell polarization is of pivotal importance in demyelinating lesions of peripheral nerves and nerve roots. However, the regulatory function of VX-509 (Decernotinib)-modified tolerogenic dendritic cells (VX-509-tolDCs) during immune remodeling following GBS remains unclear. Here, we used experimental autoimmune neuritis (EAN) as a model to investigate these aspects of GBS. METHODS DCs were treated with varying concentrations of VX-509 (0.25, 1, and 4 μM) or served as a control using 10-8 M 1,25-(OH)2D3. Flow cytometry was employed to assess the apoptosis, phenotype, and capacity to induce T cell responses of the treated DCs. In the in vivo experiments, EAN mice received administration of VX-509-tolDCs or 1,25-(OH)2D3-tolDCs via the tail vein at a dose of 1x106 cells/mouse on days 5, 9, 13, and 17. RESULTS VX-509 inhibited the maturation of DCs and promoted the development of tolDCs. The function of antigen-specific CD4 + T cells ex vivo was influenced by VX-509-tolDCs. Furthermore, the adoptive transfer of VX-509-tolDCs effectively alleviated inflammatory demyelinating lesions in EAN by promoting Th17/Treg (T helper 17 and regulatory T cells) rebalance. CONCLUSION The adoptive transfer of VX-509-tolDCs alleviated inflammatory demyelinating lesions in a mouse model of GBS, known as the EAN mouse, by partially restoring the balance between Treg and Th17 cells.
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Affiliation(s)
- Juan Li
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Shan Chen
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Jiao Shi
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Fan Yang
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Gan Zhang
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Yan Zhou
- Department of Emergency, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan, China
| | - Yuhang Kong
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Xingyan Luo
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China
| | - Yang Liu
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China.
| | - Ying Xu
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China.
| | - Yantang Wang
- Clinical Laboratory, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu Medical College, Chengdu 610500, Sichuan, China; Department of Pharmacology, School of Pharmacy, Chengdu Medical College, Chengdu, 610500, Sichuan, China.
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Quint P, Schroeter CB, Kohle F, Öztürk M, Meisel A, Tamburrino G, Mausberg AK, Szepanowski F, Afzali AM, Fischer K, Nelke C, Räuber S, Voth J, Masanneck L, Willison A, Vogelsang A, Hemmer B, Berthele A, Schroeter M, Hartung HP, Pawlitzki M, Schreiber S, Stettner M, Maus U, Meuth SG, Stascheit F, Ruck T. Preventing long-term disability in CIDP: the role of timely diagnosis and treatment monitoring in a multicenter CIDP cohort. J Neurol 2024; 271:5930-5943. [PMID: 38990346 PMCID: PMC11377626 DOI: 10.1007/s00415-024-12548-1] [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: 03/15/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Chronic inflammatory demyelinating polyneuropathy (CIDP) is an inflammatory disease affecting the peripheral nerves and the most frequent autoimmune polyneuropathy. Given the lack of established biomarkers or risk factors for the development of CIDP and patients' treatment response, this research effort seeks to identify potential clinical factors that may influence disease progression and overall treatment efficacy. METHODS In this multicenter, retrospective analysis, we have screened 197 CIDP patients who presented to the University Hospitals in Düsseldorf, Berlin, Cologne, Essen, Magdeburg and Munich between 2018 and 2022. We utilized the respective hospital information system and examined baseline data with clinical examination, medical letters, laboratory results, antibody status, nerve conduction studies, imaging and biopsy findings. Aside from clinical baseline data, we analyzed treatment outcomes using the Standard of Care (SOC) definition, as well as a comparison of an early (within the first 12 months after manifestation) versus late (more than 12 months after manifestation) onset of therapy. RESULTS In terms of treatment, most patients received intravenous immunoglobulin (56%) or prednisolone (39%) as their first therapy. Patients who started their initial treatment later experienced a worsening disease course, as reflected by a significant deterioration in their Inflammatory Neuropathy Cause and Treatment (INCAT) leg disability score. SOC-refractory patients had worse clinical outcomes than SOC-responders. Associated factors for SOC-refractory status included the presence of fatigue as a symptom and alcohol dependence. CONCLUSION Timely diagnosis, prompt initiation of treatment and careful monitoring of treatment response are essential for the prevention of long-term disability in CIDP and suggest a "hit hard and early" treatment paradigm.
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Affiliation(s)
- Paula Quint
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christina B Schroeter
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Felix Kohle
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Menekse Öztürk
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Andreas Meisel
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Giuliano Tamburrino
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Anne K Mausberg
- Department of Neurology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Fabian Szepanowski
- Department of Neurology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Ali Maisam Afzali
- Department of Neurology, Klinikum Rechts der Isar, Technical University Munich School of Medicine and Health, Ismaninger Str. 22, 81675, Munich, Germany
- Institute for Experimental Neuroimmunology, Technical University of Munich School of Medicine and Health, Munich, Germany
| | - Katinka Fischer
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Christopher Nelke
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Saskia Räuber
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Jan Voth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Lars Masanneck
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Alice Willison
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Anna Vogelsang
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Bernhard Hemmer
- Department of Neurology, Klinikum Rechts der Isar, Technical University Munich School of Medicine and Health, Ismaninger Str. 22, 81675, Munich, Germany
- Munich Cluster for Systems Neurology (SyNergy), 81377, Munich, Germany
| | - Achim Berthele
- Department of Neurology, Klinikum Rechts der Isar, Technical University Munich School of Medicine and Health, Ismaninger Str. 22, 81675, Munich, Germany
| | - Michael Schroeter
- Department of Neurology, Faculty of Medicine, University of Cologne and University Hospital of Cologne, Cologne, Germany
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
- Brain and Mind Center, University of Sydney, 94 Mallett St, Sydney, Australia
- Department of Neurology, Palacky University Olomouc, Nová Ulice, 779 00, Olomouc, Czech Republic
| | - Marc Pawlitzki
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Stefanie Schreiber
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
- Department of Neurology, Otto-von-Guericke University, 39120, Magdeburg, Germany
- German Center for Neurodegenerative Diseases (DZNE), 39120, Magdeburg, Germany
- Center for Behavioral Brain Sciences (CBBS), Otto-von-Guericke University, 39106, Magdeburg, Germany
| | - Mark Stettner
- Department of Neurology, Essen University Hospital, University Duisburg-Essen, Essen, Germany
- Center for Translational Neuro- and Behavioral Sciences (C-TNBS), University of Duisburg-Essen, Essen, Germany
| | - Uwe Maus
- Department of Orthopaedics and Trauma Surgery, Medical Faculty, Heinrich Heine University Duesseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Sven G Meuth
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany
| | - Frauke Stascheit
- Department of Neurology and Experimental Neurology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
- Neuroscience Clinical Research Center, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Tobias Ruck
- Department of Neurology, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Duesseldorf, Germany.
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Tewedaj ZD, Huluka DK, Kebede YT, Abebe AT, Hussen MS, Mohammed BD, Juhar LH. A retrospective analysis of the clinical profile and factors associated with mortality and poor hospital outcomes in adult Guillain-Barre syndrome patients. Sci Rep 2024; 14:15520. [PMID: 38969647 PMCID: PMC11226644 DOI: 10.1038/s41598-024-65265-0] [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: 04/05/2024] [Accepted: 06/18/2024] [Indexed: 07/07/2024] Open
Abstract
Guillain-Barré syndrome (GBS) is an acute autoimmune polyneuropathy with substantial geographic variations in demography, antecedent events, clinical manifestations, electrophysiological sub-types, diagnostic findings, treatment modalities, and prognostic indicators. However, there is limited contemporary data on GBS patient profiles and prognostic factors from low-resource settings like Ethiopia. The objective of this study is to investigate the clinical profile, factors associated with mortality, and hospital outcomes among GBS patients admitted to Tikur Anbessa Specialized Hospital (TASH) in Addis Ababa, Ethiopia. A retrospective cross-sectional study was conducted among 60 GBS patients admitted to TASH from January 2018 to December 2022. Data on demographics, clinical features, treatments, complications, and outcomes were extracted from medical records. Bivariate and multivariate logistic regression analyses identified factors associated with mortality and poor hospital outcomes. The cohort had a mean age of 28.5 years, with 76.7% aged 14-34 years. Males comprised 61.7% of cases. Ascending paralysis (76.7%) was the predominant presentation. Absent or reduced reflexes were seen in 91.7% of patients. The most common antecedent event was gastroenteritis (26.7%), followed by upper respiratory tract infection (URTI) (15%) and vaccination (11.7%). The mean interval from symptom onset to hospital presentation was 8.77 days, and the peak symptom severity was 4.47 days. The axonal variant (75.5%) was the most common subtype, followed by the demyelinating variant (24.5%). Intravenous immunoglobulin was administered to 41.7% of patients. Respiratory failure requiring invasive mechanical ventilator (MV) support occurred in 26.7% of cases. The mortality rate was 10%, with mechanical ventilation being the only factor significantly associated with mortality (95% CI 2.067-184.858; P < 0.010). At discharge, 55% had a good outcome, and 45% had a poor outcome, according to the Hughes Functional Disability Scale (HFDS). Mechanical ventilation (AOR 0.024, 95% CI 0.001-0.607) and a GBS disability score > 3 (AOR 0.106, 95% CI 0.024-0.467) were factors significantly associated with poor hospital outcomes. GBS in this cohort primarily affected individuals of young age, commonly preceded by gastroenteritis and characterized by a high frequency of the axonal variant. Mechanical ventilation was found to be significantly linked to mortality. Alongside mechanical ventilation requirements, severe disability upon presentation emerged as a crucial determinant of poor outcomes upon discharge, underscoring the importance of early identification of high-risk patients and prompt interventions.
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Affiliation(s)
- Zinabu Derso Tewedaj
- Department of Internal Medicine, College of Health Science, Mekelle University, Mekelle, Ethiopia
| | - Dawit Kebede Huluka
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yabets Tesfaye Kebede
- Department of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia.
| | - Abel Tezera Abebe
- Department of Medicine, Faculty of Medical Sciences, Institute of Health, Jimma University, Jimma, Ethiopia
| | - Meksud Shemsu Hussen
- Department of Internal Medicine, Ethio-Tebib General Hospital, Addis Ababa, Ethiopia
| | - Bekri Delil Mohammed
- Department of Internal Medicine, Ethio-Tebib General Hospital, Addis Ababa, Ethiopia
| | - Leja Hamza Juhar
- Department of Internal Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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Zhang W, Tao W, Wang J, Nie P, Duan L, Yan L. A study on the role of serum uric acid in differentiating acute inflammatory demyelinating polyneuropathy from acute-onset chronic inflammatory demyelinating polyneuropathy. Eur J Neurol 2024; 31:e16222. [PMID: 38356316 PMCID: PMC11235685 DOI: 10.1111/ene.16222] [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: 09/18/2023] [Revised: 12/28/2023] [Accepted: 01/10/2024] [Indexed: 02/16/2024]
Abstract
BACKGROUND AND PURPOSE Clinical symptoms and laboratory indices for acute inflammatory demyelinating polyneuropathy (AIDP), a variant of Guillain-Barré syndrome, and acute-onset chronic inflammatory demyelinating polyneuropathy (A-CIDP) were analyzed to identify factors that could contribute to early differential diagnosis. METHODS A retrospective chart review was performed on 44 AIDP and 44 A-CIDP patients looking for any demographic characteristics, clinical manifestations or laboratory parameters that might differentiate AIDP from acutely presenting CIDP. RESULTS In Guillain-Barré syndrome patients (N = 63), 69.84% (N = 44) were classified as having AIDP, 19.05% (N = 12) were found to have acute motor axonal neuropathy, 6.35% (N = 4) were found to have acute motor and sensory axonal neuropathy, and 4.76% (N = 3) were found to have Miller Fisher syndrome. Serum uric acid (UA) was higher in A-CIDP patients (329.55 ± 72.23 μmol/L) than in AIDP patients (221.08 ± 71.32 μmol/L) (p = 0.000). Receiver operating characteristic analyses indicated that the optimal UA cutoff was 283.50 μmol/L. Above this level, patients were more likely to present A-CIDP than AIDP (specificity 81.80%, sensitivity 81.80%). During the follow-up process, serum samples were effectively collected from 19 AIDP patients during the rehabilitation phase and 28 A-CIDP patients during the remission stage, and it was found that UA levels were significantly increased in A-CIDP (remission) (298.9 ± 90.39 μmol/L) compared with AIDP (rehabilitation) (220.1 ± 108.2 μmol/L, p = 0.009). CONCLUSION These results suggest that serum UA level can help to differentiate AIDP from A-CIDP with high specificity and sensitivity, which is helpful for early diagnosis and guidance of treatment.
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Affiliation(s)
- Weiyun Zhang
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Wen Tao
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Jun Wang
- Key Lab of Modern Toxicology, Ministry of Education, and Department of Toxicology, School of Public HealthNanjing Medical UniversityNanjingJiangsuChina
| | - Ping Nie
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Lihui Duan
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
| | - Lanyun Yan
- Department of NeurologyThe First Affiliated Hospital of Nanjing Medical UniversityNanjingJiangsuChina
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Cao X, Guo J, Yang Y, Yu Z, Pan H, Zhou W. Clinical characteristics of Guillain-Barré syndrome in patients with primary Sjögren's syndrome. Sci Rep 2024; 14:5783. [PMID: 38461210 PMCID: PMC10924922 DOI: 10.1038/s41598-024-56365-y] [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: 10/07/2023] [Accepted: 03/05/2024] [Indexed: 03/11/2024] Open
Abstract
To investigate the clinical characteristics of Guillain-Barré syndrome (GBS) in patients with primary Sjögren's syndrome (SS). Records of patients with positive anti-SSA antibodies hospitalized in the Beijing Tiantan Hospital between December 2011 and May 2020 were retrieved. Patients who fulfilled the criteria for diagnosis of GBS and primary SS were included, and their clinical data were analyzed. Among the 785 patients with positive anti-SSA, 52 patients were identified in this study. They were 27 males and 25 females with median age of 59 years old. Besides anti-SSA antibodies, multiple autoantibodies were detected in these patients including antinuclear antibody, anti-Ro52, anti-mitochondrial M2, anti-thyroid peroxidase and anti-thyroglobulin autoantibodies. Preceding infection was reported in 42 patients. Hyporeflexia/areflexia and limbs weakness were the most common manifestation and 35 patients presented cranial nerve injuries. GBS disability score of 3, 4 and 5 was scaled in 28 (53.8%), 15 (28.8%) and 3 (5.8%) patients respectively. Forty-six patients received intravenous immunoglobulin (IVIG) monotherapy, 5 patients were treated by IVIG plus glucocorticoids, and 51 patients improved during hospitalization. The frequency of male gender among the patients with both GBS and primary SS suggests an independent onset of GBS and the co-existence of these autoimmune diseases in patients with multiple autoantibodies. Majority of patients with GBS and primary SS experience benign disease course.
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Affiliation(s)
- Xiaoyu Cao
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Juan Guo
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yaran Yang
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Zhibo Yu
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Hua Pan
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
| | - Wei Zhou
- Department of Rheumatology and Immunology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
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Abuawwad MT, Taha MJJ, Taha AJ, Kozaa YA, Falah O, Abuawwad IT, Hammad EM, Mahmoud AA, Aladawi M, Serhan HA. Guillain-Barré syndrome after COVID-19 vaccination: A systematic review and analysis of case reports. Clin Neurol Neurosurg 2024; 238:108183. [PMID: 38401232 DOI: 10.1016/j.clineuro.2024.108183] [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: 03/21/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 02/26/2024]
Abstract
INTRODUCTION Cases of Guillain-Barré Syndrome (GBS) have been believed to be associated with the novel COVID-19 infection, and also with the following vaccines developed against the infection. Our work aims to investigate the incidence of GBS after COVID-19 vaccination, and describe its clinical characteristics and potential confounders. METHODS An electronic search was conducted through four databases: PubMed, Scopus, medRxiv, and Google Scholar for all case reports and case series describing after COVID-19 vaccine administration. All published articles from inception until November 1st, 2022 were included. Differences between groups were assessed using Pearson chi-square test. Modified Erasmus GBS Outcome Score (mEGOS) for the ability to walk after GBS was calculated for all cases with sufficient clinical data, and Kaplan-Meier survival analysis was performed to study the effect of vaccine type on the relationship between vaccination time and complication of GBS. RESULTS About 103 studies describing 175 cases of GBS following COVID-19 vaccination were included. The Acute Inflammatory Demyelinating Polyradiculoneuropathy subtype was the most reported subtype with 74 cases (42.29%). The affected age group averaged around 53.59 ±18.83 years, with AMSAN occurring in a rather older group (63.88 ±20.87 years, p=0.049). The AstraZeneca vaccine was associated with AIDP (n=38, 21.71%) more than other vaccines, p=0.02. The bilateral facial palsy subtype was mostly linked to adenoviral vector vaccinations, accounting for an average of 72% of the total BFP cases. Dysesthesias was the most reported sensory complication (60%, p=0.349). Most GBS patients survived (96%, p=0.036), however, most patients had low mEGOS scores (4 ±3.57, p<0.01). On average, patients developed GBS at 13.43 ±11.45 days from vaccination (p=0.73), and survival analysis for complication of GBS into mechanical ventilation or walking impairment yielded a severely increased probability of complication after 25 days (p<0.01). Intravenous immunoglobulins (p=0.03) along with rehabilitation (p=0.19) were the most commonly used treatment. CONCLUSION This work investigates the incidence of Guillain-Barré Syndrome after COVID-19 vaccination. Most cases occurred after receiving the AstraZeneca or Pfizer vaccines, and despite low mortality rates, ambulation was compromised in most patients. A higher risk of GBS complication is associated with an onset later than 12-13 days, particularly with Pfizer, AstraZeneca, and Moderna vaccines. No specific predisposing or prognostic factor was identified, and the relation between the COVID-19 vaccines and GBS remain unclear.
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Affiliation(s)
- Mohammad T Abuawwad
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohammad J J Taha
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad J Taha
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Yasmeena Abdelall Kozaa
- Mansoura Manchester Programme For Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Obaida Falah
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ibrahim T Abuawwad
- Department of Clinical Medicine, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Elsayed Mohamed Hammad
- Department of Clinical Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Ayman A Mahmoud
- Rheumatology and Clinical Immunology Unit, Internal Medicine Department, Faculty of Medicine, Cairo University, Egypt
| | - Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Nebraska, USA
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporations, Doha, Qatar.
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Jia L, Ni F, Zhang HL. Is Guillain-Barré syndrome related to systemic lupus erythematosus or other autoimmune diseases? Front Neurol 2024; 14:1336794. [PMID: 38269005 PMCID: PMC10806246 DOI: 10.3389/fneur.2023.1336794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 12/20/2023] [Indexed: 01/26/2024] Open
Affiliation(s)
- Linpei Jia
- Department of Nephrology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Fengming Ni
- Department of Gastroenterology, Digestive Endoscopy Center, First Hospital, Jilin University, Changchun, China
| | - Hong-Liang Zhang
- Department of Life Sciences, National Natural Science Foundation of China, Beijing, China
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Godelaine J, Chitale Y, De Moor B, Mathieu C, Ancheva L, Van Damme P, Claeys KG, Bossuyt X, Carpentier S, Poesen K. Peptides From the Variable Domain of Immunoglobulin G as Biomarkers in Chronic Inflammatory Demyelinating Polyradiculoneuropathy. NEUROLOGY(R) NEUROIMMUNOLOGY & NEUROINFLAMMATION 2023; 10:e200162. [PMID: 37640545 PMCID: PMC10462053 DOI: 10.1212/nxi.0000000000200162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/24/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a clinically heterogeneous immune-mediated disease. Diagnostic biomarkers for CIDP are currently lacking. Peptides derived from the variable domain of circulating immunoglobulin G (IgG) have earlier been shown to be shared among patients with the same immunologic disease. Because humoral immune factors are hypothesized to be involved in the pathogenesis of CIDP, we evaluated IgG variable domain-derived peptides as diagnostic biomarkers in CIDP (primary objective) and whether IgG-derived peptides could cluster objective clinical entities in CIDP (secondary objective). METHODS IgG-derived peptides were determined in prospectively collected sera of patients with CIDP and neurologic controls by means of mass spectrometry. Peptides of interest were selected through statistical analysis in a discovery cohort followed by sequence determination and confirmation. Diagnostic performance was evaluated for individual selected peptides and for a multipeptide model incorporating selected peptides, followed by performance reassessment in a validation cohort. Clustering of patients with CIDP based on IgG-derived peptides was evaluated through unsupervised sparse principal component analysis followed by k-means clustering. RESULTS Sixteen peptides originating from the IgG variable domain were selected as candidate biomarkers in a discovery cohort of 44 patients with CIDP and 29 neurologic controls. For all 16 peptides, univariate logistic regressions and ROC curve analysis demonstrated increasing peptide abundances to associate with increased odds for CIDP (area under the curves [AUCs] ranging from 64.6% to 79.6%). When including age and sex in the logistic regression models, this remained the case for 13/16 peptides. A model composed of 5/16 selected peptides showed strong discriminating performance between patients with CIDP and controls (AUC 91.5%; 95% CI 84.6%-98.4%; p < 0.001). In the validation cohort containing 45 patients and 43 controls, 2/16 peptides demonstrated increasing abundances to associate with increased odds for CIDP, while the five-peptide model demonstrated an AUC of 61.2% (95% CI 49.3%-73.2%; p = 0.064). Peptide-based patient clusters did not associate with clinical features. DISCUSSION IgG variable domain-derived peptides showed a valid source for diagnostic biomarkers in CIDP, albeit with challenges toward replication. Our proof-of-concept findings warrant further study of IgG-derived peptides as biomarkers in more homogeneous cohorts of patients with CIDP and controls. CLASSIFICATION OF EVIDENCE This study provides Class III evidence that the pattern of serum IgG-derived peptide clusters may help differentiate between patients with CIDP and those with other peripheral neuropathies.
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Affiliation(s)
- Joris Godelaine
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Yamini Chitale
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Bart De Moor
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Chantal Mathieu
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Lina Ancheva
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Philip Van Damme
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Kristl G Claeys
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Xavier Bossuyt
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Sebastien Carpentier
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium
| | - Koen Poesen
- From the Department of Neurosciences (J.G., K.P.), Laboratory for Molecular Neurobiomarker Research, Leuven Brain Institute, KU Leuven; Laboratory Medicine (J.G., X.B., K.P.), University Hospitals Leuven; STADIUS Center for Dynamical Systems, Signal Processing, and Data Analytics (Y.C., B.D.M.), Department of Electrical Engineering (ESAT), KU Leuven; Department of Endocrinology (C.M.), University Hospitals Leuven; Department of Chronic Diseases and Metabolism (C.M.), Clinical and Experimental Endocrinology; Department of Microbiology, Immunology and Transplantation (L.A., X.B.), Clinical and Diagnostic Immunology, KU Leuven; Department of Neurology (P.V.D., K.G.C.), University Hospitals Leuven; Department of Neurosciences, Experimental Neurology, (P.V.D.) Laboratory of Neurobiology, Leuven Brain Institute, VIB KU Leuven Center for Brain and Disease Research; Department of Neurosciences (K.G.C.), Laboratory for Muscle Diseases and Neuropathies, Leuven Brain Institute, KU Leuven; and Division of Crop Biotechnics, Tropical Crop Improvement Laboratory (S.C.), Department of Biosystems, KU Leuven, Belgium.
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Habib AA, Waheed W. Guillain-Barré Syndrome. Continuum (Minneap Minn) 2023; 29:1327-1356. [PMID: 37851033 DOI: 10.1212/con.0000000000001289] [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: 10/19/2023]
Abstract
OBJECTIVE This article summarizes the clinical features, diagnostic criteria, differential diagnosis, pathogenesis, and prognosis of Guillain-Barré syndrome (GBS), with insights into the current and future diagnostic and therapeutic interventions for this neuromuscular syndrome. LATEST DEVELOPMENTS GBS is an acute, inflammatory, immune-mediated polyradiculoneuropathy that encompasses many clinical variants and divergent pathogenic mechanisms that lead to axonal, demyelinating, or mixed findings on electrodiagnostic studies. The type of antecedent infection, the development of pathogenic cross-reactive antibodies via molecular mimicry, and the location of the target gangliosides affect the subtype and severity of the illness. The data from the International GBS Outcome Study have highlighted regional variances, provided new and internationally validated prognosis tools that are beneficial for counseling, and introduced a platform for discussion of GBS-related open questions. New research has been undertaken, including research on novel diagnostic and therapeutic biomarkers, which may lead to new therapies. ESSENTIAL POINTS GBS is among the most frequent life-threatening neuromuscular emergencies in the world. At least 20% of patients with GBS have a poor prognosis and significant residual deficits despite receiving available treatments. Research is ongoing to further understand the pathogenesis of the disorder, find new biomarkers, and develop more effective and specific treatments.
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10
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Coraci D, Romano M, Ragazzo L, Restivo DA, Cipriani M, Gottardello F, Pizzolato M, Maccarone MC, Masiero S. Rehabilitation of Peripheral Neuropathies: From Lexical Analysis of the Literature to Identification of Clinical Protocols. J Clin Med 2023; 12:5879. [PMID: 37762819 PMCID: PMC10531665 DOI: 10.3390/jcm12185879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/30/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Peripheral nervous system diseases are a complex and heterogenous group of diseases affecting the different nerves with various severity and impact on quality of life. The current literature does not provide a structured guide for the rehabilitation of these conditions. We performed a lexical literature evaluation based on graph theory to clarify this topic. We performed a search on PubMed and calculated the frequencies of the words indicating rehabilitation approaches, nerves, and diseases. We found the usefulness of exercises and different physical agents, like laser and ultrasound therapy and neuromuscular stimulation vibration therapy. Orthoses are useful for entrapment, trauma, and hereditary diseases. Correct knowledge and assessment of the neuropathies are fundamental for the therapeutic decision and to guide rehabilitation. Despite the usefulness shown by the different approaches to modulating pain, improving muscle strength and endurance, and ameliorating balance and the sensory system, further studies are needed to define the best-personalized protocols.
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Affiliation(s)
- Daniele Coraci
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Marcello Romano
- Neurology Unit, Azienda Ospedaliera Ospedali Riuniti Villa Sofia Cervello, 90146 Palermo, Italy;
| | - Lisa Ragazzo
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Domenico Antonio Restivo
- Department of Clinical and Experimental Medicine, University of Messina, Piazza Pugliatti, 1, 98122 Messina, Italy;
| | - Martina Cipriani
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Federica Gottardello
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Martina Pizzolato
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
| | - Maria Chiara Maccarone
- Physical Medicine and Rehabilitation School, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy;
| | - Stefano Masiero
- Department of Neuroscience, Section of Rehabilitation, University of Padova, Via Nicolò Giustiniani, 2, 35128 Padua, Italy; (L.R.); (M.C.); (F.G.); (M.P.); (S.M.)
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