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Biggi M, Contento M, Magliani M, Giovannelli G, Barilaro A, Bessi V, Lombardo I, Massacesi L, Rosati E. Alice in wonderland syndrome "through the looking-glass" in a rare presentation of non-convulsive status epilepticus in cerebral venous sinus thrombosis and COVID-19. Cortex 2023; 167:218-222. [PMID: 37572532 DOI: 10.1016/j.cortex.2023.06.020] [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: 12/20/2022] [Revised: 04/12/2023] [Accepted: 06/26/2023] [Indexed: 08/14/2023]
Abstract
Alice in Wonderland Syndrome (AIWS) is a rare perceptual disorder, rarely associated with epileptic etiology. We report the case of a 23-year-old man with subacute onset of right peri-orbital headache and visual misperceptions consistent with AIWS Type B, who underwent laboratory tests, brain CT with venography, ophthalmic examination, and neurological assessment that turned out to be normal except for visuospatial difficulties and constructional apraxia. A nasopharyngeal SARS-CoV2 swab taken as screening protocol was positive. The EEG performed because of the persistence of AIWS showed a focal right temporo-occipital non-convulsive status epilepticus; a slow resolution of clinical and EEG alterations was achieved with anti-seizure medications. Brain MRI showed right cortical temporo-occipital signal abnormalities consistent with peri-ictal changes and post-contrast T1 revealed a superior sagittal sinus thrombosis, thus anticoagulant therapy was initiated. AIWS is associated with temporo-parieto-occipital carrefour abnormalities, where visual and somatosensory inputs are integrated to generate the representation of body schema. In this patient, AIWS is caused by temporo-occipital status epilepticus without anatomical and electroencephalographic involvement of the parietal region, consistent with the absence of somatosensory symptoms of the syndrome. Status epilepticus can be the presenting symptom of cerebral venous sinus thrombosis (CVST) which, in this case, is possibly due to the hypercoagulable state associated with COVID-19.
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Affiliation(s)
- M Biggi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - M Contento
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology, Pordenone Hospital, Pordenone, Italy
| | - M Magliani
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - G Giovannelli
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - A Barilaro
- Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - V Bessi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy
| | - I Lombardo
- Department of Neuroradiology, Careggi University Hospital, Florence, Italy
| | - L Massacesi
- Department of Neurosciences, Drug and Child Health, University of Florence, Florence, Italy; Department of Neurology 2, Careggi University Hospital, Florence, Italy
| | - E Rosati
- Department of Neurology 2, Careggi University Hospital, Florence, Italy.
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Palermo A, Bettiol A, Urban ML, Barilaro A, Danieli MG, Capassoni M, Guiducci S, Campochiaro C, Dagna L, Canti V, Rovere-Querini P, Cardelli C, Mosca M, Emmi G. POS0922 RECOMBINANT HUMAN HYALURONIDASE-FACILITATED SUBCUTANEOUS IMMUNOGLOBULIN FOR IDIOPATHIC INFLAMMATORY MYOSITIS: A MULTICENTER OBSERVATIONAL STUDY. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.4827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundThe spectrum of idiopathic inflammatory myositis (IIM) includes a heterogeneous group of diseases characterized by chronic inflammation of skeletal muscle, often associated with skin, joints, lungs, esophageal, gastrointestinal and cardiac involvement. Conventional treatment for IIM is based on glucocorticoids and immunosuppressants. Moreover, intravenous immunoglobulin (IVIg) has emerged as a promising steroid- and DMARD-sparing treatment for myositis [1]. However, the long-term use of IVIg is complicated by the fact that the intravenous route requires in-hospital drug administration, which not only influences patients’ quality of life, but is also associated with an increased risk of systemic adverse effects, difficulties in venous access over time, and high costs [2]. On these bases, administration of subcutaneous Ig (SCIg) by a programmable pump has been considered as a possible alternative to IVIg.Recombinant human hyaluronidase-facilitated (hf)-SCIg is currently approved for the use in patients with primary immunodeficiency disorders, while its efficacy and safety in myositis disorders is limited [3].ObjectivesThis multicenter retrospective observational study is sought to evaluate the effectiveness and safety of recombinant human hf-SCIg in patients with IIM treated at different referral centers.MethodsA multicenter, retrospective, cohort study was conducted on adult patients diagnosed with IIM according to the EULAR/ACR classification criteria [4] treated with recombinant human hf-SCIg according to routine clinical practice. The effectiveness of this treatment was assessed in terms of variations in the Medical Research Council (MRC) score, creatine kinase values, inflammatory parameters, and daily prednisolone dosage. Safety data were also collected.ResultsTwenty-three patients with IIM treated with hf-SCIg were included (16/23 females, 70%; median age at diagnosis of 61 years (IQR 43-65)).In most patients (22/23, 96%), IIM had been initially treated with high-dose corticosteroids (+/- synthetic or biologic DMARDs), and 20/23 patients (87%) had received previous IVIg treatment (in 12 for remission induction and in 8 for maintenance).Hf-SCIg were introduced after a median time of 2 years (1-4) from the diagnosis of IIM, mostly for remission maintenance (18/23). Hf-SCIg was started in combination with oral corticosteroids in 19/23 [83%, at a median dose of 5 mg/day (4-12.5)] and/or with traditional or biologic DMARDs (18/23, 78%).At time of hf-SCIg introduction, the median MRC score was 4 (3-4) and the median creatine kinase level was of 134 U/L (44-243). After 6 months of treatment, the median MRC score was 4 (3-5); no patient discontinued hf-SCIg, and only one experience a mild adverse event.ConclusionHf-SCIg seems effective to maintain remission in a high proportion of IIM patients, while showing a good safety profile in the first 6 months of treatment.References[1]Oddis. Treatment in myositis. Nat Rev Rheumatol 2018[2]Danieli. Subcutaneous IgG in the Myositis Spectrum Disorders. Curr Rheumatol Rev. 2018.[3]Wasserman. Recombinant human hyaluronidase-facilitated subcutaneous infusion of human immunoglobulins for primary immunodeficiency. JACI.2012.[4]Lundberg. 2017 European League Against Rheumatism/American College of Rheumatology classification criteria for adult and juvenile idiopathic inflammatory myopathies and their major subgroups. ARD. 2017Table 1.Effectiveness and safety of hf-ScIG treatment in a cohort of patients with IIMhf-ScIg beginning3 months6 monthsN patients with available follow-up data2320 *19*MRC score §4 (3-4)4 (4-5)4 (3-5)Creatine kinase, U/L §134 (44-243)118 (77-308)130 (84-222)ESR, mm/h §21 (15-28)30 (25-43)31 (23-39)CRP, mg/dl §0.2 (0.1-0.5)0.3 (0.1-0.5)0.3 (0.1-0.3)Prednisolone dosage, mg/day §5 (4-12.5)7.5 (5-10)5 (5-7.5)Adverse events-NA1 ***none discontinued**One infusion site reaction§ median value (IQR)CRP=C reactive protein; ESR=erythrocyte sedimentation rateDisclosure of InterestsNone declared
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Gastaldi M, Mariotto S, Giannoccaro MP, Iorio R, Zoccarato M, Nosadini M, Benedetti L, Casagrande S, Di Filippo M, Valeriani M, Ricci S, Bova S, Arbasino C, Mauri M, Versino M, Vigevano F, Papetti L, Romoli M, Lapucci C, Massa F, Sartori S, Zuliani L, Barilaro A, De Gaspari P, Spagni G, Evoli A, Liguori R, Ferrari S, Marchioni E, Giometto B, Massacesi L, Franciotta D. Subgroup comparison according to clinical phenotype and serostatus in autoimmune encephalitis: a multicenter retrospective study. Eur J Neurol 2020; 27:633-643. [PMID: 31814224 DOI: 10.1111/ene.14139] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [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: 07/31/2019] [Accepted: 12/03/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Autoimmune encephalitides (AE) include a spectrum of neurological disorders whose diagnosis revolves around the detection of neuronal antibodies (Abs). Consensus-based diagnostic criteria (AE-DC) allow clinic-serological subgrouping of AE, with unclear prognostic implications. The impact of AE-DC on patients' management was studied, focusing on the subgroup of Ab-negative-AE. METHODS This was a retrospective multicenter study on patients fulfilling AE-DC. All patients underwent Ab testing with commercial cell-based assays (CBAs) and, when available, in-house assays (immunohistochemistry, live/fixed CBAs, neuronal cultures) that contributed to defining final categories. Patients were classified as Ab-positive-AE [N-methyl-d-aspartate-receptor encephalitis (NMDAR-E), Ab-positive limbic encephalitis (LE), definite-AE] or Ab-negative-AE (Ab-negative-LE, probable-AE, possible-AE). RESULTS Commercial CBAs detected neuronal Abs in 70/118 (59.3%) patients. Testing 37/48 Ab-negative cases, in-house assays identified Abs in 11 patients (29.7%). A hundred and eighteen patients fulfilled the AE-DC, 81 (68.6%) with Ab-positive-AE (Ab-positive-LE, 40; NMDAR-E, 32; definite-AE, nine) and 37 (31.4%) with Ab-negative-AE (Ab-negative-LE, 17; probable/possible-AE, 20). Clinical phenotypes were similar in Ab-positive-LE versus Ab-negative-LE. Twenty-four/118 (20.3%) patients had tumors, and 19/118 (16.1%) relapsed, regardless of being Ab-positive or Ab-negative. Ab-positive-AE patients were treated earlier than Ab-negative-AE patients (P = 0.045), responded more frequently to treatments (92.3% vs. 65.6%, P < 0.001) and received second-line therapies more often (33.3% vs. 10.8%, P = 0.01). Delays in first-line therapy initiation were associated with poor response (P = 0.022; odds ratio 1.02; confidence interval 1.00-1.04). CONCLUSIONS In-house diagnostics improved Ab detection allowing better patient management but was available in a patient subgroup only, implying possible Ab-positive-AE underestimation. Notwithstanding this limitation, our findings suggest that Ab-negative-AE and Ab-positive-AE patients share similar oncological profiles, warranting appropriate tumor screening. Ab-negative-AE patients risk worse responses due to delayed and less aggressive treatments.
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Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Mariotto
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - M P Giannoccaro
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - R Iorio
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - M Zoccarato
- Ospedale S. Antonio, AULSS Euganea, Padua, Italy.,Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - M Nosadini
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Benedetti
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Casagrande
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - M Di Filippo
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy
| | - M Valeriani
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - S Ricci
- Ospedale 'Città-di-Castello-e-Branca', Italy
| | - S Bova
- Pediatric Neurology Unit, ASST Fatebenefratelli Sacco, Children Hospital Vittore Buzzi, Milan, Italy
| | | | - M Mauri
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - M Versino
- Neurology and Stroke Unit, Insubria University, Varese, Italy
| | - F Vigevano
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - L Papetti
- Neurology Unit, Bambino Gesù Children Hospital, Rome, Italy
| | - M Romoli
- Neurology Clinic, S. Maria della Misericordia Hospital, Perugia University, Perugia, Italy.,Neurology Unit, Rimini "Infermi" Hospital - AUSL Romagna, Rimini, Italy
| | - C Lapucci
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - F Massa
- IRCCS Ospedale Policlinico S. Martino, Genoa, Italy
| | - S Sartori
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Paediatric Neurology and Neurophysiology Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - L Zuliani
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy.,Neurology Department, Ospedale S. Bortolo, Vicenza, Italy
| | - A Barilaro
- Careggi University Hospital, Florence, Italy
| | - P De Gaspari
- Neuroimmunology Group, Paediatric Research Institute "Città della Speranza", Padua, Italy
| | - G Spagni
- Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - A Evoli
- Istituto di Neurologia, Fondazione Policlinico Universitario 'Agostino Gemelli' IRCCS, Rome, Italy.,Universita' Cattolica del Sacro Cuore, Rome, Italy
| | - R Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,UOC Clinica Neurologica, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - S Ferrari
- Neurology Unit, Department of Neuroscience, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - E Marchioni
- Neuroncology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | | | - L Massacesi
- Neurosciences Department, Florence University, Italy.,Careggi University Hospital, Florence, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Paganini I, Sestini R, Capone G, Putignano A, Contini E, Giotti I, Gensini F, Marozza A, Barilaro A, Porfirio B, Papi L. A novel PAX1
null homozygous mutation in autosomal recessive otofaciocervical syndrome associated with severe combined immunodeficiency. Clin Genet 2017; 92:664-668. [DOI: 10.1111/cge.13085] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 06/21/2017] [Accepted: 06/23/2017] [Indexed: 11/27/2022]
Affiliation(s)
- I. Paganini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
| | - R. Sestini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
| | - G.L. Capone
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
| | - A.L. Putignano
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
| | - E. Contini
- Diagnostic Genetics Unit; Careggi University Hospital; Florence Italy
| | - I. Giotti
- Diagnostic Genetics Unit; Careggi University Hospital; Florence Italy
| | - F. Gensini
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
| | - A. Marozza
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
- Medical Genetics Unit; Careggi University Hospital; Florence Italy
| | - A. Barilaro
- Neurology Unit; Careggi University Hospital; Florence Italy
| | - B. Porfirio
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
| | - L. Papi
- Department of Experimental and Clinical Biomedical Sciences “Mario Serio,” Medical Genetics Unit; University of Florence; Florence Italy
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Mancardi GL, Sormani MP, Di Gioia M, Vuolo L, Gualandi F, Amato MP, Capello E, Currò D, Uccelli A, Bertolotto A, Gasperini C, Lugaresi A, Merelli E, Meucci G, Motti L, Tola MR, Scarpini E, Repice AM, Massacesi L, Saccardi R, Bosi A, Guidi S, Bagigalupo A, Bonzano L, Bruzzi P, Roccatagliata L, Antenucci R, Granella F, Martino G, Rottoli M, Solaro C, Salvi F, Barilaro A, Capobianco M. Autologous haematopoietic stem cell transplantation with an intermediate intensity conditioning regimen in multiple sclerosis: the Italian multi-centre experience. Mult Scler 2011; 18:835-42. [PMID: 22127896 DOI: 10.1177/1352458511429320] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Over recent years numerous patients with severe forms of multiple sclerosis (MS) refractory to conventional therapies have been treated with intense immunosuppression followed by autologous haematopoietic stem cell transplantation (AHSCT). The clinical outcome and the toxicity of AHSCT can be diverse, depending on the various types of conditioning protocols and on the disease phase. OBJECTIVES To report the Italian experience on all the consecutive patients with MS treated with AHSCT with an intermediate intensity conditioning regimen, named BEAM/ATG, in the period from 1996 to 2008. METHODS Clinical and magnetic resonance imaging outcomes of 74 patients were collected after a median follow-up period of 48.3 (range = 0.8-126) months. RESULTS Two patients (2.7%) died from transplant-related causes. After 5 years, 66% of patients remained stable or improved. Among patients with a follow-up longer than 1 year, eight out of 25 subjects with a relapsing-remitting course (31%) had a 6-12 months confirmed Expanded Disability Status Scale improvement > 1 point after AHSCT as compared with one out of 36 (3%) patients with a secondary progressive disease course (p = 0.009). Among the 18 cases with a follow-up longer than 7 years, eight (44%) remained stable or had a sustained improvement while 10 (56%), after an initial period of stabilization or improvement with median duration of 3.5 years, showed a slow disability progression. CONCLUSIONS This study shows that AHSCT with a BEAM/ATG conditioning regimen has a sustained effect in suppressing disease progression in aggressive MS cases unresponsive to conventional therapies. It can also cause a sustained clinical improvement, especially if treated subjects are still in the relapsing-remitting phase of the disease.
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Affiliation(s)
- G L Mancardi
- Department of Neuroscience, Ophthalmology and Genetics, University of Genoa, Genoa, Italy
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Matà S, Borsini W, Ambrosini S, Toscani L, Barilaro A, Piacentini S, Sorbi S, Lolli F. IgM monoclonal gammopathy-associated neuropathies with different IgM specificity. Eur J Neurol 2011; 18:1067-73. [PMID: 21261794 DOI: 10.1111/j.1468-1331.2010.03345.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND PURPOSE Antibodies directed against myelin-associated glycoprotein (MAG) are believed to be the most frequent biologic marker of the neuropathies associated with IgM monoclonal gammopathy of undetermined significance (MGUS). The objective of this study was to examine the prevalence of antiganglioside and/or sulfatide-positive patients and their clinical findings, including therapeutic response, compared to anti-MAG-positive or seronegative patients. METHODS We prospectively followed 46 patients with MGUS who were diagnosed in our tertiary referral centers for polyneuropathy since 1997. All patients underwent nerve conduction studies and were tested for anti-MAG, gangliosides, and sulfatide antibodies. All the anagraphic and clinical data (including symptoms, disability scale, therapy, secondary malignancy development) were recorded in a database and compared between three patients' groups (anti-MAG-positive; antiganglioside/sulfatide-positive; no reactivity). RESULTS Anti-MAG reactivity was present in 17 (37%) patients; other 17 patients (37%) had antiganglioside/sulfatide reactivity and 12 (26%) had no reactivity. Patients with antiganglioside/sulfatide positivity, although heterogeneous by a clinical and neurophysiological point of view, had the most severe neuropathic manifestations and a higher disability score at nadir (P < 0.001). These patients had a better response to both intravenous immunoglobulin therapy and rituximab. CONCLUSIONS Our results suggest that antiganglioside/sulfatide-positive patients form a relevant portion of patients with MGUS-associated polyneuropathy seen in tertiary care centers and should be considered in future studies on treatment response.
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Affiliation(s)
- S Matà
- Neurology Department, University Hospital of Careggi, Firenze Neurology Department, S.M. Annunziata Hospital, Firenze, Italy.
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