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Guttikonda A, Ahmad G, Goyal P, Xiang Y, Johnson LM, Gillespie S, Carvell KT, Butera R, Verma S. Outcome measures in pediatric chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2024; 69:580-587. [PMID: 38436500 DOI: 10.1002/mus.28071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 02/17/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024]
Abstract
INTRODUCTION/AIMS Objective outcome measures in children undergoing treatment for chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) are lacking. The aim of the study was to record serial grip strength and motor nerve conduction studies to assess interval change. METHODS This was a retrospective review of 16 children (8 females and 8 males; median age, 9.7 years; interquartile range, 6-13 years) with CIDP followed at a tertiary children's hospital from 2013 to 2021. Subjects were treated with intravenous immunoglobulin (IVIG). Right and left grip strength measurements were obtained at each clinic visit using a handheld dynamometer. Annual right median motor nerve conduction study data were recorded during the study period. RESULTS Mean duration of follow-up was 2.9 years. Grip strength (right: 0.19 kg/month, p < 0.001; left 0.23 kg/month, p < 0.001) and median F-wave latencies (-0.23/month, p = 0.015) showed significant improvement over time. Akaike information criterion showed time + IVIG frequency <21 days as best fit for grip strength and distal compound muscle action potential amplitude. DISCUSSION Our study results indicate serial grip strength measurements are a feasible and objective way to assess motor strength improvement in children with CIDP receiving immunotherapy.
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Affiliation(s)
- Apoorva Guttikonda
- Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Ghazal Ahmad
- Department of Neurology, Medical College of Georgia, Augusta, Georgia, USA
| | - Parul Goyal
- Department of Neurology, Mercy Clinic, Springfield, Missouri, USA
| | - Yijin Xiang
- Epidemiology section, University of Southern California, Los Angeles, California, USA
| | - Laura Michelle Johnson
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Scott Gillespie
- Pediatric Biostatistics Core, Department of Pediatrics, Emory University, Atlanta, Georgia, USA
| | - Kimberly T Carvell
- Division of Physical Therapy, Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Robert Butera
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia, USA
| | - Sumit Verma
- Departments of Pediatrics and Neurology, Emory University School of Medicine, Atlanta, Georgia, USA
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Kozyreva AA, Bembeeva RT, Druzhinina ES, Zavadenko NN, Kolpakchi LM, Pilia SV. [Modern aspects of diagnosis and treatment of chronic inflammatory demyelinating polyneuropathy in children]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:58-68. [PMID: 38465811 DOI: 10.17116/jnevro202412402158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Analysis of demographic, clinical, laboratory, electrophysiological and neuroimaging data and pathogenetic therapy of pediatric patients with chronic inflammatory demyelinating polyneuropathy (CIDP). MATERIAL AND METHODS Patients (n=30) were observed in a separate structural unit of the Russian Children's Clinical Hospital of the Russian National Research Medical University named after. N.I. Pirogova Ministry of Health of the Russian Federation in the period from 2006 to 2023. The examination was carried out in accordance with the recommendations of the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society on the Management of CIDP (2021). All patients received immunotherapy, including intravenous immunoglobulin (IVIG) (n=1), IVIG and glucocorticosteroids (GCS) (n=17, 56.7%), IVIG+GCS+plasmapheresis (n=12, 40.0%). Alternative therapy included cyclophosphamide (n=1), cyclophosphamide followed by mycophenolate mofetil (n=1), rituximab (n=2, 6.6%), azathioprine (n=3), mycophenolate mofetil (n=2, 6.6%). RESULTS In all patients, there was a significant difference between scores on the MRCss and INCAT functional scales before and after treatment. At the moment, 11/30 (36.6%) patients are in clinical remission and are not receiving pathogenetic therapy. The median duration of remission is 48 months (30-84). The longest remission (84 months) was observed in a patient with the onset of CIDP at the age of 1 year 7 months. CONCLUSION Early diagnosis of CIDP is important, since the disease is potentially curable; early administration of pathogenetic therapy provides a long-term favorable prognosis.
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Affiliation(s)
- A A Kozyreva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - R Ts Bembeeva
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - E S Druzhinina
- Pirogov Russian National Research Medical University, Moscow, Russia
- Russian Children's Clinical Hospital, Moscow, Russia
| | - N N Zavadenko
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - L M Kolpakchi
- Russian Children's Clinical Hospital, Moscow, Russia
| | - S V Pilia
- Russian Children's Clinical Hospital, Moscow, Russia
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Tsoumanis P, Kitsouli A, Stefanou C, Papathanakos G, Stefanou S, Tepelenis K, Zikidis H, Tsoumani A, Zafeiropoulos P, Kitsoulis P, Kanavaros P. Chronic Inflammatory Demyelinating Polyneuropathy and Evaluation of the Visual Evoked Potentials: A Review of the Literature. Medicina (Kaunas) 2023; 59:2160. [PMID: 38138263 PMCID: PMC10744621 DOI: 10.3390/medicina59122160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/02/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disorder characterised by the progressive demyelination of peripheral nerves, resulting in motor and sensory deficits. While much research has focused on clinical and electrophysiological aspects of CIDP, there is an emerging interest in exploring its impact on the visual system through visual evoked potentials (VEPs). This comprehensive review synthesises existing literature on VEP findings in CIDP patients, shedding light on their potential diagnostic and prognostic value. The review thoroughly examines studies spanning the last two decades, exploring VEP abnormalities in CIDP patients. Notably, VEP studies have consistently revealed prolonged latencies and reduced amplitudes in CIDP patients compared to healthy controls. These alterations in VEP parameters suggest that the demyelinating process extends beyond the peripheral nervous system to affect the central nervous system, particularly the optic nerve and its connections. The correlation between VEP abnormalities and clinical manifestations of CIDP, such as visual impairment and sensory deficits, underscores the clinical relevance of VEP assessment in CIDP management. Furthermore, this review addresses the potential utility of VEPs in aiding CIDP diagnosis and monitoring disease progression. VEP abnormalities may serve as valuable biomarkers for disease activity, helping clinicians make timely therapeutic decisions. Moreover, this review discusses the limitations and challenges associated with VEP assessment in CIDP, including variability in recording techniques and the need for standardised protocols. In conclusion, this review highlights the evolving role of VEPs as a non-invasive tool in CIDP evaluation. The consistent VEP abnormalities observed in CIDP patients suggest the involvement of the central nervous system in this demyelinating disorder. As our understanding of CIDP and its pathophysiology continues to evolve, further research in this area may lead to improved diagnostic accuracy and monitoring strategies, ultimately enhancing the clinical management of CIDP patients.
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Affiliation(s)
- Periklis Tsoumanis
- Department of Ophthalmology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | - Aikaterini Kitsouli
- Anatomy-Histology-Embryology, University of Ioannina, 45500 Ioannina, Greece; (A.K.); (P.K.); (P.K.)
| | - Christos Stefanou
- Department of Surgery, General Hospital of Filiates, 46300 Filiates, Greece;
| | | | - Stefanos Stefanou
- Department of Endocrine Surgery, Henry Dunant Hospital Center, 11526 Athens, Greece;
| | - Kostas Tepelenis
- Department of Surgery, General Hospital of Ioannina G. Hatzikosta, 45500 Ioannina, Greece;
| | - Hercules Zikidis
- Department of Neurology, University Hospital of Ioannina, 45500 Ioannina, Greece;
| | | | | | - Panagiotis Kitsoulis
- Anatomy-Histology-Embryology, University of Ioannina, 45500 Ioannina, Greece; (A.K.); (P.K.); (P.K.)
| | - Panagiotis Kanavaros
- Anatomy-Histology-Embryology, University of Ioannina, 45500 Ioannina, Greece; (A.K.); (P.K.); (P.K.)
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Sarıkaya Uzan G, Vural A, Yüksel D, Aksoy E, Öztoprak Ü, Canpolat M, Öztürk S, Yıldırım Ç, Güleç A, Per H, Gümüş H, Okuyaz Ç, Çobanoğulları Direk M, Kömür M, Ünalp A, Yılmaz Ü, Bektaş Ö, Teber S, Aliyeva N, Olgaç Dündar N, Gençpınar P, Gürkaş E, Keskin Yılmaz S, Kanmaz S, Tekgül H, Aksoy A, Öz Tuncer G, Acar Arslan E, Tosun A, Ayanoğlu M, Kızılırmak AB, Yousefi M, Bodur M, Ünay B, Hız Kurul S, Yiş U. Pediatric-Onset Chronic Inflammatory Demyelinating Polyneuropathy: A Multicenter Study. Pediatr Neurol 2023; 145:3-10. [PMID: 37245275 DOI: 10.1016/j.pediatrneurol.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 03/31/2023] [Accepted: 04/22/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND To evaluate the clinical features, demographic features, and treatment modalities of pediatric-onset chronic inflammatory demyelinating polyneuropathy (CIDP) in Turkey. METHODS The clinical data of patients between January 2010 and December 2021 were reviewed retrospectively. The patients were evaluated according to the Joint Task Force of the European Federation of Neurological Societies and the Peripheral Nerve Society Guideline on the management of CIDP (2021). In addition, patients with typical CIDP were divided into two groups according to the first-line treatment modalities (group 1: IVIg only, group 2: IVIg + steroid). The patients were further divided into two separate groups based on their magnetic resonance imaging (MRI) characteristics. RESULTS A total of 43 patients, 22 (51.2%) males and 21 (48.8%) females, were included in the study. There was a significant difference between pretreatment and post-treatment modified Rankin scale (mRS) scores (P < 0.05) of all patients. First-line treatments include intravenous immunoglobulin (IVIg) (n = 19, 44.2%), IVIg + steroids (n = 20, 46.5%), steroids (n = 1, 2.3%), IVIg + steroids + plasmapheresis (n = 1, 2.3%), and IVIg + plasmapheresis (n = 1, 2.3%). Alternative agent therapy consisted of azathioprine (n = 5), rituximab (n = 1), and azathioprine + mycophenolate mofetil + methotrexate (n = 1). There was no difference between the pretreatment and post-treatment mRS scores of groups 1 and 2 (P > 0.05); however, a significant decrease was found in the mRS scores of both groups with treatment (P < 0.05). The patients with abnormal MRI had significantly higher pretreatment mRS scores compared with the group with normal MRI (P < 0.05). CONCLUSIONS This multicenter study demonstrated that first-line immunotherapy modalities (IVIg vs IVIg + steroids) had equal efficacy for the treatment of patients with CIDP. We also determined that MRI features might be associated with profound clinical features, but did not affect treatment response.
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Affiliation(s)
- Gamze Sarıkaya Uzan
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey.
| | - Atay Vural
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey; Department of Neurology, Koç University School of Medicine, İstanbul, Turkey
| | - Deniz Yüksel
- Faculty of Medicine, Department of Pediatric Neurology, Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Erhan Aksoy
- Faculty of Medicine, Department of Pediatric Neurology, Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ülkühan Öztoprak
- Faculty of Medicine, Department of Pediatric Neurology, Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Mehmet Canpolat
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Selcan Öztürk
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Çelebi Yıldırım
- Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Ayten Güleç
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hüseyin Per
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Hakan Gümüş
- Division of Child Neurology, Department of Pediatrics, Erciyes University Faculty of Medicine, Kayseri, Turkey
| | - Çetin Okuyaz
- Division of Child Neurology, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Meltem Çobanoğulları Direk
- Division of Child Neurology, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Mustafa Kömür
- Division of Child Neurology, Department of Pediatrics, Mersin University Faculty of Medicine, Mersin, Turkey
| | - Aycan Ünalp
- Division of Pediatric Neurology, Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Ünsal Yılmaz
- Division of Pediatric Neurology, Department of Pediatrics, University of Health Sciences Dr. Behçet Uz Child Disease and Pediatric Surgery Training and Research Hospital, Izmir, Turkey
| | - Ömer Bektaş
- Division of Child Neurology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serap Teber
- Division of Child Neurology, Department of Pediatrics, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Nargiz Aliyeva
- Division of Pediatric Neurology, Department of Pediatrics, University of Health Sciences Tepecik Research and Training Hospital, İzmir, Turkey
| | - Nihal Olgaç Dündar
- Division of Child Neurology, Department of Pediatrics, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Pınar Gençpınar
- Division of Child Neurology, Department of Pediatrics, İzmir Katip Çelebi University Faculty of Medicine, İzmir, Turkey
| | - Esra Gürkaş
- Department of Pediatric Neurology, Children's Hospital, Ankara City Hospital, Ankara, Turkey
| | - Sanem Keskin Yılmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Seda Kanmaz
- Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Hasan Tekgül
- Division of Child Neurology, Department of Pediatrics, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ayşe Aksoy
- Division of Child Neurology, Department of Pediatrics, On Dokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Gökçen Öz Tuncer
- Division of Child Neurology, Department of Pediatrics, On Dokuz Mayıs University Faculty of Medicine, Samsun, Turkey
| | - Elif Acar Arslan
- Division of Child Neurology, Department of Pediatrics, Karadeniz Technical University Faculty of Medicine, Trabzon, Turkey
| | - Ayşe Tosun
- Division of Child Neurology, Department of Pediatrics, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Müge Ayanoğlu
- Division of Child Neurology, Department of Pediatrics, Adnan Menderes University Faculty of Medicine, Aydın, Turkey
| | - Ali Burak Kızılırmak
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Mohammadreza Yousefi
- Koç University Research Center for Translational Medicine (KUTTAM), İstanbul, Turkey
| | - Muhittin Bodur
- Division of Child Neurology, Department of Pediatrics, Uludağ University Faculty of Medicine, Bursa, Turkey
| | - Bülent Ünay
- Gülhane Faculty of Medicine, Department of Pediatric Neurology, University of Health Sciences, Ankara, Turkey
| | - Semra Hız Kurul
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
| | - Uluç Yiş
- Division of Child Neurology, Department of Pediatrics, Dokuz Eylül University Faculty of Medicine, İzmir, Turkey
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Ichimiya Y, Chong PF, Sonoda Y, Tocan V, Watanabe M, Torisu H, Kira R, Takahashi T, Kira JI, Isobe N, Sakai Y, Ohga S. Long-lasting pain and somatosensory disturbances in children with myelin oligodendrocyte glycoprotein antibody-associated disease. Eur J Pediatr 2023:10.1007/s00431-023-04989-z. [PMID: 37119299 DOI: 10.1007/s00431-023-04989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/22/2023] [Accepted: 04/17/2023] [Indexed: 05/01/2023]
Abstract
Myelin oligodendrocyte glycoprotein antibody (MOG-Ab) is an autoantibody associated with acquired demyelinating syndrome (ADS) in childhood and adults. The pathogenic roles of MOG-Ab and long-term outcomes of children with MOG-Ab-associated disease (MOGAD) remain elusive. We investigated the clinical features of children with ADS during follow-up in our institute. Clinical data were retrospectively analyzed using medical charts of patients managed in Kyushu University Hospital from January 1st, 2001, to March 31st, 2022. Participants were children of < 18 years of age when they received a diagnosis of ADS in our hospital. Cell-based assays were used to detect MOG-Ab in serum or cerebrospinal fluid at the onset or recurrence of ADS. The clinical and neuroimaging data of MOG-Ab-positive and MOG-Ab-negative patients were statistically analyzed. Among 31 patients enrolled in this study, 22 (13 females, 59%) received tests for MOG antibodies. Thirteen cases (59%) were MOG-Ab-positive and were therefore defined as MOGAD; 9 (41%) were MOG-Ab-negative. There were no differences between MOGAD and MOG-Ab-negative patients in age at onset, sex, diagnostic subcategories, or duration of follow-up. MOGAD patients experienced headache and/or somatosensory symptoms more frequently than MOG-Ab-negative patients (12/13 (92%) vs. 3/9 (22%); p = 0.0066). Somatosensory problems included persistent pain with hyperesthesia in the left toe, perineal dysesthesia, and facial hypesthesia. No specific neuroimaging findings were associated with MOGAD or the presence of somatosensory symptoms. CONCLUSIONS Long-lasting somatosensory disturbances are prominent comorbidities in children with MOGAD. Prospective cohorts are required to identify molecular and immunogenetic profiles associated with somatosensory problems in MOGAD. WHAT IS KNOWN • Recurrence of demyelinating events occurs in a group of children with myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). WHAT IS NEW • Long-lasting headache and somatosensory problems are frequent comorbidities with pediatric MOGAD. Pain and somatosensory problems may persist for more than 5 years. • Neuroimaging data do not indicate specific findings in children with somatic disturbances.
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Affiliation(s)
- Yuko Ichimiya
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Pin Fee Chong
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Yuri Sonoda
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Vlad Tocan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
| | - Mitsuru Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Hiroyuki Torisu
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Section of Pediatrics, Department of Medicine, Fukuoka Dental College, Fukuoka, Japan
| | - Ryutaro Kira
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
- Department of Pediatric Neurology, Fukuoka Children's Hospital, Fukuoka, Japan
| | - Toshiyuki Takahashi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Neurology, National Hospital Organization, Yonezawa National Hospital, Yonezawa, Japan
| | - Jun-Ichi Kira
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Neurology, Brain and Nerve Center, Fukuoka Central Hospital, Fukuoka, Japan
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Sakai
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan.
| | - Shouichi Ohga
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, 812-8582, Japan
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Fargeot G, Gitiaux C, Magy L, Pereon Y, Delmont E, Viala K, Echaniz-Laguna A. French recommendations for the management of adult & pediatric chronic inflammatory demyelinating polyradiculoneuropathy (CIDP). Rev Neurol (Paris) 2022; 178:953-968. [PMID: 36182621 DOI: 10.1016/j.neurol.2022.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/31/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is a rare autoimmune disorder of the peripheral nervous system, primarily affecting the myelin sheath. The pathophysiology of CIDP is complex, involving both humoral and cellular immunity. The diagnosis of CIDP should be suspected in patients with symmetrical proximal and distal motor weakness and distal sensory symptoms of progressive onset, associated with decreased/abolished tendon reflexes. Treatments include intraveinous immunoglobulins, steroids and plasma exchange, with usually an induction phase followed by a maintenance therapy with progressive weaning. Treatment should be rapidly initiated to prevent axonal degeneration, which may compromise recovery. CIDP outcome is variable, ranging from mild distal paresthesiae to complete loss of ambulation. There have been several breakthroughs in the diagnosis and management of CIDP the past ten years, e.g. discovery of antibodies against the node of Ranvier, contribution of nerve ultrasound and magnetic resonance imaging to diagnosis, and demonstration of subcutaneous immunoglobulins efficiency. This led us to elaborate French recommendations for the management of adult & pediatric CIDP patients. These recommendations include diagnosis assessment, treatment, and follow-up.
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Affiliation(s)
- G Fargeot
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France.
| | - C Gitiaux
- Department of Paediatric Neurophysiology, Necker-Enfants-Malades Hospital, AP-HP, Paris University, Paris, France
| | - L Magy
- Department of Neurology, National Reference Center for 'Rare Peripheral Neuropathies', University Hospital of Limoges, Limoges, France
| | - Y Pereon
- CHU Nantes, Centre de Référence Maladies Neuromusculaires AOC, Filnemus, Euro-NMD, Explorations Fonctionnelles, Hôtel-Dieu, Nantes, France
| | - E Delmont
- Reference Center for Neuromuscular Diseases and ALS Timone University Hospital, Aix-Marseille University, Marseille, France
| | - K Viala
- Neurophysiology Department, Pitié-Salpêtrière Hospital, AP-HP, Paris, France
| | - A Echaniz-Laguna
- Neurology Department, CHU de Bicêtre, AP-HP, Le-Kremlin-Bicêtre, France; French National Reference Center for Rare Neuropathies (NNERF), Le-Kremlin-Bicêtre, France; Inserm U1195, Paris-Saclay University, Le-Kremlin-Bicêtre, France
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Barišić N, Turudić D, Marić LS, Tešović G. Vaccination in pediatric acquired inflammatory immune-mediated neuromuscular disorders. Eur J Paediatr Neurol 2022; 36:159-176. [PMID: 34998097 DOI: 10.1016/j.ejpn.2021.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/15/2021] [Accepted: 12/18/2021] [Indexed: 11/26/2022]
Abstract
AIM To analyse literature data on vaccine related induction, worsening of the disease and disease reccurrences as well as vaccine safety and efficacy among pediatric patients with acquired inflammatory immune-mediated neuromuscular disorders (NMD). METHODS Medline, Pub Med and Scopus database search from 1975 to 2020 focused on pediatric age was conducted including peer reviews, meta analyses and epidemiological studies on vaccination and Guillain-Barré syndrome (GBS), Bell's palsy, optic neuritis (ON), myasthenia gravis (MG), chronic inflammatory demyelinating polyneuropathy (CIDP) and immune-mediated inflammatory myopathy (IM). RESULTS AND CONCLUSION s: There are no strong evidence supporting relationship between vaccination with different pediatric vaccines and development of first episodes or reccurrences of GBS, Bell's palsy, optic neuritis (ON), juvenile MG, CIDP, and IM. The vaccination and revaccination with inactivated vaccines is considered safe in children with medical history of GBS, Bell's palsy, ON, MG and IM. Caution when immunization against influenza, quadrivalent conjugated meningococcal vaccine (MCV4) and pneumococcal disease and avoiding tetanus toxoid immunization in CIDP patients is suggested. Patients with immune mediated acquired NMD should be vaccinated with live vaccines before the initiation of immunosupressive treatment. Immunosuppressed patients with low protective antibody titers should be considered for revaccination.
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Affiliation(s)
- Nina Barišić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia; University of Zagreb, School of Medicine, Zagreb, Croatia.
| | - Daniel Turudić
- Department of Pediatrics, Clinical Medical Centre, Zagreb, Croatia
| | - Lorna Stemberger Marić
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
| | - Goran Tešović
- University of Zagreb, School of Medicine, Zagreb, Croatia; University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, Croatia
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Kostera-Pruszczyk A, Potulska-Chromik A, Łukawska M, Lipowska M, Hoffman-Zacharska D, Olchowik B, Figlerowicz M, Kanabus K, Rosiak E. Pediatric CIDP: Diagnosis and Management. A Single-Center Experience. Front Neurol 2021; 12:667378. [PMID: 34276534 PMCID: PMC8284159 DOI: 10.3389/fneur.2021.667378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare acquired polyneuropathy that especially among youngest children should be differentiated with hereditary neuropathies. Even though upon diagnosis treatment options are similar in children and adults, diagnostic challenges are faced in the pediatric population. Methods: We conducted a retrospective analysis of clinical symptoms, nerve conduction study results, modes of treatment, and final outcome in 37 children aged 3.5-17 years with a final diagnosis of CIDP (18 girls, 19 boys). We established three groups of patients based on age at onset of CIDP: 0-4, 4-13, and 13-18 years. Follow-up ranged from 10 to 222 months. Results: In our analysis, 19/37 patients (51.4%) had an atypical presentation: distal variant of CIDP in 12/37 patients (32.4%) and pure motor variant of CIDP in 5/37 patients (13.5%), and one patient had a pure sensory variant (1/37, 2.7%). Furthermore, 3/37 patients (8.1%) had additional concurring symptoms, including involuntary movements of face muscles (1/37, 2.7%) or hand tremor (2/37, 5.4%). During the follow-up, 23/37 patients (62.2%) received intravenous immunoglobulin (IVIg); 22/37 patients (59.5%) received steroids, 6/37 patients (16.2%) received IVIg and steroids, and 12/37 patients (32.4%) received immunosuppressive drugs, mostly azathioprine, but also methotrexate and rituximab. One patient was treated with plasmapheresis. Complete remission was achieved in 19/37 patients (51.4%) with CIDP in its typical form. Remission with residual symptoms or minimal deficit was observed in 4/37 patients (10.8%), whereas 14/37 patients (37.8%) remain on treatment with gradual improvement. Conclusion: Childhood CIDP may occur in its typical form, but even ~50% of children can present as an atypical variant including distal, pure motor, or pure sensory. Most children have a good prognosis; however, many of them may require long-term treatment. This highlights the importance of an early diagnosis and treatment for childhood CIDP.
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Affiliation(s)
| | | | | | - Marta Lipowska
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| | | | - Beata Olchowik
- Department of Child Neurology and Rehabilitation, Medical University of Białystok, Białystok, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznań, Poland
| | - Karolina Kanabus
- Department of Medical Genetics, Institute of Mother and Child, Warsaw, Poland
| | - Edyta Rosiak
- Department of Radiology, Medical University of Warsaw, Warsaw, Poland
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Fernandez-Garcia MA, Stettner GM, Kinali M, Clarke A, Fallon P, Knirsch U, Wraige E, Jungbluth H. Genetic neuropathies presenting with CIDP-like features in childhood. Neuromuscul Disord 2021; 31:113-122. [PMID: 33386210 DOI: 10.1016/j.nmd.2020.11.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 11/23/2020] [Accepted: 11/25/2020] [Indexed: 12/15/2022]
Abstract
Inherited neuropathies are amongst the most common neuromuscular disorders. The distinction from chronic inflammatory demyelinating polyneuropathy (CIDP) may be challenging, considering its rarity in childhood, that genetic neuropathies may show secondary inflammatory features, and that subacute CIDP presentations may closely mimic the disease course of inherited disorders. The overlap between genetic neuropathies and CIDP is increasingly recognized in adults but rarely reported in children. Here we report 4 children with a neuropathy of subacute onset, initially considered consistent with an immune-mediated neuropathy based on suggestive clinical, laboratory and neurophysiological features. None showed convincing response to intravenous immunoglobulin therapy, leading to re-evaluation and confirmation of a genetic neuropathy in each case (including PMP22, MPZ and SH3TC2 genes). A review of the few Paediatric cases reported in the literature showed similar delays in diagnosis and no significant changes to immunomodulatory treatment. Our findings emphasize the importance of considering an inherited neuropathy in children with a CIDP-like presentation. In addition to an inconclusive response to treatment, subtle details of the family and developmental history may indicate a genetic rather than an acquired background. Correct diagnostic confirmation of a genetic neuropathy in a child is crucial for appropriate management, prognostication and genetic counselling.
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Affiliation(s)
- Miguel A Fernandez-Garcia
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, F02 - Becket House, Lambeth Palace Road, London SE1 7EU, United Kingdom
| | - Georg M Stettner
- Division of Paediatric Neurology, University Children´s Hospital Zurich, Zurich, Switzerland
| | - Maria Kinali
- Department of Paediatric Neurology, The Portland Hospital, HCA Healthcare, United Kingdom; Imperial College, London, United Kingdom
| | - Antonia Clarke
- Department of Paediatric Neurosciences, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Penny Fallon
- Department of Paediatric Neurosciences, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Ursula Knirsch
- Division of Paediatric Neurology, University Children´s Hospital Zurich, Zurich, Switzerland
| | - Elizabeth Wraige
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, F02 - Becket House, Lambeth Palace Road, London SE1 7EU, United Kingdom
| | - Heinz Jungbluth
- Department of Paediatric Neurology, Neuromuscular Service, Evelina Children's Hospital, Guy's and St Thomas' Hospital NHS Foundation Trust, F02 - Becket House, Lambeth Palace Road, London SE1 7EU, United Kingdom; Muscle Signalling Section, Randall Division for Cell and Molecular Biophysics, King's College, London, United Kingdom; Department of Basic and Clinical Neuroscience, King's College, IoPPN, London, United Kingdom.
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10
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Rogers AB, Zaidman CM, Connolly AM. Pulse oral corticosteroids in pediatric chronic inflammatory demyelinating polyneuropathy. Muscle Nerve 2020; 62:705-709. [PMID: 32893348 DOI: 10.1002/mus.27058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/11/2022]
Abstract
Childhood onset chronic inflammatory demyelinating polyneuropathy (CIDP) often requires long-term immunomodulatory therapy. We report a comprehensive review of our treatment of pediatric CIDP with a focus on high-dose weekly corticosteroids ("pulse oral corticosteroids"), a treatment method that is not commonly reported. We retrospectively reviewed medical records of pediatric patients with CIDP treated at our center between 2000 and 2018 for whom we had at least 12 mo follow-up. Here, we describe the demographics, disease course, treatment regimens, and long-term outcomes of these patients. Twenty-five patients were identified for analysis. Pulse oral corticosteroid monotherapy was the predominant maintenance treatment in 56% of patients. Patients were followed for a median of 4 y. Side effects were seen in a minority of patients. The probability of a normal exam or being off treatment at last follow-up was similar regardless of predominant maintenance therapy. Pulse oral corticosteroid therapy is a safe and effective long-term treatment option in children with CIDP.
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Affiliation(s)
- Amanda B Rogers
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Craig M Zaidman
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anne M Connolly
- Department of Pediatrics, Neurology Division, Nationwide Children's Hospital, Ohio State University, Columbus, Ohio, USA
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Gilmore KJ, Kirk EA, Doherty TJ, Kimpinski K, Rice CL. Abnormal motor unit firing rates in chronic inflammatory demyelinating polyneuropathy. J Neurol Sci 2020; 414:116859. [DOI: 10.1016/j.jns.2020.116859] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/22/2020] [Accepted: 04/25/2020] [Indexed: 12/14/2022]
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12
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Stålberg E, van Dijk H, Falck B, Kimura J, Neuwirth C, Pitt M, Podnar S, Rubin DI, Rutkove S, Sanders DB, Sonoo M, Tankisi H, Zwarts M. Standards for quantification of EMG and neurography. Clin Neurophysiol 2019; 130:1688-1729. [DOI: 10.1016/j.clinph.2019.05.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/07/2019] [Accepted: 05/09/2019] [Indexed: 12/11/2022]
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13
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Bunschoten C, Jacobs BC, Van den Bergh PYK, Cornblath DR, van Doorn PA. Progress in diagnosis and treatment of chronic inflammatory demyelinating polyradiculoneuropathy. Lancet Neurol 2019; 18:784-794. [DOI: 10.1016/s1474-4422(19)30144-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 02/05/2019] [Accepted: 02/25/2019] [Indexed: 12/11/2022]
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Klotz J, Tesi Rocha C. 50 Years Ago in The Journal of Pediatrics: Chronic Polyneuritis of Childhood. J Pediatr 2019; 208:175. [PMID: 31027619 DOI: 10.1016/j.jpeds.2018.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Jenna Klotz
- Department of Neurology, Division of Child Neurology and Neuromuscular Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Carolina Tesi Rocha
- Department of Neurology, Division of Child Neurology and Neuromuscular Medicine, Stanford University School of Medicine, Palo Alto, California
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