1
|
Doneddu PE, Gentile L, Cocito D, Fazio R, Luigetti M, Briani C, Filosto M, Siciliano G, Benedetti L, Antonini G, Matà S, Marfia GA, Inghilleri M, Manganelli F, Cosentino G, Brighina F, Carpo M, Carta F, Mazzeo A, Peci E, Strano C, Romano A, Campagnolo M, Cotti-Piccinelli S, Viola DV, Germano F, Leonardi L, Sperti M, Mataluni G, Ceccanti M, Spina E, Vegezzi E, Di Stefano V, Nobile-Orazio E. Assessment of diagnostic criteria for multifocal motor neuropathy in patients included in the Italian database. Eur J Neurol 2024; 31:e16248. [PMID: 38376074 DOI: 10.1111/ene.16248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [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: 11/29/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND AND PURPOSE This study aimed to assess the diagnostic criteria, ancillary investigations and treatment response using real-life data in multifocal motor neuropathy (MMN) patients. METHODS Clinical and laboratory data were collected from 110 patients enrolled in the Italian MMN database through a structured questionnaire. Twenty-six patients were excluded due to the unavailability of nerve conduction studies or the presence of clinical signs and symptoms and electrodiagnostic abnormalities inconsistent with the MMN diagnosis. Analyses were conducted on 73 patients with a confirmed MMN diagnosis and 11 patients who did not meet the diagnostic criteria. RESULTS The European Federation of Neurological Societies/Peripheral Nerve Society (EFNS/PNS) diagnostic criteria were variably applied. AUTHOR When applying the American Association of Electrodiagnostic Medicine criteria, an additional 17% of patients fulfilled the criteria for probable/definite diagnosis whilst a further 9.5% missed the diagnosis. In 17% of the patients only compound muscle action potential amplitude, but not area, was measured and subsequently recorded in the database by the treating physician. Additional investigations, including anti-GM1 immunoglobulin M antibodies, cerebrospinal fluid analysis, nerve ultrasound and magnetic resonance imaging, supported the diagnosis in 46%-83% of the patients. Anti-GM1 immunoglobulin M antibodies and nerve ultrasound demonstrated the highest sensitivity. Additional tests were frequently performed outside the EFNS/PNS guideline recommendations. CONCLUSIONS This study provides insights into the real-world diagnostic and management strategies for MMN, highlighting the challenges in applying diagnostic criteria.
Collapse
Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Luca Gentile
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Dario Cocito
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| | - Raffaella Fazio
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | - Marco Luigetti
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Sede di Roma, Roma, Italy
| | - Chiara Briani
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Massimiliano Filosto
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical center for Neuromuscular Diseases, Brescia, Italy
| | - Gabriele Siciliano
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Giovanni Antonini
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza' University of Rome, Roma, Italy
| | - Sabrina Matà
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Girolama Alessandra Marfia
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Maurizio Inghilleri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, Italy
| | - Fiore Manganelli
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Filippo Brighina
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | | | - Francesca Carta
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
| | - Anna Mazzeo
- Department of Clinical and Experimental Medicine, Unit of Neurology, University of Messina, Messina, Italy
| | - Erdita Peci
- Presidio Sanitario Major, Istituti Clinici Scientifici Maugeri, Torino, Italy
| | - Camilla Strano
- Division of Neuroscience, Department of Neurology, Institute of Experimental Neurology (INSPE), San Raffaele Scientific Institute, Milano, Italy
| | - Angela Romano
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS, UOC Neurologia, Roma, Italy
- Università Cattolica del Sacro Cuore, Sede di Roma, Roma, Italy
| | - Marta Campagnolo
- Neurology Unit, Department of Neuroscience, University of Padova, Padova, Italy
| | - Stefano Cotti-Piccinelli
- Department of Clinical and Experimental Sciences, University of Brescia; NeMO-Brescia Clinical center for Neuromuscular Diseases, Brescia, Italy
| | - Divina Valeria Viola
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | | | - Luca Leonardi
- Unit of Neurophysiopathology, Department of Neurology Mental Health and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sant'Andrea Hospital, Sapienza' University of Rome, Roma, Italy
| | - Martina Sperti
- Department of Neurological and Psychiatric Sciences, Azienda Ospedaliero-Universitaria di Careggi, Florence, Italy
| | - Giorgia Mataluni
- Dysimmune Neuropathies Unit, Department of Systems Medicine, Tor Vergata University of Rome, Roma, Italy
| | - Marco Ceccanti
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Emanuele Spina
- Department of Neuroscience, Reproductive Sciences and Odontostomatology, University of Naples 'Federico II', Napoli, Italy
| | - Elisa Vegezzi
- Department of Brain and Behavioral Sciences, IRCCS Mondino Foundation, University of Pavia, Pavia, Italy
| | - Vincenzo Di Stefano
- Azienda Ospedaliera Universitaria Policlinico Paolo Giaccone, Palermo, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Rozzano, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, Milano, Italy
| |
Collapse
|
2
|
Boostani R, Olfati N, Shamshiri H, Salimi Z, Fatehi F, Hedjazi SA, Fakharian A, Ghasemi M, Okhovat AA, Basiri K, Haghi Ashtiani B, Ansari B, Raissi GR, Khatoonabadi SA, Sarraf P, Movahed S, Panahi A, Ziaadini B, Yazdchi M, Bakhtiyari J, Nafissi S. Iranian clinical practice guideline for amyotrophic lateral sclerosis. Front Neurol 2023; 14:1154579. [PMID: 37333000 PMCID: PMC10272856 DOI: 10.3389/fneur.2023.1154579] [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] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Amyotrophic lateral sclerosis (ALS) is a rapidly progressive neurodegeneration involving motor neurons. The 3-5 years that patients have to live is marked by day-to-day loss of motor and sometimes cognitive abilities. Enormous amounts of healthcare services and resources are necessary to support patients and their caregivers during this relatively short but burdensome journey. Organization and management of these resources need to best meet patients' expectations and health system efficiency mandates. This can only occur in the setting of multidisciplinary ALS clinics which are known as the gold standard of ALS care worldwide. To introduce this standard to the care of Iranian ALS patients, which is an inevitable quality milestone, a national ALS clinical practice guideline is the necessary first step. The National ALS guideline will serve as the knowledge base for the development of local clinical pathways to guide patient journeys in multidisciplinary ALS clinics. To this end, we gathered a team of national neuromuscular experts as well as experts in related specialties necessary for delivering multidisciplinary care to ALS patients to develop the Iranian ALS clinical practice guideline. Clinical questions were prepared in the Patient, Intervention, Comparison, and Outcome (PICO) format to serve as a guide for the literature search. Considering the lack of adequate national/local studies at this time, a consensus-based approach was taken to evaluate the quality of the retrieved evidence and summarize recommendations.
Collapse
Affiliation(s)
- Reza Boostani
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Olfati
- Department of Neurology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hosein Shamshiri
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zanireh Salimi
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Psychiatry, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farzad Fatehi
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Arya Hedjazi
- Legal Medicine Research Center, Legal Medicine Organization, Tehran, Iran
| | - Atefeh Fakharian
- Pulmonary Rehabilitation Research Center (PRRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Internal Medicine, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Ghasemi
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asghar Okhovat
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Keivan Basiri
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bahram Haghi Ashtiani
- Department of Neurology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Behnaz Ansari
- Department of Neurology, Faculty of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
- Isfahan Neuroscience Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
- AL Zahra Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholam Reza Raissi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Neuromusculoskeletal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Payam Sarraf
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Movahed
- Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
- Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Akram Panahi
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Bentolhoda Ziaadini
- Department of Neurology, Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
- Neurology Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Yazdchi
- Department of Neurology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Neurosciences Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jalal Bakhtiyari
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahriar Nafissi
- Department of Neurology, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
- Neuromuscular Research Center, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
3
|
Beecher G, Howe BM, Shelly S, Nathan P, Mauermann ML, Taylor BV, Spinner RJ, Tracy JA, Dyck PJB, Klein CJ. Plexus MRI helps distinguish the immune-mediated neuropathies MADSAM and MMN. J Neuroimmunol 2022; 371:577953. [PMID: 36007424 DOI: 10.1016/j.jneuroim.2022.577953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 06/19/2022] [Revised: 08/11/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among immune-mediated neuropathies, clinical-electrophysiological overlap exists between multifocal acquired demyelinating sensory and motor neuropathy (MADSAM) and multifocal motor neuropathy (MMN). Divergent immune pathogenesis, immunotherapy response, and prognosis exist between these two disorders. MRI reports have not shown distinction of these disorders, but biopsy confirmation is lacking in earlier reports. MADSAM nerves are hypertrophic with onion bulbs, inflammation, and edema, whereas MMN findings are limited to multifocal axonal atrophy. OBJECTIVES To understand if plexus MRI can distinguish MADSAM from MMN among pathologically (nerve biopsy) confirmed cases. METHODS Retrospective chart review and blinded plexus MRI review of biopsy-confirmed MADSAM and MMN cases at Mayo Clinic. RESULTS Nine brachial plexuses (MADSAM-5, MMN-4) and 6 lumbosacral plexuses (MADSAM-4, MMN-2) had fascicular biopsies of varied nerves. Median follow-up in MADSAM was 93 months (range: 7-180) and 27 (range: 12-109) in MMN (p = 0.34). MRI hypertrophy occurred solely in MADSAM (89%, 8/9) with T2-hyperintensity in both. There was no correlation between time to imaging for hypertrophy, symptom onset age, or motor neuropathy impairments (mNIS). At last follow-up, on diverse immunotherapies mNIS improved in MADSAM (median - 4, range: -22 to 0), whereas MMN worsened (median 3, range: 0 to 6, p = 0.03) on largely IVIG. CONCLUSION Nerve hypertrophy on plexus MRI helps distinguish MMN from MADSAM, where better immunotherapy treatment outcomes were observed. These findings are consistent with the immune pathogenesis seen on biopsies. Radiologic distinction is possible independent of time to imaging and extent of motor deficits, suggesting MRI is helpful in patients with uncertain clinical-electrophysiologic diagnosis, especially motor-onset MADSAM.
Collapse
Affiliation(s)
- Grayson Beecher
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, Rochester, MN, United States of America
| | - Shahar Shelly
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Department of Neurology, Chaim Sheba Medical Centre, Sackler Faculty Institute, Tel Aviv, Israel
| | - P Nathan
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | | | - Bruce V Taylor
- Menzies Institute for Medical Research, University of Tasmania, Australia
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, MN, United States of America
| | - Jennifer A Tracy
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - P James B Dyck
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, Rochester, MN, United States of America; Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States of America.
| |
Collapse
|
4
|
Beecher G, Shelly S, Dyck PJB, Mauermann ML, Martinez-Thompson JM, Berini SE, Naddaf E, Shouman K, Taylor BV, Dyck PJ, Engelstad J, Howe BM, Mills JR, Dubey D, Spinner RJ, Klein CJ. Pure Motor Onset and IgM-Gammopathy Occurrence in Multifocal Acquired Demyelinating Sensory and Motor Neuropathy. Neurology 2021; 97:e1392-e1403. [PMID: 34376509 DOI: 10.1212/wnl.0000000000012618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To longitudinally investigate patients with multifocal acquired demyelinating sensory and motor neuropathy (MADSAM), quantifying timing and location of sensory involvements in motor onset patients, along with clinicohistopathologic and electrophysiologic findings to ascertain differences in patients with and without monoclonal gammopathy of uncertain significance (MGUS). METHODS Patients with MADSAM seen at Mayo Clinic and tested for monoclonal gammopathy and ganglioside antibodies were retrospectively reviewed (January 1, 2007-December 31, 2018). RESULTS Of 76 patients with MADSAM, 53% had pure motor, 16% pure sensory, 30% sensorimotor, and 1% cranial nerve onsets. Motor-onset patients were initially diagnosed with multifocal motor neuropathy (MMN). MGUS occurred in 25% (89% immunoglobulin M [IgM] subtype), associating with ganglioside autoantibodies (p < 0.001) and higher IgM titers (p < 0.04). Median time to sensory involvements (confirmed by electrophysiology) in motor onset patients was 18 months (range 6-180). Compared to initial motor nerve involvements, subsequent sensory findings were within the same territory in 35% (14/40), outside in 20% (8/40), or both in 45% (18/40). Brachial and lumbosacral plexus MRI was abnormal in 87% (34/39) and 84% (21/25), respectively, identifying hypertrophy and increased T2 signal predominantly in brachial plexus trunks (64%), divisions (69%), and cords (69%), and intrapelvic sciatic (64%) and femoral (44%) nerves. Proximal fascicular nerve biopsies (n = 9) more frequently demonstrated onion-bulb pathology (p = 0.001) and endoneurial inflammation (p = 0.01) than distal biopsies (n = 17). MRI and biopsy findings were similar among patient subgroups. Initial Inflammatory Neuropathy Cause and Treatment (INCAT) disability scores were higher in patients with MGUS relative to without (p = 0.02). Long-term treatment responsiveness by INCAT score reduction ≥1 or motor Neuropathy Impairment Score (mNIS) >8-point reduction occurred in 75% (49/65) irrespective of MGUS or motor onsets. Most required ongoing immunotherapy (86%). Patients with MGUS more commonly required dual-agent immunotherapy for stability (p = 0.02). DISCUSSION Pure motor onsets are the most common MADSAM presentation. Long-term follow-up, repeat electrophysiology, and nerve pathology help distinguish motor onset MADSAM from MMN. Better long-term immunotherapy responsiveness occurs in motor onset MADSAM compared to MMN reports. Patients with MGUS commonly require dual immunotherapy. CLASSIFICATION OF EVIDENCE This study provides Class II evidence that most clinical, electrophysiologic, and histopathologic findings were similar between patients with MADSAM with and without MGUS.
Collapse
Affiliation(s)
- Grayson Beecher
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Shahar Shelly
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - P James B Dyck
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Michelle L Mauermann
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Jennifer M Martinez-Thompson
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Sarah E Berini
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Elie Naddaf
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Kamal Shouman
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Bruce V Taylor
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Peter James Dyck
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - JaNean Engelstad
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Benjamin M Howe
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - John R Mills
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Divyanshu Dubey
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Robert J Spinner
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia
| | - Christopher J Klein
- From the Departments of Neurology (G.B., S.S., P. James B. Dyck, M.L.M., J.M.M.-T., S.E.B., E.N., K.S., Peter James B. Dyck, D.D., C.J.K.), Radiology (B.M.H.), Laboratory Medicine and Pathology (P. James B. Dyck, Peter James B. Dyck, J.E., J.R.M., D.D., C.J.K.), and Neurosurgery (R.J.S.), Mayo Clinic, Rochester, MN; and Menzies Institute for Medical Research (B.V.T.), University of Tasmania, Australia.
| |
Collapse
|