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Le Doare K, Gaylord MA, Anderson AS, Andrews N, Baker CJ, Bolcen S, Felek A, Giardina PC, Grube CD, Hall T, Hallis B, Izu A, Madhi SA, Maniatis P, Matheson M, Mawas F, McKeen A, Rhodes J, Alston B, Patel P, Schrag S, Simon R, Tan CY, Taylor S, Kwatra G, Gorringe A. Interlaboratory comparison of a multiplex immunoassay that measures human serum IgG antibodies against six-group B streptococcus polysaccharides. Hum Vaccin Immunother 2024; 20:2330138. [PMID: 38608170 PMCID: PMC11018077 DOI: 10.1080/21645515.2024.2330138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/09/2024] [Indexed: 04/14/2024] Open
Abstract
Measurement of IgG antibodies against group B streptococcus (GBS) capsular polysaccharide (CPS) by use of a standardized and internationally accepted multiplex immunoassay is important for the evaluation of candidate maternal GBS vaccines in order to compare results across studies. A standardized assay is also required if serocorrelates of protection against invasive GBS disease are to be established in infant sera for the six predominant GBS serotypes since it would permit the comparison of results across the six serotypes. We undertook an interlaboratory study across five laboratories that used standardized assay reagents and protocols with a panel of 44 human sera to measure IgG antibodies against GBS CPS serotypes Ia, Ib, II, III, IV, and V. The within-laboratory intermediate precision, which included factors like the lot of coated beads, laboratory analyst, and day, was generally below 20% relative standard deviation (RSD) for all six serotypes, across all five laboratories. The cross-laboratory reproducibility was < 25% RSD for all six serotypes, which demonstrated the consistency of results across the different laboratories. Additionally, anti-CPS IgG concentrations for the 44-member human serum panel were established. The results of this study showed assay robustness and that the resultant anti-CPS IgG concentrations were reproducible across laboratories for the six GBS CPS serotypes when the standardized assay was used.
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Affiliation(s)
- Kirsty Le Doare
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London, UK
- Makerere University Johns Hopkins University, Kampala, Uganda
- UK Health Security Agency, Porton Down, UK
| | | | | | - Nick Andrews
- Immunisation and Vaccine Preventable Diseases Division, United Kingdom Health Security Agency (UKHSA), London, UK
| | - Carol J. Baker
- Department of Pediatrics, Division of Infectious Disease, McGovern Medical School and UT Health, Houston, TX, USA
| | - Shanna Bolcen
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Arif Felek
- Vaccine Division, Scientific Research & Innovation Group, MHRA, Potters Bar, UK
| | | | | | - Tom Hall
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George’s, University of London, London, UK
| | | | - Alane Izu
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Shabir A. Madhi
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
| | - Pete Maniatis
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Fatme Mawas
- Vaccine Division, Scientific Research & Innovation Group, MHRA, Potters Bar, UK
| | - Andrew McKeen
- Pfizer Global Biometrics & Data Management, Pearl River, NY, USA
| | - Julia Rhodes
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | | | - Palak Patel
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Stephanie Schrag
- The Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Raphael Simon
- Pfizer Vaccine Research & Development, Pearl River, NY, USA
| | - Charles Y. Tan
- Pfizer Global Biometrics & Data Management, Pearl River, NY, USA
| | | | - Gaurav Kwatra
- South African Medical Research Council: Vaccines and Infectious Diseases Analytics Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Science/National Research Foundation: Vaccine Preventable Diseases, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Clinical Microbiology, Christian Medical College, Vellore, India
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Pravallika R, Suthar R, Patil A, Malviya M, Saxena S, Saini L, Bansal A. Efficacy of Teleconsultation-Based Rehabilitation in Children with Landry-Guillain-Barré Syndrome: An Open Label Randomized Controlled Trial (Tele Rehab-LGBS Trial). Indian J Pediatr 2024; 91:455-462. [PMID: 37889455 DOI: 10.1007/s12098-023-04882-5] [Citation(s) in RCA: 1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023]
Abstract
OBJECTIVES To evaluate the feasibility and efficacy of teleconsultation-based rehabilitation in children with Landry-Guillain-Barré syndrome (LGBS), measured with Medical Research Council (MRC) sum score and Hughes score. METHODS A pragmatic, prospective, parallel open label randomized controlled trial was conducted among a total of 50 children with LGBS. The children were randomized using computer generated block randomization into 2 groups (25 in each group): Standard of care (Group A) and teleconsultation-based rehabilitation (Group B). Primary and secondary outcomes were measured with MRC sum score and Hughes score at 12- and 24-wk follow-up. RESULTS The mean age was 6.4 ± 3.3 y; 29 (58%) were boys. Baseline MRC sum score (median, IQR), and Hughes score (median, IQR) in group A was 24 (7-31) and 5 (4-5) respectively; and in group B was 18 (9-24) and 4 (4-5) respectively. At discharge, median (IQR) MRC sum score in group A and B was 34 (28-41), and 30 (25-43) (p value = 0.31) respectively. Tele-rehabilitation was provided to group B for 24 wk with 96% compliance. At 12 wk, median MRC sum score in group A and group B were similar [48 (IQR 44-54) vs. 52 (IQR 46-60), p value = 0.08]. At 12 wk and 24 wk, median Hughes score in group A and B were similar. At 24 wk, 15 out of 23 subjects of group A and 18 out of 25 subjects of group B were ambulatory (p value = 0.61). CONCLUSIONS Teleconsultation-based rehabilitation was feasible with a high compliance rate. The functional outcomes measured with MRC sum score and Hughes score were similar in both the groups at 12 and 24 wk follow-up. Teleconsultation-based rehabilitation has similar efficacy as physical rehabilitation.
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Affiliation(s)
| | - Renu Suthar
- Department of Pediatrics, PGIMER, Chandigarh, India.
| | - Amol Patil
- Department of Pharmacology, PGIMER, Chandigarh, India
| | | | - Somya Saxena
- Department of Physical Medicine and Rehabilitation, PGIMER, Chandigarh, India
| | - Lokesh Saini
- Department of Pediatrics, PGIMER, Chandigarh, India
- Department of Pediatrics, AIIMS, Jodhpur, India
| | - Arun Bansal
- Department of Pediatrics, PGIMER, Chandigarh, India
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Sudeep KC, Bansal A, Randhawa MS, Muralidharan J, Nallasamy K, Angurana SK, Sankhyan N. Recurrent Guillain-Barré Syndrome: Clinical Profile and Outcome. Indian J Pediatr 2024; 91:448-454. [PMID: 37505408 DOI: 10.1007/s12098-023-04746-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023]
Abstract
OBJECTIVES To compare clinical, neurological, treatment and outcome of recurrent Guillian-Barré Syndrome (GBS) with non-recurrent GBS. Also, to compare different episodes of recurrent GBS. METHODS The patient's case records were retrieved retrospectively from the electronic database and case record files. Clinical profile, nerve conduction study, treatment, and outcome details of children with a diagnosis of GBS admitted in Pediatric Intensive Care Unit (PICU) from 2010 to March 2022 were screened. Recurrent GBS cases, as defined by the National Institute of Neurological and Communicative Diseases and Strokes (NINCDS) criteria, were analysed separately. The comparison was made between the first episode of recurrent GBS with non-recurrent GBS, and predictors of recurrence were identified. A comparison of course and outcome was also done between different episodes of GBS in recurrent cases. RESULTS Recurrent GBS was observed in 11 (4.7%) out of 234 cases during the study period. The presence of respiratory (p 0.015) and gastrointestinal illness (p 0.007) as preceding illnesses were associated with recurrence. No difference was noted between the first episode of recurrent GBS and non-recurrent GBS. The first and second episodes of GBS in 11 recurrent cases were similar in course and outcome. CONCLUSIONS Recurrent GBS is underreported but a known entity. No difference was seen between the two episodes of recurrent GBS. However, more data is required to find the features of recurrent GBS so that limited PICU resources can be used judiciously and intervention planned accordingly.
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Affiliation(s)
- K C Sudeep
- Division of Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Arun Bansal
- Division of Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India.
| | - Manjinder Singh Randhawa
- Division of Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Jayashree Muralidharan
- Division of Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Karthi Nallasamy
- Division of Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Suresh Kumar Angurana
- Division of Pediatric Emergency and Intensive Care Unit, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Naveen Sankhyan
- Division of Pediatric Neurology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
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Krishna D, Chakrabarty B. The Curious Story of Recurrent Guillain-Barré Syndrome; A Lot More to Know. Indian J Pediatr 2024; 91:428-429. [PMID: 38270751 DOI: 10.1007/s12098-024-05031-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Deepthi Krishna
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Biswaroop Chakrabarty
- Child Neurology Division, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
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Castro VFDS, Oliveira RTGD, Santos JDLD, Mendes RDS, Pessoa Neto AD, Fidelix EC, Dourado Júnior MET. The sural-sparing pattern in clinical variants and electrophysiological subtypes of Guillain-Barré syndrome. Arq Neuropsiquiatr 2024; 82:1-7. [PMID: 38641340 PMCID: PMC11031252 DOI: 10.1055/s-0044-1785692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/01/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is the most common cause of acute flaccid paralysis worldwide and can be classified into electrophysiological subtypes and clinical variants. OBJECTIVE This study aimed to compare the frequency of the sural-sparing pattern (SSP) in subtypes and variants of GBS. METHODS This retrospective cohort study analyzed clinical and electrophysiological data of 171 patients with GBS hospitalized in public and private hospitals of Natal, Rio Grande do Norte, Brazil, between 1994 and 2018; all cases were followed up by the same neurologist in a reference neurology center. Patients were classified according to electrophysiological subtypes and clinical variants, and the SSP frequency was compared in both categories. The exact Fisher test and Bonferroni correction were used for statistical analysis. RESULTS The SSP was present in 53% (57 of 107) of the patients with acute inflammatory demyelinating polyradiculoneuropathy (AIDP), 8% (4 of 48) of the patients with axonal subtypes, and 31% (5 of 16) of the equivocal cases. The SSP frequency in the AIDP was significantly higher than in the axonal subtypes (p < 0.0001); the value was kept high after serial electrophysiological examinations. Only the paraparetic subtype did not present SSP. CONCLUSION The SSP may be present in AIDP and axonal subtypes, including acute motor axonal neuropathy, but it is significantly more present in AIDP. Moreover, the clinical variants reflect a specific pathological process and are correlated to its typical electrophysiological subtype, affecting the SSP frequency.
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Affiliation(s)
- Vinicius Furtado da Silva Castro
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Departamento de Medicina Integrada, Natal RN, Brazil.
| | - Roberto Teodoro Gurgel de Oliveira
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Departamento de Medicina Integrada, Natal RN, Brazil.
- Universidade Federal do Rio Grande do Norte, Departamento de Metemática, Natal RN, Brazil.
| | - João Daniel Lima dos Santos
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Departamento de Medicina Integrada, Natal RN, Brazil.
| | - Ramon de Souza Mendes
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Departamento de Medicina Integrada, Natal RN, Brazil.
| | - Agábio Diógenes Pessoa Neto
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Departamento de Medicina Integrada, Natal RN, Brazil.
| | - Emanuela Coriolano Fidelix
- Universidade Federal do Rio Grande do Norte, Hospital Universitário Onofre Lopes, Departamento de Medicina Integrada, Natal RN, Brazil.
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Cooksey R, Kubaney H, Loudamy L, Mitchell M, Cohn S. Guillain-Barre syndrome as a paraneoplastic phenomenon in a child with MYC rearranged B-cell acute lymphoblastic leukemia. Pediatr Blood Cancer 2024; 71:e30886. [PMID: 38289008 DOI: 10.1002/pbc.30886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 02/24/2024]
Affiliation(s)
- Raven Cooksey
- Dell Children's Medical Center of Central Texas, Austin, Texas, USA
| | - Holly Kubaney
- Dell Children's Medical Center of Central Texas, Austin, Texas, USA
| | - Lane Loudamy
- The University of Texas at Austin, Austin, Texas, USA
| | - Michael Mitchell
- Dell Children's Medical Center of Central Texas, Austin, Texas, USA
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
| | - Shannon Cohn
- Dell Children's Medical Center of Central Texas, Austin, Texas, USA
- Department of Pediatrics, The University of Texas at Austin Dell Medical School, Austin, Texas, USA
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Fukami Y, Iijima M, Koike HH, Yagi S, Furukawa S, Mouri N, Ouchida J, Murakami A, Iida M, Yokoi S, Hashizume A, Iguchi Y, Imagama S, Katsuno M. Autoantibodies Against Dihydrolipoamide S-Acetyltransferase in Immune-Mediated Neuropathies. Neurol Neuroimmunol Neuroinflamm 2024; 11:e200199. [PMID: 38181320 DOI: 10.1212/nxi.0000000000200199] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 11/16/2023] [Indexed: 01/07/2024]
Abstract
BACKGROUND AND OBJECTIVES This study aimed to identify disease-related autoantibodies in the serum of patients with immune-mediated neuropathies including chronic inflammatory demyelinating polyneuropathy (CIDP) and to investigate the clinical characteristics of patients with these antibodies. METHODS Proteins extracted from mouse brain tissue were used to react with sera from patients with CIDP by western blotting (WB) to determine the presence of common bands. Positive bands were then identified by mass spectrometry and confirmed for reactivity with patient sera using enzyme-linked immunosorbent assay (ELISA) and WB. Reactivity was further confirmed by cell-based and tissue-based indirect immunofluorescence assays. The clinical characteristics of patients with candidate autoantibody-positive CIDP were analyzed, and their association with other neurologic diseases was also investigated. RESULTS Screening of 78 CIDP patient sera by WB revealed a positive band around 60-70 kDa identified as dihydrolipoamide S-acetyltransferase (DLAT) by immunoprecipitation and mass spectrometry. Serum immunoglobulin G (IgG) and IgM antibodies' reactivity to recombinant DLAT was confirmed using ELISA and WB. A relatively high reactivity was observed in 29 of 160 (18%) patients with CIDP, followed by patients with sensory neuropathy (6/58, 10%) and patients with MS (2/47, 4%), but not in patients with Guillain-Barré syndrome (0/27), patients with hereditary neuropathy (0/40), and healthy controls (0/26). Both the cell-based and tissue-based assays confirmed reactivity in 26 of 33 patients with CIDP. Comparing the clinical characteristics of patients with CIDP with anti-DLAT antibodies (n = 29) with those of negative cases (n = 131), a higher percentage of patients had comorbid sensory ataxia (69% vs 37%), cranial nerve disorders (24% vs 9%), and malignancy (20% vs 5%). A high DLAT expression was observed in human autopsy dorsal root ganglia, confirming the reactivity of patient serum with mouse dorsal root ganglion cells. DISCUSSION Reactivity to DLAT was confirmed in patient sera, mainly in patients with CIDP. DLAT is highly expressed in the dorsal root ganglion cells, and anti-DLAT antibody may serve as a biomarker for sensory-dominant neuropathies.
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Affiliation(s)
- Yuki Fukami
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Masahiro Iijima
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Haruki H Koike
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Satoru Yagi
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Soma Furukawa
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Naohiro Mouri
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Jun Ouchida
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Ayuka Murakami
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Madoka Iida
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Satoshi Yokoi
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Atsushi Hashizume
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Yohei Iguchi
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Shiro Imagama
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
| | - Masahisa Katsuno
- From the Department of Neurology (Y.F., M. Iijima, H.H.K., S. Yagi, S.F., N.M., A.M., M. Iida, S. Yokoi, A.H., Y.I., M.K.), Nagoya University Graduate School of Medicine; Department of Advanced Medicine (M.I.), Nagoya University Hospital; Department of Orthopedic Surgery (J.O., S.I.); and Department of Clinical Research Education (A.H., M.K.), Nagoya University Graduate School of Medicine, Japan
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Tasdemir V, Sirin NG, Cakar A, Culha A, Soysal A, Elmali AD, Gunduz A, Arslan B, Yalcin D, Atakli D, Orhan EK, Sanli E, Tuzun E, Gozke E, Gursoy E, Savrun FK, Uslu FI, Aysal F, Durmus H, Bulbul H, Ertas FI, Uluc K, Tutkavul K, Baysal L, Baslo MB, Kiziltan M, Mercan M, Pazarci N, Uzun N, Akan O, Cokar O, Koytak PK, Sürmeli R, Gunaydin S, Ayas S, Baslo SA, Yayla V, Yilmaz V, Parman Y, Matur Z, Acar ZU, Oge AE. Electrodiagnostic methods to verify Guillain-Barré syndrome subtypes in Istanbul: A prospective multicenter study. J Peripher Nerv Syst 2024; 29:72-81. [PMID: 38291679 DOI: 10.1111/jns.12612] [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: 07/16/2023] [Revised: 01/07/2024] [Accepted: 01/09/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND AND AIMS This study aimed to identify the clinical characteristics and electrodiagnostic subtypes of Guillain-Barré syndrome (GBS) in Istanbul. METHODS Patients with GBS were prospectively recruited between April 2019 and March 2022 and two electrodiagnostic examinations were performed on each patient. The criteria of Ho et al., Hadden et al., Rajabally et al., and Uncini et al. were compared for the differentiation of demyelinating and axonal subtypes, and their relations with anti-ganglioside antibodies were analyzed. RESULTS One hundred seventy-seven patients were included, 69 before the coronavirus disease 2019 pandemic (April 2019-February 2020) and 108 during the pandemic (March 2020-March 2022), without substantial changes in monthly frequencies. As compared with the criteria of Uncini et al., demyelinating GBS subtype diagnosis was more frequent according to the Ho et al. and Hadden et al. criteria (95/162, 58.6% vs. 110/174, 63.2% and 121/174, 69.5%, respectively), and less frequent according to Rajabally et al.'s criteria (76/174, 43.7%). Fourteen patients' diagnoses made using Rajabally et al.'s criteria were shifted to the other subtype with the second electrodiagnostic examination. Of the 106 analyzed patients, 22 had immunoglobulin G anti-ganglioside antibodies (14 with the axonal subtype). They had less frequent sensory symptoms (54.5% vs. 83.1%, p = 0.009), a more frequent history of previous gastroenteritis (54.5% vs. 22.9%, p = 0.007), and a more severe disease as compared with those without antibodies. INTERPRETATION Serial electrodiagnostic examinations are more helpful for accurate subtype diagnosis of GBS because of the dynamic pathophysiology of the disease. We observed no significant increase in GBS frequency during the pandemic in this metropolis.
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Affiliation(s)
- Volkan Tasdemir
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Nermin Gorkem Sirin
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Arman Cakar
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Ayla Culha
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Aysun Soysal
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ayse Deniz Elmali
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Aysegul Gunduz
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Beyza Arslan
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Destina Yalcin
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Dilek Atakli
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Elif Kocasoy Orhan
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Elif Sanli
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Erdem Tuzun
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Eren Gozke
- Fatih Sultan Mehmet Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Esra Gursoy
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Feray Karaali Savrun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ferda Ilgen Uslu
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Fikret Aysal
- Faculty of Medicine, Department of Neurology, Medipol University, Istanbul, Turkey
| | - Hacer Durmus
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Hafsa Bulbul
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - F Inci Ertas
- Sisli Hamidiye Etfal Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Kayihan Uluc
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Kemal Tutkavul
- Haydarpaşa Numune Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Leyla Baysal
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Baris Baslo
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Meral Kiziltan
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Metin Mercan
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nevin Pazarci
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Nurten Uzun
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Onur Akan
- Prof. Dr. Cemil Taşçıoğlu City Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ozlem Cokar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Pinar Kahraman Koytak
- Department of Neurology and Clinical Neurophysiology, Marmara University Faculty of Medicine, Istanbul, Turkey
| | - Reyhan Sürmeli
- Umraniye Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Sefer Gunaydin
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Selahattin Ayas
- Cerrahpasa Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sezin Alpaydin Baslo
- Bakirkoy Prof. Dr. Mazhar Osman Mental Health and Neurological Diseases Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vildan Yayla
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Vuslat Yilmaz
- Aziz Sancar Institute of Experimental Medicine, Department of Neuroscience, Istanbul University, Istanbul, Turkey
| | - Yesim Parman
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
| | - Zeliha Matur
- Faculty of Medicine Hospital, Department of Neurology, Bezmialem Vakif University, Istanbul, Turkey
| | - Zeynep Unlusoy Acar
- Haseki Training and Research Hospital, Department of Neurology, University of Health Sciences, Istanbul, Turkey
| | - Ali Emre Oge
- Istanbul Faculty of Medicine, Department of Neurology and Clinical Neurophysiology, Istanbul University, Istanbul, Turkey
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Donaldson L, Jeeva-Patel T, Mandell D, Margolin E. Enhancement of Subarachnoid Oculomotor Nerves in Bickerstaff Brainstem Encephalitis. Can J Neurol Sci 2024; 51:323-324. [PMID: 36537000 DOI: 10.1017/cjn.2022.333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Laura Donaldson
- Department of Surgery, Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada
| | - Trishal Jeeva-Patel
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Daniel Mandell
- Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Edward Margolin
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Department of Neurology, University of Toronto, Toronto, Ontario, Canada
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10
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Akan S, Atmaca MC. [Guillain-Barré syndrome caused by intravesical instillation of Bacillus Calmette-Guérin]. Ideggyogy Sz 2024; 77:65-68. [PMID: 38321852 DOI: 10.18071/isz.77.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Introduction - Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyneuropathy. In the vast majority of patients, 1-4 weeks before the onset of GBS-related symptoms, an event such as upper respiratory tract or gastrointestinal tract infection, surgical intervention or vaccination is present. To the best of our knowledge, this is the first case of GBS that occurred after intravesical Bacillus Calmette-Guérin (BCG) therapy in the absence of tuberculosis or any other infection in the English literature. Case report – A 65-year-old male patient, who had no systemic disorders except hypertension and coronary artery disease, underwent transurethral resection of a bladder tumour further to imaging studies investigating macroscopic haematuria. A pathologic examination revealed a non-muscle-invasive high-grade (pT1HG) transitional cell carcinoma. Immediately after the fourth cycle of intravesical BCG, which was administered 2 months after surgery, the patient experienced numbness and weakness in his lower and upper extremities, respectively. There were no signs or symptoms related to an acute cranial pathology or infectious disease. Nerve conduction studies, which were carried out on the 7th day after the onset of the neurologic symptoms, revealed a demyelinating sensorimotor polyneuropathy with mild secondary axonal damage in upper and lower limbs with a sural sparing pattern. Conclusion - Without tuberculosis infection, GBS can occur secondary to increased immune response and antibodies triggered by intravesical BCG therapy. However, considering the worldwide use of BCG vaccination and thousands of intravesical BCG therapies, this is a very rare adverse effect. .
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Affiliation(s)
- Serkan Akan
- University of Health Sciences, Fatih Sultan Mehmet Research & Training Hospital, Department of Urology, Istanbul, Turkey
| | - Melek Colak Atmaca
- University of Health Sciences, Sancaktepe Sehit Prof. Dr. İlhan Varank Research & Training Hospital, Department of Neurology, Istanbul, Turkey
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11
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Yoon D, Jeon HL, Kim JH, Lee H, Shin JY. Cardiovascular, Neurological, and Immunological Adverse Events and the 23-Valent Pneumococcal Polysaccharide Vaccine. JAMA Netw Open 2024; 7:e2352597. [PMID: 38252436 PMCID: PMC10804273 DOI: 10.1001/jamanetworkopen.2023.52597] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 11/30/2023] [Indexed: 01/23/2024] Open
Abstract
Importance Despite widespread immunization with the 23-valent pneumococcal polysaccharide vaccine (PPSV23), safety concerns remain owing to a lack of statistical power and largely outdated evidence. Objective To evaluate the association between cardiovascular, neurological, and immunological adverse events and PPSV23 vaccination in older adults. Design, Setting, and Participants This population-based cohort study using a self-controlled risk interval design used a large linked database created by linking the Korea Immunization Registry Information System and the National Health Information Database (2018 to 2021). Participants included patients aged 65 years or older with a history of PPSV23 vaccination and incident cardiovascular, neurological, or immunological events during the risk and control intervals. Data were analyzed from November 2022 to April 2023. Exposure 23-valent pneumococcal polysaccharide vaccine. Main Outcomes and Measures The occurrence of 1 among 6 cardiovascular events (myocardial infarction, atrial fibrillation, cardiomyopathy, heart failure, hypotension, and myocarditis or pericarditis), 2 neurological events (Bell palsy and Guillain-Barré syndrome), and 3 immunological events (sepsis, thrombocytopenia, and anaphylaxis) during the risk and control periods. The risk and control intervals were defined as 1 to 28 and 57 to 112 days after PPSV23 vaccination, respectively. Conditional Poisson regression was used to estimate the incidence rate ratio (IRR) with a 95% CI. Results Altogether, 4355 of the 1 802 739 individuals who received PPSV23 vaccination and experienced at least 1 outcome event were included (mean [SD] age, 72.4 [8.2] years; 2272 male participants [52.1%]). For cardiovascular events, there were no significant associations for myocardial infarction (IRR, 0.96; 95% CI, 0.81-1.15), heart failure (IRR, 0.85; 95% CI, 0.70-1.04), and stroke (IRR, 0.92; 95% CI, 0.84-1.02). Similarly, no increased risks were observed for neurological and immunological outcomes: Bell palsy (IRR, 0.95; 95% CI, 0.72-1.26), Guillain-Barré syndrome (IRR, 0.27; 95% CI, 0.06-1.17), sepsis (IRR, 0.99; 95% CI, 0.74-1.32), and thrombocytopenia (IRR, 1.18; 95% CI, 0.60-2.35). Conclusions and Relevance In this self-controlled risk interval study, there was no appreciable increase in risk for most cardiovascular, neurological, or immunological adverse events following PPSV23. The updated safety profile of PPSV23 provides supportive evidence for the establishment of immunization strategies for older adults.
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Affiliation(s)
- Dongwon Yoon
- School of Pharmacy, Sungkyunkwan University, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, South Korea
| | - Ha-Lim Jeon
- School of Pharmacy and Institute of New Drug Development, Jeonbuk National University, South Korea
| | - Ju Hwan Kim
- School of Pharmacy, Sungkyunkwan University, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, South Korea
| | - Hyesung Lee
- School of Pharmacy, Sungkyunkwan University, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, South Korea
- Department of Biohealth Regulatory Science, School of Pharmacy, Sungkyunkwan University, South Korea
- Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, South Korea
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12
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Norman J, Leclair B, Clua M, Aubert L, Pigan M, Cudennec T. Syndrome de Guillain-Barré en gériatrie. Soins Gerontol 2024; 29:47-48. [PMID: 38331525 DOI: 10.1016/j.sger.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/10/2024]
Affiliation(s)
- Juliette Norman
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France.
| | - Bathilde Leclair
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Morane Clua
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Lucie Aubert
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Maria Pigan
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
| | - Tristan Cudennec
- Service de gériatrie, Université Paris-Saclay, Site Ambroise-Paré, AP-HP, 9 avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France
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13
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Ginanneschi F, Vinciguerra C, Volpi N, Piscosquito G, Barone P, Rossi A. Chronic inflammatory demyelinating polyneuropathy after SARS-CoV2 vaccination: update of the literature and patient characterization. Immunol Res 2023; 71:833-838. [PMID: 37395901 DOI: 10.1007/s12026-023-09406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 06/28/2023] [Indexed: 07/04/2023]
Abstract
Since the beginning of worldwide vaccination against COVID-19 disease, some reports have revealed a possible relationship between SARS CoV2 vaccination and chronic inflammatory demyelinating polyneuropathy (CIDP). We reviewed the available evidences regarding this topic, adding three new cases to those reported so far, with the purpose to outline the characteristics of these post-vaccinal CIDP. Seventeen subjects were studied. A total of 70.6% of CIDP cases were related to viral vector vaccines, most occurring after the administration of the first dose. CIDPs that occurred after the second dose (17%) were temporally associated with mRNA vaccines. The clinical course and electrophysiology of all patients met the criteria for acute-subacute CIDP (A-CIDP). Administration of the viral vector vaccine was significantly correlated with a higher probability of having cranial nerve impairment (p = 0.004). The electrophysiological phenotype, laboratory and imaging data, and first-line therapies were substantially similar to those of the classical CIDP. The take-home message of the present paper is that the SARS CoV2 vaccine, especially the AstraZeneca vaccine, may be associated with inflammatory neuropathies with acute onset, often indistinguishable from Guillain-Barré syndrome (GBS). Hence, the importance of tracked prospectively patients with GBS occurred post-SARS-CoV2 vaccine. Distinguishing GBS from A-CIDP is crucial because treatment strategies and long-term prognosis are different.
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Affiliation(s)
- Federica Ginanneschi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
| | - Claudia Vinciguerra
- Neurology Unit, University Hospital "San Giovanni Di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Nila Volpi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, University Hospital "San Giovanni Di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Paolo Barone
- Neurology Unit, University Hospital "San Giovanni Di Dio e Ruggi d'Aragona", Salerno, Italy
| | - Alessandro Rossi
- Neurology and Clinical Neurophysiology Unit, Department of Medical, Surgical and Neurological Sciences, University of Siena, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
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Akhlaque U, Khalil MT, Ahmad N, Aftab A. Outcome of Neuromuscular Electrodiagnostic Testing in Children. J Coll Physicians Surg Pak 2023; 33:1457-1459. [PMID: 38062607 DOI: 10.29271/jcpsp.2023.12.1457] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 06/27/2023] [Indexed: 12/18/2023]
Abstract
This study aimed to describe the spectrum of the results of neuromuscular electrodiagnostic investigations performed by age and pathology in paediatric patients. This retrospective observational study took place from January 2019 to December 2021. Electrodiagnostic records of paediatric patients (birth to 15 years) were referred to the electromyography (EMG) laboratory for EMG and nerve conduction study (NCS). Electrodiagnostic and demographic data were collected. Among these, 151 (56%) were males and 118 (44%) were females. Forty-four percent tests came out to be normal and 151(56%) tests revealed electrophysiological abnormality. Peripheral nerve neuropathy (n = 39, 14.5%), polyneuropathy (n = 35, 13%) and myopathy (n = 28, 10%) were the most common electrophysiological diagnoses. The electrodiagnostic test helps in differentiating the aetiologies, thus guiding the subsequent work-up logically in the paediatric population. Key Words: Brachial plexus neuropathies, Electromyography, Duchene muscular dystrophy, Neuromuscular junction disorders, Nerve conduction studies, Acute inflammatory demyelinating polyneuropathy, Rehabilitation, Electromyography, Hereditary sensory motor polyneuropathy.
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Affiliation(s)
- Uzma Akhlaque
- Department of Rehabilitation Medicine, Combined Military Hospital, Kharian, Pakistan
| | - Muhammad Tawab Khalil
- Department of Rehabilitation Medicine, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, Pakistan
| | - Nadeem Ahmad
- Department of Rehabilitation Medicine, Combined Military Hospital, Kharian, Pakistan
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Karbian N, Eshed-Eisenbach Y, Zeibak M, Tabib A, Sukhanov N, Vainshtein A, Morgan BP, Fellig Y, Peles E, Mevorach D. Complement-membrane regulatory proteins are absent from the nodes of Ranvier in the peripheral nervous system. J Neuroinflammation 2023; 20:245. [PMID: 37875972 PMCID: PMC10594684 DOI: 10.1186/s12974-023-02920-9] [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: 03/26/2023] [Accepted: 10/02/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Homozygous CD59-deficient patients manifest with recurrent peripheral neuropathy resembling Guillain-Barré syndrome (GBS), hemolytic anemia and recurrent strokes. Variable mutations in CD59 leading to loss of function have been described and, overall, 17/18 of patients with any mutation presented with recurrent GBS. Here we determine the localization and possible role of membrane-bound complement regulators, including CD59, in the peripheral nervous systems (PNS) of mice and humans. METHODS We examined the localization of membrane-bound complement regulators in the peripheral nerves of healthy humans and a CD59-deficient patient, as well as in wild-type (WT) and CD59a-deficient mice. Cross sections of teased sciatic nerves and myelinating dorsal root ganglia (DRG) neuron/Schwann cell cultures were examined by confocal and electron microscopy. RESULTS We demonstrate that CD59a-deficient mice display normal peripheral nerve morphology but develop myelin abnormalities in older age. They normally express myelin protein zero (P0), ankyrin G (AnkG), Caspr, dystroglycan, and neurofascin. Immunolabeling of WT nerves using antibodies to CD59 and myelin basic protein (MBP), P0, and AnkG revealed that CD59 was localized along the internode but was absent from the nodes of Ranvier. CD59 was also detected in blood vessels within the nerve. Finally, we show that the nodes of Ranvier lack other complement-membrane regulatory proteins, including CD46, CD55, CD35, and CR1-related gene-y (Crry), rendering this area highly exposed to complement attack. CONCLUSION The Nodes of Ranvier lack CD59 and are hence not protected from complement terminal attack. The myelin unit in human PNS is protected by CD59 and CD55, but not by CD46 or CD35. This renders the nodes and myelin in the PNS vulnerable to complement attack and demyelination in autoinflammatory Guillain-Barré syndrome, as seen in CD59 deficiency.
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Affiliation(s)
- Netanel Karbian
- Rheumatology and Rare Disease Research Center, The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center and School of Medicine, Jerusalem, Israel
| | - Yael Eshed-Eisenbach
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Marian Zeibak
- Rheumatology and Rare Disease Research Center, The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center and School of Medicine, Jerusalem, Israel
| | - Adi Tabib
- Rheumatology and Rare Disease Research Center, The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center and School of Medicine, Jerusalem, Israel
| | - Natasha Sukhanov
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Anya Vainshtein
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - B. Paul Morgan
- Systems Immunity Research Institute, Cardiff University, Cardiff, Wales UK
| | - Yakov Fellig
- Department of Pathology, School of Medicine, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Elior Peles
- Department of Molecular Cell Biology, Weizmann Institute of Science, Rehovot, Israel
- Department of Molecular Neuroscience, Weizmann Institute of Science, Rehovot, Israel
| | - Dror Mevorach
- Rheumatology and Rare Disease Research Center, The Wohl Institute for Translational Medicine, Hadassah-Hebrew University Medical Center and School of Medicine, Jerusalem, Israel
- The Institute of Rheumatology-Immunology-Allergology, The Wohl Institute for Translational Medicine, Department of Medicine, Hadassah-Hebrew University Medical Center and School of Medicine, POB 12000, 91120 Jerusalem, Israel
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Hirano M, Kuwahara M, Yamagishi Y, Samukawa M, Fujii K, Yamashita S, Ando M, Oka N, Nagano M, Matsui T, Takeuchi T, Saigoh K, Kusunoki S, Takashima H, Nagai Y. CANVAS-related RFC1 mutations in patients with immune-mediated neuropathy. Sci Rep 2023; 13:17801. [PMID: 37853169 PMCID: PMC10584897 DOI: 10.1038/s41598-023-45011-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 09/01/2023] [Accepted: 10/14/2023] [Indexed: 10/20/2023] Open
Abstract
Cerebellar ataxia, neuropathy, and vestibular areflexia syndrome (CANVAS) has recently been attributed to biallelic repeat expansions in RFC1. More recently, the disease entity has expanded to atypical phenotypes, including chronic neuropathy without cerebellar ataxia or vestibular areflexia. Very recently, RFC1 expansions were found in patients with Sjögren syndrome who had neuropathy that did not respond to immunotherapy. In this study RFC1 was examined in 240 patients with acute or chronic neuropathies, including 105 with Guillain-Barré syndrome or Miller Fisher syndrome, 76 with chronic inflammatory demyelinating polyneuropathy, and 59 with other types of chronic neuropathy. Biallelic RFC1 mutations were found in three patients with immune-mediated neuropathies, including Guillain-Barré syndrome, idiopathic sensory ataxic neuropathy, or anti-myelin-associated glycoprotein (MAG) neuropathy, who responded to immunotherapies. In addition, a patient with chronic sensory autonomic neuropathy had biallelic mutations, and subclinical changes in Schwann cells on nerve biopsy. In summary, we found CANVAS-related RFC1 mutations in patients with treatable immune-mediated neuropathy or demyelinating neuropathy.
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Affiliation(s)
- Makito Hirano
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Motoi Kuwahara
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuko Yamagishi
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Makoto Samukawa
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kanako Fujii
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Shoko Yamashita
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masahiro Ando
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Nobuyuki Oka
- Department of Neurology, NHO Minami-Kyoto Hospital, Joyo, Japan
| | - Mamoru Nagano
- Department of Anatomy, Kindai University, Faculty of Medicine, Osakasayama, Japan
| | - Taro Matsui
- Division of Neurology, Anti-Aging, and Vascular Medicine, Department of Internal Medicine, National Defense Medical College, Tokorozawa, Japan
| | - Toshihide Takeuchi
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kazumasa Saigoh
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Susumu Kusunoki
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Hiroshi Takashima
- Department of Neurology and Geriatrics, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Yoshitaka Nagai
- Department of Neurology, Kindai University, Faculty of Medicine, Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan
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17
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Chang T, Wijeyekoon R, Keshavaraj A, Ranawaka U, Senanayake S, Ratnayake P, Senanayake B, Caldera MC, Pathirana G, Sirisena D, Wanigasinghe J, Gunatilake S. Neurological disorders associated with COVID-19 in Sri Lanka. BMC Neurol 2023; 23:351. [PMID: 37794324 PMCID: PMC10548601 DOI: 10.1186/s12883-023-03399-w] [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: 03/27/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka. METHODS COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 - May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations. RESULTS One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain-Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 - 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 - 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period. A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p = 0.046). CONCLUSIONS The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Ruwani Wijeyekoon
- Association of Sri Lankan Neurologists, Wijerama Mawatha, Colombo, Sri Lanka
| | | | - Udaya Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | | | | | | | | | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Saman Gunatilake
- Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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18
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Appeltshauser L, Doppler K. Pan-Neurofascin autoimmune nodopathy - a life-threatening, but reversible neuropathy. Curr Opin Neurol 2023; 36:394-401. [PMID: 37639464 DOI: 10.1097/wco.0000000000001195] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
PURPOSE OF REVIEW Autoimmune nodopathies are immune-mediated neuropathies associated with antibodies targeting the peripheral node of Ranvier. Recently, antibodies against all neurofascin-isoforms (pan-neurofascin) have been linked to a clinical phenotype distinct from previously described autoimmune nodopathies. Here, we aim at highlighting the molecular background and the red flags for diagnostic assessment and provide treatment and surveillance approaches for this new disease. RECENT FINDINGS Neurofascin-isoforms are located at different compartments of the node of Ranvier: Neurofascin-186 at the axonal nodal gap, and Neurofascin-155 at the terminal Schwann cell loops at the paranode. Pan-neurofascin antibodies recognize a common epitope on both isoforms and can access the node of Ranvier directly. Depending on their subclass profile, antibodies can induce direct structural disorganization and complement activation. Affected patients present with acute and immobilizing sensorimotor neuropathy, with cranial nerve involvement and long-term respiratory insufficiency. Early antibody-depleting therapy is crucial to avoid axonal damage, and remission is possible despite extended disease and high mortality. The antibody titer and serum neurofilament light chain levels can serve as biomarkers for diagnosis and therapy monitoring. SUMMARY Pan-neurofascin-associated autoimmune nodopathies has unique molecular and clinical features. Testing should be considered in severe and prolonged Guillain-Barré-like phenotype.
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Affiliation(s)
- Luise Appeltshauser
- Department of Neurology, University Hospital Würzburg (UKW), Würzburg, Germany
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19
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Tavee J, Brannagan TH, Lenihan MW, Muppidi S, Kellermeyer L, D Donofrio P. Updated consensus statement: Intravenous immunoglobulin in the treatment of neuromuscular disorders report of the AANEM ad hoc committee. Muscle Nerve 2023; 68:356-374. [PMID: 37432872 DOI: 10.1002/mus.27922] [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: 06/05/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023]
Abstract
Intravenous immune globulin (IVIG) is an immune-modulating biologic therapy that is increasingly being used in neuromuscular disorders despite the paucity of high-quality evidence for various specific diseases. To address this, the AANEM created the 2009 consensus statement to provide guidance on the use of IVIG in neuromuscular disorders. Since then, there have been several randomized controlled trials for IVIG, a new FDA-approved indication for dermatomyositis and a revised classification system for myositis, prompting the AANEM to convene an ad hoc panel to update the existing guidelines.New recommendations based on an updated systemic review of the literature were categorized as Class I-IV. Based on Class I evidence, IVIG is recommended in the treatment of chronic inflammatory demyelinating polyneuropathy, Guillain-Barré Syndrome (GBS) in adults, multifocal motor neuropathy, dermatomyositis, stiff-person syndrome and myasthenia gravis exacerbations but not stable disease. Based on Class II evidence, IVIG is also recommended for Lambert-Eaton myasthenic syndrome and pediatric GBS. In contrast, based on Class I evidence, IVIG is not recommended for inclusion body myositis, post-polio syndrome, IgM paraproteinemic neuropathy and small fiber neuropathy that is idiopathic or associated with tri-sulfated heparin disaccharide or fibroblast growth factor receptor-3 autoantibodies. Although only Class IV evidence exists for IVIG use in necrotizing autoimmune myopathy, it should be considered for anti-hydroxy-3-methyl-glutaryl-coenzyme A reductase myositis given the risk of long-term disability. Insufficient evidence exists for the use of IVIG in Miller-Fisher syndrome, IgG and IgA paraproteinemic neuropathy, autonomic neuropathy, chronic autoimmune neuropathy, polymyositis, idiopathic brachial plexopathy and diabetic lumbosacral radiculoplexopathy.
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Affiliation(s)
- Jinny Tavee
- National Jewish Health, Division of Neurology, Denver, Colorado, USA
| | - Thomas H Brannagan
- Vagelos College of Physicians and Surgeons, Neurological Institute, Columbia University, New York, New York, USA
| | | | - Sri Muppidi
- Stanford Neuroscience Health Center, Palo Alto, California, USA
| | | | - Peter D Donofrio
- Neurology Clinic, Vanderbilt University, Nashville, Tennessee, USA
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20
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Woo EJ, Gee J, Marquez P, Baggs J, Abara WE, McNeil MM, Dimova RB, Su JR. Post-authorization safety surveillance of Ad.26.COV2.S vaccine: Reports to the Vaccine Adverse Event Reporting System and v-safe, February 2021-February 2022. Vaccine 2023; 41:4422-4430. [PMID: 37321898 PMCID: PMC10264169 DOI: 10.1016/j.vaccine.2023.06.023] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND On 2/27/2021, FDA authorized Janssen COVID-19 Vaccine (Ad.26.COV2.S) for use in individuals 18 years of age and older. Vaccine safety was monitored using the Vaccine Adverse Event Reporting System (VAERS), a national passive surveillance system, and v-safe, a smartphone-based surveillance system. METHODS VAERS and v-safe data from 2/27/2021 to 2/28/2022 were analyzed. Descriptive analyses included sex, age, race/ethnicity, seriousness, AEs of special interest (AESIs), and cause of death. For prespecified AESIs, reporting rates were calculated using the total number of doses of Ad26.COV2.S administered. For myopericarditis, observed-to-expected (O/E) analysis was performed based on the number verified cases, vaccine administration data, and published background rates. Proportions of v-safe participants reporting local and systemic reactions, as well as health impacts, were calculated. RESULTS During the analytic period, 17,018,042 doses of Ad26.COV2.S were administered in the United States, and VAERS received 67,995 reports of AEs after Ad26.COV2.S vaccination. Most AEs (59,750; 87.9 %) were non-serious and were similar to those observed during clinical trials. Serious AEs included COVID-19 disease, coagulopathy (including thrombosis with thrombocytopenia syndrome; TTS), myocardial infarction, Bell's Palsy, and Guillain-Barré syndrome (GBS). Among AESIs, reporting rates per million doses of Ad26.COV2.S administered ranged from 0.06 for multisystem inflammatory syndrome in children to 263.43 for COVID-19 disease. O/E analysis revealed elevated reporting rate ratios (RRs) for myopericarditis; among adults ages 18-64 years, the RR was 3.19 (95 % CI 2.00, 4.83) within 7 days and 1.79 (95 % CI 1.26, 2.46) within 21 days of vaccination. Of 416,384 Ad26.COV2.S recipients enrolled into v-safe, 60.9 % reported local symptoms (e.g. injection site pain) and 75.9 % reported systemic symptoms (e.g., fatigue, headache). One-third of participants (141,334; 33.9 %) reported a health impact, but only 1.4 % sought medical care. CONCLUSION Our review confirmed previously established safety risks for TTS and GBS and identified a potential safety concern for myocarditis.
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Affiliation(s)
- Emily Jane Woo
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20903, United States.
| | - Julianne Gee
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - Paige Marquez
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - James Baggs
- Epidemiology Research and Innovations Branch, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA 30333, United States
| | - Winston E Abara
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - Michael M McNeil
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
| | - Rositsa B Dimova
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, 10903 New Hampshire Ave, Silver Spring, MD 20903, United States
| | - John R Su
- Immunization Safety Office, Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1825 Century Center Blvd, Atlanta, GA 303239, United States
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21
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Finsterer J, Scorza FA. Only blame SARS-CoV-2 vaccination for facial palsy after alternative etiologies have been ruled out. Therapie 2023; 78:463-464. [PMID: 37268504 PMCID: PMC10186848 DOI: 10.1016/j.therap.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/15/2023] [Indexed: 06/04/2023]
Affiliation(s)
- Josef Finsterer
- Neurology and Neurophysiology Center, Postfach 20, 1180 Vienna, Austria.
| | - Fulvio A Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, SP 05508-220, Brazil
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22
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Szczygieł A, Logoń K, Poznański P, Koszewicz M, Krajewska M, Kamińska D. Guillain-Barré syndrome following severe COVID-19 directly after kidney transplantation. Pol Arch Intern Med 2023; 133:16472. [PMID: 36994916 DOI: 10.20452/pamw.16472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Affiliation(s)
- Aleksandra Szczygieł
- Student Scientific Club, Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Katarzyna Logoń
- Student Scientific Club, Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland.
| | | | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Wrocław, Poland
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23
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Shastri A, Al Aiyan A, Kishore U, Farrugia ME. Immune-Mediated Neuropathies: Pathophysiology and Management. Int J Mol Sci 2023; 24:7288. [PMID: 37108447 PMCID: PMC10139406 DOI: 10.3390/ijms24087288] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 12/24/2022] [Revised: 03/12/2023] [Accepted: 03/21/2023] [Indexed: 04/29/2023] Open
Abstract
Dysfunction of the immune system can result in damage of the peripheral nervous system. The immunological mechanisms, which include macrophage infiltration, inflammation and proliferation of Schwann cells, result in variable degrees of demyelination and axonal degeneration. Aetiology is diverse and, in some cases, may be precipitated by infection. Various animal models have contributed and helped to elucidate the pathophysiological mechanisms in acute and chronic inflammatory polyradiculoneuropathies (Guillain-Barre Syndrome and chronic inflammatory demyelinating polyradiculoneuropathy, respectively). The presence of specific anti-glycoconjugate antibodies indicates an underlying process of molecular mimicry and sometimes assists in the classification of these disorders, which often merely supports the clinical diagnosis. Now, the electrophysiological presence of conduction blocks is another important factor in characterizing another subgroup of treatable motor neuropathies (multifocal motor neuropathy with conduction block), which is distinct from Lewis-Sumner syndrome (multifocal acquired demyelinating sensory and motor neuropathy) in its response to treatment modalities as well as electrophysiological features. Furthermore, paraneoplastic neuropathies are also immune-mediated and are the result of an immune reaction to tumour cells that express onconeural antigens and mimic molecules expressed on the surface of neurons. The detection of specific paraneoplastic antibodies often assists the clinician in the investigation of an underlying, sometimes specific, malignancy. This review aims to discuss the immunological and pathophysiological mechanisms that are thought to be crucial in the aetiology of dysimmune neuropathies as well as their individual electrophysiological characteristics, their laboratory features and existing treatment options. Here, we aim to present a balance of discussion from these diverse angles that may be helpful in categorizing disease and establishing prognosis.
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Affiliation(s)
- Abhishek Shastri
- Central and North West London NHS Foundation Trust, London NW1 3AX, UK
| | - Ahmad Al Aiyan
- Department of Veterinary Medicine, UAE University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Uday Kishore
- Department of Veterinary Medicine, UAE University, Al Ain P.O. Box 15551, United Arab Emirates
| | - Maria Elena Farrugia
- Department of Neurology, Institute of Neurological Sciences, Southern General Hospital, Glasgow G51 4TF, UK
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24
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Qinrong H, Yuxia C, Ling L, Huayu L, Lei X, Xiaoli L, Nong X. Reliability and validity of prognostic indicators for Guillain-Barré syndrome in children. Dev Med Child Neurol 2023; 65:563-570. [PMID: 36175376 DOI: 10.1111/dmcn.15418] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 12/29/2021] [Revised: 08/20/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
AIM To explore the clinical characteristics and prognostic predictors of Guillain-Barré syndrome (GBS) in Chinese paediatric patients. METHOD The clinical features of children with GBS hospitalized in the Children's Hospital of Chongqing Medical University were summarized retrospectively. The correlation between the Erasmus GBS Outcome Score (EGOS)/modified Erasmus GBS Outcome Score (mEGOS), GBS disability score (GDS)/modified Rankin Scale (MRS), Erasmus GBS Respiratory Insufficiency Score (EGRIS), and mechanical ventilation were evaluated. RESULTS One hundred forty-two patients (86 males, 56 females; median 62.50 months [interquartile range 41.00-97.50]) with classic GBS were enrolled in the study. In the present GBS cohort, 134 (94.37%) patients could walk independently (GDS ≤2) and 121 (85.21%) could manage without assistance (MRS ≤2) at 6 months. Eighteen (12.68%) patients with GBS required mechanical ventilation. The performance of mEGOS on admission, mEGOS on day 7, and EGOS-predicted GDS outcome at 4 weeks, 3 months, and 6 months in the paediatric patients with GBS admitted within 2 weeks of disease onset and that of the MRS outcome were evaluated. The EGRIS in individuals who required mechanical ventilation was significantly higher than in patients without mechanical ventilation (median = 6 vs median = 3, p < 0.001). INTERPRETATION In Chinese paediatric patients with GBS who were admitted 2 weeks after disease onset, the mEGOS and EGOS are validated indicators for the prediction of clinical outcomes 6 months after onset. EGRIS is helpful in predicting the implementation of mechanical ventilation in the acute phase. WHAT THIS PAPER ADDS The Erasmus Guillain-Barré syndrome (GBS) Outcome Score (EGOS) and modified EGOS are reliable prognostic predictors in paediatric patients with GBS. The Erasmus GBS Respiratory Insufficiency Score (EGRIS) is an effective predictor of mechanical ventilation in paediatric patients with GBS. An EGRIS of ≥5 indicates a high risk of mechanical ventilation in the acute phase.
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Affiliation(s)
- Huang Qinrong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Chen Yuxia
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Liu Ling
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Luo Huayu
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xu Lei
- Department of Rehabilitation Children's Hospital of Fudan University, Shanghai, People's Republic of China
| | - Li Xiaoli
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
| | - Xiao Nong
- Department of Rehabilitation Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, People's Republic of China
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25
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Affiliation(s)
- Nihal Akçay
- Department of Pediatric Intensive Care Unit, Bakirköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Oğur
- Department of Pediatric Intensive Care Unit, Bakirköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mehmet Emin Menentoglu
- Department of Pediatric Intensive Care Unit, Bakirköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Ayşe İrem Sofuoğlu
- Department of Pediatric Intensive Care Unit, Bakirköy Dr. Sadi Konuk Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
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26
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Misra UK. Prognosis of Guillain-Barré syndrome in children: More questions to answer. Dev Med Child Neurol 2023; 65:448-449. [PMID: 36175365 DOI: 10.1111/dmcn.15415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 09/02/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Usha K Misra
- Neurosciences Department, Apollomedics Super Speciality Hospital & Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, India
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27
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Devi AK, Randhawa MS, Bansal A, Angurana SK, Malhi P, Nallasamy K, Jayashree M. Long-Term Neurological, Behavioral, Functional, Quality of Life, and School Performance Outcomes in Children With Guillain-Barré Syndrome Admitted to PICU. Pediatr Neurol 2023; 140:18-24. [PMID: 36587490 DOI: 10.1016/j.pediatrneurol.2022.11.002] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 09/24/2022] [Accepted: 11/03/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Most children with Guillain-Barré syndrome (GBS) recover but may suffer from long-term sequelae, interfering with development and quality of life. Owing to the lack of published data, we aimed to assess the long-term neurological, behavioral, functional, quality of life, and school performance outcomes them. METHODS Design: Cross-sectional observational. SETTING Pediatric intensive care unit. PATIENTS Children, aged one to 12 years, with GBS admitted over five years (July 2012 to June 2017) were enrolled during one year (July 2017 to June 2018). These children were assessed for the following outcomes: neurological (Hughes disability score, Pediatric Cerebral Performance Category [PCPC], Pediatric Overall Performance Category [POPC], and Glasgow Outcome Scale-Extended Pediatric version [GOS-E Peds] scales), behavioral (Childhood Psychopathology Measurement Schedule [CPMS]), functional (Vineland Social Maturity Scale [VSMS]-Indian Adaptation), quality of life (Pediatric Quality of Life [PedsQL]), and school performance (Parent-Directed Questionnaire). RESULTS Eighty children were enrolled after a median of 3.0 (1.3-4.2) years from discharge. The majority (95%) had favorable neurological recovery (Hughes disability score 0 to 1). Favorable outcome was noted in 95% of children on PCPC, 87.5% on POPC, 60% on GOS-E Peds, 86.2% on CPMS, 92.5% on VSMS, and 98% on PedsQL. The majority (97.5%) of childre were attending schools, and 57.7% had satisfactory school performance. The presence of quadriparesis at admission, mechanical ventilation, tracheostomy requirement, poor ambulatory status at discharge, and longer pediatric intensive care unit and hospital stay predicted unfavorable neurological outcome on different tools. Absence of quadriparesis at admission and no requirement of mechanical ventilation predicted a favorable result on all outcome measures. CONCLUSIONS On long-term follow-up, most children with severe GBS showed favorable neurological, behavioral, functional, and quality of life outcomes. Severe clinical presentation and prolonged intensive care unit stay predict poor long-term outcome.
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Affiliation(s)
- Angom Kiran Devi
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Manjinder Singh Randhawa
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Arun Bansal
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Suresh Kumar Angurana
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Prahbhjot Malhi
- Pediatric Psychology, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Karthi Nallasamy
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Muralidharan Jayashree
- Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
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28
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Halstead SK, Jackson M, Bianchi E, Rupp S, Granger N, Menchetti M, Galli G, Freeman P, Kaczmarska A, Bhatti SFM, Brocal J, José‐López R, Tipold A, Gutierrez Quintana R, Ives EJ, Liatis T, Nessler J, Rusbridge C, Willison HJ, Rupp A. Serum anti-GM2 and anti-GalNAc-GD1a ganglioside IgG antibodies are biomarkers for immune-mediated polyneuropathies in cats. J Peripher Nerv Syst 2023; 28:32-40. [PMID: 36573790 PMCID: PMC10946849 DOI: 10.1111/jns.12529] [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: 09/22/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
Recent work identified anti-GM2 and anti-GalNAc-GD1a IgG ganglioside antibodies as biomarkers in dogs clinically diagnosed with acute canine polyradiculoneuritis, in turn considered a canine equivalent of Guillain-Barré syndrome. This study aims to investigate the serum prevalence of similar antibodies in cats clinically diagnosed with immune-mediated polyneuropathies. The sera from 41 cats clinically diagnosed with immune-mediated polyneuropathies (IPN), 9 cats with other neurological or neuromuscular disorders (ONM) and 46 neurologically normal cats (CTRL) were examined for the presence of IgG antibodies against glycolipids GM1, GM2, GD1a, GD1b, GalNAc-GD1a, GA1, SGPG, LM1, galactocerebroside and sulphatide. A total of 29/41 IPN-cats had either anti-GM2 or anti-GalNAc-GD1a IgG antibodies, with 24/29 cats having both. Direct comparison of anti-GM2 (sensitivity: 70.7%; specificity: 78.2%) and anti-GalNAc-GD1a (sensitivity: 70.7%; specificity: 70.9%) antibodies narrowly showed anti-GM2 IgG antibodies to be the better marker for identifying IPN-cats when compared to the combined ONM and CTRL groups (P = .049). Anti-GA1 and/or anti-sulphatide IgG antibodies were ubiquitously present across all sample groups, whereas antibodies against GM1, GD1a, GD1b, SGPG, LM1 and galactocerebroside were overall only rarely observed. Anti-GM2 and anti-GalNAc-GD1a IgG antibodies may serve as serum biomarkers for immune-mediated polyneuropathies in cats, as previously observed in dogs and humans.
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Affiliation(s)
- Susan K. Halstead
- Neuroimmunology Laboratories, School of Infection and ImmunityUniversity of GlasgowGlasgowUK
| | - Mark Jackson
- School of Cancer SciencesUniversity of GlasgowBearsdenUK
| | - Ezio Bianchi
- Department of Veterinary ScienceUniversity of ParmaParmaItaly
| | | | - Nicolas Granger
- Queen Mother Hospital for Animals, Royal Veterinary CollegeUniversity of LondonHatfieldUK
- CVS ReferralsBristol Veterinary SpecialistsBristolUK
| | - Marika Menchetti
- Neurology and Neurosurgery DivisionSan Marco Veterinary Clinic and LaboratoryVeggianoItaly
| | - Greta Galli
- Neurology and Neurosurgery DivisionSan Marco Veterinary Clinic and LaboratoryVeggianoItaly
| | - Paul Freeman
- Queens Veterinary School Hospital, Dept of Veterinary MedicineUniversity of CambridgeCambridgeUK
| | - Adriana Kaczmarska
- Small Animal Hospital, School of Biodiversity, One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Sofie F. M. Bhatti
- Small Animal Department, Faculty of Veterinary MedicineGhent UniversityMerelbekeBelgium
| | | | | | - Andrea Tipold
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine FoundationHannoverGermany
| | - Rodrigo Gutierrez Quintana
- Small Animal Hospital, School of Biodiversity, One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
| | | | - Theofanis Liatis
- Queen Mother Hospital for Animals, Royal Veterinary CollegeUniversity of LondonHatfieldUK
- Small Animal Hospital, School of Biodiversity, One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
| | - Jasmin Nessler
- Department of Small Animal Medicine and SurgeryUniversity of Veterinary Medicine FoundationHannoverGermany
| | - Clare Rusbridge
- School of Veterinary MedicineThe University of SurreyGuildfordUK
| | - Hugh J. Willison
- Neuroimmunology Laboratories, School of Infection and ImmunityUniversity of GlasgowGlasgowUK
| | - Angie Rupp
- Division of Pathology, Public Health and Disease Investigation, School of Biodiversity, One Health and Veterinary MedicineUniversity of GlasgowGlasgowUK
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Sidoli C, Bruni AA, Beretta S, Mazzola P, Bellelli G. Guillain-Barré syndrome AMSAN variant in a 90-year-old woman after COVID-19: a case report. BMC Geriatr 2023; 23:114. [PMID: 36859256 PMCID: PMC9975860 DOI: 10.1186/s12877-023-03833-1] [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: 06/25/2022] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND Guillain-Barré syndrome (GBS) is an inflammatory disease of the peripheral nervous system characterized by rapidly evolving polyneuropathy caused by autoimmune demyelination and/or axonal degeneration. Since SARS-CoV-2 outbreak, several GBS cases following exposure to coronavirus disease-2019 (COVID-19) have been reported in literature, raising the concern of the latter being a potential trigger event for GBS. CASE PRESENTATION We report the case of a 90-year-old Caucasian woman who was admitted to our hospital because of fatigue, worsening gait and leg strength, dysphonia, dysarthria and dysphagia, started 3 weeks after being exposed to COVID-19. Based on clinical presentation GBS was suspected, so she performed a lumbar puncture and electromyography, which confirmed the diagnosis of acute motor and sensory axonal neuropathy (AMSAN) variant. We administered high dose of intravenous immunoglobulin with slight neurological improvement. However, after 2 weeks of hospitalization with maximization of care, her physical condition worsen, manifesting severe frailty. The patient was discharged with home support services for managing parenteral nutrition and intense scheduled physiotherapy. A few days later, the patient experienced a further decline in her clinical condition and died at home. CONCLUSIONS To the best of our knowledge, we report the oldest woman with GBS AMSAN variant after COVID-19 described in the existing literature. Our case supports further research aimed at improving recognition, characterization and prompt management of neurological diseases related to COVID-19 in older patients.
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Affiliation(s)
- Chiara Sidoli
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
| | | | - Simone Beretta
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
- Neurology Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy
| | - Paolo Mazzola
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy.
- Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy.
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy.
| | - Giuseppe Bellelli
- School of Medicine and Surgery, University of Milano-Bicocca, U8 Building, Floor 4, Lab 4045, Via Cadore, 48, 20900, Monza, MB, Italy
- Acute Geriatrics Unit, San Gerardo hospital ASST Monza, Monza, MB, Italy
- NeuroMI - Milan Center for Neuroscience, Clinical Neurosciences Research Area, Milan, MI, Italy
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Cunningham ME, McGonigal R, Barrie JA, Campbell CI, Yao D, Willison HJ. Axolemmal nanoruptures arising from paranodal membrane injury induce secondary axon degeneration in murine Guillain-Barré syndrome. J Peripher Nerv Syst 2023; 28:17-31. [PMID: 36710500 PMCID: PMC10947354 DOI: 10.1111/jns.12532] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/09/2022] [Revised: 01/19/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023]
Abstract
The major determinant of poor outcome in Guillain-Barré syndrome (GBS) is axonal degeneration. Pathways leading to primary axonal injury in the motor axonal variant are well established, whereas mechanisms of secondary axonal injury in acute inflammatory demyelinating polyneuropathy (AIDP) are unknown. We recently developed an autoantibody-and complement-mediated model of murine AIDP, in which prominent injury to glial membranes at the node of Ranvier results in severe disruption to paranodal components. Acutely, axonal integrity was maintained, but over time secondary axonal degeneration occurred. Herein, we describe the differential mechanisms underlying acute glial membrane injury and secondary axonal injury in this model. Ex vivo nerve-muscle explants were injured for either acute or extended periods with an autoantibody-and complement-mediated injury to glial paranodal membranes. This model was used to test several possible mechanisms of axon degeneration including calpain activation, and to monitor live axonal calcium signalling. Glial calpains induced acute disruption of paranodal membrane proteins in the absence of discernible axonal injury. Over time, we observed progressive axonal degeneration which was markedly attenuated by axon-specific calpain inhibition. Injury was unaffected by all other tested methods of protection. Trans-axolemmal diffusion of fluorescent proteins and live calcium imaging studies indirectly demonstrated the presence of nanoruptures in the axon membrane. This study outlines one mechanism by which secondary axonal degeneration arises in the AIDP variant of GBS where acute paranodal loop injury is prominent. The data also support the development of calpain inhibitors to attenuate both primary and secondary axonal degeneration in GBS.
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Affiliation(s)
| | - Rhona McGonigal
- School of Infection & ImmunityUniversity of GlasgowGlasgowUK
| | | | | | - Denggao Yao
- School of Infection & ImmunityUniversity of GlasgowGlasgowUK
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McGonigal R, Cunningham ME, Smyth D, Chou M, Barrie JA, Wilkie A, Campbell C, Saatman KE, Lunn M, Willison HJ. The endogenous calpain inhibitor calpastatin attenuates axon degeneration in murine Guillain-Barré syndrome. J Peripher Nerv Syst 2023; 28:4-16. [PMID: 36335586 PMCID: PMC10947122 DOI: 10.1111/jns.12520] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 09/27/2022] [Revised: 10/24/2022] [Accepted: 10/30/2022] [Indexed: 11/08/2022]
Abstract
Axon degeneration accounts for the poor clinical outcome in Guillain-Barré syndrome (GBS), yet no treatments target this key pathogenic stage. Animal models demonstrate anti-ganglioside antibodies (AGAb) induce axolemmal complement pore formation through which calcium flux activates the intra-axonal calcium-dependent proteases, calpains. We previously showed protection of axonal components using soluble calpain inhibitors in ex vivo GBS mouse models, and herein, we assess the potential of axonally-restricted calpain inhibition as a neuroprotective therapy operating in vivo. Using transgenic mice that over-express the endogenous human calpain inhibitor calpastatin (hCAST) neuronally, we assessed distal motor nerve integrity in our established GBS models. We induced immune-mediated injury with monoclonal AGAb plus a source of human complement. The calpain substrates neurofilament and AnkyrinG, nerve structural proteins, were assessed by immunolabelling and in the case of neurofilament, by single-molecule arrays (Simoa). As the distal intramuscular portion of the phrenic nerve is prominently targeted in our in vivo model, respiratory function was assessed by whole-body plethysmography as the functional output in the acute and extended models. hCAST expression protects distal nerve structural integrity both ex and in vivo, as shown by attenuation of neurofilament breakdown by immunolabelling and Simoa. In an extended in vivo model, while mice still initially undergo respiratory distress owing to acute conduction failure, the recovery phase was accelerated by hCAST expression. Axonal calpain inhibition can protect the axonal integrity of the nerve in an in vivo GBS paradigm and hasten recovery. These studies reinforce the strong justification for developing further animal and human clinical studies using exogenous calpain inhibitors.
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Affiliation(s)
- Rhona McGonigal
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | | | - Duncan Smyth
- National Hospital for Neurology and Neurosurgery, Centre for Neuromuscular DiseasesUniversity College LondonLondonUnited Kingdom
| | - Michael Chou
- National Hospital for Neurology and Neurosurgery, Centre for Neuromuscular DiseasesUniversity College LondonLondonUnited Kingdom
| | - Jennifer A. Barrie
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | - Andrew Wilkie
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | - Clare Campbell
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
| | - Kathryn E. Saatman
- Department of Physiology, Spinal Cord and Brain Injury Research CenterUniversity of KentuckyLexingtonKYUSA
| | - Michael Lunn
- National Hospital for Neurology and Neurosurgery, Centre for Neuromuscular DiseasesUniversity College LondonLondonUnited Kingdom
| | - Hugh J. Willison
- School of Infection & ImmunityUniversity of GlasgowGlasgowUnited Kingdom
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Abstract
This JAMA Patient Page describes the autoimmune disease Guillain-Barré syndrome and its risk factors, diagnosis, treatment, and prognosis.
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Zou H, Zou S. Advanced thallium toxicity. Pract Neurol 2023; 23:85-87. [PMID: 36424143 DOI: 10.1136/pn-2022-003577] [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] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
Thallium is a highly toxic tasteless, odourless and water-soluble metal that can be absorbed through the skin, inhaled or ingested. Due to the rarity of thallium toxicity, it is frequently misdiagnosed or the diagnosis is delayed. We report a 41-year-old male landscaper admitted for acute polyneuropathy and abdominal pain. He was treated for suspected Guillain-Barré syndrome and later autoimmune encephalopathy. However, over the next 42 days, he developed worsening muscle weakness, delirium and alopecia, and was diagnosed with thallium toxicity. After combining Prussian blue, activated charcoal and continuous venovenous haemofiltration, he improved though with neuropsychiatric and neuromuscular sequelae. We highlight the need to manage information disclosure properly and to preserve evidence, when the source of a toxin is unclear.
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Affiliation(s)
- Henry Zou
- College of Human Medicine, Michigan State University, Grand Rapids, Michigan, USA
| | - Simeon Zou
- Department of Neurology, Bronson Neuroscience Center, Kalamazoo, Michigan, USA
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Ganesh A, Galetta S. Editors' Note: An International Perspective on Preceding Infections in Guillain-Barré Syndrome: The IGOS-1000 Cohort. Neurology 2023; 100:263. [PMID: 36717235 DOI: 10.1212/wnl.0000000000206815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Finsterer J. On "Guillain-Barré Syndrome Related and Unrelated to COVID-19: Clinical Follow-Up in the COVID-19 Era." Masuccio FG, Tipa V, Invernizzi M, Solaro C. Phys Ther. 2022; 102:pzac049. https://doi.org/10.1093/ptj/pzac049. Phys Ther 2022; 102:pzac125. [PMID: 36168885 PMCID: PMC9619447 DOI: 10.1093/ptj/pzac125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022]
Affiliation(s)
- J Finsterer
- Neurology & Neurophysiology Center, Postfach 20, 1180 Vienna, Austria
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Liu X, Chen X, Zhou Y, Zhang X. Paralytic ileus as first symptom of Miller Fisher syndrome: A case report. Medicine (Baltimore) 2022; 101:e30434. [PMID: 36086690 PMCID: PMC10980455 DOI: 10.1097/md.0000000000030434] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 07/28/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Miller Fisher syndrome (MFS), regarded by many scholars as a variant of Guillain Barre syndrome (GBS), accounts for approximately 5% to 10% of GBS cases. The typical clinical manifestations of MFS are extraocular muscle paralysis, ataxia, and tendon reflex loss or disappearance. To date, intestinal obstruction has rarely been reported as the initial symptom. PATIENT CONCERNS A 48-year-old woman presenting with abdominal pain and distention was diagnosed with paralytic ileus. There was no significant improvement in symptoms after symptomatic treatment. After that, the patient developed visual rotation, with limited binocular abduction and adduction, and ataxia. Anti-ganglioside testing revealed positive anti-ganglioside antibodies. DIAGNOSIS The patient was diagnosed as MFS. INTERVENTIONS The early stage is mainly symptomatic treatment of paralytic ileus. After MFS was diagnosed, the patient was given large amounts of immunoglobulin and hormone shock therapy. OUTCOMES After 1 week, the symptoms of intestinal obstruction and MFS gradually improved. The patient was later discharged automatically for financial reasons. Six months after discharge, the patient was interviewed by telephone, and she had recovered. CONCLUSION To date, intestinal obstruction has rarely been reported as the initial symptom. In case of inconsistencies between the imaging examinations and clinical symptoms, neuroelectrophysiology and cerebrospinal fluid puncture should be performed, striving for timely detection and treatment.
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Affiliation(s)
- Xiubin Liu
- Shandong Institute of Literature and Culture, Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, People’s Republic of China
| | - Xiqi Chen
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, People’s Republic of China
| | - Yongkun Zhou
- Department of General Surgery, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, People’s Republic of China
| | - Xiaoxia Zhang
- Shandong Institute of Literature and Culture, Shandong University of Traditional Chinese Medicine, Jinan City, Shandong Province, People’s Republic of China
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Börü ÜT, Bölük C, Toksoy CK, Demirbaş H. Acute cerebellitis, transverse myelitis and polyradiculoneuritis related to post-COVID-19 infection. J Spinal Cord Med 2022; 45:765-768. [PMID: 36175361 PMCID: PMC9542541 DOI: 10.1080/10790268.2021.1969502] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
CONTEXT Guillain-Barré syndrome (GBS), acute cerebellitis and transverse myelitis are rare complications of COVID-19 infection separately. The combination of these three, however, has not yet been reported. FINDINGS We present an atypical case (42-year-old man) that developed acute ascending flaccid paraparesis, ataxia and urinary retention two weeks after COVID-19 infection. Neurological examination revealed distal and proximal weakness (4/5) on lower extremities, decreased tendon reflexes, sixth cranial nerve palsy and dysmetria without sensory disturbance. His cranial MRI showed cerebellitis whereas the spinal MRI showed transverse myelitis at the T11/12 level. Albuminocytologic dissociation was present in the cerebrospinal fluid. The nerve conduction study was concordant with early findings of GBS. He recovered well after corticosteroid treatment without needing any immunotherapy. On day seven of hospitalization, the modified Rankin Scale score was 0. CONCLUSION COVID-19 infection may present with a combination of neurological manifestations such as cerebellitis, transverse myelitis and GBS. This patient presented significant functional recovery after treatment with corticosteroid without immunotherapy.
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Affiliation(s)
- Ülkü Türk Börü
- Department of Neurology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Cem Bölük
- Department of Neurology, Cerrahpasa Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Cansu Köseoğlu Toksoy
- Department of Neurology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
| | - Hayri Demirbaş
- Department of Neurology, Afyonkarahisar University of Health Sciences, Afyonkarahisar, Turkey
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Cunningham ME, McGonigal R, Barrie JA, Yao D, Willison HJ. Real time imaging of intra-axonal calcium flux in an explant mouse model of axonal Guillain-Barré syndrome. Exp Neurol 2022; 355:114127. [PMID: 35640716 PMCID: PMC7614209 DOI: 10.1016/j.expneurol.2022.114127] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/12/2022] [Accepted: 05/26/2022] [Indexed: 11/19/2022]
Abstract
The acute motor axonal variant of Guillain-Barré syndrome is associated with the attack of motor axons by anti-ganglioside antibodies which activate complement on the axonal plasma membrane. Animal models have indirectly implicated complement pore-mediated calcium influx as a trigger of axonal damage, through the activation of the protease calpain. However, this calcium influx has never been imaged directly. Herein we describe a method to detect changes in intra-axonal calcium in an ex vivo mouse model of axonal Guillain-Barré syndrome and describe the influence of calcium on axonal injury and the effects of calpain inhibition on axonal outcome. Using ex vivo nerve-muscle explants from Thy1-TNXXL mice which axonally express a genetically encoded calcium indicator, we studied the effect of the binding and activation of complement by an anti-GD1b ganglioside antibody which targets the motor axon. Using live multiphoton imaging, we found that a wave of calcium influx extends retrogradely from the motor nerve terminal as far back as the large bundles within the muscle explant. Despite terminal complement pores being detectable only at the motor nerve terminal and, to a lesser degree, the most distal node of Ranvier, disruption of axonal proteins occurred at more proximal sites implicating the intra-axonal calcium wave. Morphological analysis indicated two different types of calcium-induced changes: acutely, distal axons showed swelling and breakdown at sites where complement pores were present. Distally, in areas of raised calcium which lacked detectable complement pores, axons developed a spindly, vacuolated appearance suggestive of early signs of degeneration. All morphological changes were prevented with treatment with a calpain inhibitor. This is the first investigation of axonal calcium dynamics in a mouse model of Guillain-Barré syndrome and demonstrates the proximal reach of calcium influx following an injury which is confined to the most distal parts of the motor axon. We also demonstrate that calpain inhibition remains a promising candidate for both acute and sub-acute consequences of calcium-induced calpain activation.
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Affiliation(s)
- Madeleine E Cunningham
- Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Rhona McGonigal
- Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Jennifer A Barrie
- Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Denggao Yao
- Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Hugh J Willison
- Institute of Infection, Immunity, and Inflammation, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Berciano J. Axonal pathology in early stages of Guillain-Barré syndrome. Neurologia 2022; 37:466-479. [PMID: 30057217 DOI: 10.1016/j.nrl.2018.06.002] [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: 05/15/2018] [Revised: 06/05/2018] [Accepted: 06/12/2018] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Guillain-Barré syndrome (GBS) is an acute-onset, immune-mediated disease of the peripheral nervous system. It may be classified into 2 main subtypes: demyelinating (AIDP) and axonal (AMAN). This study aims to analyse the mechanisms of axonal damage in the early stages of GBS (within 10days of onset). DEVELOPMENT We analysed histological, electrophysiological, and imaging findings from patients with AIDP and AMAN, and compared them to those of an animal model of myelin P2 protein-induced experimental allergic neuritis. Inflammatory oedema of the spinal nerve roots and spinal nerves is the initial lesion in GBS. The spinal nerves of patients with fatal AIDP may show ischaemic lesions in the endoneurium, which suggests that endoneurial inflammation may increase endoneurial fluid pressure, reducing transperineurial blood flow, potentially leading to conduction failure and eventually to axonal degeneration. In patients with AMAN associated with anti-ganglioside antibodies, nerve conduction block secondary to nodal sodium channel dysfunction may affect the proximal, intermediate, and distal nerve trunks. In addition to the mechanisms involved in AIDP, active axonal degeneration in AMAN may be associated with nodal axolemma disruption caused by anti-ganglioside antibodies. CONCLUSION Inflammatory oedema of the proximal nerve trunks can be observed in early stages of GBS, and it may cause nerve conduction failure and active axonal degeneration.
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Affiliation(s)
- J Berciano
- Servicio de Neurología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Universidad de Cantabria, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, España.
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Jolobe OMP. Towards a deeper understanding of the dynamics of COVID-19-associated Guillain-Barre syndrome. QJM 2022; 115:342-343. [PMID: 34240216 PMCID: PMC8344536 DOI: 10.1093/qjmed/hcab186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Oscar M P Jolobe
- Flat 6 Souchay Court, 1 Clothorn Road, Manchester, 6BR M20
- Corresponding. Emial: Telephone: 44 161 900 6887
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Wang Y, Wang Y, Li X, Wang H. Re: Towards a deeper understanding of the dynamics of COVID-19-associated Guillain-Barre syndrome. QJM 2022; 115:344-345. [PMID: 34240218 PMCID: PMC8344588 DOI: 10.1093/qjmed/hcab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yumin Wang
- Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine,No.15 Rd.Yuquan,Beijing 100049, PR China
| | - Yanchao Wang
- Department of Neurology, The Affiliated Hospital of Chifeng University, No.42 Street Wangfu, Chifeng 024005, PR China
| | - Xiujun Li
- Department of Nursing, School of Clinical Medicine, Chifeng University, No.1 Rd.Yingbin, Chifeng 024005, PR China
| | - Hongquan Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, No.15 Rd.Yuquan, Beijing 100049, PR China
- Address correspondence to Hongquan Wang, Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China. or
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Brudvig JM, Cluett MM, Gensterblum-Miller EU, Chen J, Bell JA, Mansfield LS. Th1/Th17-mediated Immunity and Protection from Peripheral Neuropathy in Wildtype and IL10 -/- BALB/c Mice Infected with a Guillain-Barré Syndrome-associated Campylobacter jejuni Strain. Comp Med 2022; 72:63-77. [PMID: 35272743 PMCID: PMC9084571 DOI: 10.30802/aalas-cm-21-000059] [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: 03/08/2021] [Revised: 05/07/2021] [Accepted: 09/03/2021] [Indexed: 11/05/2022]
Abstract
Campylobacter jejuni is an important cause of bacterial gastroenteritis worldwide and is linked to Guillain-Barré syndrome (GBS), a debilitating postinfectious polyneuropathy. The immunopathogenesis of GBS involves the generation of antibodies that are cross reactive to C. jejuni lipooligosaccharide and structurally similar peripheral nerve gangliosides. Both the C. jejuni infecting strain and host factors contribute to GBS development. GBS pathogenesis is associated with Th2-mediated responses in patients. Moreover, induction of IgG1 antiganglioside antibodies in association with colonic Th2-mediated immune responses has been reported in C. jejuni-infected C57BL/6 IL10-/- mice at 4 to 6 wk after infection. We hypothesized that, due to their Th2 immunologic bias, BALB/c mice would develop autoantibodies and signs of peripheral neuropathy after infection with a GBS patient-derived strain of C. jejuni (strain 260.94). WT and IL10-/- BALB/c mice were orally inoculated with C. jejuni 260.94, phenotyped weekly for neurologic deficits, and euthanized after 5 wk. Immune responses were assessed as C. jejuni-specific and antiganglioside antibodies in plasma and cytokine production and histologic lesions in the proximal colon. Peripheral nerve lesions were assessed in dorsal root ganglia and their afferent nerve fibers by scoring immunohistochemically labeled macrophages through morphometry. C. jejuni 260.94 stably colonized both WT and IL10-/- mice and induced systemic Th1/Th17-mediated immune responses with significant increases in C. jejuni-specific IgG2a, IgG2b, and IgG3 plasma antibodies. However, C. jejuni 260.94 did not induce IgG1 antiganglioside antibodies, colitis, or neurologic deficits or peripheral nerve lesions in WT or IL10-/- mice. Both WT and IL10-/- BALB/c mice showed relative protection from development of Th2-mediated immunity and antiganglioside antibodies as compared with C57BL/6 IL10-/- mice. Therefore, BALB/c mice infected with C. jejuni 260.94 are not an effective disease model but provide the opportunity to study the role of immune mechanisms and host genetic background in the susceptibility to post infectious GBS.
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Affiliation(s)
- Jean M Brudvig
- Comparative Enteric Diseases Laboratory, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan; Comparative Medicine and Integrative Biology, Michigan State University, East Lansing, Michigan; College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Matthew M Cluett
- Comparative Enteric Diseases Laboratory, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan; College of Veterinary Medicine, Michigan State University, East Lansing, Michigan
| | - Elizabeth U Gensterblum-Miller
- Comparative Enteric Diseases Laboratory, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan; College of Veterinary Medicine, Michigan State University, East Lansing, Michiga
| | - James Chen
- Comparative Enteric Diseases Laboratory, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan; College of Veterinary Medicine, Michigan State University, East Lansing, Michiga
| | - Julia A Bell
- Comparative Enteric Diseases Laboratory, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan; College of Veterinary Medicine, Michigan State University, East Lansing, Michiga
| | - Linda S Mansfield
- Comparative Enteric Diseases Laboratory, Department of Large Animal Clinical Sciences, Michigan State University, East Lansing, Michigan; Comparative Medicine and Integrative Biology, Michigan State University, East Lansing, Michigan; College of Veterinary Medicine, Michigan State University, East Lansing, Michigan; Department of Microbiology and Molecular Genetics, Michigan State University, East Lansing, Michigan;,
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Walusinski O. Louis Duménil (1823-1890), surgeon and pioneer in neurology. Rev Neurol (Paris) 2022; 178:298-305. [PMID: 34565621 DOI: 10.1016/j.neurol.2021.06.011] [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: 05/17/2021] [Revised: 06/02/2021] [Accepted: 06/03/2021] [Indexed: 11/16/2022]
Abstract
Louis-Stanislas Duménil (1823-1890) was a surgeon from Normandy who was a contemporary of Jean-Martin Charcot (1825-1893). Throughout his career, Duménil published annotated observations of neurological pathologies. One year before Guillaume Duchenne de Boulogne (1806-1875), he reported a case of "progressive muscular paralysis of the tongue, soft palate, and lips". He added five other cases of progressive muscular atrophy in 1867, together with histological examinations which showed atrophy in the anterior horns of the spinal cord. Charcot, who described amyotrophic lateral sclerosis, did not fail to pay homage to Duménil for his contribution. In 1862, Duménil added clinical observations of progressive locomotor ataxia, one of the first to do so. This included anatomopathological examinations, thus significantly completing the clinical picture presented by Duchenne in 1858. He confirmed the damage to the roots and posterior tracts of the spinal cord. Finally, by providing multiple observations of the syndrome described by Octave Landry (1826-1865) in 1859, he contributed to the clinical picture of "acute ascending paralysis" which has come down to us as Guillain-Barré syndrome, with no mention of the perspicacious physicians of the previous century who had already perfectly recognised this disease. Finally, Augusta Dejerine-Klumpke (1859-1927) paid a warm tribute to Duménil in her 1889 thesis, calling him one of the pioneers in understanding "the individuality and autonomy of the peripheral nervous system." He was indeed a pioneer, although he has been often overlooked.
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Yan W, Zhao C, Zhang H, Hu Z, Wang C. Case Report: Guillain-Barré Syndrome Characterized by Severe Headache Associated With Metabotropic Glutamate Receptor 5 Antibody. Front Immunol 2022; 13:808131. [PMID: 35386694 PMCID: PMC8977415 DOI: 10.3389/fimmu.2022.808131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/16/2022] [Indexed: 12/03/2022] Open
Abstract
Autoantibodies to metabotropic glutamate receptor 5 (mGluR5) are known to be the cause of autoimmune encephalitis, particularly limbic encephalitis, closely related to Hodgkin’s lymphoma (HL). The involvement of peripheral neuropathy is rarely reported. In our case, mGluR5 antibody was found in a Guillain-Barré syndrome (GBS) patient accompanied by severe headache but without neuropsychiatric manifestations or HL. Presenting with severe headache, the patient developed progressive bilateral limb weakness, areflexia, and cranial nerve involvement consisting of eye movement disorder, restricted mouth opening and chewing, bilateral facial paralysis and bulbar palsy. Cerebrospinal fluid (CSF) revealed elevated CSF protein level and normal cell count, known as “albumino-cytological dissociation”. Oligoclonal IgG bands were found in both the CSF and serum. Electrophysiological studies revealed symmetrical sensory and motor neuropathy with a mixture of axonal and demyelinating features. Brain and spinal cord magnetic resonance imaging (MRI), as well as the electroencephalogram, were normal. The mGluR5 antibody was positive in both serum and CSF with a Cell-Based Assay (CBA). The patient responded well to intravenous gammaglobulin therapy, correlated with a reduction of mGluR5 antibody titer from 1:30 to 1:10 in the serum. After 6 months, the patient recovered completely without any sign of recurrence or neoplasm. This first case of mGluR5 antibody-associated GBS accompanied by severe headache shows that mGluR5-associated disorders are not limited to manifestations of limbic encephalitis and HL.
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Affiliation(s)
- Weiqian Yan
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Zhao
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Hainan Zhang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiping Hu
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chunyu Wang
- Department of Neurology, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Chunyu Wang,
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Affiliation(s)
- Emily Jane Woo
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Rositsa B Dimova
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
| | - Adamma Mba-Jonas
- Office of Biostatistics and Epidemiology, Center for Biologics Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
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Fukushima T, Tomita M, Ikeda S, Hattori N. A case of sensory ataxic Guillain-Barré syndrome with immunoglobulin G anti-GM1 antibodies following the first dose of mRNA COVID-19 vaccine BNT162b2 (Pfizer). QJM 2022; 115:25-27. [PMID: 34871447 PMCID: PMC8690109 DOI: 10.1093/qjmed/hcab296] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- T Fukushima
- Department of Neurology, Toyota Kosei Hospital, 500-1 Ibobara Josui-cho, Toyota City JP470-0396, Japan
- Address correspondence to T. Fukushima, Department of Neurology, Toyota Kosei Hospital, 500-1 Ibobara Josui-cho, Toyota City JP470-0396, Japan.
| | - M Tomita
- Department of Neurology, Toyota Kosei Hospital, 500-1 Ibobara Josui-cho, Toyota City JP470-0396, Japan
| | - S Ikeda
- Department of Neurology, Toyota Kosei Hospital, 500-1 Ibobara Josui-cho, Toyota City JP470-0396, Japan
| | - N Hattori
- Department of Neurology, Toyota Kosei Hospital, 500-1 Ibobara Josui-cho, Toyota City JP470-0396, Japan
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Wang Y, Wang Y, Li X, Wang H. Reply to the spectrum of SARS-CoV-2 associated polyradiculitis is broad. QJM 2022; 114:836-837. [PMID: 34191014 DOI: 10.1093/qjmed/hcab179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Y Wang
- Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, No.15 Rd.Yuquan, Beijing 100049, PR China
| | - Y Wang
- Department of Neurology, The Affiliated Hospital of Chifeng University, No.42 Street.Wangfu, Chifeng 024005, PR China
| | - X Li
- Department of Nursing, School of Clinical Medicine, Chifeng University, No.1 Rd.Yingbin, Chifeng 024005, PR China
| | - H Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, No.15 Rd.Yuquan, Beijing 100049, PR China
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Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neuron, peripheral nerve, and neuromuscular junction disorders. Handb Clin Neurol 2022; 189:259-270. [PMID: 36031308 DOI: 10.1016/b978-0-323-91532-8.00014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In amyotrophic lateral sclerosis (ALS), Guillain-Barré syndrome (GBS), and neuromuscular junction disorders, three mechanisms may lead, singly or together, to respiratory emergencies and increase the disease burden and mortality: (i) reduced strength of diaphragm and accessory muscles; (ii) oropharyngeal dysfunction with possible aspiration of saliva/bronchial secretions/drink/food; and (iii) inefficient cough due to weakness of abdominal muscles. Breathing deficits may occur at onset or more often along the chronic course of the disease. Symptoms and signs are dyspnea on minor exertion, orthopnea, nocturnal awakenings, excessive daytime sleepiness, fatigue, morning headache, poor concentration, and difficulty in clearing bronchial secretions. The "20/30/40 rule" has been proposed to early identify GBS patients at risk for respiratory failure. The mechanical in-exsufflator is a device that assists ALS patients in clearing bronchial secretions. Noninvasive ventilation is a safe and helpful support, especially in ALS, but has some contraindications. Myasthenic crisis is a clinical challenge and is associated with substantial morbidity including prolonged mechanical ventilation and 5%-12% mortality. Emergency room physicians and consultant pulmonologists and neurologists must know such respiratory risks, be able to recognize early signs, and treat properly.
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Affiliation(s)
- Andrea Vianello
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Fabrizio Racca
- Department of Anaesthesiology and Intensive Care, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gian Luca Vita
- Unit of Neurology, Emergency Department, P.O. Piemonte, IRCCS Centro Neurolesi "Bonino-Pulejo", Messina, Italy
| | - Paola Pierucci
- Cardiothoracic Department, Respiratory and Critical Care Unit, "Aldo Moro" Bari University School of Medicine, Bari, Italy
| | - Giuseppe Vita
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, Messina University Hospital, Messina, Italy.
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Yariv O, Benouaich-Amiel A, Kab T, Yust-Katz S, Yerushalmi R, Goldvaser H. [RAPIDLY PROGRESSING PARAPARESIS AND LOSS OF SENSATION BELOW T10 DURING NEOADJUVANT CHEMOTHERAPY FOR BREAST CANCER]. Harefuah 2022; 161:14-16. [PMID: 35077053] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
A 35 years old woman was diagnosed with clinical stage 2, grade 3, hormone receptor positive, human epidermal growth factor receptor 2 (HER2) negative invasive ductal carcinoma, with ki-67 of 60%. She was treated with neoadjuvant chemotherapy with dose dense adriamycin and cyclophosphamide followed by paclitaxel. Six days following the third cycle of paclitaxel the patient presented with rapidly progressive weakness, proximal paresthesia and decreased sensation in both legs. Physical examination revealed hypoesthesia below level, proximal and distal weakness in both lower limbs and absence of reflexes. MRI of the spine demonstrated diffuse leptomeningeal enhancement from T11 to S1 including the cauda equina roots. The rapidly progressive neurological symptoms and the MRI findings were initially interpreted as leptomeningeal spread. High dose dexamethasone was promptly initiated and the patient was urgently planned for radiotherapy and received the first fraction of 3 Gy to level T11-S1. Further workup included lumbar puncture which showed elevated protein level (350 mg/dL), negative cytology for malignancy and EMG which demonstrated demyelinating injury compatible with Guillain-Barre syndrome (GBS). A diagnosis of GBS was made and treatment with intravenous immunoglobulins (IVIG) was initiated, followed by a gradual clinical improvement. Two months after the initial diagnosis, she had a near complete resolution of her neurological deficits. This case illustrates both the tendency to ascribe new symptoms and clinical findings in cancer patients to progressive disease, and the importance of keeping a wide differential diagnosis for non-cancer etiologies when treating our patients.
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Affiliation(s)
- Orly Yariv
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva , Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alexandra Benouaich-Amiel
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva , Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tanseem Kab
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Neurology, Rabin Medical Center, Beilinson Hospital, Petach Tikva, Israel
| | - Shlomit Yust-Katz
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva , Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rinat Yerushalmi
- Davidoff Cancer Center, Rabin Medical Center, Beilinson Hospital, Petach Tikva , Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hadar Goldvaser
- Department of Medical Oncology, Shaare Zedek Medical Center, and the Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Covid-19 associated Guillain-Barré syndrome: A series of a relatively uncommon neurological complication. Diabetes Metab Syndr 2021; 16:102370. [PMID: 34972040 DOI: 10.1016/j.dsx.2021.102370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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