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Cayuela N, Jaramillo-Jiménez E, Majós C, Velasco R, Boget T, Graus F, Bruna J, Simó M. Corrigendum. Neuro Oncol 2021; 23:1210. [PMID: 30462315 PMCID: PMC8248828 DOI: 10.1093/neuonc/noy179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Cayuela
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, Barcelona, Spain, Hospitalet de Llobregat, Spain
| | - E Jaramillo-Jiménez
- Neuro-Oncology Unit, Instituto Neurológico de Colombia (INDEC), Universidad CES, Medellín, Colombia, Medellín, Colombia
| | - C Majós
- Radiology, Institut Diagnòstic per la Imatge (IDI), L'Hospitalet de Llobregat, Barcelona, Spain, Hospitalet de Llobregat, Spain
| | - R Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, Barcelona, Spain, Hospitalet de Llobregat, Spain
| | - T Boget
- Epilepsy Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clinic de Barcelona, Barcelona, Spain, Barcelona, Spain
| | - F Graus
- Department of Neurology, IDIBAPS, Hospital Clínic, Barcelona, Spain, Barcelona, Spain
| | - J Bruna
- Institute of Neurosciences, Department of Cell Biology, Physiology and Immunology, Universitat Autònoma de Barcelona, CIBERNED, Bellaterra, Spain, Bellaterra, Spain
| | - M Simó
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO l'Hospitalet, IDIBELL, Barcelona, Spain, Hospitalet de Llobregat, Spain
- Cognition and Brain Plasticity Group, IDIBELL, Barcelona, Spain, Hospitalet de Llobregat, Spain
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Velasco R, Mercadal S, Vidal N, Alañá M, Barceló MI, Ibáñez-Juliá MJ, Bobillo S, Caldú Agud R, García Molina E, Martínez P, Cacabelos P, Muntañola A, García-Catalán G, Sancho JM, Camro I, Lado T, Erro ME, Gómez-Vicente L, Salar A, Caballero AC, Solé-Rodríguez M, Gállego Pérez-Larraya J, Huertas N, Estela J, Barón M, Barbero-Bordallo N, Encuentra M, Dlouhy I, Bruna J, Graus F. Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study. J Neurooncol 2020; 148:545-554. [PMID: 32524392 DOI: 10.1007/s11060-020-03547-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. METHODS Retrospective analysis of 327 immunocompetent patients with histologically confirmed PCNSL diagnosed between 2005 and 2014 in 27 Spanish hospitals. RESULTS Median age was 64 years (range: 19-84; 33% ≥ 70 years), 54% were men, and 59% had a performance status (PS) ≥ 2 at diagnosis. Median delay to diagnosis was 47 days (IQR 24-81). Diagnostic delay > 47 days was associated with PS ≥ 2 (OR 1.99; 95% CI 1.13-3.50; p = 0.016) and treatment with corticosteroids (OR 2.47; 95% CI 1.14-5.40; p = 0.023), and it did not improve over the years. Patients treated with corticosteroids (62%) had a higher risk of additional biopsies (11.7% vs 4.0%, p = 0.04) but corticosteroids withdrawal before surgery did not reduce this risk and increased the diagnostic delay (64 vs 40 days, p = 0.04). Median overall survival (OS) was 8.9 months [95% CI 5.9-11.7] for the whole series, including 52 (16%) patients that were not treated, and 14.1 months (95%CI 7.7-20.5) for the 240 (73.4%) patients that received high-dose methotrexate (HD-MTX)-based chemotherapy. Median OS was shorter in patients ≥ 70 years (4.1 vs. 13.4 months; p < 0.0001). Multivariate analysis identified age ≥ 65 years, PS ≥ 2, no treatment, and cognitive/psychiatric symptoms at diagnosis as independent predictors of short survival. CONCLUSIONS Corticosteroids withdrawal before surgery does not decrease the risk of a negative biopsy but delays diagnosis. In this community-based study, only 73.4% of patients could receive HD-MTX-based chemotherapy and OS remains poor, particularly in elderly patients ≥ 70 years.
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Affiliation(s)
- R Velasco
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. .,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain. .,Department of Neurology, Neuro-Oncology Unit, Hospital Universitari de Bellvitge and ICO L'Hospitalet, C/Feixa Llarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
| | - S Mercadal
- Department of Hematology, Catalan Institute of Oncology-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - N Vidal
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Pathology, Unit of Neuro-Oncology. Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet del Llobregat, Barcelona, Spain
| | - M Alañá
- Department of Neurology, Complejo Asistencial Universitario, Salamanca, Spain
| | - M I Barceló
- Department of Neurology, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - M J Ibáñez-Juliá
- Department of Neurology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - S Bobillo
- Department of Hematology, Vall d'Hebron Institute of Oncology (VHIO), University Hospital Vall d'Hebron, Barcelona, Spain
| | - R Caldú Agud
- Department of Neurology, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - E García Molina
- Department of Neurology, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | - P Martínez
- Department of Hematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Cacabelos
- Department of Neurology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, La Coruña, Spain
| | - A Muntañola
- Department of Hematology, Hospital Universitario Mutua de Terrassa, Terrassa, Spain
| | - G García-Catalán
- Department of Neurosurgery, Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - J M Sancho
- Department of Hematology, ICO-IJC-Hospital Germans Trias i Pujol, Badalona, Spain
| | - I Camro
- Department of Neurology, Hospital Universitario Cruces, Barakaldo, Vizcaya, Spain
| | - T Lado
- Department of Hematology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - M E Erro
- Neurology Department, Complejo Hospitalario de Navarra, Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - L Gómez-Vicente
- Department of Neurology, Hospital Universitario Quirónsalud Madrid, Pozuelo de Alarcón, Madrid, Spain
| | - A Salar
- Department of Hematology, Hospital del Mar, Barcelona, Spain
| | - A C Caballero
- Department of Hematology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - M Solé-Rodríguez
- Department of Hematology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - J Gállego Pérez-Larraya
- Departament of Neurology, Clínica Universidad de Navarra, IdiSNA, Instituto de Investigación Sanitaria de Navarra, Pamplona, Spain
| | - N Huertas
- Department of Neurology, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain
| | - J Estela
- Department of Neurology, Hospital Parc Taulí, Sabadell, Spain
| | - M Barón
- Unit of Neurology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - N Barbero-Bordallo
- Department of Neurology, Hospital Universitario Rey Juan Carlos, HURJC-HUIE-HCV, Madrid, Spain
| | - M Encuentra
- Department of Hematology, Catalan Institute of Oncology-Hospital Duran i Reynals, IDIBELL, Universitat de Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - I Dlouhy
- Department of Hematology and Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
| | - J Bruna
- Neuro-Oncology Unit, Hospital Universitari de Bellvitge-ICO Duran i Reynals, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Cell Biology, Physiology and Immunology, Institute of Neurosciences, Universitat Autònoma de Barcelona, and Centro de Investigación Biomédica en Red Sobre Enfermedades Neurodegenerativas (CIBERNED), Bellaterra, Spain
| | - F Graus
- Department of Hematology and Neurology, Hospital Clínic de Barcelona, Barcelona, Spain
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Vialatte de Pémille C, Psimaras D, Adanyegu I, Graus F, Dürr A, Honnorat J, Delattre J, Alentorn A. P14.102 Cerebellar atrophy patterns in paraneoplastic cerebellar degeneraiton and spinocerebellar ataxia 1 (SCA1). Neuro Oncol 2019. [DOI: 10.1093/neuonc/noz126.337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
BACKGROUND
Brain and more specifically cerebellar atrophy is a major radiological finding in both Paraneoplastic Cerebellar Degeneration (PCD) with anti-Yo antibodies and Spinocerebellar Ataxia type 1 (SCA1).We sought to analyze the different brain volumetric patterns of cerebellar atrophy in these diseases.
MATERIAL AND METHODS
We performed a retrospective multicentric study (Paris, Lyon, Barcelona reference centres) with either anti-Yo PCD (n=16) or SCA1 (n=17) and 30 healthy subjects paired by age. We used VolBrain and CERES algorithms to obtain the brain and cerebellum segmentation, respectively as well as the cortical thickness. We used a Sparse Canonical Correlation Analysis (SCCAN) and Voxel Brain Morphometry (VBM) with family wise error correction to analyze volumetric differences between the different conditions.
RESULTS
SCA patients were younger than PCD patients (p<0.05, ANOVA). In univariate analysis, most of the atrophic regions (p<0.05) were common between PCD and SCA1 compared to controls. Isolated cortical thickness and grey matter analysis showed predominant atrophy in PCD patients. Multivariate analysis using SCCAN and VBM confirmed these results. We identified a particular atrophy pattern in PCD patients involving lobules III to VII. We observed a more diffuse atrophy distribution in SCA1 patients and a lower cortical atrophy in PCD patients.
CONCLUSION
We described the specific pattern of topographic cerebellar atrophy in PCD and SCA1 patients. The cerebellar atrophy in PCD is mainly localized in the neocerebellum.
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Affiliation(s)
- C Vialatte de Pémille
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2,Sorbonne Université, UPMC Univ, Paris, France
| | - D Psimaras
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2,Sorbonne Université, UPMC Univ, Paris, France
| | - I Adanyegu
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Genetics,Sorbonne Université, Paris, France
| | - F Graus
- AP-HP, GDepartment of Neurology, Hospital Clinic, University of Barcelona and Institut d’Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.roupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2, Sorbonne Université, UPMC Univ, Barcelona, Spain
| | - A Dürr
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Department of Genetics,Sorbonne Université, Paris, France
| | - J Honnorat
- AP-HP,French Reference Center on Paraneoplastic Neurological Syndromes, Hospices Civils de Lyon, and Institut NeuroMyoGene INSERM U1217/CNRS UMR 5310, Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France, Lyon, France
| | - J Delattre
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2,Sorbonne Université, UPMC Univ, Paris, France
| | - A Alentorn
- AP-HP, Groupe Hospitalier Pitié-Salpêtrière, Service de Neurologie 2,Sorbonne Université, UPMC Univ, Paris, France
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Graus F, Escudero D, Oleaga L, Bruna J, Villarejo-Galende A, Ballabriga J, Barceló MI, Gilo F, Popkirov S, Stourac P, Dalmau J. Syndrome and outcome of antibody-negative limbic encephalitis. Eur J Neurol 2018; 25:1011-1016. [PMID: 29667271 DOI: 10.1111/ene.13661] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 04/09/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND PURPOSE The aim was to report the clinical characteristics of 12 patients with limbic encephalitis (LE) who were antibody-negative after a comprehensive immunological study. METHODS The clinical records of 163 patients with LE were reviewed. Immunohistochemistry on rat brain, cultured neurons and cell-based assays were used to identify neuronal autoantibodies. Patients were included if (i) there was adequate clinical, cerebrospinal fluid (CSF) and magnetic resonance imaging information to classify the syndrome as LE, (ii) magnetic resonance images were accessible for central review and (iii) serum and CSF were available and were confirmed negative for neuronal antibodies. RESULTS Twelve (7%) of 163 LE patients [median age 62 years; range 40-79; 9 (75%) male] without neuronal autoantibodies were identified. The most frequent initial complaints were deficits in short-term memory leading to hospital admission in a few weeks (median time 2 weeks; range 0.5-12). In four patients the short-term memory dysfunction remained as an isolated symptom during the entire course of the disease. Seizures, drowsiness and psychiatric problems were unusual. Four patients had solid tumors (one lung, one esophagus, two metastatic cervical adenopathies of unknown primary tumor) and one chronic lymphocytic leukemia. CSF showed pleocytosis in seven (58%) with a median of 13 white blood cells/mm3 (range 9-25). Immunotherapy included corticosteroids, intravenous immunoglobulins and combinations of both drugs or with rituximab. Clinical improvement occurred in six (54%) of 11 assessable patients. CONCLUSIONS Despite the discovery of new antibodies, 7% of LE patients remain seronegative. Antibody-negative LE is more frequent in older males and usually develops with predominant or isolated short-term memory loss. Despite the absence of antibodies, patients may have an underlying cancer and respond to immunotherapy.
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Affiliation(s)
- F Graus
- Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Service of Neurology, Hospital Clinic, Barcelona, Spain
| | - D Escudero
- Service of Neurology, Hospital Clinic, Barcelona, Spain
| | - L Oleaga
- Department of Radiology, Hospital Clinic, Barcelona, Spain
| | - J Bruna
- Unit of Neuro-Oncology, Hospital de Bellvitge, Institut Català d'Oncologia (ICO) L'Hospitalet, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Hospitalet del Llobregat, Spain
| | | | - J Ballabriga
- Service of Neurology, Hospital Son Llatzer, Palma de Mallorca, Spain
| | - M I Barceló
- Service of Neurology, Hospital Son Espases, Palma de Mallorca, Spain
| | - F Gilo
- Service of Neurology, Hospital Nuestra Señora del Rosario, Madrid, Spain
| | - S Popkirov
- Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr-University Bochum, Bochum, Germany
| | - P Stourac
- Department of Neurology, Masaryk University and University Hospital, Brno, Czech Republic
| | - J Dalmau
- Neuroimmunology Program, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Spain.,Institució Catalana de Recerca i Estudis Avançats (ICREA), Barcelona, Spain.,Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA
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Cayuela N, Simó M, Majós C, Rifà‐Ros X, Gállego Pérez‐Larraya J, Ripollés P, Vidal N, Miró J, Gil F, Gil‐Gil M, Plans G, Graus F, Bruna J. Seizure‐susceptible brain regions in glioblastoma: identification of patients at risk. Eur J Neurol 2017; 25:387-394. [DOI: 10.1111/ene.13518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 11/02/2017] [Indexed: 01/13/2023]
Affiliation(s)
- N. Cayuela
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
| | - M. Simó
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
- Cognition and Brain Plasticity Group IDIBELL Barcelona Spain
| | - C. Majós
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
| | - X. Rifà‐Ros
- Cognition and Brain Plasticity Group IDIBELL Barcelona Spain
| | | | - P. Ripollés
- Cognition and Brain Plasticity Group IDIBELL Barcelona Spain
| | - N. Vidal
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
| | - J. Miró
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
- Cognition and Brain Plasticity Group IDIBELL Barcelona Spain
| | - F. Gil
- Department of Neurology IDIBAPS, Hospital Clínic Barcelona Spain
| | - M. Gil‐Gil
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
| | - G. Plans
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
| | - F. Graus
- Department of Neurology IDIBAPS, Hospital Clínic Barcelona Spain
| | - J. Bruna
- Neuro‐Oncology Unit Hospital Universitari de Bellvitge–ICO l'Hospitalet, IDIBELL Barcelona Spain
- Institute of Neurosciences Department of Cell Biology, Physiology and Immunology Universitat Autònoma de Barcelona CIBERNED Bellaterra Spain
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Mercadal S, Vidal N, López-Parra M, Ibañez M, Caldú R, Bobillo S, Barceló I, García E, Martinez P, Cacabelos P, Dlouhy I, Sancho J, Muntañola A, Gómez L, Erro E, Gállego J, Salar A, Caballero A, Solé M, Huertas N, Estela J, Baron M, Barbero N, González-Barca E, Graus F, Velasco R. Initial management of primary central nervous system lymphoma in Spain in the last decade. The experience of the GELTAMO and Spanish neuro-oncology groups. Hematol Oncol 2017. [DOI: 10.1002/hon.2439_107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S. Mercadal
- Hematology; Catalan Institute of Oncology. Hospital Duran i Reynals., L'Hospitalet de Llobregat; Barcelona Spain
| | - N. Vidal
- Pathology; Hospital de Bellvitge, L'Hospitalet de Llobregat; Barcelona Spain
| | - M. López-Parra
- Hematology; Hospital Universitario de Salamanca; Salamanca Spain
| | - M. Ibañez
- Neurology; Hospital Universitario i Politècnic La Fe; Valencia Spain
| | - R. Caldú
- Neurology; Hospital Universitario Miguel Servet; Zaragoza Spain
| | - S. Bobillo
- Hematology; Hospital Vall d'Hebrón; Barcelona Spain
| | - I. Barceló
- Neurology; Hospital Universitario Son Espases; Palma de Mallorca Spain
| | - E. García
- Neurology; Hospital Universitario Virgen de la Arrixaca; Murcia Spain
| | - P. Martinez
- Hematology; Hospital Universitario Doce de Octubre; Madrid Spain
| | - P. Cacabelos
- Neurology; Complejo hospitalario Santiago Compostela; Santiago Compostela Spain
| | - I. Dlouhy
- Hematology; Hospital Clínic; Barcelona Spain
| | - J. Sancho
- Hematology; ICO. Hospital Germans Trias i Pujol; Badalona Spain
| | - A. Muntañola
- Hematology; Hospital Mutua de Terrassa; Terrassa Spain
| | - L. Gómez
- Neurology; Hospital Quirón; Madrid Spain
| | - E. Erro
- Neurology; Hospital de Navarra; Pamplona Spain
| | - J. Gállego
- Neurology; Clínica Universitaria de Navarra; Pamplona Spain
| | - A. Salar
- Hematology; Hospital del Mar; Barcelona Spain
| | - A. Caballero
- Hematology; Hospital de Sant Pau; Barcelona Spain
| | - M. Solé
- Hematology; Hospital Virgen del Rocío; Sevilla Spain
| | - N. Huertas
- Neurology; Hospiatl Severo Ochoa; Leganés Spain
| | - J. Estela
- Neurology; Hospital Parc Taulí; Sabadell Spain
| | - M. Baron
- Neurology; Hospital Fundación Alcorcón; Alcorcón Spain
| | - N. Barbero
- Neurology; Hospital Rey Juan Carlos; Móstoles Spain
| | - E. González-Barca
- Hematology; Catalan Institute of Oncology. Hospital Duran i Reynals., L'Hospitalet de Llobregat; Barcelona Spain
| | - F. Graus
- Hematology; Hospital Clínic; Barcelona Spain
| | - R. Velasco
- Neurology; Hospital de Bellvitge, L'Hospitalet de Llobregat; Barcelona Spain
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Velasco R, Mercadal S, Vidal N, Bruna J, González-Barca E, López-Guillermo A, Graus F. OS08.9 Management of Primary Central Nervous System Lymphoma in Spain in the last decade: a case series of the Spanish Group of Neuro-Oncology and GELTAMO. Neuro Oncol 2017. [DOI: 10.1093/neuonc/nox036.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Velasco R, Mercadal S, Vidal N, López-Guillermo A, Bruna J, Graus F. P17.02 Diagnostic delay and treatment options of Primary Central Nervous System Lymphoma in the last decade: preliminary results of first 50 patients from two Catalan institutions. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.276] [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: 11/14/2022] Open
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9
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Cayuela N, Majos C, Simó M, Ripollés P, Gállego J, Graus F, Gil F, Gil-Gil M, Vidal N, Bruna J. P07.07 Tumor location and seizure risk in glioblastoma population. Neuro Oncol 2016. [DOI: 10.1093/neuonc/now188.118] [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: 11/15/2022] Open
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Ortega Suero G, Sola-Valls N, Escudero D, Saiz A, Graus F. Anti-Ma and anti-Ma2-associated paraneoplastic neurological syndromes. Neurologia 2016; 33:18-27. [PMID: 27460184 DOI: 10.1016/j.nrl.2016.05.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 05/05/2016] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE Analyse the clinical profile, associated tumour types, and response to treatment of paraneoplastic neurological syndromes associated with antibodies against Ma proteins. METHODS A retrospective study of patients with antibodies against Ma proteins identified in a neuroimmunology laboratory of reference. RESULTS Of the 32 patients identified, 20 showed reactivity against Ma2 only (anti-Ma2 antibodies), 11 against Ma1 and Ma2 (anti-Ma antibodies), and 1 with reactivity against Ma1 only (anti-Ma1 antibodies). The most common clinical presentations were limbic encephalopathy, diencephalic dysfunction, or brainstem encephalopathy, frequently appearing as a combination of these features. Three patients had isolated cerebellar dysfunction with anti-Ma antibodies, and 2 exhibited peripheral nervous system syndrome with anti-Ma2 antibodies. Testicular tumours were the most common neoplasms (40%) in the anti-Ma2 cases. In the group associated with anti-Ma1 antibodies, the most common were lung tumours (36%), followed by testicular tumours. All idiopathic cases were reactive to Ma2. The clinical outcome was significantly better in the anti-Ma2 group. The patient with anti-Ma1 presented with limbic encephalitis and brainstem dysfunction associated with lymphoepithelioma of the bladder. CONCLUSIONS Specifically determining the different reactivities of anti-Ma protein antibodies in order to differentiate between Ma1 and Ma2 antibodies is important because anti-Ma2-associated paraneoplastic syndromes have a better outcome. Lastly, this study is the first to confirm that there may be cases that react exclusively to antibodies against Ma1.
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Affiliation(s)
- G Ortega Suero
- Servicio de Neurología, Hospital Clínico San Carlos, Madrid, España.
| | - N Sola-Valls
- Servicio de Neurología, Hospital Clínic, Barcelona, España
| | - D Escudero
- Servicio de Neurología, Hospital Clínic, Barcelona, España
| | - A Saiz
- Servicio de Neurología, Hospital Clínic, Barcelona, España
| | - F Graus
- Servicio de Neurología, Hospital Clínic, Barcelona, España
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11
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Falip M, Miró J, Jaraba S, Cusó S, Capdevila O, Graus F, Martínez-Yélamos A. Immunosuppressive therapy for pharmacoresistant epilepsy due to primary antiphospholipid syndrome. Scand J Rheumatol 2015; 44:515-7. [PMID: 26165723 DOI: 10.3109/03009742.2015.1041155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Falip
- a Epilepsy Unit, Neurology Service , Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona , Spain
| | - J Miró
- a Epilepsy Unit, Neurology Service , Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona , Spain
| | - S Jaraba
- a Epilepsy Unit, Neurology Service , Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona , Spain
| | - S Cusó
- a Epilepsy Unit, Neurology Service , Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona , Spain
| | - O Capdevila
- b Internal Medicine Service , Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona , Spain
| | - F Graus
- c Neuroimmunology Unit, Neurology Service , Hospital Clinic i Provincial , Barcelona , Spain
| | - A Martínez-Yélamos
- d Neurology Service , Bellvitge University Hospital , L'Hospitalet de Llobregat , Barcelona , Spain
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Kenda J, Švigelj V, Rodi Z, Koritnik B, Graus F, Kojović M. Glycine receptor antibodies and progressive encephalomyelitis with rigidity and myoclonus with predominant motor neuron degeneration — Expanding the clinical spectrum. J Neurol Sci 2015; 353:177-8. [DOI: 10.1016/j.jns.2015.03.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Revised: 03/22/2015] [Accepted: 03/31/2015] [Indexed: 12/14/2022]
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Montojo M, Petit-Pedrol M, Graus F, Dalmau J. Clinical spectrum and diagnostic value of antibodies against the potassium channel-related protein complex. Neurología (English Edition) 2015. [DOI: 10.1016/j.nrleng.2013.12.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
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Huijbers MG, Querol LA, Niks EH, Plomp JJ, van der Maarel SM, Graus F, Dalmau J, Illa I, Verschuuren JJ. The expanding field of IgG4-mediated neurological autoimmune disorders. Eur J Neurol 2015; 22:1151-61. [PMID: 26032110 DOI: 10.1111/ene.12758] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [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: 04/09/2015] [Accepted: 04/27/2015] [Indexed: 12/13/2022]
Abstract
At least 13 different disease entities affecting the central nervous system, peripheral nervous system and connective tissue of the skin or kidneys are associated with immunoglobulin G4 (IgG4) immune reactivity. IgG4 has always been considered a benign, non-inflammatory subclass of IgG, in contrast to the well-known complement-activating pro-inflammatory IgG1 subclass. A comprehensive review of these IgG4 autoimmune disorders reveals striking similarities in epitope binding and human leukocyte antigen (HLA) associations. Mechanical interference of extracellular ligand-receptor interactions by the associated IgG4 antibodies seems to be the common/converging disease mechanism in these disorders.
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Affiliation(s)
- M G Huijbers
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - L A Querol
- Department of Neurology, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - E H Niks
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - J J Plomp
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - S M van der Maarel
- Department of Human Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - F Graus
- Department of Neurology, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - J Dalmau
- Department of Neurology, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - I Illa
- Department of Neurology, Hospital Santa Creu I Sant Pau, Barcelona, Spain
| | - J J Verschuuren
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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Kenda J, Kojović M, Graus F, Gregorič Kramberger M. (Pseudo)hemidystonia associated with anti-glutamic acid decarboxylase antibodies - a case report. Eur J Neurol 2015; 22:1573-4. [DOI: 10.1111/ene.12700] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2014] [Accepted: 02/06/2015] [Indexed: 11/30/2022]
Affiliation(s)
- J. Kenda
- Department of Neurology; University Medical Center Ljubljana; Ljubljana Slovenia
| | - M. Kojović
- Department of Neurology; University Medical Center Ljubljana; Ljubljana Slovenia
| | - F. Graus
- Department de Neurologia; Hospital Clínic; Barcelona Spain
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Izquierdo C, Velasco R, Vidal N, Sola N, Llufriu S, Sanchez J, Besora S, Nakayama R, Graus F, Bruna J. P11.06 * LYMPHOMATOSIS CEREBRI: A RARE FORM OF PRIMARY CENTRAL NERVOUS SYSTEM LYMPHOMA. Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.229] [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: 11/12/2022] Open
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Pineda E, Valduvieco I, Pujol T, Oleaga L, Ribalta T, Caral L, Gonzalez J, Boget T, Graus F, Verger E. P17.70 * CAN ELDERLY PATIENTS WITH GLIOBLASTOMA BENEFIT FROM CONVENTIONAL CHEMO-RADIOTHERAPY TREATMENT? Neuro Oncol 2014. [DOI: 10.1093/neuonc/nou174.399] [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: 11/14/2022] Open
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Ducray F, Demarquay G, Graus F, Decullier E, Antoine JC, Giometto B, Psimaras D, Delattre JY, Carpentier AF, Honnorat J. Seronegative paraneoplastic cerebellar degeneration: the PNS Euronetwork experience. Eur J Neurol 2014; 21:731-5. [PMID: 24471811 DOI: 10.1111/ene.12368] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 12/17/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND AND PURPOSE To describe the characteristics of patients presenting a paraneoplastic cerebellar degeneration without classical onconeural antibodies (seronegative PCD). METHODS Thirty-nine seronegative PCD patients from the Paraneoplastic Neurological Syndrome Euronetwork were retrospectively analyzed and compared with 180 patients with PCD associated with classical onconeural antibodies (seropositive PCD). RESULTS No patient had anti-CASPR2 or anti-mGluR1 antibodies. No significant difference between the clinical characteristics of seronegative and seropositive PCD patients was observed. Yet the frequency of associated tumors was different. Lymphoma was more frequent in seronegative than in seropositive women (24% vs. 2%, P = 0.002) whilst gynecological cancer were less frequent (38% vs. 74%, P = 0.002). In comparison with seropositive men, seronegative men more frequently had a non-small-cell lung cancer (27% vs. 6%, P = 0.08) or a genitourinary cancer (22% vs. 0%, P = 0.04) but less frequently a small-cell lung cancer (23% vs. 74%, P = 0.002). Seronegative and seropositive PCD patients with similar tumors had a similar overall survival. CONCLUSION The clinical characteristics of seronegative and seropositive PCD are similar but the spectrum of associated tumors is different. The immunological scenario of seronegative PCD seems to be different from that of limbic encephalitis with only few patients harboring anti-neuropile antibodies.
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Affiliation(s)
- F Ducray
- French Reference Center on Paraneoplastic Neurological Syndrome, Department of Neuro-oncology, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France; Lyon Neuroscience Research Center INSERM U1028/CNRS UMR 5292, Lyon, France; Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France
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Valduvieco Ruiz I, Verger Fransoy E, Pujol T, Falcón C, Herreros A, Caral L, Graus F, Pineda E, Oleaga L. Best oral presentation: Glioblastomas with complete resection: Changes in relative cerebral blood volume in white matter irradiated. Rep Pract Oncol Radiother 2013. [DOI: 10.1016/j.rpor.2013.03.730] [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] Open
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Valduvieco I, Verger E, Oleaga L, Pujol T, Caral L, Ribalta T, Boget T, Pineda E, Graus F. PO-0650 ANALYSIS OF PERFUSION MAGNETIC RESONANCE CHANGES IN RADIATED WHITE MATTER IN PATIENTS WITH GLIOBLASTOMA. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)70983-0] [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: 11/16/2022]
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Akasbi M, Berenguer J, Saiz A, Brito-Zerón P, Pérez-De-Lis M, Bové A, Diaz-Lagares C, Retamozo S, Blanco Y, Perez-Alvarez R, Bosch X, Sisó A, Graus F, Ramos-Casals M. White matter abnormalities in primary Sjögren syndrome. QJM 2012; 105:433-43. [PMID: 22156707 DOI: 10.1093/qjmed/hcr218] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To describe the main characteristics of patients with primary Sjögren syndrome (SS) and white matter abnormalities (WMA) seen by a specialist SS unit. METHODS The study cohort included 321 consecutive patients fulfilling the 2002 classification criteria for primary SS. We retrospectively analyzed the results of neuroimaging studies performed in patients who presented with neurological symptoms. Patients were further evaluated by three neurologists to determine fulfillment of the McDonald criteria for the diagnosis of multiple sclerosis (MS). RESULTS Fifty-one (16%) patients had at least one neuroimaging study, and 25 of these had WMA. WMA were classified as vascular pathological changes in 21 patients: 10 had multiple small focal lesions, 7 had beginning confluence of lesions and 4 had diffuse involvement of the entire region. WMA were classified as inflammatory/demyelinating lesions (MS-like) in 4 patients who fulfilled the MRI Barkhof criteria. Patients with inflammatory/demyelinating lesions were younger (53.7 vs. 73.5 years, P = 0.001) and had a lower frequency of hypertension (25% vs. 86%, P = 0.031) and altered glomerular filtration rate (0% vs. 70%, P = 0.047) in comparison with patients with vascular lesions. The multivariate age-sex adjusted model including the seven variables which were statistically significant in the univariate analysis (antimalarial therapy, leukopenia, anti-La/SSB antibodies, diabetes, hypertension, metabolic syndrome and HDL-c levels) identified hypertension (P = 0.019) and HDL-c levels (P = 0.032) as independent predictors of WMA in primary SS patients. CONCLUSION Neuroimaging studies disclosed WMA in 49% of patients with primary SS and suspected neurological involvement. WMA were identified as vascular pathological changes in 80% of the patients, and hypertension and HDL-c levels as predictive factors for this association.
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Affiliation(s)
- M Akasbi
- Sjögren Syndrome Research Group (AGAUR), Laboratory of Autoimmune Diseases Josep Font, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Department of Autoimmune Diseases, Hospital do Meixoeiro, Vigo, Spain
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Gabilondo I, Saiz A, Martinez E, Fraga E, Llufriu S, Ortiz S, Berenguer J, Hernandez E, Sepulveda M, Blanco Y, Graus F, Sanchez-Dalmau B, Villoslada P. Contribution of Trans-Synaptic Neuronal Degeneration to Retinal Atrophy in MS (P01.161). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p01.161] [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: 11/15/2022] Open
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Titulaer M, McCracken L, Gabilondo Cuellar I, Martinez-Hernandez E, Graus F, Balice-Gordon R, Dalmau J. Clinical Features, Treatment, and Outcome of 500 Patients with Anti-NMDA Receptor Encephalitis (PL01.001). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.pl01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Nunez-Enamorado N, Camacho-Salas A, Belda-Hofheinz S, Cordero-Castro C, Simon-De Las Heras R, Saiz-Diaz R, Martinez-Sarries FJ, Martinez-Menendez B, Graus F. [Fast and spectacular clinical response to plasmapheresis in a paediatric case of anti-NMDA encephalitis]. Rev Neurol 2012; 54:420-424. [PMID: 22451129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Autoimmune encephalitis against N-methyl-D-aspartate (NMDA) receptors is being diagnosed more and more frequently in the paediatric age. It should be suspected in children with psychiatric symptoms, encephalopathy, abnormal movements or epileptic seizures. Paraneoplastic cases are less frequent than in adults. CASE REPORT We report the case of a boy, 2.5 years of age, with subacute encephalopathic signs and symptoms and epileptic seizures followed by behaviour disorders, neurological regression, dyskinesias and insomnia. Results of a cerebrospinal fluid study were normal, the magnetic resonance scan of the head revealed a focal periventricular lesion and diffuse leptomeningeal uptake; moreover, the serial electroencephalograms showed high-amplitude delta activity interspersed with generalised intercritical epileptiform activity. The patient was given empirical treatment with high doses of corticoids and intravenous immunoglobulins with no response. After showing up positive for antibodies against the NMDA receptor, plasmapheresis was begun, which led to his swift and spectacular recovery. After more than 18 months' follow-up, his sequelae are limited to mild behavioural and language alterations. He has had no relapses and has not needed any kind of maintenance treatment. CONCLUSIONS Anti-NMDA encephalitis is a treatable disorder and, sometimes, the first evidence of an underlying neoplasia, which makes its early recognition and treatment essential. Treatment of the non-paraneoplastic forms are based on immunotherapy: glucocorticoids, intravenous immunoglobulins, plasmapheresis and immunosuppressants. Plasmapheresis can bring about a fast, spectacular improvement.
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Falip M, Carreño M, Miró J, Saiz A, Villanueva V, Quílez A, Molins A, Barceló I, Sierra A, Graus F. Prevalence and immunological spectrum of temporal lobe epilepsy with glutamic acid decarboxylase antibodies. Eur J Neurol 2012; 19:827-33. [DOI: 10.1111/j.1468-1331.2011.03609.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Rojas-Marcos I, Picard G, Chinchón D, Gelpi E, Psimaras D, Giometto B, Delattre JY, Honnorat J, Graus F. Human epidermal growth factor receptor 2 overexpression in breast cancer of patients with anti-Yo--associated paraneoplastic cerebellar degeneration. Neuro Oncol 2012; 14:506-10. [PMID: 22351748 DOI: 10.1093/neuonc/nos006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Isolated case reports suggest that breast tumors from patients with paraneoplastic cerebellar degeneration (PCD) and Yo antibodies overexpress human epidermal growth factor receptor 2 (HER2). HER2 overexpression is present in 15%-25% of breast cancers and is associated with poor prognosis. We retrospectively analyzed the status of HER2 in breast tumors of 27 patients with anti-Yo-associated PCD to evaluate whether HER2 overexpression in this group of patients is higher than expected. In addition, we analyzed HER2 status of 19 breast tumors from patients with paraneoplastic neurological syndromes and Ri antibodies to see whether HER2 was specifically related to anti-Yo-associated PCD. We also assessed cdr2 expression (the onconeural antigen recognized by Yo antibodies) in 21 HER2-positive breast tumors from patients without paraneoplastic neurological syndromes. HER2 was overexpressed in 26 patients (96.3%) with anti-Yo-associated PCD but only in 2 patients (10.5%) with paraneoplastic neurological syndromes associated with Ri antibodies (P< .0001). Only 5 (23.8%) of the 21 HER2-positive breast tumors showed cdr2 immunoreactivity. This study shows a very high frequency of HER2 overexpression in breast cancers in patients with anti-Yo-associated PCD but not in those from patients with Ri antibodies. Although the expression of cdr2 onconeural antigen is not high in HER2-positive breast cancers, HER2 overexpression seems to be an important requirement to develop an anti-Yo-associated PCD.
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Affiliation(s)
- Iñigo Rojas-Marcos
- Service of Neurology and Pathology, Hospital Juan Ramón Jiménez, Huelva, Spain
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Verger E, Valduvieco I, Caral L, Pujol T, Ribalta T, Viñolas N, Boget T, Oleaga L, Blanco Y, Graus F. Does gender matter in glioblastoma? Clin Transl Oncol 2012; 13:737-41. [PMID: 21975336 DOI: 10.1007/s12094-011-0725-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
BACKGROUND The clinical outcome of glioblastoma (GBM) patients who receive radiotherapy alone or with chemotherapy is well established. However, little is known about how many patients do not receive this treatment. We consider it is important to investigate why a proportion of operated patients do not receive further treatment after surgery. METHODS We reviewed all consecutive GBM patients operated on in our hospital between January 2000 and December 2008. RESULTS A total of 216 patients with GBM were identified. Fifty-five (25%) did not receive any treatment after surgery. Univariate analysis showed that factors associated with no further treatment after surgery were older than 60 years (p=0.002), of female gender (p=0.03), had a KPS<70 (p<0.001) and had had a biopsy (p<0.001). Multivariate analysis indicated that age =60 years and KPS <70 were independent predictors of no further treatment after surgery. Gender was not an independent variable. However, women in the whole series were older than 60 years (p=0.01), and they had a worse KPS (p=0.02) and more biopsies (p=0.04) than men. In the whole group, median survival time was 10.4 months for men (n=125) vs. 7.2 months for women (n=91), log rank p<0.04. This difference was not observed in the group that was treated after surgery. CONCLUSIONS One out of four patients could not be treated after surgery. Independent predictors were older age and low KPS. These poor risk variables were more frequent in women and their survival was therefore lower than men in our series.
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Affiliation(s)
- E Verger
- Institute of Haematology and Oncology, Department of Radiation Oncology, Hospital Clínic, University of Barcelona, Spain.
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Gabilondo I, Saiz A, Galán L, González V, Jadraque R, Sabater L, Sans A, Sempere A, Vela A, Villalobos F, Viñals M, Villoslada P, Graus F. Analysis of relapses in anti-NMDAR encephalitis. Neurology 2011; 77:996-9. [PMID: 21865579 DOI: 10.1212/wnl.0b013e31822cfc6b] [Citation(s) in RCA: 163] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The clinical characteristics of patients with relapsing anti-NMDA receptor (NMDAR) encephalitis are not well-defined. In this study, we report the clinical profile and outcome of relapses in a series of anti-NMDAR encephalitis. METHODS We did a retrospective review of relapses that occurred in 25 patients with anti-NMDAR encephalitis. Relapses were defined as any new psychiatric or neurologic syndrome, not explained by other causes, which improved after immunotherapy or, less frequently, spontaneously. RESULTS A total of 13 relapses were identified in 6 patients. Four of them had several, 2 to 4, relapses. There was a median delay of 2 years (range 0.5 to 13 years) for the first relapse. Median relapse rate was 0.52 relapses/patient-year. Relapse risk was higher in patients who did not receive immunotherapy in the first episode (p = 0.009). Most cases (53%) presented partial syndromes of the typical anti-NMDAR encephalitis. Main symptoms of relapses were speech dysfunction (61%), psychiatric (54%), consciousness-attention disturbance (38%), and seizures (31%). Three relapses (23%) presented with isolated atypical symptoms suggestive of brainstem-cerebellar involvement. An ovarian teratoma was detected at relapse in only 1 patient (17%). Relapses did not add residual deficit to that caused by the first episode. CONCLUSIONS Relapses in anti-NMDAR encephalitis are common (24%). They may occur many years after the initial episode. Relapses may present with partial aspects or with isolated symptoms of the full-blown syndrome. Immunotherapy at first episode reduces the risk of relapses.
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Affiliation(s)
- I Gabilondo
- Center for Neuroimmunology, Service of Neurology, Hospital Clinic and Institut d’Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain
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Blanco Y, Ercilla-González G, Llufriu S, Casanova-Estruch B, Magraner MJ, Ramió-Torrentá L, Mendibe-Bilbao MM, Uclés-Sánchez AJ, Casado-Chocán JL, López de Munain A, Ramo-Tello C, Santos-Lasaosa S, Fernández-Bolaños Porras R, Segura-Bruna N, Sepulveda-Gázquez M, Villoslada P, Graus F, Saiz A. [HLA-DRB1 typing in Caucasians patients with neuromyelitis optica]. Rev Neurol 2011; 53:146-152. [PMID: 21748712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
INTRODUCTION The existence of antibodies to aquaporin-4 (AQP-4-ab) has identified neuromyelitis optica (NMO) and multiple sclerosis (MS) as different diseases. Although HLA-DRB1 alleles contribute to MS risk, recent studies suggest that HLA back-ground differs between patients with NMO or MS in non-Caucasians populations. Our study was aimed to analyze HLA-DRB1 distribution in Caucasians NMO patients. SUBJECTS AND METHODS We recruited a cohort of 22 NMO patients (73% were AQP-4-ab positive), 228 MS patients and 225 healthy controls from Spain and we genotyped the HLA-DRB1 locus. Then, we performed a pool analysis using reported data from 45 NMO patients (53% were AQP-4-ab positive), 156 MS patients and 310 healthy controls from Caucasian French population. RESULTS In the Spanish cohort, NMO was associated with increased frequency of DRB1*10 allele compared with MS (odds ratio, OR = 15.1; 95% confidence interval, 95% CI = 3.26-69.84; p = 0.012). In the pooled analysis, by comparison with healthy controls, NMO was associated with increased frequency of DRB1*03 allele (OR = 2.27; 95% CI = 1.44-3.58; p < 0.0008) which was related to AQP-4-ab seropositivity (OR = 2.74; 95% CI = 1.58-4.77; p < 0.0008). By contrast, MS was associated with increased frequency of DRB1*15 allele (OR = 2.09; 95% CI = 1.62-2.68; p < 0.0008) and decreased frequency of DRB1*07 allele (OR = 0.58; 95% CI = 0.44-0.78; p < 0.0008). CONCLUSIONS Caucasian patients with NMO and MS have a different HLA-DRB1 allelic distribution. DRB1*03 allele seems to contribute to NMO seropositivity. Multicenter collaborative efforts are needed to adequately address the genetic contribution to NMO susceptibility.
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Affiliation(s)
- Y Blanco
- Servicio de Neurología, Hospital Clínicm, Barcelona, España
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Boronat A, Sabater L, Saiz A, Dalmau J, Graus F. GABA(B) receptor antibodies in limbic encephalitis and anti-GAD-associated neurologic disorders. Neurology 2011; 76:795-800. [PMID: 21357831 DOI: 10.1212/wnl.0b013e31820e7b8d] [Citation(s) in RCA: 215] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND γ-Aminobutyric acid-B receptor antibodies (GABA(B)R-ab) were recently described in 15 patients with limbic encephalitis (LE), associated with small-cell lung cancer (SCLC) or with concurrent glutamic acid decarboxylase (GAD) antibodies. We analyzed the frequency of GABA(B)R-ab in 147 patients with LE or neurologic syndromes associated with GAD-ab. METHODS We examined the presence of GABA(B)R-ab in 70 patients with LE (33 paraneoplastic with onconeural antibodies, 18 paraneoplastic without onconeural antibodies [5 with Gad-ab], and 19 idiopathic with either GAD-ab [5 patients] or seronegative) and 77 patients with GAD-ab-associated neurologic syndromes other than LE (29 stiff-person syndrome, 28 cerebellar ataxia, 14 epilepsy, and 6 with diverse paraneoplastic neurologic syndromes). GABA(B)R-ab were analyzed in serum or CSF by indirect immunofluorescence on HEK293 cells transfected with GABA(B1) and GABA(B2) receptor subunits. RESULTS GABA(B)R-ab were detected in 10 of the 70 patients with LE (14%). Eight had SCLC and 2 were idiopathic. One of the 8 patients with LE with SCLC had an additional onconeural antibody (Hu) and 2 GAD-ab. GABA(B)R-ab were identified in 7 (70%) of the 10 patients with LE and SCLC without onconeural antibodies. GABA(B)R-ab antibodies were not found in patients with GAD-ab and stiff-person syndrome, idiopathic cerebellar ataxia, or epilepsy. However, one patient with GAD-ab, paraneoplastic cerebellar ataxia, and anaplastic carcinoid of the thymus also presented GABA(B)R-ab. CONCLUSIONS GABA(B)R-ab are the most common antibodies found in LE associated with SCLC previously considered "seronegative." In patients with GAD-ab, the frequency of GABA(B)R-ab is low and only observed in the context of cancer.
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Affiliation(s)
- A Boronat
- Servei de Neurologia, Hospital Clínic, Villarroel 170, Barcelona 08036, Spain
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Graus F, Cordon-Cardo C, Posner JB. Neuronal antinuclear antibody in sensory neuronopathy from lung cancer. Neurology 2011. [DOI: 10.1212/01.wnl.0000397289.39301.1d] [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: 11/15/2022] Open
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Briani C, Vitaliani R, Grisold W, Honnorat J, Graus F, Antoine JC, Bertolini G, Giometto B. Spectrum of paraneoplastic disease associated with lymphoma. Neurology 2011; 76:705-10. [PMID: 21339498 DOI: 10.1212/wnl.0b013e31820d62eb] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To define the frequency and clinical and immunologic characteristics of patients affected by paraneoplastic neurologic syndromes (PNS) and lymphoma. METHODS Patients fulfilling the criteria for PNS associated with lymphoma collected from the European Commission-funded PNS Euronetwork group database were analyzed. RESULTS Fifty-three patients with Hodgkin lymphoma (HL) (24 patients, mean age 51, range 16-84) or non-Hodgkin lymphoma (NHL) (29 patients, mean age 64, range 31-82) and PNS were analyzed. The most commonly associated PNS was paraneoplastic cerebellar degeneration, present in 21 cases, with a higher prevalence in HL (16/24 cases). Peripheral nervous system (mainly demyelinating polyradiculopathies) and motor neuron involvement were more common in NHL. Onconeural antibodies were more frequent in patients with paraneoplastic cerebellar degeneration, most commonly against the Tr antigen. Fifty percent of the patients with PNS and HL responded to chemotherapy, whereas neurologic improvement was less frequent (24%) in patients with PNS and NHL. In both groups, the survival rate was good. Overall, 10 out of 53 patients eventually died, with only 2 patients (1 with HL, 1 with NHL) dying from PNS. CONCLUSIONS PNS in patients with lymphoma are relatively rare. Paraneoplastic cerebellar degeneration, mainly associated with anti-Tr antibodies, is more prevalent in HL and NHL, followed in our study by motor neuron disease in patients with NHL. Involvement of the peripheral nervous system is heterogeneous, with a prevalence of polyradiculoneuritis in patients with NHL.
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Affiliation(s)
- C Briani
- Department of Neurosciences, University of Padova, Padova, Italy.
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Reñé R, Ferrer I, Graus F. Clinical and immunohistochemical comparison of in vivo injected anti-Hu and control IgG in the nervous system of the mouse. Eur J Neurol 2011. [DOI: 10.1111/j.1468-1331.1996.tb00224.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Titulaer MJ, Soffietti R, Dalmau J, Gilhus NE, Giometto B, Graus F, Grisold W, Honnorat J, Sillevis Smitt PAE, Tanasescu R, Vedeler CA, Voltz R, Verschuuren JJGM. Screening for tumours in paraneoplastic syndromes: report of an EFNS task force. Eur J Neurol 2010; 18:19-e3. [PMID: 20880069 DOI: 10.1111/j.1468-1331.2010.03220.x] [Citation(s) in RCA: 303] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND paraneoplastic neurological syndromes (PNS) almost invariably predate detection of the malignancy. Screening for tumours is important in PNS as the tumour directly affects prognosis and treatment and should be performed as soon as possible. OBJECTIVES an overview of the screening of tumours related to classical PNS is given. Small cell lung cancer, thymoma, breast cancer, ovarian carcinoma and teratoma and testicular tumours are described in relation to paraneoplastic limbic encephalitis, subacute sensory neuronopathy, subacute autonomic neuropathy, paraneoplastic cerebellar degeneration, paraneoplastic opsoclonus-myoclonus, Lambert-Eaton myasthenic syndrome (LEMS), myasthenia gravis and paraneoplastic peripheral nerve hyperexcitability. METHODS many studies with class IV evidence were available; one study reached level III evidence. No evidence-based recommendations grade A-C were possible, but good practice points were agreed by consensus. RECOMMENDATIONS the nature of antibody, and to a lesser extent the clinical syndrome, determines the risk and type of an underlying malignancy. For screening of the thoracic region, a CT-thorax is recommended, which if negative is followed by fluorodeoxyglucose-positron emission tomography (FDG-PET). Breast cancer is screened for by mammography, followed by MRI. For the pelvic region, ultrasound (US) is the investigation of first choice followed by CT. Dermatomyositis patients should have CT-thorax/abdomen, US of the pelvic region and mammography in women, US of testes in men under 50 years and colonoscopy in men and women over 50. If primary screening is negative, repeat screening after 3-6 months and screen every 6 months up till 4 years. In LEMS, screening for 2 years is sufficient. In syndromes where only a subgroup of patients have a malignancy, tumour markers have additional value to predict a probable malignancy.
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Affiliation(s)
- M J Titulaer
- Department of Neurology, Leiden University Medical Center, Leiden, Netherlands.
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Soffietti R, Baumert B, Bello L, Von Deimling A, Duffau H, Frénay M, Grisold W, Grant R, Graus F, Hoang‐Xuan K, Klein M, Melin B, Rees J, Siegal T, Smits A, Stupp R, Wick W. Guidelines on management of low‐grade gliomas: report of an EFNS–EANO* Task Force. Eur J Neurol 2010; 17:1124-1133. [PMID: 20718851 DOI: 10.1111/j.1468-1331.2010.03151.x] [Citation(s) in RCA: 395] [Impact Index Per Article: 28.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R. Soffietti
- Department of Neuroscience, University Hospital San Giovanni Battista, Turin, Italy
| | - B.G. Baumert
- Department of Radiation‐Oncology (MAASTRO), GROW (School for Oncology & Developmental Biology), Maastricht University Medical Center (MUMC), The Netherlands
| | - L. Bello
- Department of Neurological Sciences, Neurosurgery, University, Milan, Italy
| | - A. Von Deimling
- Department of Neuropathology, University, Heidelberg, Germany
| | - H. Duffau
- Department of Neurosurgery, Hôspital Guide Chauliac, Montpellier, France
| | - M. Frénay
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - W. Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria
| | - R. Grant
- Centre for Neuro‐Oncology, Western General Hospital, Edinburgh, UK
| | - F. Graus
- Service of Neurology, Hospital Clinic, Barcelona, Spain
| | - K. Hoang‐Xuan
- Service de Neurologie, Groupe Hospitalier Pitié‐Salpêtrière, Paris, France
| | - M. Klein
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - B. Melin
- Department of Radiation Sciences, Oncology, Umeå University, Umeå, Sweden
| | - J. Rees
- National Hospital for Neurology and Neurosurgery, London, UK
| | - T. Siegal
- Center for Neuro‐Oncology, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - A. Smits
- Department of Neuroscience, Neurology, University Hospital, Uppsala, Sweden
| | - R. Stupp
- Department of Neurosurgery, Medical Oncology, University Hospital, Lausanne, Switzerland
| | - W. Wick
- Department of Neurooncology, University, Heidelberg, Germany
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Villa S, Weber DC, Moretones C, Manes A, Puyalto P, Cuadras P, Bruna J, Verger E, Graus F, Balana C. Prospective validation of the new graded prognostic assessment scale for brain metastases: A multicenter study. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.2074] [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: 11/20/2022] Open
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Graus F, Boronat A, Xifro X, Boix M, Svigelj V, Garcia A, Palomino A, Sabater L, Alberch J, Saiz A. THE EXPANDING CLINICAL PROFILE OF ANTI-AMPA RECEPTOR ENCEPHALITIS. Neurology 2010; 74:857-9. [DOI: 10.1212/wnl.0b013e3181d3e404] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Blanco Y, Hankiewicz K, Llufriu S, Sabater L, Graus F, Saiz A. Clinical spectrum associated with aquaporin-4 antibodies (NMO-IgG). Neurología (English Edition) 2010. [DOI: 10.1016/s2173-5808(10)70002-x] [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: 11/30/2022] Open
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Blanco Y, Hankiewicz K, Llufriu S, Sabater L, Graus F, Saiz A. [Clinical spectrum associated with aquaporin-4 antibodies (NMO-IgG)]. Neurologia 2010; 25:5-12. [PMID: 20388455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
INTRODUCTION The description of a highly sensitive and specific biomarker for neuromyelitis optica (NMO-IgG/aquaporin-4 antibody) extended the clinical spectrum of NMO to limited forms such as optic neuritis (ON) and longitudinally extensive myelitis (LEM). OBJECTIVE To asses the sensitivity and specificity of our assay, and to describe the clinical characteristics of the patients who were tested for NMO-IgG. METHODS NMO-IgG was analysed by immunohistochemistry and confirmed by assay on HEK cells transfected with aquaporin-4. The clinical information was obtained from forms filled in by the referring neurologists. RESULTS A total of 580 samples from 518 patients were analysed from November 2005 to September 2008. Clinical information was available from 358 (68%) patients. All 33 (100%) positive cases were followed up. Twenty-eight of the 43 (65%) patients diagnosed with NMO by the revised criteria of 2006 were positive; the sensitivity was 62.5% when applying the same criteria, but discounting the criterion of NMO-IgG status, or 57% when applying the criteria of 1999. NMO-IgG was detected in 3 (13%) of the recurrent LEM and 2 (4%) of the recurrent ON. NMO-IgG was not detected in the remaining patients (96 with a final diagnosis of multiple sclerosis; 80 with myelitis; 28 with non-recurrent ON; and 33 other diagnosis). CONCLUSIONS No false positive cases were found in this large and non-selected study. NMO-IgG positive cases were mostly associated with NMO, and only in a low percentage with recurrent ON or LEM.
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Affiliation(s)
- Y Blanco
- Servei de Neurologia, Hospital Clínic, Universitat de Barcelona e Institut d'Investigació August Pi i Sunyer (IDIBAPS), Barcelona, España
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Cabre P, González-Quevedo A, Bonnan M, Saiz A, Olindo S, Graus F, Smadja D, Merle H, Thomas L, Cabrera-Gomez JA. Relapsing neuromyelitis optica: long term history and clinical predictors of death. J Neurol Neurosurg Psychiatry 2009; 80:1162-4. [PMID: 19762908 DOI: 10.1136/jnnp.2007.143529] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Relapsing neuromyelitis optica (RNMO) is an uncommon but devastating inflammatory disorder of the central nervous system. Long term history in a wide series of RNMO is required for better knowledge of the course of the disease and identification of patients at high risk of death. METHODS Clinical features of patients with RNMO (88 women/eight men) obtained from the geographic Caribbean database (Cuba and French West Indies) were used to determine the progression of disability and to identify clinical predictors of death. RESULTS Median age at onset of RNMO was 29.5 years (range 11-74). Median duration of disease was 9.5 years (1-40). Median relapse rate was 0.7 attack/patient/year (0.1-3). 66 patients experienced severe visual loss in at least one eye and 46 in both eyes. Median time from onset to unilateral and bilateral severe visual loss was 3 and 15 years, respectively. Median times to reach Kurtzke Disability Status Scale 3, 6 and 8 from onset of RNMO were 1, 8 and 22 years. There were 24 deaths (25%); within 5 years in 63% of cases. A higher attack frequency during the first year of disease (p = 0.009), blindness (p = 0.04) and sphincter signs at onset (p = 0.02) and lack of recovery of first attack (p = 0.003) were independently associated with a shorter time to death. CONCLUSION RNMO is a very rapidly disabling disease affecting primarily young women. This study has identified clinical features that predict a poor outcome. These findings suggest that early and aggressive immunotherapy might be warranted in RNMO.
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Affiliation(s)
- P Cabre
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies.
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Llufriu S, Castillo J, Blanco Y, Ramio-Torrenta L, Rio J, Valles M, Lozano M, Castella MD, Calabia J, Horga A, Graus F, Montalban X, Saiz A. Plasma exchange for acute attacks of CNS demyelination: Predictors of improvement at 6 months. Neurology 2009; 73:949-53. [DOI: 10.1212/wnl.0b013e3181b879be] [Citation(s) in RCA: 142] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Cabrera-Gómez JA, Bonnan M, González-Quevedo A, Saiz-Hinarejos A, Marignier R, Olindo S, Graus F, Smadja D, Merle H, Thomas L, Gómez-García A, Cabre P. Neuromyelitis optica positive antibodies confer a worse course in relapsing-neuromyelitis optica in Cuba and French West Indies. Mult Scler 2009; 15:828-33. [PMID: 19498017 DOI: 10.1177/1352458509104585] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background In Caucasian populations Neuromyelitis Optica (NMO-IgG) antibody has been detected in 27.1% / 78.2% of patients with relapsing-NMO (R-NMO). The prevalence reported for the disease in the Caribbean is 3.1/100,000 in the French West Indies (FWI) and 0.52 /100,000 in Cuba, but the NMO antibody status is unknown. Objective To assess the NMO-IgG antibody status of Cuban/FWI RNMO patients, comparing with European cases tested at the same laboratories. Methods Serum NMO-IgG antibodies were assayed in 48 R-NMO patients (Wingerchuck´s 1999 criteria): Cuba (24)/FWI (24), employing Lennon et al´s method. We compared the demographic, clinical, disability and laboratory data between NMO-IgG +/- patients. All the data were reviewed and collected blinded to the NMO-IgG status. Results Seropositivity of the NMO-IgG antibody demonstrated a lower rate in the Caribbean (33.3%), as compared with Caucasian patients from Spain/Italy (62.5%) and France (53.8%). Caribbean patients with NMO-IgG (+) displayed more attacks, more spinal attacks and a higher EDSS than NMO-IgG (-) cases, while brain and spinal cord MRI lesions were more frequent during remission, with more vertebral segments, more gray, white matter and holocord involvement. Conclusions NMO IgG positive antibodies in NMO patients had a lower rate in the Caribbean area – where the population has a predominant African ancestry – than in Caucasian Europeans, suggesting the influence of a possible ethnic factor in the pathogenesis of the disease, but they confer a worse course with more attacks, more disability and MRI lesions.
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Affiliation(s)
- JA Cabrera-Gómez
- Cuban Multiple Sclerosis Society and International Neurological Restoration Center, Havana, Cuba
| | - M Bonnan
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - A González-Quevedo
- Institute of Neurology and Neurosurgery, Havana, Cuba. Calle 29 y D, Vedado, La Habana, Cuba
| | - A Saiz-Hinarejos
- Service of Neurology Hospital Clinic and Institut d’Invesigación Biomèdica August Pi i Sanyer (IAIBAPS), University of Barcelona, Villarroel, Barcelona, Spain
| | - R Marignier
- Hôpital Neurologique Pierre Wertheimer, Lyon, France; U842 INSERM, Faculté Laënnec, Lyon Cedex
| | - S Olindo
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - F Graus
- Service of Neurology Hospital Clinic and Institut d’Invesigación Biomèdica August Pi i Sanyer (IAIBAPS), University of Barcelona, Villarroel, Barcelona, Spain
| | - D Smadja
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - H Merle
- Department of Ophthalmology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - L Thomas
- Emergency Department, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
| | - A Gómez-García
- Sancti Spiritus Children Hospital, Sancti Spiritus, Cuba
| | - P Cabre
- Department of Neurology, Pierre Zobda Quitman Hospital, Fort de France, Martinique, French West Indies
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Honnorat J, Cartalat-Carel S, Ricard D, Camdessanche JP, Carpentier AF, Rogemond V, Chapuis F, Aguera M, Decullier E, Duchemin AM, Graus F, Antoine JC. Onco-neural antibodies and tumour type determine survival and neurological symptoms in paraneoplastic neurological syndromes with Hu or CV2/CRMP5 antibodies. J Neurol Neurosurg Psychiatry 2009; 80:412-6. [PMID: 18931014 PMCID: PMC2664637 DOI: 10.1136/jnnp.2007.138016] [Citation(s) in RCA: 164] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Anti-Hu antibodies (Hu-Ab) and anti-CV2/CRMP5 antibodies (CV2/CRMP5-Ab) have been identified in association with paraneoplastic neurological disorders. However, it is not clear whether these antibodies are associated with specific neurological symptoms or are only markers of anti-cancer immune reaction. METHODS To address this question, 37 patients with CV2/CRMP5-Ab and 324 patients with Hu-Ab were compared. RESULTS Whereas the age and sex ratio were the same between the two groups, the distribution of neurological symptoms was not. Patients with CV2/CRMP5-Ab presented more frequently cerebellar ataxia, chorea, uveo/retinal symptoms and myasthenic syndrome (Lambert-Eaton myasthenic syndrome LEMS or myasthenia gravis). They also had a better Rankin score. In contrast, dysautonomia, brainstem encephalitis and peripheral neuropathy were more frequent in patients with Hu-Ab. Limbic encephalitis occurred similarly in both groups. Small-cell lung cancer was the most frequently associated tumour in both groups of patients, while malignant thymoma was observed only in patients with CV2/CRMP5-Ab. In particular, patients with CV2/CRMP5-Ab and thymoma developed myasthenic syndrome more frequently, while patients with SCLC developed neuropathies more frequently. Chorea and myasthenic syndrome were only seen in patients with CV2/CRMP5-Ab. The median survival time was significantly longer in patients with CV2/CRMP5-Ab, and this effect was not dependent on the type of tumour. INTERPRETATION The data demonstrate that in patients with paraneoplastic neurological syndromes, the neurological symptoms and survival vary with both the type of associated onco-neural antibody and the type of tumour.
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Affiliation(s)
- J Honnorat
- Centre de Référence Maladies Rares Syndromes Neurologiques Paranéoplasiques, Hospices Civils de Lyon, Hôpital Neurologique, Bron, France.
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Casadevall T, Costa-Jussà F, Llufriu S, Graus F, Saiz A. [Pruritus as initial manifestation of a paraneoplastic stiff person syndrome associated to anti-amphiphysin antibodies]. Neurologia 2009; 24:215-216. [PMID: 19418303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Saiz A, Bruna J, Stourac P, Vigliani MC, Giometto B, Grisold W, Honnorat J, Psimaras D, Voltz R, Graus F. Anti-Hu-associated brainstem encephalitis. J Neurol Neurosurg Psychiatry 2009; 80:404-7. [PMID: 19015226 DOI: 10.1136/jnnp.2008.158246] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE A series of patients with anti-Hu-associated brainstem encephalitis is reviewed to better define the clinical presentation and to improve its recognition. METHODS Data were collected from 14 patients diagnosed by members of the Paraneoplastic Neurological Syndromes Euronetwork, and eight patients from the literature who presented with isolated brainstem encephalitis and had anti-Hu antibodies. RESULTS The median age of the 22 patients was 64 years (range 42-83), and 50% were men. All patients developed a subacute neurological syndrome, in days or weeks. Brain MRI was always normal. Mild cerebrospinal fluid pleocytosis was reported in only two patients. The following syndromes were identified on admission: A medullary syndrome was seen in 11 (50%) patients. Seven of them presented with dysphagia, dysarthria and central hypoventilation. The other four in addition of bulbar symptoms, without central hypoventilation, presented pontine manifestations. Six (27%) patients developed a pontine syndrome with paresis of the VI or VII cranial nerves, nystagmus, usually vertical, and gait ataxia. There was a rapid downward progression to the medulla in all patients. Five (23%) patients presented a ponto-mesencephalic syndrome with uni- or bilateral palsy of the III and VI cranial nerves and gait ataxia, but rapidly progressed to complete gaze paresis and medullary dysfunction. CONCLUSIONS The study confirms the predominant medullary involvement but also shows that half of the patients present with clinical features that indicate an upper, mainly pontine, dysfunction before downward progression.
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Affiliation(s)
- A Saiz
- Servei de Neurologia, Hospital Clinic, Barcelona, Spain
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Cánovas D, Martínez JM, Viguera M, Ribera G, Graus F, Saiz A. [Paraneoplastic stiff-person syndrome with antiamphiphysin antibodies with small-cell lung cancer]. Neurologia 2009; 24:139-140. [PMID: 19322697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Grimm SA, McCannel CA, Omuro AMP, Ferreri AJM, Blay JY, Neuwelt EA, Siegal T, Batchelor T, Jahnke K, Shenkier TN, Hall AJ, Graus F, Herrlinger U, Schiff D, Raizer J, Rubenstein J, Laperriere N, Thiel E, Doolittle N, Iwamoto FM, Abrey LE. Primary CNS lymphoma with intraocular involvement: International PCNSL Collaborative Group Report. Neurology 2008; 71:1355-60. [PMID: 18936428 DOI: 10.1212/01.wnl.0000327672.04729.8c] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe the demographics, diagnostic details, therapeutic management, and outcome in patients with primary CNS lymphoma (PCNSL) with ocular involvement. METHODS A retrospective study of 221 patients was assembled from 16 centers in seven countries. Only HIV-negative, immunocompetent patients with brain and ocular lymphoma were included; none had systemic lymphoma. RESULTS Median age at diagnosis was 60. Fifty-seven percent were women. Median Eastern Cooperative Oncology Group performance status was 2. Ocular disturbance and behavioral/cognitive changes were the most common presenting symptoms. Diagnosis of lymphoma was made by brain biopsy (147), vitrectomy (65), or CSF cytology (11). Diagnosis of intraocular lymphoma was made by vitrectomy/choroidal/retinal biopsy (90) or clinical ophthalmic examination (141). CSF cytology was positive in 23%. Treatment information was available for 176 patients. A total of 102 received dedicated ocular therapy (ocular radiotherapy 79, intravitreal methotrexate 22, and both 1) in addition to treatment for their brain lymphoma. Sixty-nine percent progressed at a median of 13 months; sites of progression included brain 52%, eyes 19%, brain and eyes 12%, and systemic 2%. Patients treated with local ocular therapy did not have a statistically significant decreased risk of failing in the eyes (p = 0.7). Median progression free survival and overall survival for the entire cohort were 18 and 31 months. CONCLUSION This is the largest reported series of primary CNS lymphoma (PCNSL) with intraocular involvement. Progression free and overall survival was similar to that reported with PCNSL. Dedicated ocular therapy improved disease control but did not affect overall survival.
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Affiliation(s)
- S A Grimm
- Department of Neurology, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
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Navarro J, Llufrí S, Valldeoriola F, Graus F. [Copper deficiency myelopathy]. Neurologia 2008; 23:612-613. [PMID: 18925447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Graus F, Saiz A, Lai M, Bruna J, López F, Sabater L, Blanco Y, Rey MJ, Ribalta T, Dalmau J. Neuronal surface antigen antibodies in limbic encephalitis: clinical-immunologic associations. Neurology 2008; 71:930-6. [PMID: 18794496 DOI: 10.1212/01.wnl.0000325917.48466.55] [Citation(s) in RCA: 150] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To report the frequency and type of antibodies against neuronal surface antigens (NSA-ab) in limbic encephalitis (LE). METHODS Analysis of clinical features, neuropathologic findings, and detection of NSA-ab using immunochemistry on rat tissue and neuronal cultures in a series of 45 patients with paraneoplastic (23) or idiopathic (22) LE. RESULTS NSA-ab were identified in 29 patients (64%; 12 paraneoplastic, 17 idiopathic). Thirteen patients had voltage-gated potassium channels (VGKC)-ab, 11 novel NSA (nNSA)-ab, and 5 NMDA receptor (NMDAR)-ab. nNSA-ab did not identify a common antigen and were more frequent in paraneoplastic than idiopathic LE (39% vs 9%; p = 0.03). When compared with VGKC-ab or NMDAR-ab, the nNSA associated more frequently with intraneuronal antibodies (11% vs 73%; p = 0.001). Of 12 patients (9 nNSA-ab, 2 VGKC-ab, 1 NMDAR-ab) with paraneoplastic LE and NSA-ab, concomitant intraneuronal antibodies occurred in 9 (75%). None of these 12 patients improved with immunotherapy. The autopsy of three of them showed neuronal loss, microgliosis, and cytotoxic T cell infiltrates in the hippocampus and amygdala. These findings were compatible with a T-cell mediated neuronal damage. In contrast, 13 of 17 (76%) patients with idiopathic LE and NSA-ab (8 VGKC-ab, 4 NMDAR-ab, 1 nNSA-ab) and 1 of 5 (20%) without antibodies had clinical improvement (p = 0.04). CONCLUSIONS In paraneoplastic limbic encephalitis (LE), novel antibodies against neuronal surface antigens (nNSA-ab) occur frequently, coexist with antibodies against intracellular antigens, and these cases are refractory to immunotherapy. In idiopathic LE, the likelihood of improvement is significantly higher in patients with NSA-ab than in those without antibodies.
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Affiliation(s)
- F Graus
- Servei de Neurologia, Hospital Clinic and Institut d' Investigació Biomèdica August Pi i Sunyer, Barcelona, Spain.
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