101
|
Viala K. Diagnosis of atypical forms of chronic inflammatory demyelinating polyradiculoneuropathy: a practical overview based on some case studies. Int J Neurosci 2015; 126:777-85. [DOI: 10.3109/00207454.2015.1096786] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
|
102
|
Yang M, Peyret C, Shi XQ, Siron N, Jang JH, Wu S, Fournier S, Zhang J. Evidence from Human and Animal Studies: Pathological Roles of CD8(+) T Cells in Autoimmune Peripheral Neuropathies. Front Immunol 2015; 6:532. [PMID: 26528293 PMCID: PMC4606118 DOI: 10.3389/fimmu.2015.00532] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/30/2015] [Indexed: 01/28/2023] Open
Abstract
Autoimmune peripheral neuropathies such as Guillain-Barre Syndrome (GBS) and chronic inflammatory demyelinating polyneuropathy (CIDP) affect millions of people worldwide. Despite significant advances in understanding the pathology, the molecular and cellular mechanisms of immune-mediated neuropathies remain elusive. T lymphocytes definitely play an important role in disease pathogenesis and CD4+ T cells have been the main area of research for decades. This is partly due to the fact that the most frequent animal model to study autoimmune peripheral neuropathy is experimental allergic neuritis (EAN). As it is induced commonly by immunization with peripheral nerve proteins, EAN is driven mainly by CD4+ T cells. However, similarly to what has been reported for patients suffering from multiple sclerosis, a significant body of evidence indicates that CD8+ T cells may play a pathogenic role in GBS and CIDP disease development and/or progression. Here, we summarize clinical studies pertaining to the presence and potential role of CD8+ T cells in autoimmune peripheral neuropathies. We also discuss the findings from our most recent studies using a transgenic mouse line (L31 mice) in which the T cell co-stimulator molecule B7.2 (CD86) is constitutively expressed in antigen presenting cells of the nervous tissues. L31 mice spontaneously develop peripheral neuropathy, and CD8+ T cells are found accumulating in peripheral nerves of symptomatic animals. Interestingly, depletion of CD4+ T cells accelerates disease onset and increases disease prevalence. Finally, we point out some unanswered questions for future research to dissect the critical roles of CD8+ T cells in autoimmune peripheral neuropathies.
Collapse
Affiliation(s)
- Mu Yang
- Department of Neurology and Neurosurgery, McGill University , Montreal, QC , Canada ; The Alan Edwards Centre for Research on Pain, McGill University , Montreal, QC , Canada
| | - Corentin Peyret
- Department of Microbiology and Immunology, McGill University , Montreal, QC , Canada
| | - Xiang Qun Shi
- The Alan Edwards Centre for Research on Pain, McGill University , Montreal, QC , Canada
| | - Nicolas Siron
- The Alan Edwards Centre for Research on Pain, McGill University , Montreal, QC , Canada
| | - Jeong Ho Jang
- The Alan Edwards Centre for Research on Pain, McGill University , Montreal, QC , Canada
| | - Sonia Wu
- The Alan Edwards Centre for Research on Pain, McGill University , Montreal, QC , Canada
| | - Sylvie Fournier
- Department of Microbiology and Immunology, McGill University , Montreal, QC , Canada
| | - Ji Zhang
- Department of Neurology and Neurosurgery, McGill University , Montreal, QC , Canada ; The Alan Edwards Centre for Research on Pain, McGill University , Montreal, QC , Canada ; Department of Microbiology and Immunology, McGill University , Montreal, QC , Canada ; Faculty of Dentistry, McGill University , Montreal, QC , Canada
| |
Collapse
|
103
|
|
104
|
Gallardo E, Noto YI, Simon NG. Ultrasound in the diagnosis of peripheral neuropathy: structure meets function in the neuromuscular clinic. J Neurol Neurosurg Psychiatry 2015; 86:1066-74. [PMID: 25653385 DOI: 10.1136/jnnp-2014-309599] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Accepted: 01/08/2015] [Indexed: 02/06/2023]
Abstract
Peripheral nerve ultrasound (US) has emerged as a promising technique for the diagnosis of peripheral nerve disorders. While most experience with US has been reported in the context of nerve entrapment syndromes, the role of US in the diagnosis of peripheral neuropathy (PN) has recently been explored. Distinctive US findings have been reported in patients with hereditary, immune-mediated, infectious and axonal PN; US may add complementary information to neurophysiological studies in the diagnostic work-up of PN. This review describes the characteristic US findings in PN reported to date and a classification of abnormal nerve US patterns in PN is proposed. Closer scrutiny of nerve abnormalities beyond assessment of nerve calibre may allow for more accurate diagnostic classification of PN, as well as contribute to the understanding of the intersection of structure and function in PN.
Collapse
Affiliation(s)
- Elena Gallardo
- Service of Radiology, University Hospital Marqués de Valdecilla; Instituto de Investigación Marqués de Valdecilla (IDIVAL), Santander, Spain University of Cantabria (UC); and Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Santander, Spain
| | - Yu-Ichi Noto
- Department of Neurology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Japan
| | - Neil G Simon
- Prince of Wales Clinical School, University of New South Wales, Australia Central Clinical School, The University of Sydney, Australia
| |
Collapse
|
105
|
Kontzialis M, Poretti A, Michell H, Bosemani T, Tekes A, Huisman TAGM. Spinal Nerve Root Enhancement on MRI Scans in Children: A Review. J Neuroimaging 2015; 26:169-79. [PMID: 26365273 DOI: 10.1111/jon.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/04/2015] [Indexed: 12/17/2022] Open
Abstract
Spinal nerve root enhancement in pediatric patients is generally nonspecific, and clinical and laboratory correlation is essential. Nerve root enhancement indicates lack of integrity of the blood-nerve barrier. In this review, we will present a range of pediatric conditions that can present with spinal nerve root enhancement including inflammatory, infectious, hereditary, and neoplastic causes. Familiarity with the various pathologic entities associated with spinal nerve root enhancement is important for a concise differential diagnosis in the appropriate clinical setting. This will avoid unnecessary additional investigations.
Collapse
Affiliation(s)
- Marinos Kontzialis
- Division of Neuroradiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Andrea Poretti
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Hans Michell
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thangamadhan Bosemani
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Aylin Tekes
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Thierry A G M Huisman
- Pediatric Radiology, Russell H Morgan Department of Radiology and Radiological Science, The Johns Hopkins University School of Medicine, Baltimore, MD
| |
Collapse
|
106
|
Vo ML, Martin P, Latov N. Correlation of Changes in Gait Parameters, With Phenotype, Outcome Measures, and Electrodiagnostic Abnormalities in a Patient With Anti-MAG Neuropathy After Exacerbation and Improvement. J Clin Neuromuscul Dis 2015; 17:22-26. [PMID: 26301376 DOI: 10.1097/cnd.0000000000000087] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Gait impairment is a common presentation in patients with IgM anti-myelin-associated glycoprotein (anti-MAG) antibody demyelinating neuropathy. However, current methods used to assess gait are limited. We report spatiotemporal gait parameters captured by GAITRite, a computerized walkway with embedded pressure sensors. The patient worsened after treatment with rituximab and subsequently improved with intravenous immunoglobulin. Serial gait assessments were performed at baseline and after treatment. Spatiotemporal gait parameters correlated with Medical Research Council sum score, Inflammatory Neuropathy Cause and Treatment disability score, and grip strength. Quantitative gait assessment may provide a new dimension to standard clinical evaluation and may help to clarify treatment response in patients with anti-MAG neuropathy when used in combination with other validated assessment tools.
Collapse
Affiliation(s)
- Mary L Vo
- Departments of *Neurology; and †Hematology and Oncology, Weill Cornell Medical College, New York, NY
| | | | | |
Collapse
|
107
|
Kung NH, Bucelli RC, McClelland CM, Van Stavern GP. Ocular Neuromyotonia Associated with Chronic Inflammatory Demyelinating Polyneuropathy. Neuroophthalmology 2015; 39:240-242. [PMID: 27928362 DOI: 10.3109/01658107.2015.1059464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 05/26/2015] [Accepted: 06/02/2015] [Indexed: 11/13/2022] Open
Abstract
Ocular neuromyotonia (ONM) is a neuro-ophthalmic disorder characterized by episodic diplopia caused by contraction of one or more ocular muscles due to spontaneous excitation of the respective ocular motor nerve. We report a patient whose ocular neuromyotonia arose in the setting of a subacute demyelinating polyneuropathy consistent with chronic inflammatory demyelinating polyneuropathy (CIDP) and subsequently resolved following the initiation of intravenous immunoglobulin (IVIg) for her neuropathy. Our patient provides additional evidence towards the role of demyelination and ephaptic neurotransmission in ocular neuromyotonia and also represents the first reported case of ocular neuromyotonia associated with a systemic neurological condition.
Collapse
Affiliation(s)
- Nathan H Kung
- Department of Neurology, Washington University in St. Louis , St. Louis, Missouri, USA
| | - Robert C Bucelli
- Department of Neurology, Washington University in St. Louis , St. Louis, Missouri, USA
| | - Collin M McClelland
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis , St. Louis, Missouri, USA
| | - Gregory P Van Stavern
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis , St. Louis, Missouri, USA
| |
Collapse
|
108
|
Chin RL, Deng C, Bril V, Hartung HP, Merkies ISJ, Donofrio PD, Van Doorn PA, Dalakas MC, Latov N. Follow-up nerve conduction studies in CIDP after treatment with IGIV-C: Comparison of patients with and without subsequent relapse. Muscle Nerve 2015; 52:498-502. [DOI: 10.1002/mus.24624] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 02/10/2015] [Accepted: 02/23/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Russell L. Chin
- Weill Cornell Medical College; 1305 York Avenue, Room 217 New York New York 10021 USA
| | | | - Vera Bril
- Toronto General Hospital; Toronto Ontario Canada
| | | | - Ingemar S. J. Merkies
- Maastricht University Medical Center; Maastricht and Spaarne Hospital; Hoofdorp The Netherlands
| | | | | | | | - Norman Latov
- Weill Cornell Medical College; 1305 York Avenue, Room 217 New York New York 10021 USA
| |
Collapse
|
109
|
Rajabally YA, Blomkwist-Markens PH, Katzberg HD. New insights into the management of chronic inflammatory demyelinating polyradiculoneuropathy. Neurodegener Dis Manag 2015; 5:257-68. [PMID: 26107324 DOI: 10.2217/nmt.15.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) and its variants can be challenging to diagnose and treat. A combination of clinical, electrophysiological and laboratory features is often required to reach a diagnosis. New data are emerging about potential biomarkers and factors that may indicate treatment needs in individual patients. High-quality evidence exists for the efficacy of intravenous immunoglobulin (IVIG) in the treatment of CIDP, including quality of life (QoL) benefits. Besides pharmacological treatment, psychological factors must also be addressed to improve patients' QoL. Home-based IVIG infusion therapy is currently a well-established approach in some countries. A 6-month pilot study conducted in Ontario, Canada, provided proof of safety and patient acceptance of home-based IVIG therapy, although some logistical issues emerged.
Collapse
Affiliation(s)
- Yusuf A Rajabally
- Regional Neuromuscular Clinic, Queen Elizabeth Neuroscience Centre, University Hospitals of Birmingham, Birmingham, B15 2TH, UK
| | | | - Hans D Katzberg
- Neuromuscular Medicine, University of Toronto, Toronto General Hospital/UHN, Toronto, Canada
| |
Collapse
|
110
|
Wang X, Yu X, Zhu D, Zhang S, Zhou X, Liu M, Guan Y. POEMS syndrome with vascular transformation of the lymph node sinuses: A case report. Oncol Lett 2015; 10:1789-1792. [PMID: 26622751 DOI: 10.3892/ol.2015.3413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 05/14/2015] [Indexed: 11/06/2022] Open
Abstract
POEMS syndrome is a rare multisystem disorder associated with the clinical signs of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin changes. However, there is often a delay in the diagnosis due to a lack of overall consideration of the symptoms collectively. For this reason, POEMS syndrome is frequently mistaken for other diseases, such as chronic inflammatory demyelinating polyneuropathy. The present study reports the case of a 40-year-old female patient, who presented with a progressive lack of strength in the lower limbs and a unilateral cervical lump. The patient's enlarged cervical lymph nodes were mistaken for local hemangioma. However, subsequently POEMS syndrome with vascular transformation of the lymph node sinuses (VTS) was diagnosed. The patient received glucocorticoid treatment (20 mg prednisone acetate, daily), which is ongoing. The most recent follow-up examination revealed that the patient's strength had improved and at the time of writing the patient remained alive. The study discusses the clinical manifestations, auxiliary examinations and reason for the misdiagnosis. Hematoxylin and eosin staining and cluster of differentiation 31 immunostaining were adopted to identify the VTS. To the best of our knowledge, this is the first report of POEMS syndrome with VTS.
Collapse
Affiliation(s)
- Xiaoqing Wang
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Xiaowen Yu
- Department of Gerontology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Desheng Zhu
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Sheqing Zhang
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Xiajun Zhou
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Mingyuan Liu
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China
| | - Yangtai Guan
- Department of Neurology, Changhai Hospital, Second Military Medical University, Shanghai 200433, P.R. China ; Department of Neurology, Renji Hospital, Shanghai Jiaotong University, Shanghai 200433, P.R. China
| |
Collapse
|
111
|
Grimm A, Rasenack M, Athanasopoulou I, Peters N, Fuhr P. Long-term observations in asymmetric immune-mediated neuropathy with vagus hypertrophy using ultrasound of the nerves. J Neurol Sci 2015; 356:205-8. [PMID: 26081119 DOI: 10.1016/j.jns.2015.06.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/03/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Alexander Grimm
- Department of Neurology, Hospital of University of Basel, Switzerland.
| | - Maria Rasenack
- Department of Neurology, Hospital of University of Basel, Switzerland
| | | | - Nils Peters
- Department of Neurology, Hospital of University of Basel, Switzerland
| | - Peter Fuhr
- Department of Neurology, Hospital of University of Basel, Switzerland
| |
Collapse
|
112
|
Grimm A, Décard BF, Axer H, Fuhr P. The Ultrasound pattern sum score - UPSS. A new method to differentiate acute and subacute neuropathies using ultrasound of the peripheral nerves. Clin Neurophysiol 2015; 126:2216-25. [PMID: 25691156 DOI: 10.1016/j.clinph.2015.01.011] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 12/21/2014] [Accepted: 01/27/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Ultrasound differentiation of neuropathies is a great challenge. We, therefore, suggest a standardized score to operationalize differentiation between several acute and subacute onset neuropathies. METHOD We retrospectively analyzed the ultrasound data of 61 patients with acute or subacute neuropathies, e.g. chronic immune-mediated neuropathies, Guillain-Barré syndrome (GBS), and axonal/vasculitic neuropathies. We compared these data to 28 healthy controls. Based on these results an ultrasound pattern sum score (UPSS) with three sub-scores (UPS-A for the sensorimotor nerves, UPS-B for the cervical roots and the vagal nerve and UPS-C for the sural nerve) was developed. Afterwards, the applicability of the score was prospectively validated in 10 patients with chronic neuropathies and in 14 patients with unknown acute and subacute PNP before performing additional tests. RESULTS UPS-A and UPSS were significantly higher in CIDP than in other neuropathies and controls (p<0.001). UPS-B was significantly more often pathologic in GBS than in CIDP and other neuropathies (p<0.001). Using receiver operation characteristics curve analysis boundary values for each score were defined. Positive predictive value (PPV) of these scores for CIDP and GBS was >85%. Vasculitic neuropathies showed an intermediate type of UPSS compared to other axonal neuropathies (p<0.001). In the prospective application the pattern score could be used with good accuracy in several types of neuropathy. CONCLUSION UPS-A and UPSS operationalize to diagnose acute and subacute-onset CIDP and its variants with high sensitivity, specificity, and PPV. An increased UPS-B with normal UPSS and other sub scores may point to the diagnosis of GBS with high PPV and enables the differentiation from CIDP. SIGNIFICANCE Using the UPSS and its sub-scores gives a new diagnostic power to the method of the peripheral nerve ultrasound.
Collapse
Affiliation(s)
- Alexander Grimm
- Department of Neurology, Basel University Hospital, Basel, Switzerland.
| | - Bernhard F Décard
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| | - Hubertus Axer
- Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - Peter Fuhr
- Department of Neurology, Basel University Hospital, Basel, Switzerland
| |
Collapse
|
113
|
Talamo G, Mir MA, Pandey MK, Sivik JK, Raheja D. IgM MGUS associated with anti-MAG neuropathy: a single institution experience. Ann Hematol 2015; 94:1011-6. [DOI: 10.1007/s00277-014-2294-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 12/23/2014] [Indexed: 11/24/2022]
|
114
|
Vo ML, Hanineva A, Chin RL, Carey BT, Latov N, Langsdorf JA. Reply: Comparison of 2-limb versus 3-limb electrodiagnostic studies in the evaluation of CIDP. Muscle Nerve 2014; 51:148-9. [DOI: 10.1002/mus.24479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Mary L. Vo
- Weill Cornell Medical Center; New York New York USA
| | | | | | | | - Norman Latov
- Weill Cornell Medical Center; New York New York USA
| | | |
Collapse
|