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Martinez ARM, de Lima FD, Martins MP, Pereira IE, Miotto N, Mazo DFC, Vigani AG, da Costa LBE, Stucchi RSB, Almeida JRS, Nucci A, França MC. Sensory neuronopathy is a specific and disabling neurological manifestation of autoimmune hepatitis. Eur J Neurol 2020; 27:2072-2078. [PMID: 32441838 DOI: 10.1111/ene.14355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 05/15/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Neurological manifestations have been identified in the context of autoimmune hepatitis (AIH). Previous case reports highlighted the association between AIH and sensory neuronopathy (SN). Despite that, little is known about the frequency of AIH-related SN and its clinical/neurophysiological profile. Moreover, it is not clear whether SN is an AIH-specific manifestation or related to chronic liver damage. METHODS Seventy consecutive AIH patients were enrolled and their characteristics were compared with 52 consecutive patients with chronic active hepatitis B. All subjects underwent clinical and neurophysiological evaluation. Further comparisons were performed between AIH SN and AIH non-SN patients. RESULTS Mean ages and male:female proportions in the AIH and chronic active hepatitis B groups were 42.2 ± 16.3/51.7 ± 13.6 years and 14:56/29:23, respectively. The frequencies of carpal tunnel syndrome, radiculopathy and polyneuropathy were similar between groups. In contrast, SN was identified only in AIH patients (5/70 vs. 0/52, P = 0.04); the overall prevalence of AIH-related SN was 7% with an average profile of a woman in her 40s with asymmetric onset of sensory deficits that chronically evolved to disabling proprioceptive ataxia associated with marked dysautonomia. Neurological disability and hepatocellular damage did not follow in parallel. Anti-fibroblast growth factor receptor type 3 antibodies were found in 3/5 (60%) of the patients with AIH-related SN. Clinical or demographic predictors of SN in the context of AIH could not be identified. CONCLUSION Sensory neuronopathy, but not other peripheral nervous system diseases, is a specific AIH neurological manifestation. It is often disabling and, in contrast to hepatocellular injury, does not respond to immunosuppression.
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Affiliation(s)
- A R M Martinez
- Department of Neurology - Neuromuscular Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - F D de Lima
- Department of Neurology - Neuromuscular Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - M P Martins
- Department of Neurology - Neuromuscular Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - I E Pereira
- Department of Internal Medicine - Gastroenterology Division (Gastrocentro), University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - N Miotto
- Department of Internal Medicine - Infectious Diseases Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - D F C Mazo
- Department of Internal Medicine - Gastroenterology Division (Gastrocentro), University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - A G Vigani
- Department of Internal Medicine - Infectious Diseases Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - L B E da Costa
- Department of Pathology - Hepatic Disorders Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - R S B Stucchi
- Department of Internal Medicine - Infectious Diseases Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - J R S Almeida
- Department of Internal Medicine - Gastroenterology Division (Gastrocentro), University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - A Nucci
- Department of Neurology - Neuromuscular Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - M C França
- Department of Neurology - Neuromuscular Division, University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
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González‐Salazar C, Takazaki KAG, Martinez ARM, Pimentel‐Silva LR, Jacinto‐Scudeiro LA, Nakagawa ÉY, Fujiwara Murakami CE, Saute JAM, Pedroso JL, Barsottini OGP, Teive HAG, França Jr MC. Autonomic dysfunction in hereditary spastic paraplegia type 4. Eur J Neurol 2019; 26:687-693. [DOI: 10.1111/ene.13878] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 02/03/2023]
Affiliation(s)
- C. González‐Salazar
- Department of Neurology School of Medical Sciences University of Campinas (UNICAMP) CampinasBrazil
| | - K. A. G. Takazaki
- Department of Neurology School of Medical Sciences University of Campinas (UNICAMP) CampinasBrazil
| | - A. R. M. Martinez
- Department of Neurology School of Medical Sciences University of Campinas (UNICAMP) CampinasBrazil
| | - L. R. Pimentel‐Silva
- Department of Neurology School of Medical Sciences University of Campinas (UNICAMP) CampinasBrazil
| | - L. A. Jacinto‐Scudeiro
- Medical Genetics and Neurology Services Hospital de Clínicas de Porto Alegre Porto AlegreBrazil
- Department of Internal Medicine and Sciences Universidade Federal do Rio Grande do Sul (UFRGS) Porto AlegreBrazil
| | - É. Y. Nakagawa
- Department of Internal Medicine Neurology Service Universidade Federal do Paraná CuritibaBrazil
| | - C. E. Fujiwara Murakami
- Department of Internal Medicine Neurology Service Universidade Federal do Paraná CuritibaBrazil
| | - J. A. M. Saute
- Medical Genetics and Neurology Services Hospital de Clínicas de Porto Alegre Porto AlegreBrazil
- Department of Internal Medicine and Sciences Universidade Federal do Rio Grande do Sul (UFRGS) Porto AlegreBrazil
| | - J. L. Pedroso
- Department of Neurology Federal University of São Paulo (UNIFESP) São Paulo Brazil
| | - O. G. P. Barsottini
- Department of Neurology Federal University of São Paulo (UNIFESP) São Paulo Brazil
| | - H. A. G. Teive
- Department of Internal Medicine Neurology Service Universidade Federal do Paraná CuritibaBrazil
| | - M. C. França Jr
- Department of Neurology School of Medical Sciences University of Campinas (UNICAMP) CampinasBrazil
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Rezende TJR, Martinez ARM, Faber I, Girotto Takazaki KA, Martins MP, de Lima FD, Lopes-Cendes I, Cendes F, França MC. Developmental and neurodegenerative damage in Friedreich's ataxia. Eur J Neurol 2018; 26:483-489. [PMID: 30326180 DOI: 10.1111/ene.13843] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/04/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND PURPOSE Friedreich's ataxia (FRDA) is the most common autosomal-recessive ataxia worldwide. It is characterized by early onset, sensory abnormalities and slowly progressive ataxia. All magnetic resonance imaging (MRI)-based studies have focused on the evaluation of adult patients. Therefore, we designed a cross-sectional multimodal MRI-based study to investigate the anatomical substrates involved in the early stages of FRDA. METHODS We enrolled 37 patients (12 children) and 38 controls. All subjects underwent MRI in a 3T device to assess gray and white matter. We used measures from FreeSurfer and CERES to evaluate the cerebral and cerebellar cortices. The T1 multiatlas assessed deep gray matter. The diffusion tensor imaging multiatlas was used to investigate microstructural abnormalities in brain white matter and SpineSeg was used to assess the cervical spinal cord. All analyses were corrected for multiple comparisons. RESULTS Comparison with age-matched controls showed that pediatric patients have spinal cord, inferior cerebellar peduncle and red nucleus damage. In contrast, adult patients showed more widespread white matter damage than pediatric patients. With regard to gray matter, we found cortical thinning at the left central sulcus and volumetric reduction in the thalami and hippocampi only in adult patients. Finally, values of fractional anisotropy in adult patients and radial diffusivity in pediatric patients from the inferior cerebellar peduncle correlated with disease duration and ataxia severity, respectively. CONCLUSIONS Structural damage in FRDA begins in the spinal cord and inferior cerebellar peduncle as well as the red nucleus, and progresses to cerebral areas in adulthood. These results shed some light on the early stages of FRDA and highlight potential neuroimaging markers for therapeutic trials.
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Affiliation(s)
- T J R Rezende
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - A R M Martinez
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - I Faber
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - K A Girotto Takazaki
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - M P Martins
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - F D de Lima
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - I Lopes-Cendes
- Department of Medical Genetics, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - F Cendes
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
| | - M C França
- Department of Neurology and Neuroimaging Laboratory, School of Medical Sciences, University of Campinas (UNICAMP), Campinas
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Faber I, Prota JRM, Martinez ARM, Lopes-Cendes I, França MC. A new phenotype associated with homozygous GRN mutations: complicated spastic paraplegia. Eur J Neurol 2016; 24:e3-e4. [PMID: 28000352 DOI: 10.1111/ene.13194] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/27/2016] [Indexed: 11/29/2022]
Affiliation(s)
- I Faber
- Department of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - J R M Prota
- Department of Medical Genetics, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - A R M Martinez
- Department of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - I Lopes-Cendes
- Department of Medical Genetics, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
| | - M C França
- Department of Neurology, School of Medical Sciences, University of Campinas - UNICAMP, Campinas, SP, Brazil
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Damasceno A, von Glehn F, Martinez ARM, Longhini ALF, Deus-Silva L, Brandão CO, Santos LMB, Damasceno BP. Early onset of natalizumab-related progressive multifocal leukoencephalopathy. Mult Scler 2011; 17:1397-8. [DOI: 10.1177/1352458511422929] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- A Damasceno
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas (UNICAMP), Campinas, Brazil
| | - F von Glehn
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas (UNICAMP), Campinas, Brazil
| | - ARM Martinez
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - ALF Longhini
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas (UNICAMP), Campinas, Brazil
| | - L Deus-Silva
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
| | - CO Brandão
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas (UNICAMP), Campinas, Brazil
| | - LMB Santos
- Neuroimmunology Unit, Department of Genetics, Evolution and Bioagents, University of Campinas (UNICAMP), Campinas, Brazil
| | - BP Damasceno
- Department of Neurology, University of Campinas (UNICAMP), Campinas, Brazil
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