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Luo Z, Wang J, Zhou Y, Mao Q, Lang B, Xu S. Workplace bullying and suicidal ideation and behaviour: a systematic review and meta-analysis. Public Health 2023; 222:166-174. [PMID: 37544128 DOI: 10.1016/j.puhe.2023.07.007] [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: 12/15/2022] [Revised: 06/11/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Suicidal ideation and behaviour are potential outcomes of workplace bullying. This review aimed to determine the extent of the association between workplace bullying and suicidal ideation and behaviour. STUDY DESIGN The study incorporated a systematic review and meta-analysis. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement was followed to conduct a comprehensive systematic review and meta-analysis. A combination of subject terms and free words was used to search nine electronic databases. Two reviewers independently screened articles and extracted information according to the inclusion criteria. A meta-analysis was performed with averaged weighted correlations across samples using the STATA software (version 16.0) from pooled estimates of the main results from all studies. RESULTS In total, 25 articles of high or medium quality were included in the systematic review; 15 of these were included in the meta-analysis. The prevalence of suicidal ideation and behaviour was 18% and 4%, respectively. Individuals who experienced workplace bullying had 2.03-times and 2.67-times higher odds of reporting suicidal ideation and behaviour, respectively, after adjustment for confounding factors. Moderating and mediating factors may help reduce the risk of suicidal ideation and behaviour for individuals experiencing workplace bullying. CONCLUSION This study indicated that exposure to workplace bullying significantly increased the risk of suicidal ideation and behaviour.
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Affiliation(s)
- Z Luo
- Hospital of Chengdu Office of People's Government of Tibetan Autonomous Region (West China Hospital Sichuan University Tibet Chengdu Branch Hospital), No. 20 Ximianqiao Hengjie, Chengdu 610041, China.
| | - J Wang
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Y Zhou
- College of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 610041, China
| | - Q Mao
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
| | - B Lang
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
| | - S Xu
- Hospital of Chengdu University of Traditional Chinese Medicine, No. 39, Shierqiao Road, Jinniu District, Chengdu 6100752, China
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Hintze J, Lang B, Subramaniam T, Kruseman N, O'Regan E, Brennan S, Lennon P. Factors influencing nodal yield in neck dissections for head and neck malignancies. J Laryngol Otol 2023; 137:925-929. [PMID: 36651334 DOI: 10.1017/s0022215122002687] [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: 01/19/2023]
Abstract
OBJECTIVE A standard lateral neck dissection should yield at least 18 lymph nodes. The goal of the present study was to examine what factors might influence the number of lymph nodes retrieved during a neck dissection. METHODS This was a retrospective cohort study in a tertiary academic referral centre for head and neck oncology. Two hundred and nineteen consecutive neck dissections were examined. Age of the patient and primary site were recorded, along with tumour histology, previous radiotherapy and final nodal count. RESULTS The mean age was 62.2 ± 13.0 years. The most common primary site was the oral cavity (38.8 per cent). The mean number of lymph nodes was 30.63 ± 13.9. In total, 17.8 per cent had undergone previous radiotherapy. The mean number of lymph nodes was 33.26 ± 13.27 in patients with no previous radiation exposure and 18.47 ± 9.46 in those with previous radiation treatment. CONCLUSION Lymph node yield from a neck dissection is likely multi-factorial in nature. Previous radiotherapy, the only significant contributor, led to a mean reduction of lymph node yield from 33.3 to 18.5.
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Affiliation(s)
- J Hintze
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - B Lang
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - T Subramaniam
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - N Kruseman
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - E O'Regan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Histopathology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - S Brennan
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Department of Radiation Oncology, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
| | - P Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James's Hospital, Dublin, Ireland
- Trinity College Dublin, University of Dublin, Ireland
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Smitherman EA, Chahine RA, Beukelman T, Lewandowski LB, Rahman AKMF, Wenderfer SE, Curtis JR, Hersh AO, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar‐Smiley F, Barillas‐Arias L, Basiaga M, Baszis K, Becker M, Bell‐Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang‐Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel‐Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie‐Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui‐Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein‐Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PM, McGuire S, McHale I, McMonagle A, McMullen‐Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O'Brien B, O'Brien T, Okeke O, Oliver M, Olson J, O'Neil K, Onel K, Orandi A, Orlando M, Osei‐Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan‐Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas‐Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth‐Wojcicki E, Rouster – Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert‐Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner‐Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Childhood-Onset Lupus Nephritis in the Childhood Arthritis and Rheumatology Research Alliance Registry: Short-Term Kidney Status and Variation in Care. Arthritis Care Res (Hoboken) 2023; 75:1553-1562. [PMID: 36775844 PMCID: PMC10500561 DOI: 10.1002/acr.25002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 07/14/2022] [Accepted: 08/16/2022] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The goal was to characterize short-term kidney status and describe variation in early care utilization in a multicenter cohort of patients with childhood-onset systemic lupus erythematosus (cSLE) and nephritis. METHODS We analyzed previously collected prospective data from North American patients with cSLE with kidney biopsy-proven nephritis enrolled in the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry from March 2017 through December 2019. We determined the proportion of patients with abnormal kidney status at the most recent registry visit and applied generalized linear mixed models to identify associated factors. We also calculated frequency of medication use, both during induction and ever recorded. RESULTS We identified 222 patients with kidney biopsy-proven nephritis, with 64% class III/IV nephritis on initial biopsy. At the most recent registry visit at median (interquartile range) of 17 (8-29) months from initial kidney biopsy, 58 of 106 patients (55%) with available data had abnormal kidney status. This finding was associated with male sex (odds ratio [OR] 3.88, 95% confidence interval [95% CI] 1.21-12.46) and age at cSLE diagnosis (OR 1.23, 95% CI 1.01-1.49). Patients with class IV nephritis were more likely than class III to receive cyclophosphamide and rituximab during induction. There was substantial variation in mycophenolate, cyclophosphamide, and rituximab ever use patterns across rheumatology centers. CONCLUSION In this cohort with predominately class III/IV nephritis, male sex and older age at cSLE diagnosis were associated with abnormal short-term kidney status. We also observed substantial variation in contemporary medication use for pediatric lupus nephritis between pediatric rheumatology centers. Additional studies are needed to better understand the impact of this variation on long-term kidney outcomes.
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Glantschnigg-Eisl U, Klang A, Kneissl S, Lang B, Waters P, Irani SR, Binks SNM, Pakozdy A. A feline model of spontaneously occurring autoimmune limbic encephalitis. Vet J 2023; 296-297:105974. [PMID: 36958405 DOI: 10.1016/j.tvjl.2023.105974] [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: 02/25/2022] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
Autoimmune encephalitis (AE) is an important cause of encephalitis in humans and occurs at a similar rate to infectious encephalitis. It is frequently associated with antibodies against the extracellular domain of neuronal proteins. Among human AE, that with antibodies against leucine-rich glioma-inactivated 1 (LGI1) is one of the most prevalent forms, and was recently described in cats with limbic encephalitis (LE). In this study, we describe a large cohort (n = 32) of cats with AE, tested positive for voltage gated potassium channel (VGKC)-antibodies, of which 26 (81%) harboured LGI1-antibodies. We delineate their clinical and paraclinical features as well as long-term outcomes up to 5 years. Similar to human cases, most cats with LGI1-antibodies had a history of focal seizures (83%), clustering in the majority (88%), with interictal behavioural changes (73%). Among feline AE patients, there was no seizure type or other clinical characteristic that could distinguish LGI1-antibody positive from negative cats, unlike the pathognomic faciobrachial dystonic seizures seen in humans. Although six cats were euthanased in the first year for epilepsy-associated reasons, those attaining at least 1-year survival had good seizure control and quality of life with appropriate veterinary care and medication. Acute-phase immunotherapy (prednisolone) was given to the most severely unwell cases and its effect is retrospectively evaluated in 10 cats. Our data show LGI1-antibodies are an important cause of feline encephalitis, sharing many features with human AE. Further research should examine optimal therapeutic management strategies and the cause of LE in seronegative cats, building on paradigms established in the counterpart human disease.
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Affiliation(s)
- U Glantschnigg-Eisl
- Clinic for Small Animals, Internal Medicine, University of Veterinary Medicine Vienna, Austria.
| | - A Klang
- Institute for Pathology and Forensic Veterinary Medicine, Universitiy of Veterinary Medicine Vienna, Austria
| | - S Kneissl
- Diagnostic Imaging, University of Veterinary Medicine Vienna, Austria
| | - B Lang
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK
| | - P Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK
| | - S R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK
| | - S N M Binks
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, OX3 9DU, UK; Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals Foundation Trust, Oxford OX3 9DU, UK
| | - A Pakozdy
- Clinic for Small Animals, Internal Medicine, University of Veterinary Medicine Vienna, Austria
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Juhl R, Birnbaum B, Barnes A, Gibson W, Mullapudi B, Lang B, Faseler M, Heble D, Urban V, Fischer R, Gannon J, Sutcliffe D. A Metabolic, Mechanical, Multi-Organ Masterpiece: Durable Device Support Bridge to Heart-Liver Transplantation in Propionic Acidemia. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Hahn T, Daymont C, Beukelman T, Groh B, Hays K, Bingham CA, Scalzi L, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Intraarticular steroids as DMARD-sparing agents for juvenile idiopathic arthritis flares: Analysis of the Childhood Arthritis and Rheumatology Research Alliance Registry. Pediatr Rheumatol Online J 2022; 20:107. [PMID: 36434731 PMCID: PMC9701017 DOI: 10.1186/s12969-022-00770-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/08/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Children with juvenile idiopathic arthritis (JIA) who achieve a drug free remission often experience a flare of their disease requiring either intraarticular steroids (IAS) or systemic treatment with disease modifying anti-rheumatic drugs (DMARDs). IAS offer an opportunity to recapture disease control and avoid exposure to side effects from systemic immunosuppression. We examined a cohort of patients treated with IAS after drug free remission and report the probability of restarting systemic treatment within 12 months. METHODS We analyzed a cohort of patients from the Childhood Arthritis and Rheumatology Research Alliance (CARRA) Registry who received IAS for a flare after a period of drug free remission. Historical factors and clinical characteristics and of the patients including data obtained at the time of treatment were analyzed. RESULTS We identified 46 patients who met the inclusion criteria. Of those with follow up data available 49% had restarted systemic treatment 6 months after IAS injection and 70% had restarted systemic treatment at 12 months. The proportion of patients with prior use of a biologic DMARD was the only factor that differed between patients who restarted systemic treatment those who did not, both at 6 months (79% vs 35%, p < 0.01) and 12 months (81% vs 33%, p < 0.05). CONCLUSION While IAS are an option for all patients who flare after drug free remission, it may not prevent the need to restart systemic treatment. Prior use of a biologic DMARD may predict lack of success for IAS. Those who previously received methotrexate only, on the other hand, are excellent candidates for IAS.
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Affiliation(s)
- Timothy Hahn
- Department of Pediatrics, Penn State Children's Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA, 17033-0855, USA.
| | - Carrie Daymont
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Timothy Beukelman
- grid.265892.20000000106344187Department of Pediatrics, University of Alabama at Birmingham, CPPN G10, 1600 7th Ave South, Birmingham, AL 35233 USA
| | - Brandt Groh
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | | | - Catherine April Bingham
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
| | - Lisabeth Scalzi
- grid.240473.60000 0004 0543 9901Department of Pediatrics, Penn State Children’s Hospital, 500 University Dr, Hershey, 90 Hope Drive, P.O. Box 855, Hershey, PA 17033-0855 USA
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Kostick-Quenet K, Blumenthal-Barby J, Mehra M, Lang B, Dorfman N, Bhimaraj A, Civitello A, Jorde U, Trachtenberg B, Uriel N, Kaplan H, Gilmore-Szott E, Volk R, Estep J. Integrating Personalized Risk Scores in Decision Making About Left Ventricular Assist Device (LVAD) Therapy: Clinician and Patient Perspectives. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.1714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Soulsby WD, Balmuri N, Cooley V, Gerber LM, Lawson E, Goodman S, Onel K, Mehta B, Abel N, Abulaban K, Adams A, Adams M, Agbayani R, Aiello J, Akoghlanian S, Alejandro C, Allenspach E, Alperin R, Alpizar M, Amarilyo G, Ambler W, Anderson E, Ardoin S, Armendariz S, Baker E, Balboni I, Balevic S, Ballenger L, Ballinger S, Balmuri N, Barbar-Smiley F, Barillas-Arias L, Basiaga M, Baszis K, Becker M, Bell-Brunson H, Beltz E, Benham H, Benseler S, Bernal W, Beukelman T, Bigley T, Binstadt B, Black C, Blakley M, Bohnsack J, Boland J, Boneparth A, Bowman S, Bracaglia C, Brooks E, Brothers M, Brown A, Brunner H, Buckley M, Buckley M, Bukulmez H, Bullock D, Cameron B, Canna S, Cannon L, Carper P, Cartwright V, Cassidy E, Cerracchio L, Chalom E, Chang J, Chang-Hoftman A, Chauhan V, Chira P, Chinn T, Chundru K, Clairman H, Co D, Confair A, Conlon H, Connor R, Cooper A, Cooper J, Cooper S, Correll C, Corvalan R, Costanzo D, Cron R, Curiel-Duran L, Curington T, Curry M, Dalrymple A, Davis A, Davis C, Davis C, Davis T, De Benedetti F, De Ranieri D, Dean J, Dedeoglu F, DeGuzman M, Delnay N, Dempsey V, DeSantis E, Dickson T, Dingle J, Donaldson B, Dorsey E, Dover S, Dowling J, Drew J, Driest K, Du Q, Duarte K, Durkee D, Duverger E, Dvergsten J, Eberhard A, Eckert M, Ede K, Edelheit B, Edens C, Edens C, Edgerly Y, Elder M, Ervin B, Fadrhonc S, Failing C, Fair D, Falcon M, Favier L, Federici S, Feldman B, Fennell J, Ferguson I, Ferguson P, Ferreira B, Ferrucho R, Fields K, Finkel T, Fitzgerald M, Fleming C, Flynn O, Fogel L, Fox E, Fox M, Franco L, Freeman M, Fritz K, Froese S, Fuhlbrigge R, Fuller J, George N, Gerhold K, Gerstbacher D, Gilbert M, Gillispie-Taylor M, Giverc E, Godiwala C, Goh I, Goheer H, Goldsmith D, Gotschlich E, Gotte A, Gottlieb B, Gracia C, Graham T, Grevich S, Griffin T, Griswold J, Grom A, Guevara M, Guittar P, Guzman M, Hager M, Hahn T, Halyabar O, Hammelev E, Hance M, Hanson A, Harel L, Haro S, Harris J, Harry O, Hartigan E, Hausmann J, Hay A, Hayward K, Heiart J, Hekl K, Henderson L, Henrickson M, Hersh A, Hickey K, Hill P, Hillyer S, Hiraki L, Hiskey M, Hobday P, Hoffart C, Holland M, Hollander M, Hong S, Horwitz M, Hsu J, Huber A, Huggins J, Hui-Yuen J, Hung C, Huntington J, Huttenlocher A, Ibarra M, Imundo L, Inman C, Insalaco A, Jackson A, Jackson S, James K, Janow G, Jaquith J, Jared S, Johnson N, Jones J, Jones J, Jones J, Jones K, Jones S, Joshi S, Jung L, Justice C, Justiniano A, Karan N, Kaufman K, Kemp A, Kessler E, Khalsa U, Kienzle B, Kim S, Kimura Y, Kingsbury D, Kitcharoensakkul M, Klausmeier T, Klein K, Klein-Gitelman M, Kompelien B, Kosikowski A, Kovalick L, Kracker J, Kramer S, Kremer C, Lai J, Lam J, Lang B, Lapidus S, Lapin B, Lasky A, Latham D, Lawson E, Laxer R, Lee P, Lee P, Lee T, Lentini L, Lerman M, Levy D, Li S, Lieberman S, Lim L, Lin C, Ling N, Lingis M, Lo M, Lovell D, Lowman D, Luca N, Lvovich S, Madison C, Madison J, Manzoni SM, Malla B, Maller J, Malloy M, Mannion M, Manos C, Marques L, Martyniuk A, Mason T, Mathus S, McAllister L, McCarthy K, McConnell K, McCormick E, McCurdy D, Stokes PMC, McGuire S, McHale I, McMonagle A, McMullen-Jackson C, Meidan E, Mellins E, Mendoza E, Mercado R, Merritt A, Michalowski L, Miettunen P, Miller M, Milojevic D, Mirizio E, Misajon E, Mitchell M, Modica R, Mohan S, Moore K, Moorthy L, Morgan S, Dewitt EM, Moss C, Moussa T, Mruk V, Murphy A, Muscal E, Nadler R, Nahal B, Nanda K, Nasah N, Nassi L, Nativ S, Natter M, Neely J, Nelson B, Newhall L, Ng L, Nicholas J, Nicolai R, Nigrovic P, Nocton J, Nolan B, Oberle E, Obispo B, O’Brien B, O’Brien T, Okeke O, Oliver M, Olson J, O’Neil K, Onel K, Orandi A, Orlando M, Osei-Onomah S, Oz R, Pagano E, Paller A, Pan N, Panupattanapong S, Pardeo M, Paredes J, Parsons A, Patel J, Pentakota K, Pepmueller P, Pfeiffer T, Phillippi K, Marafon DP, Phillippi K, Ponder L, Pooni R, Prahalad S, Pratt S, Protopapas S, Puplava B, Quach J, Quinlan-Waters M, Rabinovich C, Radhakrishna S, Rafko J, Raisian J, Rakestraw A, Ramirez C, Ramsay E, Ramsey S, Randell R, Reed A, Reed A, Reed A, Reid H, Remmel K, Repp A, Reyes A, Richmond A, Riebschleger M, Ringold S, Riordan M, Riskalla M, Ritter M, Rivas-Chacon R, Robinson A, Rodela E, Rodriquez M, Rojas K, Ronis T, Rosenkranz M, Rosolowski B, Rothermel H, Rothman D, Roth-Wojcicki E, Rouster-Stevens K, Rubinstein T, Ruth N, Saad N, Sabbagh S, Sacco E, Sadun R, Sandborg C, Sanni A, Santiago L, Sarkissian A, Savani S, Scalzi L, Schanberg L, Scharnhorst S, Schikler K, Schlefman A, Schmeling H, Schmidt K, Schmitt E, Schneider R, Schollaert-Fitch K, Schulert G, Seay T, Seper C, Shalen J, Sheets R, Shelly A, Shenoi S, Shergill K, Shirley J, Shishov M, Shivers C, Silverman E, Singer N, Sivaraman V, Sletten J, Smith A, Smith C, Smith J, Smith J, Smitherman E, Soep J, Son M, Spence S, Spiegel L, Spitznagle J, Sran R, Srinivasalu H, Stapp H, Steigerwald K, Rakovchik YS, Stern S, Stevens A, Stevens B, Stevenson R, Stewart K, Stingl C, Stokes J, Stoll M, Stringer E, Sule S, Sumner J, Sundel R, Sutter M, Syed R, Syverson G, Szymanski A, Taber S, Tal R, Tambralli A, Taneja A, Tanner T, Tapani S, Tarshish G, Tarvin S, Tate L, Taxter A, Taylor J, Terry M, Tesher M, Thatayatikom A, Thomas B, Tiffany K, Ting T, Tipp A, Toib D, Torok K, Toruner C, Tory H, Toth M, Tse S, Tubwell V, Twilt M, Uriguen S, Valcarcel T, Van Mater H, Vannoy L, Varghese C, Vasquez N, Vazzana K, Vehe R, Veiga K, Velez J, Verbsky J, Vilar G, Volpe N, von Scheven E, Vora S, Wagner J, Wagner-Weiner L, Wahezi D, Waite H, Walker J, Walters H, Muskardin TW, Waqar L, Waterfield M, Watson M, Watts A, Weiser P, Weiss J, Weiss P, Wershba E, White A, Williams C, Wise A, Woo J, Woolnough L, Wright T, Wu E, Yalcindag A, Yee M, Yen E, Yeung R, Yomogida K, Yu Q, Zapata R, Zartoshti A, Zeft A, Zeft R, Zhang Y, Zhao Y, Zhu A, Zic C. Social determinants of health influence disease activity and functional disability in Polyarticular Juvenile Idiopathic Arthritis. Pediatr Rheumatol Online J 2022; 20:18. [PMID: 35255941 PMCID: PMC8903717 DOI: 10.1186/s12969-022-00676-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Social determinants of health (SDH) greatly influence outcomes during the first year of treatment in rheumatoid arthritis, a disease similar to polyarticular juvenile idiopathic arthritis (pJIA). We investigated the correlation of community poverty level and other SDH with the persistence of moderate to severe disease activity and functional disability over the first year of treatment in pJIA patients enrolled in the Childhood Arthritis and Rheumatology Research Alliance Registry. METHODS In this cohort study, unadjusted and adjusted generalized linear mixed effects models analyzed the effect of community poverty and other SDH on disease activity, using the clinical Juvenile Arthritis Disease Activity Score-10, and disability, using the Child Health Assessment Questionnaire, measured at baseline, 6, and 12 months. RESULTS One thousand six hundred eighty-four patients were identified. High community poverty (≥20% living below the federal poverty level) was associated with increased odds of functional disability (OR 1.82, 95% CI 1.28-2.60) but was not statistically significant after adjustment (aOR 1.23, 95% CI 0.81-1.86) and was not associated with increased disease activity. Non-white race/ethnicity was associated with higher disease activity (aOR 2.48, 95% CI: 1.41-4.36). Lower self-reported household income was associated with higher disease activity and persistent functional disability. Public insurance (aOR 1.56, 95% CI 1.06-2.29) and low family education (aOR 1.89, 95% CI 1.14-3.12) was associated with persistent functional disability. CONCLUSION High community poverty level was associated with persistent functional disability in unadjusted analysis but not with persistent moderate to high disease activity. Race/ethnicity and other SDH were associated with persistent disease activity and functional disability.
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Affiliation(s)
- William Daniel Soulsby
- University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA, 94158, USA.
| | - Nayimisha Balmuri
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Victoria Cooley
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Linda M. Gerber
- grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Erica Lawson
- grid.266102.10000 0001 2297 6811University of California, San Francisco, 550 16th Street, 4th Floor, Box #0632, San Francisco, CA 94158 USA
| | - Susan Goodman
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Karen Onel
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
| | - Bella Mehta
- grid.239915.50000 0001 2285 8823Hospital for Special Surgery, New York, NY USA ,grid.5386.8000000041936877XWeill Cornell Medicine, New York, NY USA
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Maddison P, Lang B, Thomsen S, Moloney TC, Gozzard P, Chapman CJ, Barnard V, Ferry B, Vincent A. Prospective study of cancer survival in patients with HuD-antibody-associated paraneoplastic neurological disorders. J Neurol Neurosurg Psychiatry 2021; 92:1350-1351. [PMID: 33785578 DOI: 10.1136/jnnp-2021-326067] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/17/2021] [Accepted: 03/08/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Paul Maddison
- Department of Neurology, Nottingham University Hospitals NHS Trust, Nottingham, Nottingham, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Selina Thomsen
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Teresa C Moloney
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Paul Gozzard
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK
| | - Caroline J Chapman
- Department of Pathology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham, UK
| | - Victoria Barnard
- Clinical Laboratory Immunology, Churchill Hospital, Oxford, Oxfordshire, UK
| | - Berne Ferry
- Clinical Laboratory Immunology, Churchill Hospital, Oxford, Oxfordshire, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurosciences, Weatherall Institute of Molecular Medicine, Oxford, Oxfordshire, UK
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Kavanagh FG, James DL, Brinkman D, Cornyn S, Murphy C, O'Neill S, O'Shea R, Affendi A, Lang B, O'Connor A, Keogh I, Lang E, Russell J, O'Brien D, Sheahan P. Safety of elective paediatric surgery during the coronavirus disease 2019 pandemic. Int J Pediatr Otorhinolaryngol 2021; 150:110861. [PMID: 34583300 PMCID: PMC8349430 DOI: 10.1016/j.ijporl.2021.110861] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 07/12/2021] [Accepted: 07/27/2021] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Corona-virus Disease 2019 (COVID-19) has had a huge impact on the delivery of healthcare worldwide, particularly elective surgery. There is a lack of data regarding risk of postoperative COVID-19 infection in children undergoing elective surgery, and regarding the utility of pre-operative COVID-19 testing, and preoperative "cocooning" or restriction of movements. The purpose of this present study was to examine the safety of elective paediatric Otolaryngology surgery during the COVID-19 pandemic with respect to incidence of postoperative symptomatic COVID-19 infection or major respiratory complications. MATERIALS AND METHODS Prospective cohort study of paediatric patients undergoing elective Otolaryngology surgery between September and December 2020. Primary outcome measure was incidence of symptomatic COVID-19 or major respiratory complications within the 14 days after surgery. Parents of prospectively enrolled patients were contacted 14 days after surgery and enquiry made regarding development of postoperative symptoms, COVID-19 testing, or diagnosis of COVID-19. RESULTS 302 patients were recruited. 125 (41.4%) underwent preoperative COVID-19 RT-PCR testing. 66 (21.8%) restricted movements prior to surgery. The peak 14-day COVID-19 incidence during the study was 302.9 cases per 100,000 population. No COVID-19 infections or major respiratory complications were reported in the 14 day follow-up period. CONCLUSION The results of our study support the safety of elective paediatric Otolaryngology surgery during the pandemic, in the setting of community incidence not exceeding that observed during the study period.
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Affiliation(s)
- F G Kavanagh
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland; Institute of Research, Royal College of Surgeons in Ireland, 121 St. Stephens Green, Dublin, Ireland.
| | - D L James
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - D Brinkman
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Waterford, Waterford, Ireland
| | - S Cornyn
- Department of Otolaryngology, Children's Health Ireland @ Temple Street, Temple Street, Dublin 1, Ireland
| | - C Murphy
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
| | - S O'Neill
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
| | - R O'Shea
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - A Affendi
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - B Lang
- Department of Otolaryngology, Children's Health Ireland @ Crumlin, Cooley Road, Dublin 12, Ireland
| | - A O'Connor
- Department of Otolaryngology, Children's Health Ireland @ Temple Street, Temple Street, Dublin 1, Ireland
| | - I Keogh
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Ireland
| | - E Lang
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Waterford, Waterford, Ireland
| | - J Russell
- Department of Otolaryngology, Children's Health Ireland @ Crumlin, Cooley Road, Dublin 12, Ireland
| | - D O'Brien
- Department of Microbiology, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland
| | - P Sheahan
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Old Blackrock Road, Cork, Ireland; ENTO Research Unit, College of Medicine and Health, University College Cork, College Road, Cork, Ireland; Department of Surgery, University College Cork, College Road, Cork, Ireland
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11
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Urriola N, Lang B, Adelstein S. Evaluation of commercially available antibodies and fluorescent conotoxins for the detection of surface ganglionic acetylcholine receptor on the neuroblastoma cell line, IMR-32 by flow cytometry. J Immunol Methods 2021; 498:113124. [PMID: 34425081 DOI: 10.1016/j.jim.2021.113124] [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: 07/12/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
Commercially available antibodies that bind to the human muscle acetylcholine receptor (ACHR) have been validated previously for flow cytometric use (Keefe et al., 2009; Leite et al., 2008; Lozier et al., 2015). Despite a multitude of commercially available antibodies to other nicotinic ACHRs, validation in a wide variety of immunoassay formats is lacking; when studied, a large proportion of these antibodies have been deemed not fit for most research purposes (Garg and Loring, 2017). We have recently described a flow cytometric immunomodulation assay for the diagnosis of Autoimmune Autonomic Ganglionopathy (AAG) (Urriola et al., 2021) that utilises the monoclonal antibody mab35(Urriola et al., 2021) which is specific for ganglionic ACHR (gnACHR) that contain α3 subunits (Vernino et al., 1998). Other fluorescent ligands for α3-gnACHR have not been validated for flow cytometric use. We investigated 7 commercially sourced antibodies and 3 synthetic fluorescent novel conotoxins purported to specifically bind to the extracellular domains of the gnACHR, and compared the results to staining by mab35, using flow cytometry with the neuroblastoma cell line IMR-32. We also evaluated the degree of non-specific binding by depleting the cell membrane of the relevant acetylcholine receptor with a pre-incubation step involving the serum from a patient with Autoimmune Autonomic Ganglionopathy containing pathogenic antibodies to the ganglionic acetylcholine receptor. None of the assessed conotoxins, and only one antibody (mab35) was found to perform adequately in flow cytometric staining of the native ganglionic acetylcholine receptor.
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Affiliation(s)
- Nicolás Urriola
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, UK
| | - Stephen Adelstein
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia; Central Sydney Immunopathology Laboratory, NSW Health Pathology, Australia
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12
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Kavanagh FG, Brinkman D, James DL, O’Neill S, Murphy C, O’Riordan I, O’Flanagan G, Lang B, Keogh I, Lang E, Casserly P, Russell J, O’Brien D, Sheahan P. Outcomes of preoperative real-time polymerase chain reaction testing for SARS CoV-2 in elective otolaryngology surgical patients during the pandemic: a prospective cohort study. Br J Surg 2021; 108:znab266. [PMID: 34426824 PMCID: PMC8499765 DOI: 10.1093/bjs/znab266] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/22/2021] [Indexed: 11/29/2022]
Abstract
Real-time polymerase chain reaction (RT-PCR) is used to rule out SARS-CoV-2 prior to surgery, however few studies have evaluated patients with negative testing after surgery. Some 499 patients with negative tests were followed for 14 days after surgery, 39 were retested but none developed positive RT-PCR after operation. The risk of developing a positive RT-PCR after surgery was 0.74 per cent.
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Affiliation(s)
- F G Kavanagh
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
- Institute of Research, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - D Brinkman
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
| | - D L James
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
| | - S O’Neill
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Republic of Ireland
| | - C Murphy
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Republic of Ireland
| | - I O’Riordan
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland
| | - G O’Flanagan
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland
| | - B Lang
- Department of Otolaryngology, Children’s Health Ireland @ Crumlin, Dublin, Republic of Ireland
| | - I Keogh
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Galway, Galway, Republic of Ireland
| | - E Lang
- Department of Otolaryngology, Head and Neck Surgery, University Hospital Waterford, Waterford, Republic of Ireland
| | - P Casserly
- Department of Otolaryngology, Royal Victoria Eye and Ear Hospital, Dublin, Republic of Ireland
| | - J Russell
- Department of Otolaryngology, Children’s Health Ireland @ Crumlin, Dublin, Republic of Ireland
| | - D O’Brien
- Department of Microbiology, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
| | | | - P Sheahan
- Department of Otolaryngology, Head and Neck Surgery, South Infirmary Victoria University Hospital, Cork, Republic of Ireland
- ENTO Research Unit, College of Medicine and Health, University College Cork, Cork, Republic of Ireland
- Department of Surgery, University College Cork, Cork, Republic of Ireland
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13
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Urriola N, Spies JM, Blazek K, Lang B, Adelstein S. A Flow Cytometric Assay to Detect Functional Ganglionic Acetylcholine Receptor Antibodies by Immunomodulation in Autoimmune Autonomic Ganglionopathy. Front Immunol 2021; 12:705292. [PMID: 34249013 PMCID: PMC8261233 DOI: 10.3389/fimmu.2021.705292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 05/05/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022] Open
Abstract
Autoimmune Autonomic Ganglionopathy (AAG) is an uncommon immune-mediated neurological disease that results in failure of autonomic function and is associated with autoantibodies directed against the ganglionic acetylcholine receptor (gnACHR). The antibodies are routinely detected by immunoprecipitation assays, such as radioimmunoassays (RIA), although these assays do not detect all patients with AAG and may yield false positive results. Autoantibodies against the gnACHR exert pathology by receptor modulation. Flow cytometric analysis is able to determine if this has occurred, in contrast to the assays in current use that rely on immunoprecipitation. Here, we describe the first high-throughput, non-radioactive flow cytometric assay to determine autoantibody mediated gnACHR immunomodulation. Previously identified gnACHR antibody seronegative and seropositive sera samples (RIA confirmed) were blinded and obtained from the Oxford Neuroimmunology group along with samples collected locally from patients with or without AAG. All samples were assessed for the ability to cause gnACHR immunomodulation utilizing the prototypical gnACHR expressing cell line, IMR-32. Decision limits were calculated from healthy controls, and Receiver Operating Characteristic (ROC) curves were constructed after unblinding all samples. One hundred and ninety serum samples were analyzed; all 182 expected negative samples (from healthy controls, autonomic disorders not thought to be AAG, other neurological disorders without autonomic dysfunction and patients with Systemic Lupus Erythematosus) were negative for immunomodulation (<18%), as were the RIA negative AAG and unconfirmed AAG samples. All RIA positive samples displayed significant immunomodulation. There were no false positive or negative samples. There was perfect qualitative concordance as compared to RIA, with an Area Under ROC of 1. Detection of Immunomodulation by flow cytometry for the identification of gnACHR autoantibodies offers excellent concordance with the gnACHR antibody RIA, and overcomes many of the shortcomings of immunoprecipitation assays by directly measuring the pathological effects of these autoantibodies at the cellular level. Further work is needed to determine the correlation between the degree of immunomodulation and disease severity.
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Affiliation(s)
- Nicolás Urriola
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Judith M Spies
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Katrina Blazek
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Sydney, NSW, Australia
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Stephen Adelstein
- Department of Clinical Immunology and Allergy, Royal Prince Alfred Hospital, Sydney, NSW, Australia.,Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Central Sydney Immunopathology Laboratory, NSW Health Pathology, Sydney, NSW, Australia
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14
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McGinty RN, Handel A, Moloney T, Ramesh A, Fower A, Torzillo E, Kramer H, Howell S, Waters P, Adcock J, Sen A, Lang B, Irani SR. Clinical features which predict neuronal surface autoantibodies in new-onset focal epilepsy: implications for immunotherapies. J Neurol Neurosurg Psychiatry 2021; 92:291-294. [PMID: 33219046 PMCID: PMC7892387 DOI: 10.1136/jnnp-2020-325011] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/28/2020] [Accepted: 10/08/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To generate a score which clinically identifies surface-directed autoantibodies in adults with new-onset focal epilepsy, and evaluate the value of immunotherapy in this clinical setting. METHODS Prospective clinical and autoantibody evaluations in a cohort of 219 consecutive patients with new-onset focal epilepsy. RESULTS 10.5% (23/219) of people with new-onset focal epilepsy had detectable serum autoantibodies to known or novel cell surface antigenic targets. 9/23 with autoantibodies were diagnosed with encephalitis, by contrast to 0/196 without autoantibodies (p<0.0001). Multivariate analysis identified six features which predicted autoantibody positivity (area under the curve=0.83): age ≥54 years, ictal piloerection, lowered self-reported mood, reduced attention, MRI limbic system changes and the absence of conventional epilepsy risk factors. 11/14 (79%) patients with detectable autoantibodies, but without encephalitis, showed excellent long-term outcomes (modified Rankin Score=0) despite no immunotherapy. These outcomes were superior to those of immunotherapy-treated patients with confirmed autoantibody-mediated encephalitis (p<0.05). CONCLUSIONS Seizure semiology, cognitive and mood phenotypes, alongside inflammatory investigation findings, aid the identification of surface autoantibodies among unselected people with new-onset focal epilepsy. The excellent immunotherapy-independent outcomes of autoantibody-positive patients without encephalitis suggests immunotherapy administration should be guided by clinical features of encephalitis, rather than autoantibody positivity. Our findings suggest that, in this cohort, immunotherapy-responsive seizure syndromes with autoantibodies largely fall under the umbrella of autoimmune encephalitis.
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Affiliation(s)
- Ronan N McGinty
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Adam Handel
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Teresa Moloney
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Archana Ramesh
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Andrew Fower
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Emma Torzillo
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Holger Kramer
- MRC London Institute of Medical Sciences, Imperial College, London, UK
| | - Stephen Howell
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, The University of Sheffield, Sheffield, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Jane Adcock
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Arjune Sen
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Bethan Lang
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK .,Department of Neurology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
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15
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Koay S, Vichayanrat E, Bremner F, Panicker JN, Lang B, Lunn MP, Watson L, Ingle GT, Hagen EM, McNamara P, Jacobson L, Provitera V, Nolano M, Vincent A, Mathias CJ, Iodice V. Multimodal Biomarkers Quantify Recovery in Autoimmune Autonomic Ganglionopathy. Ann Neurol 2021; 89:753-768. [PMID: 33438240 DOI: 10.1002/ana.26018] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 01/06/2021] [Accepted: 01/08/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate patients with ganglionic acetylcholine receptor antibody (gAChR-Ab) positive autoimmune autonomic ganglionopathy using a multimodal testing protocol to characterize their full clinical phenotype and explore biomarkers to quantify immunotherapy response. METHODS We conducted a cohort study of 13 individuals (7 women, 21-69 years of age) with autonomic failure and gAChR-Ab >100 pM identified between 2005 and 2019. From 2018, all patients were longitudinally assessed with cardiovascular, pupillary, urinary, sudomotor, lacrimal and salivary testing, and Composite Autonomic Symptom Score (COMPASS-31) autonomic symptom questionnaires. The orthostatic intolerance ratio was calculated by dividing change in systolic blood pressure over time tolerated on head-up tilt. Eleven patients received immunotherapy. RESULTS At first assessment, all 13 patients had cardiovascular and pupillary impairments, 7 of 8 had postganglionic sudomotor dysfunction, 9 of 11 had urinary retention and xeropthalmia, and 6 of 8 had xerostomia. After immunotherapy, there were significant improvements in orthostatic intolerance ratio (33.3 [17.8-61.3] to 5.2 [1.4-8.2], p = 0.007), heart rate response to deep breathing (1.5 [0.0-3.3] to 4.5 [3.0-6.3], p = 0.02), pupillary constriction to light (12.0 [5.5-18.0] to 19.0 [10.6-23.8]%, p = 0.02), saliva production (0.01 [0.01-0.05] to 0.08 [0.02-0.20] g/min, p = 0.03), and COMPASS-31 scores (52 to 17, p = 0.03). Orthostatic intolerance ratio correlated with autonomic symptoms at baseline (r = 0.841, p = 0.01) and following immunotherapy (r = 0.889, p = 0.02). Immunofluorescence analyses of skin samples from a patient 32 years after disease onset showed loss of nerve fibers supplying the dermal autonomic adnexa and epidermis, with clear improvements following immunotherapy. INTERPRETATION Patients with autoimmune autonomic ganglionopathy demonstrated objective evidence of widespread sympathetic and parasympathetic autonomic failure, with significant improvements after immunotherapy. Quantitative autonomic biomarkers should be used to define initial deficits, guide therapeutic decisions, and document treatment response. ANN NEUROL 2021;89:753-768.
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Affiliation(s)
- Shiwen Koay
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Ekawat Vichayanrat
- Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Fion Bremner
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Neuro-Ophthalmology Department, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Jalesh N Panicker
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Department of Uro-Neurology, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK
| | - Michael P Lunn
- Neuroimmunology Unit, University College London Queen Square Institute of Neurology, London, UK.,MRC Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Laura Watson
- Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Gordon T Ingle
- Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Ellen Merete Hagen
- Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Patricia McNamara
- Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK
| | - Vincenzo Provitera
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Maria Nolano
- Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy.,Department of Neurosciences, Reproductive Sciences and Odontostomatology, University Federico II of Naples, Naples, Italy
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, Oxford University, John Radcliffe Hospital, Oxford, UK.,Neurology Department, Skin Biopsy Laboratory, Istituti Clinici Scientifici Maugeri IRCCS, Telese Terme, Italy
| | - Christopher J Mathias
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Autonomic and Neurovascular Medicine Centre, Hospital of St. John and St. Elizabeth, London, UK
| | - Valeria Iodice
- Department of Brain, Repair and Rehabilitation, University College London Queen Square Institute of Neurology, London, UK.,Autonomic Unit, The National Hospital for Neurology and Neurosurgery, London, UK
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16
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Hintze JM, Fitzgerald C, Lang B, O'Shea J, Barry C, Brennan S, Lennon P. Tracheostomy stomal seeding following oral cavity resection. Oral Oncol 2020; 115:105097. [PMID: 33229202 DOI: 10.1016/j.oraloncology.2020.105097] [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: 11/06/2020] [Accepted: 11/08/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Tracheal stoma recurrence following oral cavity surgery is exceedingly rare. Although several different mechanisms for this have been described, the pathogenesis still remains uncertain. METHODS We present the case of a gentleman who presented 6-months following oral cavity SCC resection with a large fungating mass at his previous tracheostomy site, and also review the reported literature on this rare phenomenon. RESULTS Four weeks after diagnosis of his recurrence he underwent a total laryngectomy, wide-local skin excision and reconstruction with a pectoralis major pedicled flap. He recovered well initially following his operation, however unfortunately contracted nosocomial SARS-Cov2 and succumbed from respiratory complications during his post-operative recovery. CONCLUSION Stomal recurrence after temporary tracheostomy for oral cavity malignancies are very rare. Previously reported management of these can vary from surgical to palliative treatment. Methods to prevent these include delaying tracheostomy until after surgical resection, packing the pharynx during resection and adjuvant radiotherapy.
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Affiliation(s)
- J M Hintze
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland.
| | - C Fitzgerald
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland
| | - B Lang
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland
| | - J O'Shea
- Trinity College, University of Dublin, Dublin, Ireland; Department of Radiation Oncology, St James Hospital, Dublin, Ireland
| | - C Barry
- Royal College of Surgeons in Ireland, Ireland; Trinity College, University of Dublin, Dublin, Ireland; Department of Maxillofacial Surgery, St James Hospital, Dublin, Ireland
| | - S Brennan
- Trinity College, University of Dublin, Dublin, Ireland; Department of Radiation Oncology, St James Hospital, Dublin, Ireland
| | - P Lennon
- Department of Otolaryngology - Head and Neck Surgery, St James Hospital, Dublin, Ireland; Trinity College, University of Dublin, Dublin, Ireland
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17
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Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 emerged in December 2019 in Wuhan, China, and was declared a global health emergency of international concern by the World Health Organization on 30th January 2020. It has resulted in almost 600 000 deaths to date worldwide. Sudden sensorineural hearing loss is a known complication of a number of viral infections, but there is little in the literature to date on its association with coronavirus disease 2019. CASE REPORT This paper presents the case of a 30-year-old female staff nurse who contracted coronavirus disease 2019 and presented to our department with a significant unilateral sensorineural hearing loss confirmed on audiogram. She was treated with a course of oral steroids, but unfortunately there was no improvement in her hearing. CONCLUSION This case report is important as it highlights the importance of having a low index of suspicion when patients present with a variety of symptoms not previously associated with coronavirus disease 2019. The paper also discusses the controversy surrounding the use of steroids in the management of this disease.
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Affiliation(s)
- B Lang
- Department of Otorhinolaryngology and Head and Neck Surgery, St James University Hospital, Dublin, Ireland
| | - J Hintze
- Department of Otorhinolaryngology and Head and Neck Surgery, St James University Hospital, Dublin, Ireland
| | - B Conlon
- Department of Otorhinolaryngology and Head and Neck Surgery, St James University Hospital, Dublin, Ireland
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18
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Carvajal-González A, Jacobson L, Clover L, Wickremaratchi M, Shields S, Lang B, Vincent A. Systemic delivery of human GlyR IgG antibody induces GlyR internalization into motor neurons of brainstem and spinal cord with motor dysfunction in mice. Neuropathol Appl Neurobiol 2020; 47:316-327. [PMID: 32910464 PMCID: PMC7873718 DOI: 10.1111/nan.12666] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 05/05/2020] [Accepted: 08/22/2020] [Indexed: 01/24/2023]
Abstract
Aims Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a life‐threatening condition often associated with highly raised serum antibodies to glycine receptors (GlyRs); these bind to the surface of large neurons and interneurons in rodent brain and spinal cord sections and, in vitro, inhibit function and reduce surface expression of the GlyRs. The effects in vivo have not been reported. Methods Purified plasma IgG from a GlyR antibody‐positive patient with PERM, and a healthy control (HC), was injected daily into the peritoneal cavity of mice for 12 days; lipopolysaccharide (LPS) to open the blood–brain barrier, was injected on days 3 and 8. Based on preliminary data, behavioural tests were only performed 48 h post‐LPS on days 5–7 and 10–12. Results The GlyR IgG injected mice showed impaired ability on the rotarod from days 5 to 10 but this normalized by day 12. There were no other behavioural differences but, at termination (d13), the GlyR IgG‐injected mice had IgG deposits on the neurons that express GlyRs in the brainstem and spinal cord. The IgG was not only on the surface but also inside these large GlyR expressing neurons, which continued to express surface GlyR. Conclusions Despite the partial clinical phenotype, not uncommon in passive transfer studies, the results suggest that the antibodies had accessed the GlyRs in relevant brain regions, led to antibody‐mediated internalization and increased GlyR synthesis, compatible with the temporary loss of function.
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Affiliation(s)
- A Carvajal-González
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - L Jacobson
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - L Clover
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - M Wickremaratchi
- Hurstwood Park Neurological Centre, Brighton and Sussex University Hospitals NHS Trust, West Sussex, UK
| | - S Shields
- Neurosciences Department, Taunton and Somerset NS Foundation Trust, Musgrove Park Hospital, Taunton, UK
| | - B Lang
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
| | - A Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK
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19
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Symonds JD, Moloney TC, Lang B, McLellan A, O'Regan ME, MacLeod S, Jollands A, Vincent A, Kirkpatrick M, Brunklaus A, Shetty J, Dorris L, Forbes K, Abu-Arafeh I, Andrew J, Brink P, Callaghan M, Cruden J, Findlay C, Grattan R, MacDonnell J, McKnight J, Morrison CA, Nairn L, Pilley E, Stephen E, Thomsen S, Webb A, Wilson M, Zuberi SM. Neuronal antibody prevalence in children with seizures under 3 years: A prospective national cohort. Neurology 2020; 95:e1590-e1598. [PMID: 32690789 DOI: 10.1212/wnl.0000000000010318] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 03/30/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report the prevalence of anti-neuronal antibodies in a prospective whole-nation cohort of children presenting with seizures before their third birthday. METHODS This was a prospective population-based national cohort study involving all children presenting with new-onset epilepsy or complex febrile seizures before their third birthday over a 3-year period. Patients with previously identified structural, metabolic, or infectious cause for seizures were excluded. Serum samples were obtained at first presentation and tested for 7 neuronal antibodies using live cell-based assays. Clinical data were collected with structured proformas at recruitment and 24 months after presentation. In addition, patients with seizures and clinically suspected autoimmune encephalitis were independently identified by a review of the case records of all children <3 years of age in Scotland who had undergone EEG. RESULTS Two hundred ninety-eight patients were identified and recruited and underwent autoantibody testing. Antibody positivity was identified in 18 of 298 (6.0%). The antibodies identified were GABA receptor B (n = 8, 2.7%), contactin-associated protein 2 (n = 4, 1.3%), glycine receptor (n = 3, 1.0%), leucine-rich glioma inactivated 1 (n = 2, 0.7%), NMDA receptor (n = 1, 0.3%), and GABA receptor A (n = 1, 0.3%). None of these patients had a clinical picture of autoimmune encephalitis. Seizure classification and clinical phenotype did not correlate with antibody positivity. CONCLUSIONS Autoimmune encephalitis is very rare in early childhood. However serum neuronal antibodies are identified in 6.4% of children presenting with seizures at <3 years of age. Antibody testing should not be a routine clinical test in early childhood-onset epilepsy because, in the absence of other features of autoimmune encephalitis, antibody positivity is of doubtful clinical significance. Antibody testing should be reserved for patients with additional features of encephalitis.
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Affiliation(s)
- Joseph D Symonds
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Teresa C Moloney
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Bethan Lang
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Ailsa McLellan
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Mary E O'Regan
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Stewart MacLeod
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Alice Jollands
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Angela Vincent
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Martin Kirkpatrick
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Andreas Brunklaus
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Jayakara Shetty
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Liam Dorris
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Kirsten Forbes
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Ishaq Abu-Arafeh
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Jamie Andrew
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Philip Brink
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Mary Callaghan
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Jamie Cruden
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Christine Findlay
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Rosemary Grattan
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Jane MacDonnell
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Jean McKnight
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Calum A Morrison
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Lesley Nairn
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Elizabeth Pilley
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Elma Stephen
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Selina Thomsen
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Alan Webb
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Margaret Wilson
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK
| | - Sameer M Zuberi
- From the Paediatric Neurosciences Research Group (J.D.S., M.E.O., S.M., A.B., L.D., M.W., S.M.Z.), Royal Hospital for Children; College of Medical, Veterinary & Life Sciences (J.D.S., A.B., L.D., S.M.Z.), University of Glasgow; Nuffield Department of Clinical Neurosciences (T.C.M., B.L., A.V., S.T.), John Radcliffe Hospital, Oxford; Department of Paediatric Neurosciences (A.M., J.S.), Royal Hospital for Sick Children, Edinburgh; Paediatric Neurology (A.J., M.K., P.B., E.P.), Tayside Children's Hospital, Dundee; Neuroradiology (K.F.), Queen Elizabeth University Hospitals, Glasgow; Department of Paediatrics (I.A.-A., R.G.), Forth Valley Royal Hospital, Larbert; Department of Paediatrics (J.A., M.C.), University Hospital Wishaw; Department of Paediatrics (J.C.), Victoria Hospital, Kirkcaldy; Department of Paediatrics (C.F., C.A.M.), University Hospital Crosshouse, Kilmarnock; Department of Paediatrics (J. MacDonnell), Borders General Hospital, Melrose; Department of Paediatrics (J. McKnight), Dumfries and Galloway Royal Infirmary; Department of Paediatrics (L.N.), Royal Alexandra Hospital, Paisley; Paediatric Neurology (E.S.), Royal Aberdeen Children's Hospital; and Department of Paediatrics (A.W.), Raigmore Hospital, Inverness, UK.
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20
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Breitegger P, Schweighofer B, Wegleiter H, Knoll M, Lang B, Bergmann A. Towards low-cost QEPAS sensors for nitrogen dioxide detection. Photoacoustics 2020; 18:100169. [PMID: 32309133 PMCID: PMC7155225 DOI: 10.1016/j.pacs.2020.100169] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 01/07/2020] [Accepted: 01/14/2020] [Indexed: 05/09/2023]
Abstract
Increasing awareness of the adverse health effects of air pollution leads to a demand of low-cost sensors for the measurement of pollutants such as NO2. However, commercially available low-cost sensors lack accuracy and long-term stability, and suffer from cross-sensitivity to other gases. These drawbacks can be overcome by the method of quartz-enhanced photoacoustic spectroscopy (QEPAS). In QEPAS modulated light is absorbed by the NO2 molecules, which results in the production of a sound wave. The sound wave is detected by resonance of a quartz tuning fork, which results in a measurable electric signal. Due to the small size of the tuning forks, the gas sensing element can be smaller than 1 cm3. We present the first bare fork QEPAS setup for the ppb-level detection of NO2, which is ideally suited for environmental trace gas detection without the need of using micro-resonators. Micro-resonators are commonly used to amplify photoacoustic signals. However, micro-resonators have different dependencies on environmental conditions than tuning forks, which makes them difficult to operate in changing conditions. In contrast, our bare fork QEPAS setup is more robust and easily adopted by the use of a low-cost temperature and humidity sensor. By using acoustic filters the integration time could be increased to offer higher sensitivity at a continuous flow rate of 200 std cm3 min-1. The 1σ noise equivalent concentration is determined to 21 ppb NO2 in synthetic air for 120 s measurement time, allowing detection which satisfies international health and safety standards thresholds.
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Affiliation(s)
- P Breitegger
- Institute of Electrical Measurement and Sensor Systems, Graz University of Technology, 8010 Graz, Austria
| | - B Schweighofer
- Institute of Electrical Measurement and Sensor Systems, Graz University of Technology, 8010 Graz, Austria
| | - H Wegleiter
- Institute of Electrical Measurement and Sensor Systems, Graz University of Technology, 8010 Graz, Austria
| | - M Knoll
- Institute of Electrical Measurement and Sensor Systems, Graz University of Technology, 8010 Graz, Austria
| | - B Lang
- Institute of Electrical Measurement and Sensor Systems, Graz University of Technology, 8010 Graz, Austria
| | - A Bergmann
- Institute of Electrical Measurement and Sensor Systems, Graz University of Technology, 8010 Graz, Austria
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21
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Symonds JD, Zuberi SM, Stewart K, McLellan A, O'Regan M, MacLeod S, Jollands A, Joss S, Kirkpatrick M, Brunklaus A, Pilz DT, Shetty J, Dorris L, Abu-Arafeh I, Andrew J, Brink P, Callaghan M, Cruden J, Diver LA, Findlay C, Gardiner S, Grattan R, Lang B, MacDonnell J, McKnight J, Morrison CA, Nairn L, Slean MM, Stephen E, Webb A, Vincent A, Wilson M. Incidence and phenotypes of childhood-onset genetic epilepsies: a prospective population-based national cohort. Brain 2020; 142:2303-2318. [PMID: 31302675 PMCID: PMC6658850 DOI: 10.1093/brain/awz195] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [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: 09/15/2018] [Revised: 04/19/2019] [Accepted: 05/06/2019] [Indexed: 01/24/2023] Open
Abstract
Epilepsy is common in early childhood. In this age group it is associated with high rates of therapy-resistance, and with cognitive, motor, and behavioural comorbidity. A large number of genes, with wide ranging functions, are implicated in its aetiology, especially in those with therapy-resistant seizures. Identifying the more common single-gene epilepsies will aid in targeting resources, the prioritization of diagnostic testing and development of precision therapy. Previous studies of genetic testing in epilepsy have not been prospective and population-based. Therefore, the population-incidence of common genetic epilepsies remains unknown. The objective of this study was to describe the incidence and phenotypic spectrum of the most common single-gene epilepsies in young children, and to calculate what proportion are amenable to precision therapy. This was a prospective national epidemiological cohort study. All children presenting with epilepsy before 36 months of age were eligible. Children presenting with recurrent prolonged (>10 min) febrile seizures; febrile or afebrile status epilepticus (>30 min); or with clusters of two or more febrile or afebrile seizures within a 24-h period were also eligible. Participants were recruited from all 20 regional paediatric departments and four tertiary children’s hospitals in Scotland over a 3-year period. DNA samples were tested on a custom-designed 104-gene epilepsy panel. Detailed clinical information was systematically gathered at initial presentation and during follow-up. Clinical and genetic data were reviewed by a multidisciplinary team of clinicians and genetic scientists. The pathogenic significance of the genetic variants was assessed in accordance with the guidelines of UK Association of Clinical Genetic Science (ACGS). Of the 343 patients who met inclusion criteria, 333 completed genetic testing, and 80/333 (24%) had a diagnostic genetic finding. The overall estimated annual incidence of single-gene epilepsies in this well-defined population was 1 per 2120 live births (47.2/100 000; 95% confidence interval 36.9–57.5). PRRT2 was the most common single-gene epilepsy with an incidence of 1 per 9970 live births (10.0/100 000; 95% confidence interval 5.26–14.8) followed by SCN1A: 1 per 12 200 (8.26/100 000; 95% confidence interval 3.93–12.6); KCNQ2: 1 per 17 000 (5.89/100 000; 95% confidence interval 2.24–9.56) and SLC2A1: 1 per 24 300 (4.13/100 000; 95% confidence interval 1.07–7.19). Presentation before the age of 6 months, and presentation with afebrile focal seizures were significantly associated with genetic diagnosis. Single-gene disorders accounted for a quarter of the seizure disorders in this cohort. Genetic testing is recommended to identify children who may benefit from precision treatment and should be mainstream practice in early childhood onset epilepsy.
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Affiliation(s)
- Joseph D Symonds
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Sameer M Zuberi
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Kirsty Stewart
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospitals, Glasgow, UK
| | - Ailsa McLellan
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, UK
| | - Mary O'Regan
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Stewart MacLeod
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
| | - Alice Jollands
- Paediatric Neurology, Tayside Children's Hospital, Dundee, UK
| | - Shelagh Joss
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospitals, Glasgow, UK
| | | | - Andreas Brunklaus
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Daniela T Pilz
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospitals, Glasgow, UK
| | - Jay Shetty
- Department of Paediatric Neurosciences, Royal Hospital for Sick Children, Sciennes Road, Edinburgh, UK
| | - Liam Dorris
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK.,College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Ishaq Abu-Arafeh
- Department of Paediatrics, Forth Valley Royal Hospital, Larbert, UK
| | - Jamie Andrew
- Department of Paediatrics, University Hospital Wishaw, Netherton Street, Wishaw, UK
| | - Philip Brink
- Paediatric Neurology, Tayside Children's Hospital, Dundee, UK
| | - Mary Callaghan
- Department of Paediatrics, University Hospital Wishaw, Netherton Street, Wishaw, UK
| | - Jamie Cruden
- Department of Paediatrics, Victoria Hospital, Kirkcaldy, UK
| | - Louise A Diver
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospitals, Glasgow, UK
| | - Christine Findlay
- Department of Paediatrics, University Hospital Crosshouse, Kilmarnock, UK
| | - Sarah Gardiner
- West of Scotland Regional Genetics Service, Queen Elizabeth University Hospitals, Glasgow, UK
| | - Rosemary Grattan
- Department of Paediatrics, Forth Valley Royal Hospital, Larbert, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Jane MacDonnell
- Department of Paediatrics, Borders General Hospital, Melrose, UK
| | - Jean McKnight
- Department of Paediatrics, Dumfries and Galloway Royal Infirmary, Dumfries, UK
| | - Calum A Morrison
- Department of Paediatrics, University Hospital Crosshouse, Kilmarnock, UK
| | - Lesley Nairn
- Department of Paediatrics, Royal Alexandra Hospital, Paisley, UK
| | - Meghan M Slean
- College of Medical, Veterinary and Life Sciences, University of Glasgow, UK
| | - Elma Stephen
- Department of Paediatrics, Royal Aberdeen Children's Hospital, Aberdeen, UK
| | - Alan Webb
- Department of Paediatrics, Raigmore Hospital, Inverness, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, Level 6, West Wing, John Radcliffe Hospital, Oxford, UK
| | - Margaret Wilson
- Paediatric Neurosciences Research Group, Royal Hospital for Children, Glasgow, UK
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22
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Maddison P, Gozzard P, Sadalage G, Ambrose PA, Chapman CJ, Murray A, Thomsen S, Berretta A, Lang B. Neuronal antibody detection and improved lung cancer prediction in Lambert-Eaton myasthenic syndrome. J Neuroimmunol 2020; 340:577149. [PMID: 31951874 DOI: 10.1016/j.jneuroim.2020.577149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 12/11/2019] [Revised: 01/09/2020] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
Since approximately 50% of patients with Lambert-Eaton myasthenic syndrome (LEMS) subsequently develop small-cell lung cancer (SCLC), it is important to be able to predict cancer occurrence in these patients at neurological presentation. We aimed to determine whether circulating biomarkers were effective and objective predictors of cancer development in LEMS. We found that the presence of either SOX2, N-type voltage gated calcium channel or GABAb antibodies at LEMS diagnosis was highly sensitive (84%) and specific (87%) for the detection of SCLC. Screening for SOX2 and neuronal antibodies is a useful adjunct to clinical predictive scoring tools in predicting SCLC in LEMS.
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Affiliation(s)
- Paul Maddison
- Department of Neurology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK.
| | - Paul Gozzard
- Department of Neurology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield S10 2JF, UK
| | - Girija Sadalage
- Division of Neurology, University of Nottingham, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Philip A Ambrose
- Division of Neurology, University of Nottingham, Nottingham University Hospitals NHS Trust, Queens Medical Centre, Nottingham, UK
| | - Caroline J Chapman
- Department of Pathology, Nottingham University Hospitals NHS Trust, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | | | - Selina Thomsen
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Antonio Berretta
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford OX3 9DS, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, West Wing, John Radcliffe Hospital, Oxford OX3 9DS, UK
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23
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Vincent A, Pettingill P, Pettingill R, Lang B, Birch R, Waters P, Irani SR, Buckley C, Watanabe O, Arimura K, Kiernan MC. Association of Leucine-Rich Glioma Inactivated Protein 1, Contactin-Associated Protein 2, and Contactin 2 Antibodies With Clinical Features and Patient-Reported Pain in Acquired Neuromyotonia. JAMA Neurol 2019; 75:1519-1527. [PMID: 30242309 PMCID: PMC6583195 DOI: 10.1001/jamaneurol.2018.2681] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Questions Which specific targets of voltage-gated potassium channel–complex antibodies are found in acquired neuromyotonia, and are these antibodies associated with additional clinical features of tumors, pain, or autonomic or central disorders? Findings This cohort study combined with a patient-led survey found that antibodies to the extracellular aspects of leucine-rich glioma inactivated protein, contactin-associated protein 2, and contactin 2 were variably present in 45% of patients with neuromyotonia. Paresthesia and various pain manifestations were common in neuromyotonia, and the type and severity of pain were found to exert a substantial influence on quality of life. Meaning Antibodies to voltage-gated potassium channel–complex proteins are not found in all patients with neuromyotonia and do not individually relate to specific clinical features, but the presence of pain and its effects on quality of life need greater recognition. Importance Although acquired autoimmune neuromyotonia (NMT) is associated with voltage-gated potassium channel (VGKC)–complex antibodies, to date there has been no systematic study of autoantibodies to the specific antigens leucine-rich glioma inactivated protein 1 (LGI1), contactin-associated protein 2 (CASPR2), and contactin 2 together with the full clinical syndrome, particularly pain and autonomic and central nervous system involvement. Objectives To study the full spectrum of clinical features and serum autoantibodies in patients with NMT, including the effects of pain on quality of life. Design, Setting, and Participants A cohort study of clinical features and serologic testing in 38 patients with electrophysiologically-confirmed NMT, reviewed clinically between February 2007 and August 2009, in the Universities of Sydney and Kagoshima and followed up across 2 to 4 years. Association of NMT with quality of life was researched in an independent, patient-led, online pain survey conducted from April 2012 to May 2012. Serologic analyses were performed in 2012, and final data analysis was performed in 2016. Main Outcomes and Measures Clinical data and scores on the modified Rankin Scale (mRS), which measures disability on a range of 0 to 6, with 0 indicating normal and 6 indicating death, before and after treatments were combined with CASPR2, LGI1, and contactin 2 antibody status. Results Among the 38-person NMT cohort, 25 (65.8%) were male and the median (range) age was 55 (12-85) years. Twenty-three (60.5%) were Japanese and 15 (39.5%) were of white race/ethnicity. Symptomatic treatments (mainly antiepileptic drugs) were used in most patients with mild disease (12 patients with mRS <3), whereas immunotherapies were successful in most patients with mRS scores greater than 2. Autoantibodies to VGKC-complex antigens (17 patients [45%]), bound to CASPR2 (5 [13%]), contactin 2 (5 patients, 1 with CASPR2 [13%]), LGI1 (2 [5%]), or both LGI1 and CASPR2 (6 [16%]). The last group of 6 patients had high mRS scores (mean [SD], 3.8 [1.7]), thymoma (4 patients), pain (5 patients), autonomic (6 patients) and sleep (5 patients) disturbance, suggesting Morvan syndrome. The 56 responders to the independent patient-led survey reported pain that could be severe, anatomically widespread, and that often resulted in unemployment, domestic problems, and poor quality of life. Conclusions and Relevance The cohort study detailed underrecognized aspects of the clinical and serologic spectrum of NMT. The heterogeneity of clinical features and of specific antibodies limit associations, but the common existence of thymoma, pain, and autonomic and central nervous system features, often with both LGI1 and CASPR2 antibodies, should be better recognized to more completely address the range of comorbidities and consequences of the disease regarding quality of life.
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Affiliation(s)
- Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Philippa Pettingill
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Rosie Pettingill
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Ron Birch
- Patient representative, Highland Park, Gold Coast, Australia
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Camilla Buckley
- Nuffield Department of Clinical Neurosciences, University of Oxford, John Radcliffe Hospital, Oxford, United Kingdom
| | - Osamu Watanabe
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kimiyoshi Arimura
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Matthew C Kiernan
- Brain and Mind Centre, University of Sydney, Sydney, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, Australia
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Baum P, Visvanathan S, Bossert S, Lang B, Schmid R, Garcet S, Padula S, Bachelez H, Thoma C, Krueger J. LB1140 Treatment with BI 655130, an anti-interleukin-36 receptor antibody, in patients with generalized pustular psoriasis, is associated with the downregulation of biomarkers linked to innate, Th1/Th17, and neutrophilic pathways. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.06.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baum P, Visvanathan S, Bossert S, Lang B, Schmid R, Garcet S, Padula S, Bachelez H, Thoma C, Krueger J. 388 Treatment with spesolimab, an anti-interleukin-36 receptor antibody, in patients with generalized pustular psoriasis, is associated with the downregulation of biomarkers linked to innate, Th1/17 and neutrophilic pathways. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.07.390] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ring A, Lang B, Kazaroho C, Labes D, Schall R, Schütz H. Sample size determination in bioequivalence studies using statistical assurance. Br J Clin Pharmacol 2019; 85:2369-2377. [PMID: 31276603 DOI: 10.1111/bcp.14055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 12/10/2018] [Revised: 05/28/2019] [Accepted: 06/03/2019] [Indexed: 12/20/2022] Open
Abstract
AIMS Bioequivalence (BE) trials aim to demonstrate that the 90% confidence interval of the T/R-ratio of the pharmacokinetic metrics between two formulations (test [T] and reference [R]) of a drug is fully included in the acceptance interval [0.80, 1.25]. Traditionally, the sample size of BE trials is based on a power calculation based on the intrasubject variability coefficient of variation (CV) and the T/R-ratio of the metrics. Since the exact value of the T/R-ratio is not known prior to the trial, it is often assumed that the difference between the treatments does not exceed 5%. Hence, uncertainty about the T/R-ratio is expressed by using a fixed value for the sample size calculation. We propose to characterise the uncertainty about the T/R-ratio by a (normal) distribution for the log(T/R-ratio), with an assumed mean of log θ = 0.00 (i.e. θ = 1.00) and a standard deviation σu , which quantifies the uncertainty. Evaluating this distribution leads to the statistical assurance of the BE trial. METHODS The assurance of a clinical trial can be derived by integrating the power over the distribution of the input parameters, in this case, the assumed distribution of the log(T/R)-ratio. Because it is an average power, the assurance can be interpreted as a measure of the probability of success that does not depend on a specific assumed value for the log(T/R)-ratio. The relationship between power and assurance will be analysed by comparing the numerical outcomes. RESULTS Using the assurance concept, values of the standard deviation for the distribution of potential log(T/R)-ratios can be chosen to reflect the magnitude of uncertainty. For most practical cases (i.e. when 0.95 ≤ θ ≤ 1.05), the sample size is not, or only slightly, changed when σ = |log(θ)|. CONCLUSION The advantage of deriving the assurance for BE trials is that uncertainty is directly expressed as a parameter of variability.
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Affiliation(s)
- A Ring
- University of the Free State, Bloemfontein, South Africa.,medac, Wedel, Germany
| | - B Lang
- Boehringer Ingelheim, Biberach, Germany
| | | | | | - R Schall
- University of the Free State, Bloemfontein, South Africa.,IQVIA Biostatistics, Bloemfontein, South Africa
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Giannoccaro MP, Menassa DA, Jacobson L, Coutinho E, Prota G, Lang B, Leite MI, Cerundolo V, Liguori R, Vincent A. Behaviour and neuropathology in mice injected with human contactin-associated protein 2 antibodies. Brain 2019; 142:2000-2012. [PMID: 31079141 DOI: 10.1093/brain/awz119] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 08/21/2018] [Revised: 01/21/2019] [Accepted: 03/05/2019] [Indexed: 12/31/2022] Open
Abstract
Serum antibodies that bind to the surface of neurons or glia are associated with a wide range of rare but treatable CNS diseases. In many, if not most instances, the serum levels are higher than CSF levels yet most of the reported attempts to reproduce the human disease in mice have used infusion of antibodies into the mouse cerebral ventricle(s) or intrathecal space. We used the intraperitoneal route and injected purified plasma IgG from either a CASPR2-antibody-positive patient (n = 10 mice) or healthy individual (n = 9 mice) daily for 8 days. Lipopolysaccharide was injected intraperitoneally on Day 3 to cause a temporary breach in the blood brain barrier. A wide range of baseline behaviours, including tests of locomotion, coordination, memory, anxiety and social interactions, were established before the injections and tested from Day 5 until Day 11. At termination, brain tissue was analysed for human IgG, CASPR2 and c-fos expression, lymphocyte infiltration, and neuronal, astrocytic and microglial markers. Mice exposed to CASPR2-IgG, compared with control-IgG injected mice, displayed reduced working memory during the continuous spontaneous alternation test with trends towards reduced short-term and long-term memories. In the open field tests, activities were not different from controls, but in the reciprocal social interaction test, CASPR2-IgG injected mice showed longer latency to start interacting, associated with more freezing behaviour and reduced non-social activities of rearing and grooming. At termination, neuropathology showed more IgG deposited in the brains of CASPR2-IgG injected mice, but a trend towards increased CASPR2 expression; these results were mirrored in short-term in vitro experiments where CASPR2-IgG binding to hippocampal neurons and to CASPR2-transfected HEK cells led to some internalization of the IgG, but with a trend towards higher surface CASPR2 expression. Despite these limited results, in the CASPR2-IgG injected mouse brains there was increased c-fos expression in the piriform-entorhinal cortex and hypothalamus, and a modest loss of Purkinje cells. There was also increased microglia density, morphological changes in both microglia and astrocytes and raised complement C3 expression on astrocytes, all consistent with glial activation. Patients with CASPR2 antibodies can present with a range of clinical features reflecting central, autonomic and peripheral dysfunction. Although the behavioural changes in mice were limited to social interactions and mild working-memory defects, the neuropathological features indicate potentially widespread effects of the antibodies on different brain regions.
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Affiliation(s)
- Maria Pia Giannoccaro
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - David A Menassa
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
- Biological Sciences, University of Southampton, Southampton, UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Ester Coutinho
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Gennaro Prota
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Vincenzo Cerundolo
- MRC Human Immunology Unit, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
- IRCSS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Thompson J, Bi M, Murchison AG, Makuch M, Bien CG, Chu K, Farooque P, Gelfand JM, Geschwind MD, Hirsch LJ, Somerville E, Lang B, Vincent A, Leite MI, Waters P, Irani SR. The importance of early immunotherapy in patients with faciobrachial dystonic seizures. Brain 2019; 141:348-356. [PMID: 29272336 PMCID: PMC5837230 DOI: 10.1093/brain/awx323] [Citation(s) in RCA: 227] [Impact Index Per Article: 45.4] [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: 03/25/2017] [Accepted: 10/10/2017] [Indexed: 12/18/2022] Open
Abstract
Faciobrachial dystonic seizures and limbic encephalitis closely associate with antibodies to leucine-rich glioma-inactivated 1 (LGI1). Here, we describe 103 consecutive patients with faciobrachial dystonic seizures and LGI1 antibodies to understand clinical, therapeutic and serological differences between those with and without cognitive impairment, and to determine whether cessation of faciobrachial dystonic seizures can prevent cognitive impairment. The 22/103 patients without cognitive impairment typically had normal brain MRI, EEGs and serum sodium levels (P < 0.0001). Overall, cessation of faciobrachial dystonic seizures with antiepileptic drugs alone occurred in only 9/89 (10%) patients. By contrast, 51% showed cessation of faciobrachial dystonic seizures 30 days after addition of immunotherapy (P < 0.0001), with earlier cessation in cognitively normal patients (P = 0.038). Indeed, expedited immunotherapy (P = 0.031) and normal cognition (P = 0.0014) also predicted reduced disability at 24 months. Furthermore, of 80 patients with faciobrachial dystonic seizures as their initial feature, 56% developed cognitive impairment after 90 days of active faciobrachial dystonic seizures. Whereas only one patient developed cognitive impairment after cessation of faciobrachial dystonic seizures (P < 0.0001). All patients had IgG4-LGI1 antibodies, but those with cognitive impairment had higher proportions of complement-fixing IgG1 antibodies (P = 0.03). Both subclasses caused LGI1-ADAM22 complex internalization, a potential non-inflammatory epileptogenic mechanism. In summary, faciobrachial dystonic seizures show striking time-sensitive responses to immunotherapy, and their cessation can prevent the development of cognitive impairment.
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Affiliation(s)
- Julia Thompson
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Mian Bi
- Dementia Research Unit, University of New South Wales, Kensington, Sydney, New South Wales, NSW 2052, Australia
| | - Andrew G Murchison
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Mateusz Makuch
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Christian G Bien
- Krankenhaus Mara, Epilepsy Center Bethel, Bielefeld D-33617, Germany
| | - Kon Chu
- Department of Neurology, Comprehensive Epilepsy Center, Biomedical Research Institute, Seoul National University Hospital, Seoul, 110-744, South Korea
| | - Pue Farooque
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Jeffrey M Gelfand
- UCSF Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94143, USA
| | - Michael D Geschwind
- UCSF Department of Neurology, 675 Nelson Rising Lane, San Francisco, CA 94143, USA
| | - Lawrence J Hirsch
- Comprehensive Epilepsy Center, Department of Neurology, Yale University School of Medicine, New Haven, CT 06510, USA
| | - Ernest Somerville
- Comprehensive Epilepsy Service, Prince of Wales Clinical School, University of New South Wales, Sydney, New South Wales, NSW 2052, Australia
| | - Bethan Lang
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Angela Vincent
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Maria I Leite
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Patrick Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
| | - Sarosh R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, OX3 9DS, UK
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Gastaldi M, De Rosa A, Maestri M, Zardini E, Scaranzin S, Guida M, Borrelli P, Ferraro OE, Lampasona V, Furlan R, Irani SR, Waters P, Lang B, Vincent A, Marchioni E, Ricciardi R, Franciotta D. Acquired neuromyotonia in thymoma-associated myasthenia gravis: a clinical and serological study. Eur J Neurol 2019; 26:992-999. [PMID: 30714278 PMCID: PMC6593867 DOI: 10.1111/ene.13922] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 12/01/2018] [Accepted: 01/30/2019] [Indexed: 12/27/2022]
Abstract
Background and purpose Acquired neuromyotonia can occur in patients with thymoma, alone or in association with myasthenia gravis (MG), but the clinical prognostic significance of such comorbidity is largely unknown. The clinico‐pathological features were investigated along with the occurrence of neuromyotonia as predictors of tumour recurrence in patients with thymoma‐associated myasthenia. Methods A total number of 268 patients with thymomatous MG were studied retrospectively. Patients with symptoms of spontaneous muscle overactivity were selected for autoantibody testing using immunohistology for neuronal cell‐surface proteins and cell‐based assays for contactin‐associated protein 2 (CASPR2), leucine‐rich glioma inactivated 1 (LGI1), glycine receptor and Netrin‐1 receptor antibodies. Neuromyotonia was diagnosed according to the presence of typical electromyography abnormalities and/or autoantibodies against LGI1/CASPR2. Results Overall, 33/268 (12%) MG patients had a thymoma recurrence. Five/268 (2%) had neuromyotonia, four with typical autoantibodies, including LGI1 (n = 1), CASPR2 (n = 1) or both (n = 2). Three patients had Netrin‐1 receptor antibodies, two with neuromyotonia and concomitant CASPR2+LGI1 antibodies and one with spontaneous muscle overactivity without electromyography evidence of neuromyotonia. Thymoma recurrence was more frequent in those with (4/5, 80%) than in those without (28/263, 10%, P < 0.001) neuromyotonia. Neuromyotonia preceded the recurrence in 4/5 patients. In univariate analysis, predictors of thymoma recurrence were age at thymectomy [odds ratio (OR) 0.95, 95% confidence interval (CI) 0.93–0.97], Masaoka stage ≥IIb (OR 10.73, 95% CI 2.38–48.36) and neuromyotonia (OR 41.78, 95% CI 4.71–370.58). Conclusions De novo occurrence of neuromyotonia in MG patients with previous thymomas is a rare event and may herald tumour recurrence. Neuronal autoantibodies can be helpful to assess the diagnosis. These observations provide pragmatic risk stratification for tumour vigilance in patients with thymomatous MG.
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Affiliation(s)
- M Gastaldi
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - A De Rosa
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Maestri
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - E Zardini
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - S Scaranzin
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
| | - M Guida
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - P Borrelli
- Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - O E Ferraro
- Unit of Biostatistics and Clinical Epidemiology, University of Pavia, Pavia, Italy
| | - V Lampasona
- Division of Genetics and Cell Biology, Genomic Unit for the Diagnosis of Human Pathologies, San Raffaele Scientific Institute, Milan, Italy
| | - R Furlan
- Division of Neuroscience, INSPE, San Raffaele Scientific Institute, Milan, Italy
| | - S R Irani
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - P Waters
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - B Lang
- Oxford Autoimmune Neurology Group, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - A Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - E Marchioni
- Neuroncology and Neuroinflammation Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - R Ricciardi
- Neurology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - D Franciotta
- Neuroimmunology Laboratory, IRCCS Mondino Foundation, Pavia, Italy
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Berridge G, Menassa DA, Moloney T, Waters PJ, Welding I, Thomsen S, Zuberi S, Fischer R, Aricescu AR, Pike M, Dale RC, Kessler B, Vincent A, Lim M, Irani SR, Lang B. Glutamate receptor δ2 serum antibodies in pediatric opsoclonus myoclonus ataxia syndrome. Neurology 2018; 91:e714-e723. [PMID: 30045961 PMCID: PMC6107266 DOI: 10.1212/wnl.0000000000006035] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 05/18/2018] [Indexed: 12/03/2022] Open
Abstract
Objective To identify neuronal surface antibodies in opsoclonus myoclonus ataxia syndrome (OMAS) using contemporary antigen discovery methodology. Methods OMAS patient serum immunoglobulin G immunohistochemistry using age-equivalent rat cerebellar tissue was followed by immunoprecipitation, gel electrophoresis, and mass spectrometry. Data are available via ProteomeXchange (identifier PXD009578). This generated a list of potential neuronal surface cerebellar autoantigens. Live cell-based assays were used to confirm membrane-surface antigens and adsorb antigen-specific immunoglobulin Gs. The serologic results were compared to the clinical data. Results Four of the 6 OMAS sera tested bound rat cerebellar sections. Two of these sera with similar immunoreactivities were used in immunoprecipitation experiments using cerebellum from postnatal rat pups (P18). Mass spectrometry identified 12 cell-surface proteins, of which glutamate receptor δ2 (GluD2), a predominately cerebellar-expressed protein, was found at a 3-fold-higher concentration than the other 11 proteins. Antibodies to GluD2 were identified in 14/16 (87%) OMAS samples, compared with 5/139 (5%) pediatric and 1/38 (2.6%) adult serum controls (p < 0.0001), and in 2/4 sera from patients with neuroblastoma without neurologic features. Adsorption of positive OMAS sera against GluD2-transfected cells substantially reduced but did not eliminate reactivity toward cerebellar sections. Conclusion Autoantibodies to GluD2 are common in patients with OMAS, bind to surface determinants, and are potentially pathogenic.
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Affiliation(s)
- Georgina Berridge
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - David A Menassa
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Teresa Moloney
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Patrick J Waters
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Imogen Welding
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Selina Thomsen
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Sameer Zuberi
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Roman Fischer
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - A Radu Aricescu
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Michael Pike
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Russell C Dale
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Benedikt Kessler
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Angela Vincent
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Ming Lim
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Sarosh R Irani
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK
| | - Bethan Lang
- From the Oxford Autoimmune Neurology Group (G.B., D.A.M., T.M., P.J.W., I.W., S.T., M.P., A.V., S.R.I., B.L.), Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford; Target Discovery Institute (G.B., R.F., B.K.), NDM Research Building, University of Oxford, Old Road Campus, Oxford; Paediatric Neurosciences Research Group (S.Z.), School of Medicine, University of Glasgow; Division of Structural Biology (A.R.A.), Nuffield Department of Clinical Medicine, University of Oxford, UK; Clinical Neuroimmunology (R.C.D.), Institute for Neuroscience and Muscle Research, University of Sydney, Australia; Children's Neuroscience Centre (M.L.), Evelina London Children's Hospital at St Thomas' NHS Foundation Trust, King's Health Partners Academic Health Science Centre, London; and Faculty of Medicine and Life Sciences (M.L.), King's College London, UK.
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Park KH, Waters P, Woodhall M, Lang B, Smith T, Sung JJ, Kim KK, Lim YM, Kim JE, Kim BJ, Park JS, Lim JG, Kim DS, Kwon O, Sohn EH, Bae JS, Yoon BN, Kim NH, Ahn SW, Oh J, Park HJ, Shin KJ, Hong YH. Correction: Myasthenia gravis seronegative for acetylcholine receptor antibodies in South Korea: Autoantibody profiles and clinical features. PLoS One 2018; 13:e0200225. [PMID: 29958297 PMCID: PMC6025849 DOI: 10.1371/journal.pone.0200225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Klang A, Högler S, Nedorost N, Weissenbacher-Lang C, Pákozdy Á, Lang B, Weissenböck H. Hippocampal necrosis and sclerosis in cats: A retrospective study of 35 cases. Acta Vet Hung 2018; 66:269-280. [PMID: 29958521 DOI: 10.1556/004.2018.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hippocampal necrosis and hippocampal sclerosis in cats is a neuropathological entity which is a major concern in feline epilepsy. The aim of our study was to identify associated pathologic brain lesions possibly serving as aetiological triggers in this condition. Therefore, the formalin-fixed and paraffin waxembedded brain tissue of 35 cats diagnosed with hippocampal necrosis or sclerosis was examined retrospectively. In 26 cats inflammatory infiltrates could be found in the hippocampus or adjacent brain regions. Fifteen out of these animals demonstrated mild to moderate infiltrations by lymphocytes and complement deposition in the hippocampus similar to human limbic encephalitis, seven showed unspecific, predominantly non-suppurative inflammation, and two demonstrated suppurative inflammation of the hippocampus or adjacent brain regions. Additionally, one cat was diagnosed with central nervous manifestation of feline infectious peritonitis virus and another one with cerebral Toxoplasma gondii infection. Intracranial neoplasia was present in five cases altogether. Three of them comprised meningioma which was present additionally to lesions resembling limbic encephalitis in two cases, and a dentate gyrus alteration in one case. The other two tumour-associated cases comprised oligodendroglioma. Structural alterations of the dentate gyrus together with hippocampal sclerosis were encountered in three cases in total. Besides the case associated with a meningioma, one case demonstrated lesions resembling limbic encephalitis. A vascular infarct in the temporal lobe was encountered in one cat. In four cases no lesions other than hippocampal necrosis or sclerosis were found. The involvement of feline immunodeficiency virus infections, which may be able to produce hippocampal lesions, was not encountered in the cats examined.
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Affiliation(s)
- Andrea Klang
- 1 Institute of Pathology and Forensic Veterinary Medicine, Department of Pathobiology University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Sandra Högler
- 1 Institute of Pathology and Forensic Veterinary Medicine, Department of Pathobiology University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Nora Nedorost
- 1 Institute of Pathology and Forensic Veterinary Medicine, Department of Pathobiology University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Christiane Weissenbacher-Lang
- 1 Institute of Pathology and Forensic Veterinary Medicine, Department of Pathobiology University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Ákos Pákozdy
- 2 Clinic of Internal Medicine and Infectious Diseases, Clinical Department of Small Animals and Horses, University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
| | - Bethan Lang
- 3 Department of Clinical Neurology, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Oxford, England
| | - Herbert Weissenböck
- 1 Institute of Pathology and Forensic Veterinary Medicine, Department of Pathobiology University of Veterinary Medicine, Veterinärplatz 1, 1210 Vienna, Austria
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Gaughran F, Lally J, Beck K, McCormack R, Gardner-Sood P, Coutinho E, Jacobson L, Lang B, Sainz-Fuertes R, Papanastasiou E, Di Forti M, Nicholson T, Vincent A, Murray RM. Brain-relevant antibodies in first-episode psychosis: a matched case-control study. Psychol Med 2018; 48:1257-1263. [PMID: 28920570 DOI: 10.1017/s0033291717002689] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND There has been much recent excitement about the possibility that some cases of psychosis may be wholly due to brain-reactive antibodies, with antibodies to N-methyl-D-aspartate receptor (NMDAR) and the voltage-gated potassium channel (VGKC)-complex reported in a few patients with first-episode psychosis (FEP). METHODS Participants were recruited from psychiatric services in South London, UK, from 2009 to 2011 as part of the Genetics and Psychosis study. We conducted a case-control study to examine NMDAR and VGKC-complex antibody levels and rates of antibody positivity in 96 patients presenting with FEP and 98 controls matched for age and sex. Leucine-rich glioma inactiviated-1 (LGI1) and contactin-associated protein (CASPR) antibodies were also measured. Notably, patients with suspicion of organic disease were excluded. RESULTS VGKC-complex antibodies were found in both cases (n = 3) and controls (n = 2). NMDAR antibody positivity was seen in one case and one control. Either LGI1-Abs or CASPR2-Abs were found in three cases and three controls. Neuronal antibody staining, consistent with the above results or indicating potential novel antigens, was overall positive in four patients but also in six controls. Overall, antibody positivity was at low levels only and not higher in cases than in controls. CONCLUSIONS This case-control study of the prevalence of antibodies in FEP does not provide evidence to support the hypothesis that FEP is associated with an immune-mediated process in a subgroup of patients. Nevertheless, as other bio-clinical factors may influence the effect of such antibodies in a given individual, and patients with organic neurological disease may be misdiagnosed as FEP, the field requires more research to put these findings in context.
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service,South London and Maudsley NHS Foundation Trust
| | - John Lally
- Department of Psychosis Studies,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | - Katherine Beck
- Department of Psychosis Studies,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | | | - Poonam Gardner-Sood
- Department of Psychosis Studies,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | - Ester Coutinho
- Nuffield Department of Clinical Neurosciences,Oxford University Hospitals, University of Oxford,Oxford,UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences,Oxford University Hospitals, University of Oxford,Oxford,UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences,Oxford University Hospitals, University of Oxford,Oxford,UK
| | - Ricardo Sainz-Fuertes
- Basic and Clinical Neuroscience at the Institute of Psychiatry,Psychology, & Neuroscience,King's College London,London,UK
| | - Evangelos Papanastasiou
- Cognition Schizophrenia and Imaging Laboratory (CSI Lab),Department of Psychosis Studies,Institute of Psychiatry Psychology and Neuroscience,King's College London,London,UK
| | - Marta Di Forti
- SGDP, Institute of Psychiatry,Psychology and Neuroscience,King's College London, and South London and Maudsley NHS Foundation Trust,London,UK
| | - Tim Nicholson
- Section of Cognitive Neuropsychiatry,Department of Psychosis Studies,Institute of Psychiatry,Psychology and Neuroscience,King's College London,London,UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences,University of Oxford,John Radcliffe Hospital,Oxford,UK
| | - Robin M Murray
- National Psychosis Service,South London and Maudsley NHS Foundation Trust
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Park KH, Waters P, Woodhall M, Lang B, Smith T, Sung JJ, Kim KK, Lim YM, Kim JE, Kim BJ, Park JS, Lim JG, Kim DS, Kwon O, Sohn EH, Bae JS, Yoon BN, Kim NH, Ahn SW, Oh J, Park HJ, Shin KJ, Hong YH. Myasthenia gravis seronegative for acetylcholine receptor antibodies in South Korea: Autoantibody profiles and clinical features. PLoS One 2018. [PMID: 29518096 PMCID: PMC5843234 DOI: 10.1371/journal.pone.0193723] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Acquired myasthenia gravis (MG) is a prototype autoimmune disease of the neuromuscular junction, caused in most patients by autoantibodies to the muscle nicotinic acetylcholine receptor (AChR). There seem to be ethnic and regional differences in the frequency and clinical features of MG seronegative for the AChR antibody. This study aimed to describe the autoantibody profiles and clinical features of Korean patients with generalized MG seronegative for the AChR antibody. A total of 62 patients with a high index of clinical suspicion of seronegative generalized MG were identified from 18 centers, and we examined their sera for antibodies to clustered AChR, muscle-specific tyrosine kinase (MuSK), and low-density lipoprotein receptor-related protein 4 (LRP4) by cell-based assays (CBA) and to MuSK by radioimmunoprecipitation assay (RIPA). We also included 8 patients with ocular MG, 3 with Lambert-Eaton myasthenic syndrome, 5 with motor neuron disease, and 9 with other diagnoses as comparators for the serological testing. Antibodies were identified in 25/62 (40.3%) patients: 7 had antibodies to clustered AChR, 17 to MuSK, and 2 to LRP4. Three patients were double seropositive: 1 for MuSK and LRP4, and 2 for MuSK and clustered AChR. The patients with MuSK antibodies were mostly female (88.2%) and characterized by predominantly bulbar involvement (70%) and frequent myasthenic crises (58.3%). The patients with antibodies to clustered AChR, including 2 with ocular MG, tended to have a mild phenotype and good prognosis.
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Affiliation(s)
- Kee Hong Park
- Department of Neurology, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
- * E-mail: (YHH); (PW)
| | - Mark Woodhall
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Thomas Smith
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, United Kingdom
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kwang-Kuk Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Young-Min Lim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jee-Eun Kim
- Department of Neurology, Seoul Medical Center, Seoul, Republic of Korea
| | - Byung-Jo Kim
- Department of Neurology, Korea University College of Medicine, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jin-Sung Park
- Department of Neurology, Kyungpook National University, School of Medicine, Daegu, Republic of Korea
| | - Jeong-Geon Lim
- Department of Neurology, Keimyung University School of Medicine, Daegu, Republic of Korea
| | - Dae-Seong Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Ohyun Kwon
- Department of Neurology, School of Medicine, Eulji University, Seoul, Republic of Korea
| | - Eun Hee Sohn
- Department of Neurology, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Jong Seok Bae
- Department of Neurology, College of Medicine, Hallym University, Seoul, Republic of Korea
| | - Byung-Nam Yoon
- Department of Neurology, Inha University Hospital, Incheon, Republic of Korea
| | - Nam-Hee Kim
- Department of Neurology, Dongguk University Ilsan Hospital, Goyangsi, Gyeonggido, Republic of Korea
| | - Suk-Won Ahn
- Department of Neurology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Jeeyoung Oh
- Department of Neurology, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hyung Jun Park
- Department of Neurology, Mokdong Hospital, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Kyong Jin Shin
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul National University College of Medicine, Seoul National University Seoul Metropolitan Government Boramae Medical Center, Seoul National University Medical Research Council, Seoul, Republic of Korea
- * E-mail: (YHH); (PW)
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Schümichen C, Beck A, Lang B, Hohnloser S, Moser E, Krause T. Szintigraphie mit111 ln-markiertem Antimyosin bei Churg-Strauss-Vaskulitis mit myokardialer Beteiligung. Nuklearmedizin 2018. [DOI: 10.1055/s-0038-1629528] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
A case of Churg-Strauss vasculitis in a young woman is reported. Diagnosis was confirmed by muscle biopsy. Affection of lungs, kidneys and skin was evident. In addition, myocarditis was suspected on clinical evidence. A highly positive scintigraphy with 111 In-anti myosin enabled diagnosis and assessment of damage to the myocytes. With a heart-to-lung ratio of 3.0 the accumulated activity in the myocardium was higher than usually found in myocarditis. This finding supports the hypothesis of an additional ischemic necrosis.
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Lutz C, Weder B, Hünerwadel A, Fagagnini S, Lang B, Beerenwinkel N, Rossel JB, Rogler G, Misselwitz B, Hausmann M. Myeloid differentiation primary response gene (MyD) 88 signalling is not essential for intestinal fibrosis development. Sci Rep 2017; 7:17678. [PMID: 29247242 PMCID: PMC5732165 DOI: 10.1038/s41598-017-17755-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 11/29/2017] [Indexed: 01/15/2023] Open
Abstract
Dysregulation of the immune response to microbiota is associated with inflammatory bowel disease (IBD), which can trigger intestinal fibrosis. MyD88 is a key component of microbiota signalling but its influence on intestinal fibrosis has not been clarified. Small bowel resections from donor-mice were transplanted subcutaneously into the neck of recipients C57BL/6 B6-MyD88tm1 Aki (MyD88-/-) and C57BL/6-Tg(UBC-green fluorescence protein (GFP))30Scha/J (GFP-Tg). Grafts were explanted up to 21 days after transplantation. Collagen layer thickness was determined using Sirius Red stained slides. In the mouse model of fibrosis collagen deposition and transforming growth factor-beta 1 (TGF-β1) expression was equal in MyD88+/+ and MyD88-/-, indicating that MyD88 was not essential for fibrogenesis. Matrix metalloproteinase (Mmp)9 expression was significantly decreased in grafts transplanted into MyD88-/- recipients compared to MyD88+/+ recipients (0.2 ± 0.1 vs. 153.0 ± 23.1, respectively, p < 0.05), similarly recruitment of neutrophils was significantly reduced (16.3 ± 4.5 vs. 25.4 ± 3.1, respectively, p < 0.05). Development of intestinal fibrosis appears to be independent of MyD88 signalling indicating a minor role of bacterial wall compounds in the process which is in contrast to published concepts and theories. Development of fibrosis appears to be uncoupled from acute inflammation.
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Affiliation(s)
- C Lutz
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - B Weder
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - A Hünerwadel
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - S Fagagnini
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - B Lang
- Department of Biosystems Sciences and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - N Beerenwinkel
- Department of Biosystems Sciences and Engineering, ETH Zurich, Basel, Switzerland.,SIB Swiss Institute of Bioinformatics, Basel, Switzerland
| | - J B Rossel
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - G Rogler
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - B Misselwitz
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland
| | - M Hausmann
- Department of Gastroenterology and Hepatology, University Hospital, Zurich, Switzerland.
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Lang B, Maddison P, Dettmann I, Adcock J, Buckley C, Leite I, Vincent A, Komorowski L, Waters P, Irani S. 1645 Vgkc is dead: long live lgi1- and caspr2-antibodies. intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Maddison P, Sadalage G, Gozzard P, Thomsen S, Lang B. PO206 Lambert-eaton myasthenic syndrome – results from bnsu survey. J Neurol Neurosurg Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Varley J, Piehl F, Andersson M, Lang B, Vincent A, Waters P, Irani S. 1633 Linear- versus conformational-protein directed autoantibodies in neuropsychiatric systemic lupus erythematosis. J Neurol Psychiatry 2017. [DOI: 10.1136/jnnp-2017-abn.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Lang B, Komorowski L, Adcock J, Waters P, Irani S. Intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies: Evidence for relative pathogenicity. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Thompson J, Bi M, Makuch M, Bien C, Chu K, Gelfand J, Geschwind M, Hirsch L, Somerville E, Lang B, Vincent A, Leite M, Waters P, Irani S. Reasons for early immunotherapy in 103 patients with faciobrachial dystonic seizures: Effect on short and long-term outcomes. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Coutinho E, Menassa DA, Jacobson L, West SJ, Domingos J, Moloney TC, Lang B, Harrison PJ, Bennett DLH, Bannerman D, Vincent A. Persistent microglial activation and synaptic loss with behavioral abnormalities in mouse offspring exposed to CASPR2-antibodies in utero. Acta Neuropathol 2017; 134:567-583. [PMID: 28755208 PMCID: PMC5587616 DOI: 10.1007/s00401-017-1751-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 07/12/2017] [Accepted: 07/13/2017] [Indexed: 12/30/2022]
Abstract
Gestational transfer of maternal antibodies against fetal neuronal proteins may be relevant to some neurodevelopmental disorders, but until recently there were no proteins identified. We recently reported a fivefold increase in CASPR2-antibodies in mid-gestation sera from mothers of children with intellectual and motor disabilities. Here, we exposed mice in utero to purified IgG from patients with CASPR2-antibodies (CASPR2-IgGs) or from healthy controls (HC-IgGs). CASPR2-IgG but not HC-IgG bound to fetal brain parenchyma, from which CASPR2-antibodies could be eluted. CASPR2-IgG exposed neonates achieved milestones similarly to HC-IgG exposed controls but, when adult, the CASPR2-IgG exposed progeny showed marked social interaction deficits, abnormally located glutamatergic neurons in layers V-VI of the somatosensory cortex, a 16% increase in activated microglia, and a 15-52% decrease in glutamatergic synapses in layers of the prefrontal and somatosensory cortices. Thus, in utero exposure to CASPR2-antibodies led to permanent behavioral, cellular, and synaptic abnormalities. These findings support a pathogenic role for maternal antibodies in human neurodevelopmental conditions, and CASPR2 as a potential target.
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Affiliation(s)
- Ester Coutinho
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David A Menassa
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Steven J West
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Joana Domingos
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Teresa C Moloney
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul J Harrison
- Department of Psychiatry, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - David L H Bennett
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - David Bannerman
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
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Nibber A, Mann EO, Pettingill P, Waters P, Irani SR, Kullmann DM, Vincent A, Lang B. Pathogenic potential of antibodies to the GABA B receptor. Epilepsia Open 2017; 2:355-359. [PMID: 29588966 PMCID: PMC5862107 DOI: 10.1002/epi4.12067] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2017] [Indexed: 12/22/2022] Open
Abstract
GABAB receptor (GABABR) autoantibodies have been detected in the serum of immunotherapy-responsive patients with autoimmune encephalitis. This study aimed to investigate the effect of immunoglobulin G (IgG) from a patient with GABABR antibodies on primary neuronal cultures and acute slices of entorhinal cortex. Primary hippocampal neuronal cultures were incubated with serum immunoglobulin from patients with GABABR or AMPA receptor (AMPAR) antibodies for up to 72 h to investigate their effect on receptor surface expression. Whole-cell patch-clamp recordings from layer III pyramidal cells of the medial entorhinal cortex were used to examine the effect on neuronal activity. GABABR surface expression was unaltered by incubation with GABABR antibodies. By contrast, after 24 h application of AMPAR antibodies, AMPARs were undetectable. However, acute application of GABABR IgG decreased both the duration of network UP states and the spike rate of pyramidal cells in the entorhinal cortex. GABABR antibodies do not appear to affect GABABRs by internalization but rather reduce excitability on the medial temporal lobe networks. This unusual mechanism of action may be exploited in rational drug development strategies.
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Affiliation(s)
- Anjan Nibber
- Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom
| | - Edward O Mann
- Department of Physiology, Anatomy and Genetics University of Oxford Oxford United Kingdom
| | - Philippa Pettingill
- Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom
| | | | - Angela Vincent
- Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences University of Oxford John Radcliffe Hospital Oxford United Kingdom
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Spencer CH, Rouster-Stevens K, Gewanter H, Syverson G, Modica R, Schmidt K, Emery H, Wallace C, Grevich S, Nanda K, Zhao YD, Shenoi S, Tarvin S, Hong S, Lindsley C, Weiss JE, Passo M, Ede K, Brown A, Ardalan K, Bernal W, Stoll ML, Lang B, Carrasco R, Agaiar C, Feller L, Bukulmez H, Vehe R, Kim H, Schmeling H, Gerstbacher D, Hoeltzel M, Eberhard B, Sundel R, Kim S, Huber AM, Patwardhan A. Biologic therapies for refractory juvenile dermatomyositis: five years of experience of the Childhood Arthritis and Rheumatology Research Alliance in North America. Pediatr Rheumatol Online J 2017; 15:50. [PMID: 28610606 PMCID: PMC5470177 DOI: 10.1186/s12969-017-0174-0] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 05/17/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The prognosis of children with juvenile dermatomyositis (JDM) has improved remarkably since the 1960's with the use of corticosteroid and immunosuppressive therapy. Yet there remain a minority of children who have refractory disease. Since 2003 the sporadic use of biologics (genetically-engineered proteins that usually are derived from human genes) for inflammatory myositis has been reported. In 2011-2016 we investigated our collective experience of biologics in JDM through the Childhood Arthritis and Rheumatology Research Alliance (CARRA). METHODS The JDM biologic study group developed a survey on the CARRA member experience using biologics for Juvenile DM utilizing Delphi consensus methods in 2011-2012. The survey was completed online by the CARRA members interested in JDM in 2012. A second survey was similarly developed that provided more opportunity to describe their experiences with biologics in JDM in detail and was completed by CARRA members in Feb 2013. During three CARRA meetings in 2013-2015, nominal group techniques were used for achieving consensus on the current choices of biologic drugs. A final survey was performed at the 2016 CARRA meeting. RESULTS One hundred and five of a potential 231 pediatric rheumatologists (42%) responded to the first survey in 2012. Thirty-five of 90 had never used a biologic for Juvenile DM at that time. Fifty-five of 91 (denominators vary) had used biologics for JDM in their practice with 32%, 5%, and 4% using rituximab, etanercept, and infliximab, respectively, and 17% having used more than one of the three drugs. Ten percent used a biologic as monotherapy, 19% a biologic in combination with methotrexate (mtx), 52% a biologic in combination with mtx and corticosteroids, 42% a combination of a biologic, mtx, corticosteroids (steroids), and an immunosuppressive drug, and 43% a combination of a biologic, IVIG and mtx. The results of the second survey supported these findings in considerably more detail with multiple combinations of drugs used with biologics and supported the use of rituximab, abatacept, anti-TNFα drugs, and tocilizumab in that order. One hundred percent recommended that CARRA continue studying biologics for JDM. The CARRA meeting survey in 2016 again supported the study and use of these four biologic drug groups. CONCLUSIONS Our CARRA JDM biologic work group developed and performed three surveys demonstrating that pediatric rheumatologists in North America have been using multiple biologics for refractory JDM in numerous scenarios from 2011 to 2016. These survey results and our consensus meetings determined our choice of four biologic therapies (rituximab, abatacept, tocilizumab and anti-TNFα drugs) to consider for refractory JDM treatment when indicated and to evaluate for comparative effectiveness and safety in the future. Significance and Innovations This is the first report that provides a substantial clinical experience of a large group of pediatric rheumatologists with biologics for refractory JDM over five years. This experience with biologic therapies for refractory JDM may aid pediatric rheumatologists in the current treatment of these children and form a basis for further clinical research into the comparative effectiveness and safety of biologics for refractory JDM.
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Affiliation(s)
- CH Spencer
- 0000 0004 0392 3476grid.240344.5Nationwide Children’s Hospital and Ohio State University, Columbus, OH USA
| | - K Rouster-Stevens
- 0000 0001 0941 6502grid.189967.8Emory University School of Medicine, Atlanta, GA USA
| | - H Gewanter
- Pediatric and Adolescent Health Partners, Richmond, VA USA
| | - G Syverson
- 0000 0001 2167 3675grid.14003.36University of Wisconsin-Madison, Madison, WI USA
| | - R Modica
- 0000 0004 1936 8091grid.15276.37University of Florida, Gainesville, FL USA
| | - K Schmidt
- 0000 0001 2113 1622grid.266623.5University of Louisville, Louisville, KY USA
| | - H Emery
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - C Wallace
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Grevich
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - K Nanda
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - YD Zhao
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Shenoi
- 0000000122986657grid.34477.33Seattle Children’s Hospital, University of Washington, Seattle, WA USA
| | - S Tarvin
- Riley Hospital for Children, Indiana University Medical Center, Indianapolis, IN India
| | - S Hong
- grid.412984.2University of Iowa Health Care, Iowa City, IA USA
| | - C Lindsley
- 0000 0001 2177 6375grid.412016.0University of Kansas Medical Center, Kansas City, KS USA
| | - JE Weiss
- 0000 0004 0407 6328grid.239835.6Sanzari Children’s Hospital, Hackensack University Medical Center, Hackensack, NJ USA
| | - M Passo
- 0000 0000 9075 106Xgrid.254567.7University of South Carolina, Charleston, SC USA
| | - K Ede
- 0000 0001 0381 0779grid.417276.1Phoenix Children’s Hospital, Phoenix, AZ USA
| | - A Brown
- 0000 0001 2200 2638grid.416975.8Texas Children’s Hospital, Houston, TX USA
| | - K Ardalan
- 0000 0004 0388 2248grid.413808.6Lurie Children’s Hospital, Chicago, IL USA
| | - W Bernal
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, San Francisco, CA USA
| | - ML Stoll
- 0000000106344187grid.265892.2University of Alabama at Birmingham, Birmingham, AL USA
| | - B Lang
- 0000 0004 1936 8200grid.55602.34WK Health Center and Dalhousie University, Halifax, NS Canada
| | - R Carrasco
- Dell Children’s Hospital, Austin, TX USA
| | - C Agaiar
- Children’s Hospital of The Kings Daughter, Norfolk, VA USA
| | - L Feller
- Inland Rheumatology, Waterville, ME USA
| | - H Bukulmez
- 0000 0001 0035 4528grid.411931.fMetro Health Medical Center and Case Western Reserve University, Cleveland, OH USA
| | - R Vehe
- 0000000419368657grid.17635.36University of Minnesota, Minneapolis, MN USA
| | - H Kim
- 0000 0001 2237 2479grid.420086.8National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, MD USA
| | - H Schmeling
- 0000 0004 1936 7697grid.22072.35Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB Canada
| | - D Gerstbacher
- 0000000419368956grid.168010.eLucille Packard Children’s Hospital, Stanford University, Stanford, CA USA
| | - M Hoeltzel
- 0000000086837370grid.214458.eMott Children’s Hospital, University of Michigan, Ann Arbor, MI USA
| | - B Eberhard
- grid.415338.8Cohen Children’s Medical Center of New York, New york, USA
| | - R Sundel
- 0000 0004 0378 8438grid.2515.3Boston Children’s Hospital and Harvard Medical School, Boston, MA USA
| | - S Kim
- 0000 0001 2297 6811grid.266102.1University of California, San Francisco, San Francisco, CA USA
| | - AM Huber
- 0000 0004 1936 8200grid.55602.34WK Health Center and Dalhousie University, Halifax, NS Canada
| | - A Patwardhan
- 0000 0001 2162 3504grid.134936.aSchool of Medicine, University of Missouri, Columbia, MO USA
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Lang B, Makuch M, Moloney T, Dettmann I, Mindorf S, Probst C, Stoecker W, Buckley C, Newton CR, Leite MI, Maddison P, Komorowski L, Adcock J, Vincent A, Waters P, Irani SR. Intracellular and non-neuronal targets of voltage-gated potassium channel complex antibodies. J Neurol Neurosurg Psychiatry 2017; 88:353-361. [PMID: 28115470 PMCID: PMC5644714 DOI: 10.1136/jnnp-2016-314758] [Citation(s) in RCA: 98] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/03/2016] [Accepted: 11/30/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Autoantibodies against the extracellular domains of the voltage-gated potassium channel (VGKC) complex proteins, leucine-rich glioma-inactivated 1 (LGI1) and contactin-associated protein-2 (CASPR2), are found in patients with limbic encephalitis, faciobrachial dystonic seizures, Morvan's syndrome and neuromyotonia. However, in routine testing, VGKC complex antibodies without LGI1 or CASPR2 reactivities (double-negative) are more common than LGI1 or CASPR2 specificities. Therefore, the target(s) and clinical associations of double-negative antibodies need to be determined. METHODS Sera (n=1131) from several clinically defined cohorts were tested for IgG radioimmunoprecipitation of radioiodinated α-dendrotoxin (125I-αDTX)-labelled VGKC complexes from mammalian brain extracts. Positive samples were systematically tested for live hippocampal neuron reactivity, IgG precipitation of 125I-αDTX and 125I-αDTX-labelled Kv1 subunits, and by cell-based assays which expressed Kv1 subunits, LGI1 and CASPR2. RESULTS VGKC complex antibodies were found in 162 of 1131 (14%) sera. 90 of these (56%) had antibodies targeting the extracellular domains of LGI1 or CASPR2. Of the remaining 72 double-negative sera, 10 (14%) immunoprecipitated 125I-αDTX itself, and 27 (38%) bound to solubilised co-expressed Kv1.1/1.2/1.6 subunits and/or Kv1.2 subunits alone, at levels proportionate to VGKC complex antibody levels (r=0.57, p=0.0017). The sera with LGI1 and CASPR2 antibodies immunoprecipitated neither preparation. None of the 27 Kv1-precipitating samples bound live hippocampal neurons or Kv1 extracellular domains, but 16 (59%) bound to permeabilised Kv1-expressing human embryonic kidney 293T cells. These intracellular Kv1 antibodies mainly associated with non-immune disease aetiologies, poor longitudinal clinical-serological correlations and a limited immunotherapy response. CONCLUSIONS Double-negative VGKC complex antibodies are often directed against cytosolic epitopes of Kv1 subunits and occasionally against non-mammalian αDTX. These antibodies should no longer be classified as neuronal-surface antibodies. They consequently lack pathogenic potential and do not in themselves support the use of immunotherapies.
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Affiliation(s)
- Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Mateusz Makuch
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Teresa Moloney
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Inga Dettmann
- Institute for Experimental Immunology, Lubeck, Germany
| | | | | | | | - Camilla Buckley
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | | | - M Isabel Leite
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Paul Maddison
- Department of Neurology, Queen's Medical Centre, Nottingham, UK
| | | | - Jane Adcock
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Patrick Waters
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Sarosh R Irani
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Pavolucci L, Giannini G, Giannoccaro MP, Foschini MP, Lang B, Avoni P, Tinuper P, Vincent A, Liguori R. Paraneoplastic cerebellar degeneration and lambert-eaton myasthenia in a patient with merkel cell carcinoma and voltage-gated calcium channel antibodies. Muscle Nerve 2017; 56:998-1000. [PMID: 28006860 DOI: 10.1002/mus.25530] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2016] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Merkel cell carcinoma is a rare cutaneous, aggressive tumor. Although it shares many neuroendocrine features with small cell lung carcinoma, it has only occasionally been reported with paraneoplastic neurological syndromes. METHODS A healthy 67-year-old man developed acute ataxia, vertigo, and nausea. Subsequently he also developed dysarthria, diplopia, xerostomia, fatigability and progressive anorexia. He underwent a full diagnostic workup and was found to have a high titer of voltage-gated calcium channel antibodies in serum and cerebrospinal fluid, neurophysiological findings compatible with Lambert-Eaton myasthenia and neurological signs compatible with cerebellar degeneration. RESULTS A positron emission tomography study revealed a hypermetabolic lesion in the axilla, subsequently biopsied and consistent with Merkel cell carcinoma. CONCLUSIONS In most previous reports, neurological symptoms preceded the Merkel cell carcinoma diagnosis, and the primary localization was in lymph nodes. This tumor should be considered in patients with paraneoplastic syndrome, and particularly Lambert-Eaton myasthenia after exclusion of small cell lung carcinoma. Muscle Nerve 56: 998-1000, 2017.
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Affiliation(s)
- Lucia Pavolucci
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Giulia Giannini
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Maria Pia Giannoccaro
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Patrizia Avoni
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Paolo Tinuper
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Rocco Liguori
- Department of Biomedical and Neuromotor Sciences (DiBiNeM), University of Bologna, Via Altura 3, 40139, Bologna, Italy.,IRCCS Institute of Neurological Sciences, Bologna, Italy
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Maddison P, Gozzard P, Grainge MJ, Lang B. Long-term survival in paraneoplastic Lambert-Eaton myasthenic syndrome. Neurology 2017; 88:1334-1339. [DOI: 10.1212/wnl.0000000000003794] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 01/17/2017] [Indexed: 01/19/2023] Open
Abstract
Objective:To establish whether improved tumor survival in patients with Lambert-Eaton myasthenic syndrome (LEMS) and small-cell lung cancer (SCLC) was due to known prognostic risk factors or an effect of LEMS independently, perhaps as a result of circulating factors.Methods:We undertook a prospective observational cohort study of patients with LEMS attending Nottingham University Hospitals, UK, or via the British Neurological Surveillance Unit. In parallel, patients with a new diagnosis of biopsy-proven SCLC were enrolled, examined for neurologic illness, and followed up until death or study end.Results:Between May 2005 and November 2014, we recruited 31 patients with LEMS and SCLC and 279 patients with SCLC without neurologic illness. Allowing for known SCLC survival prognostic factors of disease extent, age, sex, performance status, and sodium values, multivariate Cox regression analysis showed that the presence of LEMS with SCLC conferred a significant survival advantage independently of the other prognostic variables (hazard ratio 1.756, 95% confidence interval 1.137–2.709, p = 0.011).Conclusions:Improved SCLC tumor survival seen in patients with LEMS and SCLC may not be due solely to lead time bias, given that survival advantage remains after allowing for other prognostic factors and that the same degree of survival advantage is not seen in patients with paraneoplastic neurologic syndromes other than LEMS presenting before SCLC diagnosis.
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Lennox BR, Pollak T, Palmer-Cooper EC, Scoriels L, Harrison PJ, Jones PB, Lang B, Crowley H, Marks J, Vincent A. Serum neuronal cell-surface antibodies in first-episode psychosis-Authors' reply. Lancet Psychiatry 2017; 4:187-188. [PMID: 28236947 DOI: 10.1016/s2215-0366(17)30053-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
| | - Thomas Pollak
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | | | - Linda Scoriels
- Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Paul J Harrison
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Peter B Jones
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Hannah Crowley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jacqui Marks
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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49
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Lennox BR, Palmer-Cooper EC, Pollak T, Hainsworth J, Marks J, Jacobson L, Lang B, Fox H, Ferry B, Scoriels L, Crowley H, Jones PB, Harrison PJ, Vincent A. Prevalence and clinical characteristics of serum neuronal cell surface antibodies in first-episode psychosis: a case-control study. Lancet Psychiatry 2017; 4:42-48. [PMID: 27965002 PMCID: PMC5890880 DOI: 10.1016/s2215-0366(16)30375-3] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 10/12/2016] [Accepted: 10/24/2016] [Indexed: 12/30/2022]
Abstract
BACKGROUND Psychosis is a common presenting feature in antibody-mediated encephalitis, for which prompt recognition and treatment usually leads to remission. We aimed to investigate whether people with circumscribed schizophrenia-like illnesses have such antibodies-especially antibodies against the N-methyl-D-aspartate receptor (NMDAR)-more commonly than do healthy controls. METHODS We recruited patients aged 14-35 years presenting to any of 35 mental health services sites across England with first-episode psychosis, less than 6 weeks of treatment with antipsychotic medication, and a score of 4 or more on at least one selected Positive and Negative Syndrome Scale (PANSS) item. Patients and controls provided venous blood samples. We completed standardised symptom rating scales (PANSS, ACE-III, GAF) at baseline, and tested serum samples for antibodies against NMDAR, LGI1, CASPR2, the GABAA receptor, and the AMPA receptor using live cell-based assays. Treating clinicians assessed outcomes of ICD diagnosis and functioning (GAF) at 6 months. We included healthy controls from the general population, recruited as part of another study in Cambridge, UK. FINDINGS Between Feb 1, 2013, and Aug 31, 2014, we enrolled 228 patients with first-episode psychosis and 105 healthy controls. 20 (9%) of 228 patients had serum antibodies against one or more of the neuronal cell surface antibodies compared with four (4%) of 105 controls (unadjusted odds ratio 2·4, 95% CI 0·8-7·3). These associations remained non-significant when adjusted for current cigarette smoking, alcohol consumption, and illicit drug use. Seven (3%) patients had NMDAR antibodies compared with no controls (p=0·0204). The other antibodies did not differ between groups. Antibody-positive patients had lower PANSS positive, PANSS total, and catatonia scores than did antibody-negative patients. Patients had comparable scores on other PANSS items, ACE-III, and GAF at baseline, with no difference in outcomes at 6 months. INTERPRETATION Some patients with first-episode psychosis had antibodies against NMDAR that might be relevant to their illness, but did not differ from patients without NMDAR antibodies in clinical characteristics. Our study suggests that the only way to detect patients with these potentially pathogenic antibodies is to screen all patients with first-episode psychosis at first presentation. FUNDING Medical Research Council.
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Affiliation(s)
- Belinda R Lennox
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK.
| | | | - Thomas Pollak
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jane Hainsworth
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Jacqui Marks
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Leslie Jacobson
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Hannah Fox
- Department of Clinical Laboratory Immunology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Berne Ferry
- Department of Clinical Laboratory Immunology, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Linda Scoriels
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK; Institute of Psychiatry, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Hannah Crowley
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Peter B Jones
- Department of Psychiatry, Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK
| | - Paul J Harrison
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
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Abstract
BACKGROUND Stiff person syndrome is a highly disabling, progressive autoimmune disorder of the central nervous system characterized by muscle rigidity and spasms. Stiff person syndrome is rare, but is believed to be under diagnosed with only 14 cases been reported among a 1.7 billion population in South Asia. We report the first authenticated case from Sri Lanka. CASE PRESENTATION A 55-year-old Sri Lankan female presented with difficulty in walking and recurrent falls due to progressive muscular rigidity in her lower limbs and trunk with superimposed muscle spasms that occurred in response to unexpected noise, startle or emotional upset. She had anxiety and specific phobias to open spaces, walking unaided and being among crowds of people. She had insulin-dependent diabetes mellitus and was on thyroxine replacement. On examination, she had hyperlordosis combined with board-like rigidity of her anterior abdomen and rigidity of her lower limbs bilaterally. Upper limbs were normal. Magnetic resonance imaging of her neuraxis was normal. Electromyography showed continuous motor unit activity at rest. Glutamic acid decarboxylase antibodies were detected in her serum at a titre of 15,500 IU/ml (normal <5). She showed a remarkable and sustained improvement to treatment with intravenous immunoglobulins, immunosuppressive and muscle relaxant medications, regaining independent ambulation. CONCLUSIONS Diagnosis of stiff person syndrome remains clinical, supported by electromyography and serology for glutamic acid decarboxylase antibodies, facilitated by a high index of clinical suspicion. An autoimmune basis lends stiff person syndrome amenable to treatment highlighting the importance of diagnosis. This case adds to map the worldwide distribution of stiff person syndrome.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, 25, Kynsey Road, Colombo, 00800, Sri Lanka.
| | - Bethan Lang
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Level 5/6 West Wing, Oxford, OX3 9DU, UK
| | - Angela Vincent
- Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Level 5/6 West Wing, Oxford, OX3 9DU, UK
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